An investigation into structural behaviors of skulls chewing food in different occlusal relationships using FEM.

OBJECTIVES: This study aims to investigate the effect of different occlusal relationships on skull structural and mechanical behaviors through simulation of chewing food. METHODS: Finite element (FE) skull models of occlusion for Class I, end-on Class II, and full-cusp Class II were generated. End-on Class II and full-cusp Class II were chosen as mild and severe Class II occlusions, respectively. A simplified food bolus was introduced between the upper and lower dentition of the right molars. Chewing food was simulated in the skulls by moving the mandible. An experiment was conducted to measure strains at selective locations and compared them to the analytical results for validation. RESULTS: In the early stages of mandibular movement, masticatory forces predicted from the skull models without food were lower than the skull models with food but increased drastically after occluding teeth full enough. As a result, the relationship between masticatory force and mandible movement shows that there is no significant difference between the skull models with food and without food in the range of human masticatory force, approximately 250 N. In all the cases of skulls including a food bolus, stress was similarly propagated from the mandible to the maxilla and concentrated in the same regions, including the mandibular notch and alveolar bone around the lower molars. CONCLUSION: It is predicted that there is no significant difference of bite force-mandible movement relationships and stress distributions of skull and teeth, between end-on Class II and full-cusp Class II models. When simulating chewing activities on candy and carrot, it is also found that there is no difference of masticatory performance between Class II occlusions, from structural as well as mechanical perspectives.

Envisioning Post-treatment Occlusions after Space Closure Using Temporary Skeletal Anchorage Devices.

Missing posterior teeth and posterior tooth extractions are commonly seen and needed within orthodontic practices. With the invention of temporary skeletal anchorage devices (TSADs), clinicians can now effectively close posterior tooth spaces. Various molar occlusions are discussed to help clinicians envision post-treatment occlusions after posterior teeth space closure using TSADs.

Comparison of the occlusal contact area of virtual models and actual models: a comparative in vitro study on Class I and Class II malocclusion models.

BACKGROUNDS: The occlusal registration of virtual models taken by intraoral scanners sometimes shows patterns which seem much different from the patients' occlusion. Therefore, this study aims to evaluate the accuracy of virtual occlusion by comparing virtual occlusal contact area with actual occlusal contact area using a plaster model in vitro. METHODS: Plaster dental models, 24 sets of Class I models and 20 sets of Class II models, were divided into a Molar, Premolar, and Anterior group. The occlusal contact areas calculated by the Prescale method and the virtual occlusion by scanning method were compared, and the ratio of the molar and incisor area were compared in order to find any particular tendencies. RESULTS: There was no significant difference between the Prescale results and the scanner results in both the molar and premolar groups (p = 0.083 and 0.053, respectively). On the other hand, there was a significant difference between the Prescale and the scanner results in the anterior group with the scanner results presenting overestimation of the occlusal contact points (p < 0.05). In Molars group, the regression analysis shows that the two variables express linear correlation and has a linear equation with a slope of 0.917. R2 is 0.930. Groups of Premolars and Anteriors had a week linear relationship and greater dispersion. CONCLUSIONS: Difference between the actual and virtual occlusion revealed in the anterior portion, where overestimation was observed in the virtual model obtained from the scanning method. Nevertheless, molar and premolar areas showed relatively accurate occlusal contact area in the virtual model.

Accuracy of bracket positions with a CAD/CAM indirect bonding system in posterior teeth with different cusp heights.

INTRODUCTION: Our objective was to evaluate the effect of cusp height of posterior teeth (first premolar, second premolar, first molar) on the accuracy of the computer-aided design and computer-aided manufacturing (CAD-CAM) indirect bonding system. MATERIAL: Five kinds of maxillary arch models, without attrition, were divided into 2 groups: control group (with 0.5 mm of grinding) and experimental group (with the addition of 0.5 mm of wax to the cusp tip). Rapid prototype models were printed for both groups. Transfer jigs of the individual tooth brackets were designed using a digital model. 3-dimensional program to evaluate the differences between the intended digital bracket position and actual bracket position after indirect bonding. The differences were measured in the linear (mesiodistal, buccolingual, vertical) and angular (angulation, rotation, torque) dimensions. The Wilcoxon signed rank test was used for statistical analyses; significance was defined as P <0.05. RESULTS: Both groups had similar frequencies of errors between the intended and actual bracket positions. The frequencies of vertical errors over 0.5 mm were 3.3% and 6.7% in the control and experimental groups, respectively. The frequencies of angulation, rotation, and torque errors over 1° were 53.3%, 43.3%, and 60%, respectively, for the control group; and 60%, 60%, and 73.3%, respectively, for the experimental group. CONCLUSIONS: A difference in cusp height of maxillary posterior teeth did not produce a statistically significant difference in the linear and angular dimensions of bracket placement with the CAD/CAM indirect bonding system. However, given the tendency for a higher frequency in bracket placement errors in posterior teeth with larger cusp tips, cusp height should be considered when using a CAD/CAM indirect bonding system.

