Orthodontic treatment and biological limits: a retrospective clinical trial.

BACKGROUND: The fundamental part of every successful orthodontic treatment is the detailed treatment planning including a precise determination of the virtual treatment objective (VTO) while considering the biological and anatomical limits. The aim of this study is to investigate and to compare the feasibility of the established reference values before and after orthodontic treatment and to determine the usefulness of this parameters as guidance for the sagittal anterior, sagittal posterior and transverse biological boundaries. MATERIALS AND METHODS: Thirty-two patients aged 9 to 18 years (12 male and 20 female) with all permanent teeth present were randomly selected for orthodontic treatment with fixed multibracket appliance regardless of the potential malocclusion. The parameters 6-PTV, 1-NB [mm] and the WALA ridge were set for the identification of the transverse, sagittal anterior and sagittal posterior tooth position. The measurements were carried out at the beginning (T0) and at the end (T1) of the orthodontic treatment. They were set in relation with their individual threshold values (G). After the results of the measurements were conducted using the software OnyxCeph3TM (version 3.2.185 (505), Image Instruments GmbH, Chemnitz, DE), they were statistically calculated in the software RStudio (2022.12.0 Build 353 © 2009-2022 Posit Software PBC). RESULTS: Among the 32 patients, the mean pre- and post-treatment changes measured through the three parameters in relation to the individual reference values were statistically significant (p < 0.01). The mean values for 6-PTV, 1-NB and the WALA ridge amounted 15.37 mm, 2.56 mm and 4.23 mm at the beginning of the treatment, while after the treatment the measured values amounted 20.31 mm, 2.4 mm and 5.55 mm. These measurements combined with the statistical analysis of the changes of WALA ridge (T0, T1) confirmed that the teeth have been successfully uprighted and aligned. Furthermore, the maxillary first molars have been moved slightly mesially, as proven by the changes in 6-PTV, without certainty as to whether bodily movement or mesial tipping took place. Additionally, the lower incisors have been protruded, slightly exceeding the individual threshold values. CONCLUSION: The parameters investigated provide a suitable assessment tool for recording the limits of the sagittal posterior, the sagittal anterior and the transverse dimension.

Three-dimensional analysis of the relationship between mandibular retromolar space and positional traits of third molars in non-hyperdivergent adults.

BACKGROUND: The anatomical position of the mandibular third molars (M3s) is located in the distal-most portions of the molar area. In some previous literature, researchers evaluated the relationship between retromolar space (RS) and different classifications of M3 in three­dimensional (3D) cone-beam computed tomography (CBCT). METHODS: Two hundred six M3s from 103 patients were included. M3s were grouped according to four classification criteria: PG-A/B/C, PG-I/II/III, mesiodistal angle and buccolingual angle. 3D hard tissue models were reconstructed by CBCT digital imaging. RS was measured respectively by utilizing the fitting WALA ridge plane (WP) which was fitted by the least square method and the occlusal plane (OP) as reference planes. SPSS (version 26) was used to analyze the data. RESULTS: In all criteria evaluated, RS decreased steadily from the crown to the root (P < 0.05), the minimum was at the root tip. From PG-A classification, PG-B classification to PG-C classification and from PG-I classification, PG-II classification to PG-III classification, RS both appeared a diminishing tendency (P < 0.05). As the degree of mesial tilt decreased, RS appeared an increasing trend (P < 0.05). RS in classification criteria of buccolingual angle had no statistical difference (P > 0.05). CONCLUSIONS: RS was associated with positional classifications of the M3. In the clinic, RS can be evaluated by watching the Pell&Gregory classification and mesial angle of M3.

A New Approach to Diagnosis to Posterior Cross Bite: Intraoral Photography and Wala Ridge.

A posterior crossbite is an occlusion disorder that occurs in the transverse plane. It occurs when the buccal cusps of the upper premolars and molars engage lingually with the buccal cusps of the lower teeth. It can be unilateral or bilateral (involving one or more teeth) in the primary, mixed, or permanent dentition. A crossbite may appear in early dentition stages and it can be dental or functional. It can lead to skeletal crossbite in mixed dentition. Therefore, early diagnosis and treatment are crucial. MATERIAL AND METHODS: The selected sample included 204 patients in growing stage divided into two groups: a study group of 102 patients with posterior crossbite and a control group of 102 patients without malocclusion. To analyze the pathology, intraoral frontal photographs and study models were taken, in which the bone component was measured from the Wala Ridge. RESULTS: The use of the photographs to study the Wala Ridge was confirmed. The mean maxillary width was 57.8 mm (SD 1.7) and mandibular width was 56.4 mm (SD 1.7) for the control group, with a maxillomandibular difference of 1.4 mm (SD 0.7); and 52.7 mm (SD 3.7) and 55.5 mm (SD 3.6), respectively, with a maxillomandibular difference of -2.8 mm (SD 1.4) for the study group. A higher maxillomandibular discrepancy was observed in patients with a posterior crossbite that involved more than one tooth in addition to the permanent first molar. It was also higher in patients with bilateral posterior crossbite. CONCLUSIONS: Intraoral frontal photography can be used as a diagnostic method to measure the maxillomandibular difference using the Wala Ridge.

