Effect of micro-osteoperforation on the rate of orthodontic tooth movement-a systematic review and a meta-analysis.

BACKGROUND: The micro-osteoperforation can be used to increase the rate of tooth movement, simplify complex orthodontic movements, and also help adjust the anchorage but there are conflicting reports on the effectiveness and adverse effects of this intervention. OBJECTIVES: The aim of our systematic review and meta-analysis was to evaluate the effects of micro-osteoperforation on the rate of tooth movement in patients undergoing orthodontic treatment. SEARCH METHODS: A comprehensive search of MEDLINE, ISI web of science, EMBASE, Scopus, and CENTRAL online databases for studies measuring the effects of micro-osteoperforation on the rate of orthodontic tooth movement from inception to February 2019 was performed. SELECTION CRITERIA: Based on the PICO model, human studies which evaluated the effects of MOP on the rate of tooth movement in patients undergoing orthodontic treatment were selected for this review. DATA COLLECTION AND ANALYSIS: The relevant data from the eligible studies were extracted using piloted custom extraction forms. The data were combined and analysed using inverse-variance random-effect meta-analysis and the mean difference was used for comparing the outcome measures. RESULTS: Six randomized clinical trials were finally included in this meta-analysis. The rate of canine retraction per month was significantly higher in the MOP group [mean difference (MD) = 0.45 mm, 95% CI = 0.17-0.74]. These results were similar with regard to different malocclusions, the jaw on which it was performed, and MOP methods. The patients did not report any significant differences in terms of pain severity levels after MOP. With regard to the adverse effects, one study reported higher amounts of root resorption among patients undergoing MOP. CONCLUSIONS: The rate of tooth movement was increased after performing MOP but in at least one study higher root resorption was observed. Therefore, the use of MOP can be recommended after weighing the benefits and disadvantages this intervention can bring for each patient. REGISTRATION: The protocol for this review was registered via crd.york.ac.uk/prospero with the ID CRD42019115499.

Skeletal Class III malocclusion treatment using mandibular and maxillary skeletal anchorage and intermaxillary elastics: a case report.

INTRODUCTION: Skeletal Class III malocclusion is one of the most challenging malocclusions to treat. In around 40% of Class III patients, maxillary retrognathia is the main cause of the problem and in most patients, orthopedic/surgical treatments includes some type of maxillary protraction. OBJECTIVE: The aim of this case report was to describe a treatment method for a patient with maxillary retrognathia and Class III skeletal discrepancy using mandibular and maxillary skeletal anchorage with intermaxillary elastics. CASE REPORT: A 13-year-old boy with maxillary retrognathia and mandibular prognathism was treated using bilateral miniplates. Two miniplates were inserted in the mandibular canine area and two other miniplates were placed in the infrazygomatic crests of the maxilla. Class III intermaxillary elastics were used between the miniplates. RESULTS: After eight months of orthopedic therapy, ANB angle increased by 4.1 degrees and ideal overjet and overbite were achieved. Mandibular plane angle was increased by 2.1 degrees and the palatal plane was rotated counterclockwise by 4.8 degrees. CONCLUSION: This case showed that the skeletal anchorage treatment method may be a viable option for treating patients with Class III skeletal malocclusion.

Skeletal Class III malocclusion treatment using mandibular and maxillary skeletal anchorage and intermaxillary elastics: a case report

ABSTRACT Introduction: Skeletal Class III malocclusion is one of the most challenging malocclusions to treat. In around 40% of Class III patients, maxillary retrognathia is the main cause of the problem and in most patients, orthopedic/surgical treatments includes some type of maxillary protraction. Objective: The aim of this case report was to describe a treatment method for a patient with maxillary retrognathia and Class III skeletal discrepancy using mandibular and maxillary skeletal anchorage with intermaxillary elastics. Case report: A 13-year-old boy with maxillary retrognathia and mandibular prognathism was treated using bilateral miniplates. Two miniplates were inserted in the mandibular canine area and two other miniplates were placed in the infrazygomatic crests of the maxilla. Class III intermaxillary elastics were used between the miniplates. Results: After eight months of orthopedic therapy, ANB angle increased by 4.1 degrees and ideal overjet and overbite were achieved. Mandibular plane angle was increased by 2.1 degrees and the palatal plane was rotated counterclockwise by 4.8 degrees. Conclusion: This case showed that the skeletal anchorage treatment method may be a viable option for treating patients with Class III skeletal malocclusion.

