Application and Future Utilization of Shellac in Orthodontics: A Systematic Review.

Background: This review examines the application of shellac in orthodontics, focusing on its properties, advantages, and potential as an alternative to conventional materials. In orthodontics, where bond strength, ease of application, and removal are paramount, shellac's capabilities meet these needs while supporting environmentally friendly practices. Methods: With objectives centered on evaluating shellac's effectiveness, biocompatibility, and impact on patient outcomes, a comprehensive search across multiple databases was conducted, including PubMed, Scopus, and Web of Science. This study's selection criteria targeted studies assessing shellac's use in orthodontic applications, measuring treatment effectiveness, biocompatibility, and patient satisfaction while excluding those not directly involving orthodontic applications or lacking empirical data. Results: Through a qualitative synthesis of the extracted data-encompassing study design, sample size, treatment outcomes, and adverse effects-the findings reveal shellac's potential benefits in orthodontics, such as enhanced patient comfort and comparable treatment outcomes to traditional materials. However, the review also notes variability in study designs and outcomes, indicating the need for further research. Conclusions: This study concluded that shellac presents a promising alternative in orthodontic materials, recommending additional studies to standardize assessment methodologies and confirm its long-term advantages.

Effect of electronic reminders on patients' compliance during clear aligner treatment: an interrupted time series study.

Patient compliance is relevant to achieving therapeutic goals during clear aligner therapy (CAT). The aim of this study was to evaluate the efficacy of remote electronic (e-)reminders and e-feedback on compliance during CAT using an interrupted time series (ITS) analysis. We used routinely collected mobile application data from a German healthtech company (PlusDental, Berlin). Our primary outcome was self-reported compliance (aligner wear time min. 22 h on 75% of their aligners were classified as fully compliant, min. 22 h on 50-74.9% of their aligners: fairly compliant; min. 22 h on < 50% of their aligners: poorly compliant). E-reminders and e-feedback were introduced in the 1st quarter of 2020. Compliance was assessed at semi-monthly intervals from June-December 2019 (n = 1899) and June-December 2020 (n = 5486), resulting in a pre- and post-intervention group. ITS and segmented regression modelling were used to estimate the effect on the change in levels and trends of poor compliance. Pre-intervention, poor compliance was at 24.47% (95% CI: 22.59% to 26.46%). After the introduction of e-reminders and e-feedback (i.e., post-intervention), the percentage of poorly compliant patients decreased substantially, levelling off at 9.32% (95% CI: 8.31% to 10.45%). E-reminders and e-feedback were effective for increasing compliance in CAT patients.Clinical Significance: Orthodontists and dentists may consider digital monitoring and e-reminders to improve compliance and increase treatment success.

Who Seeks Clear Aligner Therapy? A European Cross-National Real-World Data Analysis.

A key step prior to clear aligner therapy (CAT) is the clinical examination and case selection, which includes understanding the specific orthodontic problem to be managed and the wider evaluation of oral health. Seeking CAT may further differ along sociodemographic parameters or across countries, as may perceived orthodontic treatment needs and oral health. We aimed to characterize patients seeking CAT across five European countries. Anonymized real-life data from one large CAT provider (DrSmile, Berlin, Germany) was retrospectively sampled for the period 1 November 2021−31 December 2021. A total of 15,015 patients (68.4% females, 31.6% males, with an age range of 18−81 years, median 30.0 years) were included. The cross-national comparison revealed a significant difference in gender distribution (p < 0.001/Chi-square), with the highest proportion of males in Italy (434/1199, 36.2%) and the lowest in Poland (457/1600, 28.6%); generally, more females sought CAT. The largest motivational factor in all countries for seeking CAT was crowding, in both males and females. By and large, patients paid out of pocket for CAT. The prevalence of caries, periodontitis, and craniomandibular dysfunction as well as the numbers of missing teeth were generally low, albeit with significant differences between sociodemographic groups and countries for caries and periodontitis. Patients seeking CAT showed a low prevalence in oral conditions but differed in their sociodemographic characteristics across countries. Dentists and orthodontists should consider these country-specific differences when planning CAT.

Factors Influencing Patient Compliance during Clear Aligner Therapy: A Retrospective Cohort Study.