Evaluation of Horizontal Distance between WALA-FA Point in Angle's Class I, Class II, and Class III Malocclusion.

INTRODUCTION: The objective of the study was to measure the horizontal distance between the FA-WALA (Facial Axis Point-William Andrews and Larry Andrews) of posterior teeth in Angle's Class I, Class II, and Class III malocclusions and to assess the depth of the Curve of Spee, to find the correlation between intercanine FA and intercanine WALA and its significance. MATERIAL AND METHODS: Sixty pretreatment mandibular casts of patients with an age range of 18-35 years were included. A sample size of 20 was evaluated in Angle's Class I, Class II, and Class III, respectively. The WALA ridge and FA points were marked in the model and calibrated using the digital Vernier caliper. RESULTS: There was an incremental increase in the horizontal distance from the FA-WALA in the posterior teeth. The mandibular intercanine FA-FA and intercanine WALA-WALA distance were greater in Angle's Class III group when compared to Angle's Class II. The Curve of Spee measurement was increased in Angle's Class II group, while Angle's Class III had a flat curve. CONCLUSION: The horizontal distance between FA-WALA increased incrementally in the posterior teeth in Angle's Class I, Class II, and Class III malocclusions. In Angle's Class II malocclusion, the Curve of Spee measurement was increased and had a narrower mandibular arch.

Comparison of dental arch forms created from assessment of teeth, alveolar bone, and the overlying soft tissue.

OBJECTIVE: The objective of this study was to determine whether there are differences among the arch forms created from assessments of tooth surfaces, alveolar bone, and overlying soft tissue. MATERIALS AND METHODS: This study included 18 individuals who presented with a class I malocclusion, mild crowding, and a cone beam computed tomography (CBCT) image of good diagnostic quality. The facial axis point was chosen to create the arch form from teeth, the Bowman-Kau (BK) point was used to establish the arch form from alveolar bone, and the WALA ridge was used to calculate the soft tissue arch form. A predetermined algorithm was then used to create five separate arch forms per patient. These arch forms were categorized according to shape and were superimposed. The distances between the tooth-, bone-, and soft tissue-derived arch forms were calculated. RESULTS: The calculated distances between all arch forms were significantly different. The distances between the tooth- and bone-derived arch forms were larger for the mandible compared to the maxilla (mean 3.30 vs. 2.48 mm, respectively). The larger distances seemed to be located more posteriorly in the arch than anteriorly. The distance between tooth- and soft tissue-derived arch forms was largest for the second premolar (2.35 ± 1.59 mm), first molar (2.86 ± 0.63 mm), and second molar (3.25 ± 0.87 mm). There were no significant differences in the distance between the tooth- and either bone- or soft tissue-derived arch forms with regard to sex. CONCLUSIONS: The arch form shapes obtained from the teeth, alveolar bone, and soft tissue are correlated and show the same general shape. Although future large-scale studies are needed for confirmation, our results suggest that evaluating the easily visualized external features, including the WALA ridge, can adequately predict the underlying bone shape, and thus the desired arch form. Nevertheless, the shapes vary significantly between patients, so the final treatment plan should be individualized rather than relying on over-simplified general wire shapes.

Selected Orthodontic Principles for Management of Cranio-Maxillofacial Deformities.

An understanding of fundamental orthodontic principles involving diagnosis, treatment planning, and clinical strategies is essential for achieving successful outcomes in the treatment of craniofacial patients, particularly cleft lip/palate. This article focuses on: customizing a mandibular dental arch form using the WALA ridge; accurately diagnosing the maxillary skeletal transverse dimension (cusp to cusp/fossa to fossa); coordinating the upper dental arch with the lower; using a smiling profile and glabella vertical to assess anteroposterior jaw position; and leveling the mandibular curve of Spee while considering the lower one-third of the face. These concepts influence treatment outcomes to the extent they are used.