RESUMO Introdução: a Classe III esquelética é considerada uma das más oclusões mais difíceis de se tratar. Em cerca de 40% dos pacientes afligidos por ela, a principal causa do problema é o retrognatismo maxilar e, na maioria desses pacientes, o tratamento ortopédico/cirúrgico inclui algum tipo de protração da maxila. Objetivo: o objetivo do presente relato de caso é descrever o método de tratamento de um paciente Classe III com discrepância esquelética e retrognatismo maxilar, usando elásticos intermaxilares e ancoragem esquelética superior e inferior. Relato de caso: paciente de 13 anos de idade, com retrognatismo maxilar e prognatismo mandibular, tratado com miniplacas inseridas bilateralmente. Duas miniplacas foram instaladas na região dos caninos inferiores, e outras duas miniplacas foram inseridas na região da crista infrazigomática maxilar. Elásticos intermaxilares de Classe III foram conectados às miniplacas. Resultados: após 8 meses de tratamento ortopédico, o ângulo ANB aumentou 4,1o e obteve-se sobressaliência e sobremordida ideais. O ângulo do plano mandibular aumentou 2,1o e o plano palatal girou 4,8o no sentido anti-horário. Conclusão: esse caso clínico demonstrou que o método de tratamento com ancoragem esquelética pode ser uma opção válida para pacientes com má oclusão de Classe III esquelética.

Effect of Propolis mouthwash on plaque and gingival indices over fixed orthodontic patients.

BACKGROUND: In patients with fixed orthodontics, the presence of orthodontic appliances causes dental plaque accumulation and hygiene problems. The purpose of this study was to evaluate the effect of Propolis and chlorhexidine mouthwashes on plaque and gingival indices in patients who are undergoing orthodontic treatment. MATERIAL AND METHODS: In this triple blind study, in total, 37 patients aged from 15 to 35 years those who have been undergoing fixed orthodontic treatment were studied. After that, one of the mouthwashes that containing either Propolis or Chlorhexidine was randomly prescribed to patients. The patients were asked to use mouthwashes twice a day after brushing their teeth for three weeks consecutively. Indicators of plaque, gingival and periodontal status (PI, GI, CPI) were determined on Ramford teeth at the beginning and at the end of three weeks for each patient. Then the results were analyzed statistically. RESULTS: The difference between the values of plaque index (P<0.001), gingival index (P=0.006) and periodontal index (P= 0.005) before and after administration of Propolis were statistically significant. The difference was also statistically significant for all three indexes of plaque (P<0.001), gingival (P=0.001) and periodontal (P=0.003) before and after chlorhexidine mouthwash usage. The indices after using mouthwashes were not statistically significant different between two mouthwash groups. CONCLUSIONS: It seems that Propolis mouthwash can be used as a suitable alternative in patients with fixed orthodontic treatment without the side effects of chlorhexidine mouthwash. Key words:Mouthwash, antimicrobial, Oral hygiene, Propolis, Dental plaque.

Maternal Folic Acid Supplementation and the Risk of Oral Clefts in Offspring.

INTRODUCTION: There is controversial evidence from the literature regarding the protective effect of folic acid supplementation during pregnancy against orofacial clefts. The authors undertook this meta-analysis to assess whether folate supplementation during pregnancy can reduce the risk of nonsyndromic cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO) in infants. METHODS: Eligible articles were identified by searching databases, including PubMed, Medline, Scopus, ISI (Web of Knowledge) to September 2017. A meta-analysis was performed to evaluate the effects of maternal supplementation on oral clefts. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using Stata software. Publication bias was assessed by the Begg and Egger test. (Registration ID: CRD42018083922) RESULTS:: Out of the 1630 articles found in the authors' initial literature searches, 6 cohort studies, and 31 case-control studies were included in the authors' final meta-analysis. The results of the main analysis revealed that maternal folate supplementation was associated with a modest but statically significant decreased risk of all cleft subtypes (OR = 0.69, 95% CI: 0.60, 0.78). Folic acid intake alone was inversely associated with CL/P (OR = 0.73, 95% CI: 0.62-0.85,) but to a lesser extent than CPO (OR = 0.75, 95% CI = 053-1.04). Multivitamin intake had a significant protective effect for CL/P (OR = 0.65 95% CI = 0.55-0.80) as well as CPO (OR = 0.69, 95% CI = 0.53-0.90). CONCLUSIONS: Our results indicate that maternal supplementation in early pregnancy reduces the risk of nonsyndromic CL/P and CPO in infants. These data can serve to reassure women planning a pregnancy to consume multivitamins during the periconception period to protect against oral clefts.