A Study on Possibility of Clinical Application for Color Measurements of Shade Guides Using an Intraoral Digital Scanner.

PURPOSE: To assess if color measurement with intraoral scanner correlates with digital colorimeter and to evaluate the possibility of application of a digital scanner for shade selection. MATERIALS AND METHODS: The L*a*b* values of the five shade tabs (A1, A2, A3, A3.5, and A4) were obtained with an intraoral scanner (TRIOS Pod) and a colorimeter (ShadeEye). Both devices were calibrated according to the manufacturer's instructions before measurements. Color measurement values were compared with paired t-test, and a Pearson's correlation analysis was performed to evaluate the relationship of two methods. RESULTS: The L*a*b* values of the colorimeter were significantly different from those of the digital scanner (p < 0.001). The L* and b* values of both methods were strongly correlated with each other (both p < 0.05). The device repeatability in both methods were reported to be excellent (p < 0.05). Within the limitations of this study, color measurements with digital intraoral scanners and computer-assisted image analysis were in accordance with those of the colorimeter with respect to L* and b* values; however, all the coordinates of shade tabs were significantly different between two methods. CONCLUSIONS: The digital intraoral scanner may not be used as the primary method of color selection in clinical practices, considering significant differences in color parameters with colorimeter. The scanner's capability in shade selection should be further evaluated.

Teeth discoloration during orthodontic treatment.

OBJECTIVE: Teeth discoloration is a rare orthodontic complication. The aim of this study was to report the clinical progression of discoloration during orthodontic treatment. METHODS: Discolored teeth, detected during orthodontic treatment between January 2003 and December 2012 by a single dentist using similar techniques and appliances, were analyzed. RESULTS: The total number of teeth that showed discoloration was 28. Progression of discoloration was evaluated in only 24 teeth that were observed without any treatment. During the observation period, the discoloration "improved" in 8 of the 24 teeth (33.3%) and was "maintained" in 16 (66.6%). The electric pulp test performed at the time of initial detection of discoloration showed 14.3% positivity, which improved to 21.4% at the final follow-up. None of the initial and final follow-up radiographic findings showed any abnormalities. CONCLUSIONS: When teeth discoloration is detected during orthodontic treatment, observation as an initial management is recommended over immediate treatments.

Maxillary molar derotation and distalization by using a nickel-titanium wire fabricated on a setup model.

The purpose of this article is to introduce a simple appliance that uses a setup model and a nickel-titanium (Ni-Ti) wire for correcting the mesial rotation and drift of the permanent maxillary first molar. The technique involves bonding a Ni-Ti wire to the proper position of the target tooth on a setup model, followed by the fabrication of the transfer cap for indirect bonding and its transfer to the patient's teeth. This appliance causes less discomfort and provides better oral hygiene for the patients than do conventional appliances such as the bracket, pendulum, and distal jet. The treatment time is also shorter with the new appliance than with full-fixed appliances. Moreover, the applicability of the new appliance can be expanded to many cases by using screws or splinting with adjacent teeth to improve anchorage.

Finite-element analysis of the center of resistance of the mandibular dentition.

OBJECTIVE: The aim of this study was to investigate the three-dimensional (3D) position of the center of resistance of 4 mandibular anterior teeth, 6 mandibular anterior teeth, and the complete mandibular dentition by using 3D finite-element analysis. METHODS: Finite-element models included the complete mandibular dentition, periodontal ligament, and alveolar bone. The crowns of teeth in each group were fixed with buccal and lingual arch wires and lingual splint wires to minimize individual tooth movement and to evenly disperse the forces onto the teeth. Each group of teeth was subdivided into 0.5-mm intervals horizontally and vertically, and a force of 200 g was applied on each group. The center of resistance was defined as the point where the applied force induced parallel movement. RESULTS: The center of resistance of the 4 mandibular anterior teeth group was 13.0 mm apical and 6.0 mm posterior, that of the 6 mandibular anterior teeth group was 13.5 mm apical and 8.5 mm posterior, and that of the complete mandibular dentition group was 13.5 mm apical and 25.0 mm posterior to the incisal edge of the mandibular central incisors. CONCLUSIONS: Finite-element analysis was useful in determining the 3D position of the center of resistance of the 4 mandibular anterior teeth group, 6 mandibular anterior teeth group, and complete mandibular dentition group.