Morphological changes of dental and basal arch forms in skeletal class Ⅱ malocclusions before and after extraction treatment / 中华医学美学美容杂志

Objective To study the variation of the dental and basal arch forms before and after orthodontic treatment of patients with skeletal class Ⅱ malocclusion by tooth extraction.Methods The mandibular dental casts of 25 skeletal class Ⅱ patients were laser scanned before and after treatment.The facial axis (FA) points,which were used to represent the dental arch,and the WALA point,which were used to represent the basal bone,were identified for each tooth from the right first molar to the left first molar.We constructed the curve with points of projection of the FA and WALA point on the reference plane,and compared the curve of dental arch and basal bone before and after treatment.Results The width of anterior middle and posterior of the basal arch increased (0.835± 1.259) mm,(1.700±1.280) mm and (2.170±1.227) mm,respectively.While the dental arch had a wider width (1.110±1.566) mm in posterior segment but a narrower one in anterior (3.345±2.907) mm.Conclusions The width of middle and posterior of basal bone represented by WALA ridge becomes wider after orthodontic treatment with tooth extraction in patients with skeletal class Ⅱ malocclusion,while the dental arch turns to a new form,which is more coordinated to the basal bone.

Distances between mandibular posterior teeth and the WALA ridge in Peruvians with normal occlusion

ABSTRACT Objective: The purposes of this investigation were to determine the horizontal distances between the mandibular posterior teeth and the WALA ridge in a sample of Peruvians with normal occlusion and to compare them by tooth type, sex, arch side, and age groups. Methods: 65 dental casts of subjects with normal occlusion were collected. Posterior teeth, except for third molars, were evaluated. The horizontal distances between the occluso-gingival midpoints of the buccal surfaces (FA points) of each tooth and the WALA ridge were measured using a modified digital caliper. The values between each different tooth type within the sample were compared using the ANOVA and Scheffe tests, while comparisons by sex, arch side and age groups, using the Student's t-test. Results: The mean distances in the sample was 0.96 mm for first premolars, 1.45 mm for second premolars, 2.12 mm for first molars and 2.55 mm for second molars. Statistically significant differences between each of the four tooth types were found. There were no significant differences found between sex, arch side and age groups. Conclusion: The horizontal distances between the mandibular posterior teeth and the WALA ridge increased progressively from the first premolars to the second molars in Peruvians with normal occlusion. The WALA ridge was a good landmark to evaluate the positions of posterior teeth in Peruvians with normal occlusion.

RESUMO Objetivos: o objetivo dessa investigação foi determinar a distância horizontal entre os dentes posteroinferiores e a borda WALA, em uma amostra de peruanos com oclusão normal, e compará-la por tipo de dente, sexo, lado da arcada dentária e grupo etário. Métodos: foram selecionados 65 modelos dentários de indivíduos com oclusão normal, nos quais foram avaliados os dentes posteriores, com exceção dos terceiros molares. As distâncias horizontais entre o ponto oclusogengival médio da face vestibular (pontos EV) de cada dente e a borda WALA foram medidas utilizando-se um compasso digital modificado. Os testes de Scheffe e ANOVA foram usados para comparações entre os valores de cada tipo de dente estudado, enquanto o teste t de Student foi usado para as comparações entre sexos, lados da arcada e faixa etárias. Resultados: as distâncias médias nessa amostra foram de 0,96 mm para os primeiros pré-molares; 1,45 mm para os segundos pré-molares; 2,12 mm para os primeiros molares, e 2,55 mm para os segundos molares. Foram encontradas diferenças estatisticamente significativas entre cada um dos quatro tipos dentários. Não houve diferenças significativas entre os sexos, lados da arcada e grupos etários. Conclusão: nos peruanos com oclusão normal dessa amostra, as distâncias horizontais entre os dentes posteroinferiores e a borda WALA aumentaram progressivamente dos primeiros pré-molares para os segundos molares. Nesses pacientes, a borda WALA funcionou como um bom ponto de referência para se avaliar a posição dos dentes posteroinferiores.

Dental and alveolar arch forms in a Caucasian population compared with commercially available archwires.