Histological evaluation of orthodontic tooth movement following low level laser irradiation in rabbits.

BACKGROUND: Reduction of orthodontic treatment time is a major concern for orthodontists. Low level laser therapy (LLL) has been widely used in dentistry and it has been claimed that it could stimulate bone formation. OBJECTIVE: The aim of the present study was to evaluate histological effects of LLL on alveolar bone remodeling during experimental tooth movement in rabbits. METHODS: In this experimental study which was performed in the animal lab of Mashhad Dental School in 2016 twenty pre-pubertal female albino rabbits with the mean age of 8±1 weeks were randomly assigned into two groups. All the rabbits were examined by a veterinarian, and underweight or diseased rabbits were excluded from the study. Fifty gram orthodontic force was applied via 0.014 stainless steel spring on central teeth in both groups. In the first group, low level laser KLO3 (wave length: 980 nm, Power: 80mw) was irradiated three minutes from the buccal aspect of central teeth for 21 days. In the second group, rabbits were not exposed to laser irradiation and served as our control group. After this period, the distance between mesial corners of incisors was measured blindly by a caliper calibrated as 0.1mm. All rabbits in both groups were sacrificed by vital perfusion for histological evaluation to determine the number of resorption lacuna and amount of fibrous tissue. Independent sample t-test was used to analyze the data. RESULTS: The number of resorption lacuna, the rate of tooth movement and fibrous tissue were significantly greater in the lased group (p=0.05). CONCLUSION: Low level laser irradiation could accelerate tooth movement in rabbits via increased resorptive activity in alveolar bone.

Static and kinetic frictional forces of silica-insert ceramic brackets with coated archwires in artificial saliva.

BACKGROUND: During sliding mechanics, the frictional force (FF) is an important counterforce to orthodontic tooth movement. The purpose of this in vitro study was to investigate the static and kinetic FFs of S silica-insert ceramic (SIC) brackets with Teflon-coated (TC) and conventional S stainless steel (SS) archwires. MATERIALS AND METHODS: The target group of this study included 80 maxillary canine 0.022 inch slot SIC brackets. Forty SS brackets were used as the control. TC and conventional uncoated SS archwires of different dimensions (0.016, 0.018, 0.016 × 0.022, and 0.018 × 0.025 inch) were examined. All tests were carried out under artificial saliva injected condition. Scanning Electron Micrographs were prepared for two samples of coated and uncoated archwires. Analysis of variance and Tukey post hoc tests were used for statistical purposes (level of significance P < 0.05). RESULTS: SIC brackets showed significantly lower levels of FFs than SS brackets. TC archwires had greater frictional values than conventional uncoated ones. They also exhibited an unusual behavior of increasing kinetic FFs with time. Indentation and delamination of coating were obvious under scanning electron microscopy observations. CONCLUSION: From the standpoint of friction, SIC brackets may serve well, even better than SS brackets, in sliding mechanics. The coating layer of the archwires may delaminate and lost, causing an impediment to tooth movement.

The effect of intrusive orthodontic force on dental pulp of adults versus adolescents.

BACKGROUND: There is no conclusive evidence on the effect of orthodontic force application on dental pulp tissue. The aim of this study was to compare early and delayed histological effects of intrusive forces on dental pulp of adolescents and adults. MATERIALS AND METHODS: Patients referred to the Department of Orthodontics of Mashhad University of Medical Sciences participated in this study. They were assigned to adult (25-32-year-old) and adolescent (13-18-year-old) Groups. A cantilever spring made of 16 × 22 steel wire was used to apply intrusive force to upper first premolars (11 teeth in adolescents and 11 teeth in adults) and the opposing teeth were considered as control group. In each group, 6 pairs of teeth were extracted after one week, and the remaining 5 pairs were extracted after one month of intrusion. Histologic changes were compared between the control and intrusive groups and also between the adults and adolescents after 7 days and 1 month. Statistical analysis was performed using Statistical Package for the Social Sciences and Wilcoxon and Mann-Whitney U-tests. P ≤ 0.05 was set as statistically significant. RESULTS: Significant difference was not found in any histological parameters between intrusive and control groups 1 week and 1 month after intrusion in adolescents and adults (P > 0.05). One month after intrusion, inflammatory cell response intensity (P = 0.032) and frequency of chronic inflammation (P = 0.032) were significantly higher in adults compared to adolescents. CONCLUSION: Mild intrusive force in closed apex teeth causes no significant histologic changes in adolescents and adults. However, it seems that inflammatory-related histologic pulpal changes are more severe in adults after one month of intrusion.