Compliance is highly relevant during clear aligner therapy (CAT). In this retrospective cohort study, we assessed compliance and associated covariates in a large cohort of CAT patients. A comprehensive sample of 2644 patients (75.0% females, 25.0% males, age range 18-64 years, median 27 years), all receiving CAT with PlusDental (Berlin, Germany) finished in 2019, was analyzed. Covariates included demographic ones (age, gender) as well as self-reported questionnaire-obtained ones (satisfaction with ones' smile prior treatment, the experience of previous orthodontic therapy). The primary outcome was compliance: Based on patients' consistent use of the mobile application for self-report and aligner wear time of ≥22 h, patients were classified as fully compliant, fairly compliant, or poorly compliant. Chi-square test was used to compare compliance in different subgroups. A total of 953/2644 (36.0%) of patients showed full compliance, 1012/2644 (38.3%) fair compliance, and 679/2644 (25.7%) poor compliance. Males were significantly more compliant than females (p = 0.000014), as were patients without previous orthodontic treatment (p = 0.023). Age and self-perceived satisfaction with ones' smile prior to treatment were not sufficiently associated with compliance (p > 0.05). Our findings could be used to guide practitioners towards limitedly compliant individuals, allowing early intervention.

Immunohistochemical evidence for sclerostin during cementogenesis in mice.

The purpose of this study was to investigate systematically the expression of the glycoprotein sclerostin, the product of the SOST gene, in periodontal tissues, especially in the cementum of mice. Immunolocalization of sclerostin was performed in decalcified histological sections of the maxillary and mandibular jaws of 20 CB56BL/6 mice. For analysis, newborn mice as well as mice at the age of, 1, 2, 4 and 8 weeks were used to detect sclerostin in the cementum, periodontal ligament (PDL) and alveolar bone. For further characterization of the cells within the periodontium, antibodies for Runx2 and S100A4 were also applied. S100A4 as a marker for fibroblasts was used to characterize the fibroblasts, especially in the periodontal ligament. Runx2 as a marker for osteoblast-maturation was used to detect the osteoblasts in the alveolar bone. In addition to the detection in osteocytes, expression of sclerostin was observed in cementocytes of the cellular cementum. With regard to cementogenesis, positive identification of sclerostin could be verified in mice at the age of 4 and 8 weeks but not during the initial stages of cementogenesis. Positive immune reactions for Runx2 were observed in PDL cells, cementoblasts, cementocytes, osteoblasts and osteocytes. PDL cells generally showed positive immunoreactions for the S100A4 antibody. The main findings of this study were: (1) due to the fact that sclerostin was not identified in the initial stages of cementum development, its biological significance seems to be restricted to cementum homeostasis and possibly to regenerative processes; (2) verification of sclerostin only in cementocytes of cellular cementum points to biological similarity of cellular cementum and bone.

Evaluating miniscrew position using orthopantomograms compared to cone-beam computed tomography.

OBJECTIVE: Our objective was to compare the diagnostic capabilities of the orthopantomogram (OPT) as a standard dental diagnostic procedure with those of cone-beam computed tomography (CBCT). We examined the extent to which the OPT allowed miniscrew position to be estimated, and whether probands from different backgrounds in dental medicine arrived at the same conclusions regarding the screw position using the same radiological images (OPTs). MATERIALS AND METHODS: First, a tomas® pin 8 mm in length and 1.2 mm in diameter (Dentaurum, Ispringen, Germany) was inserted in all four quadrants of nine macerated skulls. These nine skulls were then imaged by OPT and CBCT. The OPTs were presented to probands whose task it was to estimate the miniscrew position in relation to the neighboring structures in an evaluation form. The probands surveyed came from three different backgrounds in dental medicine: orthodontists, oral and maxillofacial surgeons, and dental students. Comparison with the CBCT was made by measuring the CBCTs using the GALILEOS Viewer (Sirona, Bensheim, Germany), and these results were compared with those in the evaluation forms. RESULTS: In this study, it could be shown that none of the three proband groups estimated the screw's position in the OPT significantly better or worse in comparison to the CBCT. The probands' assessments of the miniscrew's proximity to the dental root differed, and in many cases did not correspond exactly with the CBCT measurement. The majority of probands estimated the likelihood of an opposing corticalis perforation as small, as confirmed in the CBCTs. The proximity of the miniscrew to the maxillary sinus or inferior alveolar nerve was similarly assessed by most of the probands, as also determined in the CBCT. However, the OPT assessments of some probands of the proximity to the maxillary sinus and/or inferior alveolar nerve differed from the proximity measured in the CBCT. CONCLUSION: Overall our study demonstrates that the OPTs enabled a rough evaluation of the miniscrew position in relation to the surrounding structures. However, the probands' assessments were imprecise. Major deviations appeared in the determination of the proximity of the screw to the dental root. For this reason, if there is any doubt, patients should take advantage of three-dimensional (3D) diagnostics, preferably before any surgical intervention. This is true, for example, if it is unclear whether a root will be or has been perforated, or indeed whether there is sufficient transverse bone tissue.