Impact of Orthodontic Brackets on the Intraoral Scan Data Accuracy.

This study aims to compare the impact of buccal and lingual brackets on the accuracy of dental arch data acquired by 4 different digital intraoral scanners. Two pairs of dental casts, one with buccal brackets and the other with lingual brackets, were used. Digital measurements of the 3D images were compared to the actual measurements of the dental models, which were considered standard values. The horizontal measurements included intercanine widths and intermolar widths. The Mann-Whitney U test was performed for comparisons. iTero® and Trios® both showed high accuracy with relatively small maximum deviation of measurements. iTero showed a significantly higher accuracy in most of the arch width measurements on the buccal bracket model than on the lingual model (P < 0.05). Zfx IntraScan® and E4D Dentist® produced maximum deviations of more than 2 mm from both the buccal and the lingual bracket models. After comparing the degree of distortion of the arch on the digital scans with actual measurements of the same models, iTero and Trios proved to be excellent in terms of trueness and precision. Nevertheless, digital intraoral scanners should be used more cautiously in arches with lingual brackets than in those with buccal brackets.

Accuracy of four different digital intraoral scanners: effects of the presence of orthodontic brackets and wire.

OBJECTIVE: The objective of this study was to compare the accuracy of four different digital intraoral scanners and the effects of buccal brackets and orthodontic wire. METHODS: For this study, three sets of models (Control model, BKT model with buccal bracket, and WBKT model with buccal bracket and orthodontic wire) were scanned using four different types of intraoral scanners: E4D dentist, iTero, Trios, and Zfx IntraScan. The mesiodistal width of the teeth, intercanine width, and intermolar width measured by four scanners were compared. Three-dimensional (3D) images of the brackets were taken using the four scanners. Data were analyzed with one-way ANOVA, independent t test, and post-hoc Tukey test at a significance level of P < 0.05. RESULTS: When comparing the 3D images with manual measurements using a traditional caliper, iTero and Trios showed the highest accuracy in horizontal measurements.iTero had the lowest values in Devmax-min of maxillary intermolar and intercanine widths (0.16 mm and 0.20 mm, respectively), whereas Trios had the lowest values in Devmax-min of mandibular intermolar and intercanine widths (0.36 mm and 0.14 mm, respectively). The horizontal variables were barely affected by the presence of buccal brackets and orthodontic wire. Comparison of 3D bracket images scanned by the four scanners showed differences in image distortion among the scanners. Bracket characteristics did not affect the 3D bracket images. CONCLUSIONS: The four intraoral scanners used in this study differed in accuracy. However, the results acquired by iTero and Trios were more reliable. Effects of buccal brackets and orthodontic wire on the 3D images taken by intraoral scanners were not clinically significant.

Stress distributions in peri-miniscrew areas from cylindrical and tapered miniscrews inserted at different angles.

OBJECTIVE: The purpose of this study was to analyze stress distributions in the roots, periodontal ligaments (PDLs), and bones around cylindrical and tapered miniscrews inserted at different angles using a finite element analysis. METHODS: We created a three-dimensional (3D) maxilla model of a dentition with extracted first premolars and used 2 types of miniscrews (tapered and cylindrical) with 1.45-mm diameters and 8-mm lengths. The miniscrews were inserted at 30°, 60°, and 90° angles with respect to the bone surface. A simulated horizontal orthodontic force of 2 N was applied to the miniscrew heads. Then, the stress distributions, magnitudes during miniscrew placement, and force applications were analyzed with a 3D finite element analysis. RESULTS: Stresses were primarily absorbed by cortical bone. Moreover, very little stress was transmitted to the roots, PDLs, and cancellous bone. During cylindrical miniscrew insertion, the maximum von Mises stress increased as insertion angle decreased. Tapered miniscrews exhibited greater maximum von Mises stress than cylindrical miniscrews. During force application, maximum von Mises stresses increased in both groups as insertion angles decreased. CONCLUSIONS: For both cylindrical and tapered miniscrew designs, placement as perpendicular to the bone surface as possible is recommended to reduce stress in the surrounding bone.