INTRODUCTION: The aim of this study was to identify an arch form, comprising dentition and alveolus, representative of the Caucasian population, and to compare it with the shape of the main archwires on the market. MATERIALS AND METHODS: The study sample comprised 35 pairs of dental casts, taken from the arches of 35 Southern Europeans with ideal natural occlusion. After the dental casts were scanned, the reference points of the dental arches (FA points) and alveolar bone (WALA ridges) were identified with 3D software. Cartesian coordinates and intercanine and intermolar diameters were calculated for each patient, and curves representing the upper and lower dentition, as well as those showing the shape of the lower supporting bone, were traced and compared with those pertaining to different types of commonly used orthodontic archwires. RESULTS: Ideal shapes of the mandibular alveolus and of the upper and lower archwires were calculated and compared with those actually on the market. Statistical analysis showed significant differences between the two, particularly at the upper and lower molars and canines. Likewise, there were significant differences between the shapes of the available archwires and the WALA ridge, except for the intercanine width. CONCLUSIONS: None of the commercial archwires examined faithfully represented the shape of the 'ideal' dentition we calculated, particularly at the molars and canines. The bone structure of the mandibular support cannot be used as a guide to the shape of the arch form during orthodontic treatment.

Avaliação comparativa da Borda WALA em mandíbulas secas e modelos e da sua mensuração em radiografias oclusais e tomografias / A comparative assessment of the WALA ridge in dissected mandibles and cast models as well as its measurement in occlusal radiographies and tomographies

Introdução: a determinação da Borda WALA em modelos de gesso permitia defini-la como uma linha imaginária utilizada no planejamento, seguimento e finalização de casos clínicos. Procurou-se determinar a Borda WALA em modelos de gesso de pacientes ortodônticos, mandíbulas secas, radiografias oclusais e cortes tomográficos dos pacientes e mandíbulas respectivas. O objetivo foi detectar a viabilidade de mensurar e determinar, por um método reproduzível, a Borda WALA em radiografias oclusais e cortes tomográficos. Metodologia: foram utilizados modelos, radiografias oclusais e tomografias de feixe cônico de 12 pacientes ortodônticos, e 12 mandíbulas e suas respectivas radiografias oclusais e cortes tomográficos. As mensurações tomográficas foram realizadas, em todos os dentes, do ponto mais vestibular das raízes dentárias no nível cervical até a parte mais externa da cortical óssea vestibular. Nas mandíbulas secas e nos modelos, as medidas verticais partiam do ponto EV até a linha de grafite que determinou o ponto vestibular mais externo. Resultados: os arcos correspondentes à Borda WALA obtidos nos modelos de gesso e nas mandíbulas secas se equivaleram em sua forma, sendo um pouco menores, em sua dimensão, nos modelos. Os arcos obtidos a partir das mensurações realizadas em radiografias oclusais e cortes tomográficos se equivaleram, em sua forma, nos modelos e mandíbulas, com correlação fortemente positiva, detectada pelo Coeficiente de Correlação de Pearson. Conclusões: 1. a Borda WALA não representa uma estrutura anatômica, mas uma medida/anagrama/referência a ser mensurada e utilizada nos tratamentos ortodônticos e ortopédicos; 2. a Borda WALA não deve ser considerada uma linha imaginária, mas um arco a ser determinado por medidas que devem servir de parâmetro nas correções das alterações da oclusão e alinhamento dos dntes inferiores; 3. em seu contorno e forma, as medidas obtidas nos modelos e nas mandíbulas, assim como nas radiografias oclusais e tomografias...

Introduction: The WALA ridge is an imaginary line determined in cast models and used as reference for orthodontic treatment planning, execution and finalization. In the following study, the WALA ridge was defined in cast models of orthodontic patients, dissected mandibles, occlusal radiographies and tomographic slices of patients and respective mandibles aiming to find a reproducible method for determining the WALA ridge in occlusal radiographies and tomographic slices. Methodology: The sample comprised 12 cast models, occlusal radiographies and cone beam tomographies of orthodontic patients and 12 dissected mandibles, their respective occlusal radiographies and tomographic slices. Tomographic measurements were made in all teeth from the most buccal point of dental roots on their cervical level until the most external and anterior cortical line of bone. Vertical measurements on dissected mandibles and cast models were taken from FA point until the pencil line that determined the most external edge of bone around mandibular teeth. Results: The arches corresponding to the WALA ridge obtained from cast models and dissected mandibles were equivalent in form but a little smaller in size for cast models. The arches obtained from occlusal radiographies and tomographic slices were equivalent in form to the ones obtained from models and dissected mandibles, with a high positive correlation of proportion statistically confirmed by Pearsons coefficient. Conclusion: 1. The WALA ridge is not an anatomical structure, but a measurement/anagram/reference to be measured and used during orthodontic and orthopedic treatment. 2. The WALA ridge should not be considered an imaginary line, but an arch to be determined by measurements and used as parameter when correcting the occlusion of misalignment of inferior teeth; 3. The measurements obtained from models and dissected mandibles, as well as from occlusal radiographies and cone beam tomographies were equivalent in shape and form...