Expectations, acceptance and preferences of patients in treatment with orthodontic mini-implants: part II: implant removal.

OBJECTIVE: The objective of this study was to compare mechanical and manual techniques to remove orthodontic mini-implants. We also investigated whether the treated patients preferred local anesthetics. The study's focus is on the patients' perceptions and the resulting preferences. PATIENTS AND METHODS: A total of 25 patients were randomly assigned to Group A or Group B. In Group A, the mini-implants were removed with a handpiece, while the Group-B patients' mini-implants were removed completely by hand. In addition, all patients received an injection of local anesthetic into one half of the jaw. No anesthetic was used on the other half of the jaw. The patients were asked about their pain perception before treatment, immediately after treatment and one day after treatment. RESULTS: We observed no significant differences between the two groups with respect to the intensity of their symptoms. However, the noise associated with the handpiece was found to be unpleasant and tended to lead to more symptoms than when no handpiece was used. Pain perceived during mini-implant removal was relatively slight and not much affected by the use of local anesthetics. The most severe symptoms were associated with the injection itself. The non-injected side experienced significantly less discomfort and was thus the preferred side in both groups. CONCLUSION: The patients tolerated the two removal procedures equally well. As the noise associated with the handpiece increased discomfort, manual removal of the mini-implants is preferable. As regards the injection technique, our results show that local anesthesia during removal does not provide a benefit. The most pain was caused by the injection, not by removal of the mini-implants.

Patient expectations, acceptance and preferences in treatment with orthodontic mini-implants. A randomly controlled study. Part I: insertion techniques.

OBJECTIVE: The objective of this study was to compare two different insertion techniques as well as two different anesthesia injection methods carried out on patients undergoing orthodontic treatment with mini-implants to reinforce skeletal anchorage. PATIENTS AND METHODS: A total of 30 patients were enrolled and randomly divided into two groups, A and B. For the patients in group A the mini-implants were inserted manually after pre-drilling with a dental handpiece. In group B self-drilling mini-implants were inserted without pre-drilling. Furthermore, all patients were given a local anesthetic injected into the root tip area in the second quadrant. In the first quadrant the anesthetic was injected directly next to the insertion region. The patients were questioned concerning pain perception prior to, immediately after, and 1 day after the treatment. RESULTS: There were no significant differences between the two groups in the degree of discomfort described by the patients. While patients in group A considered the noise from the dental handpiece as the main discomfort factor, patients in group B reported that the pressure applied when inserting the self-drilling mini-implants was the main source of discomfort. Overall discomfort from injections immediately next to the mini-implant insertion area was lower than that resulting from the standard injection methods, where the longer lasting anesthesia was considered unpleasant. CONCLUSION: Patients tolerated the various insertion procedures equally well. However, there were differences with regard to the injection technique: The patients favored an injection immediately next to the mini-implant insertion area.

Expectations, acceptance, and preferences regarding microimplant treatment in orthodontic patients: A randomized controlled trial.

INTRODUCTION: In this study, we evaluated the pain and discomfort experienced by orthodontic patients by comparing how they rated pain associated with had microimplant placement, tooth extraction, and gingival tissue removal in preparation for implant placement. METHODS: Fifty-six microimplants were placed in 28 consecutive orthodontic patients for anchorage reinforcement in the maxilla for en-masse retraction. For all patients, extractions of maxillary, or maxillary and mandibular, premolars had been planned. The recruited patients were randomized into 2 groups according to the timing of the extractions. In group A, at least 1 extraction was performed during the evaluation period; the extractions in group B were after the evaluations. Furthermore, all patients had 2 different surgical procedures for placement. On 1 side, the gingival tissue was removed before placement. On the contralateral side, the implant was placed transgingivally. Each patient's perception of pain and discomfort was evaluated by a questionnaire before, immediately after, and 1 week after the intervention. RESULTS: The discomfort experienced during the extractions was described as very painful by 50% of the patients. It was significantly greater than during tissue removal and microimplant placement (P <0.05). Microimplant placement produced no pain in 30% of the patients and was described as the least painful procedure (P <0.05). Transgingival microimplant placement was significantly preferred by all patients (P <0.05). CONCLUSIONS: Microimplant surgery seems to be a well-accepted treatment option in orthodontic patients, with significantly lower pain levels than for tooth extractions. Furthermore, transgingival placement is clearly favored by patients who do not need tissue removed before placement.

Mental paresthesia and orthodontic treatment.

This article reports a case of mental paresthesia during orthodontic treatment. It also discusses which cases may be at risk for developing mental paresthesia and its prevention and management.