Evaluation of the effects of subgingival injection of Simvastatin on space re-opening after orthodontic space closure in adults.

Background. This clinical trial evaluated the effect of Simvastatin on space re-opening after orthodontic space closure and its effect on the gingival index (GI) and clinical attachment loss (CAL). Methods. 16 females, 25-40 years old, with spaces between anterior mandibular teeth due to chronic periodontitis were participated in this study. The patients were randomly divided into control and experimental groups. In the experimental group, 1.2% Simvastatin gel and in the control group, 0.9% sodium chloride as a placebo was injected into the pocket depth of the six anterior teeth. The amount of space reopening, GI and CAL were measured. Results. No serious complications were observed during interventions and follow-up periods. Space re-opening was significantly reduced in patients receiving Simvastatin (P < 0.001). Moreover, GI reduction was significantly greater in Sim-vastatin group compared to the control group (P < 0.001). However, CAL did not demonstrate a significant difference between the groups. Conclusion. Simvastatin may decrease space re-opening after orthodontic space closure in human anterior teeth.

Combined chlorhexidine-sodiumfluoride mouthrinse for orthodontic patients: Clinical and microbiological study.

BACKGROUND: Orthodontic appliances impede good dental plaque control by brushing. Antimicrobial mouth rinses were suggested to improve this performance. We therefore aimed to investigate the effects of combined mouthrinse containing chlorhexidine (CHX) and sodium fluoride (NaF) on clinical oral hygiene parameters,and plaque bacterial level. MATERIAL AND METHODS: In this double-blind clinical study, 60 fixed orthodontic patients aged 14-25 years were randomly assigned to one of four mouthrinses groups: 1- combined CHX /NaF 2- CHX 0.06% 3- NaF0.05% 4-placebo. Following baseline examination patients were instructed to use the assigned mouthrinse twice daily for 21 days. Bleeding index (BI), modified gingival index (MGI) and plaque index (PI) were determined at the baselineand after three weeks of rinsing. Samples from supragingival plaque were obtained for the assessment of total bacterial, Streptococcus mutans and Lactobacilli colony counts. Data were analyzed by Wilcoxon, Kruskal-Wallis, and Mann-Whitney tests. RESULTS: Clinical parameters; All three active mouth rinses induced significant improvements of BI, MGI, and PI (P<0.05). Results of CHX/NaF were slightly, but not significantly, better than CHX. CHX/NaF and CHX induced significantly more changes than NaF and placebo. Microbiological measurements; Except placebo, other mouthrinses reduced total bacterial, Streptococcus mutans, and Lactobacilli counts significantly (P<0.05). CHX/NaF acted against Lactobacilli significantly more than others. CONCLUSIONS: Adding CHX0.06%/NaF0.05% combined mouth rinse to daily oral hygiene regimen of orthodontic patients significantly improved oral hygiene status. Effect of this combined mouth rinse on dental plaque Lactobacilli was remarkable. However, large controlled trials could provide more definitive evidence. KEY WORDS: Mouthrinse, fluoride, chlorhexidine, plaque.

Analysis of Different Positions of Fiber-Reinforced Composite Retainers versus Multistrand Wire Retainers Using the Finite Element Method.

Background. The aim of this study was to evaluate root displacement of the lower incisors fixed with FRC in different positions versus FSW retainers using the finite element method. Materials and Methods. 3D finite element models were designed for a mandibular anterior segment: Model 1: flexible spiral wire bonded to the lingual teeth surfaces, Model 2: FRC bonded to the upper third of lingual teeth surfaces, and Model 3: FRC bonded to the middle third. FE analysis was performed for three models and then tooth displacements were evaluated. Results. In contrast to lateral incisors and canines, the FSW retainer caused the central teeth to move more than the teeth bonded with FRC in both loadings. Comparison between Models 2 and 3 (in vertical loading) showed that FRC retainers that bonded at the upper third of lingual teeth surfaces made central and canine teeth move less than FRC retainers bonded at the middle third; however, for lateral teeth it was the opposite. Conclusion. FRC retainers bonded at the upper third of lingual teeth surfaces make central and canine teeth move less than FRC retainers bonded at the middle third in vertical loading; however, for lateral teeth it was the opposite.

Low-level laser therapy for management of TMJ osteoarthritis.

AIMS: This study investigated the efficacy of low-level laser therapy (LLLT) for the management of temporomandibular joint (TMJ) osteoarthritis. METHODOLOGY: In a double-blind clinical trial, 20 patients with TMJ osteoarthritis were randomly divided into laser and placebo groups. The patients in the laser group received irradiation from an 810 nm low-level laser (Peak power 80 W, average power 50 mW, 1500 Hz, 1 micro s pulse width, 120 seconds, 6 J, 3.4 J/cm(2) per point), which was applied on four points around the TMJs and on painful muscles three times a week for 4 weeks. In the placebo group, the treatment was the same as that in the laser group, but with laser simulation. The patients were evaluated before laser therapy (T1), after 6 (T2) and 12 (T3) laser applications and 1 month after the last application (T4), and the amount of mouth opening and the pain intensity were recorded. RESULTS: No significant differences were found in mouth opening either between the study groups or between the different evaluation times in each group (P>0.05). There was no significant difference in pain symptoms of the masticatory muscles and TMJ between the laser and the placebo groups (P>0.05), but some significant within-group improvements were present for Visual Analogue Scale (VAS) scores of the body of the masseter and TMJ in both groups. CONCLUSIONS: LLLT using the present laser parameters was no more effective than the placebo treatment for reducing pain and improving mouth opening in patients with TMJ osteoarthritis.

Are more nickel ions accumulated in the hair of fixed orthodontic patients?

BACKGROUND AND OBJECTIVES: All elements existing in orthodontic alloys can be released to the oral cavity as corrosion products; therefore, they can accumulate in body tissues after systemic absorption. Among body tissues that can be evaluated for systemic absorption of nickel, in this study we used hair strands, because if nickel is absorbed systematically, it would accumulate in these strands over time. Furthermore, hair sampling is a non-invasive method, so the main aim of this study was the evaluation of nickel ions release into the hair strands of fixed orthodontic patients compared with the control group in a 4-month duration. MATERIALS AND METHODS: In this clinical trial, the test group included 24 female patients between 12-20 years of age that were going to begin fixed orthodontic treatment. The control group consisted of their sisters in the same age range, who volunteered to participate in this study. Initial hair samples were taken from both groups at the beginning the study and immediately before setting up the fixed appliances in test group. The samples were taken from three different scalp sites including; frontal, vertex, and occipital areas. After 16 weeks, hair samples were taken from approximately the same scalp areas in both the groups. The samples were analyzed by atomic absorption spectrophotometer and data analyzed by Mann-Whitney test. RESULTS: This study showed that there were significant differences in nickel levels before and after study for case (P = 0.004) and control groups (P = 0.012). The mean nickel concentration after four months was 0.382 ± 0.36 µg/g for controls and 0.673 ± 0.38 µg/g for the case group, which was significantly different (P = 0.002). CONCLUSION: The hair nickel concentrations significantly increased after insertion of fixed orthodontic appliances as compared with the control group.

The effect of low level laser on condylar growth during mandibular advancement in rabbits.

INTRODUCTION: It has been shown that Low Level Laser (LLL) has a positive effect on bone formation. The aim of this study was to evaluate the effect of low level laser on condylar growth during mandibular advancement in rabbits. MATERIALS AND METHODS: Continuous forward mandibular advancement was performed in fourteen male Albino rabbits with the mean age of 8 weeks and the mean weight of 1.5 ± 0.5 kg, with acrylic inclined planes. The rabbits were randomly assigned into two groups after 4 weeks. LLL (KLO3: wave length 630 nm) was irradiated at 3 points around the TMJ, through the skin in the first group. The exposure was performed for 3 minutes at each point (a total of 9 minutes) once a day for 3 weeks. The control group was not exposed to any irradiation. The rabbits in both groups were sacrificed after two months and the histological evaluation of TMJ was performed to compare fibrous tissue, cartilage, and new bone formation in condylar region in both groups. Disc displacement was also detected in both groups. Student's t-test, Exact Fisher and Chi square tests were used for the statistical analysis. RESULTS: The formation of fibrous tissue was significantly lower, while bone formation was significantly greater in lased group as compared with control group. The thickness of cartilage did not differ significantly between two groups. CONCLUSION: Irradiation of LLL (KLO3) during mandibular advancement in rabbits, increases bone formation in condylar region, while neither increase in the cartilage thickness nor fibrous tissues was observed.