Finite element analysis of maxillary incisor displacement during en-masse retraction according to orthodontic mini-implant position.

OBJECTIVE: Orthodontic mini-implants (OMI) generate various horizontal and vertical force vectors and moments according to their insertion positions. This study aimed to help select ideal biomechanics during maxillary incisor retraction by varying the length in the anterior retraction hook (ARH) and OMI position. METHODS: Two extraction models were constructed to analyze the three-dimentional finite element: a first premolar extraction model (Model 1, M1) and a residual 1-mm space post-extraction model (Model 2, M2). The OMI position was set at a height of 8 mm from the arch wire between the second maxillary premolar and the first molar (low OMI traction) or at a 12-mm height in the mesial second maxillary premolar (high OMI traction). Retraction force vectors of 200 g from the ARH (-1, +1, +3, and +6 mm) at low or high OMI traction were resolved into X-, Y-, and Z-axis components. RESULTS: In M1 (low and high OMI traction) and M2 (low OMI traction), the maxillary incisor tip was extruded, but the apex was intruded, and the occlusal plane was rotated clockwise. Significant intrusion and counter-clockwise rotation in the occlusal plane were observed under high OMI traction and -1 mm ARH in M2. CONCLUSIONS: This study observed orthodontic tooth movement according to the OMI position and ARH height, and M2 under high OMI traction with short ARH showed retraction with maxillary incisor intrusion.

A comparison of the precision of three-dimensional images acquired by 2 digital intraoral scanners: effects of tooth irregularity and scanning direction.

OBJECTIVE: The purpose of this study was to compare the precision of three-dimensional (3D) images acquired using iTero® (Align Technology Inc., San Jose, CA, USA) and Trios® (3Shape Dental Systems, Copenhagen, Denmark) digital intraoral scanners, and to evaluate the effects of the severity of tooth irregularities and scanning sequence on precision. METHODS: Dental arch models were fabricated with differing degrees of tooth irregularity and divided into 2 groups based on scanning sequence. To assess their precision, images were superimposed and an optimized superimposition algorithm was employed to measure any 3D deviation. The t-test, paired t-test, and one-way ANOVA were performed (p < 0.05) for statistical analysis. RESULTS: The iTero® and Trios® systems showed no statistically significant difference in precision among models with differing degrees of tooth irregularity. However, there were statistically significant differences in the precision of the 2 scanners when the starting points of scanning were different. The iTero® scanner (mean deviation, 29.84 ± 12.08 µm) proved to be less precise than the Trios® scanner (22.17 ± 4.47 µm). CONCLUSIONS: The precision of 3D images differed according to the degree of tooth irregularity, scanning sequence, and scanner type. However, from a clinical standpoint, both scanners were highly accurate regardless of the degree of tooth irregularity.

Changes in views on digital intraoral scanners among dental hygienists after training in digital impression taking.

BACKGROUNDS: Despite the rapid development of digital dentistry, the use of digital intraoral scanners remains limited. The aim of this study was to evaluate the changes in views on intraoral scanners among dental hygienists after training. METHODS: Thirty-four dental hygienists with >3 years of clinical experience participated and were divided into 2 groups : iTero and Trios groups. Participants of each group practiced the usage of both intraoral scanners, for total 12 times over 4 sessions, Questionnaires were given to participants at two different times; prior to and after the completion of the training sessions. The parameters of questionnaires included on difficulty of use, patient discomfort, awareness, preference, and clinical usefulness of intraoral scanners and comparison of two types of scanners. RESULTS: Upon the completion of the training, both iTero and Trios groups gave positive feedback on anticipated accuracy, efficiency, and clinical usefulness. More participants of the iTero group responded that the level of difficulty of use and patient discomfort was greater than Trios. Both groups preferred Trios for its clinical usefulness. CONCLUSIONS: The perceptions of dental hygienists on usage of intraoral scanner and digital impression improved positively with the training. The participants favored Trios over iTero in terms of difficulty of use , patient comfort, and clinical usefulness. This study showed that appropriate training could change the views on the efficiency of intraoral scanners positively among dental hygienists.

Comparison of occlusal contact areas of class I and class II molar relationships at finishing using three-dimensional digital models.

OBJECTIVE: This study compared occlusal contact areas of ideally planned set-up and accomplished final models against the initial in class I and II molar relationships at finishing. METHODS: Evaluations were performed for 41 post-orthodontic treatment cases, of which 22 were clinically diagnosed as class I and the remainder were diagnosed as full cusp class II. Class I cases had four first premolars extracted, while class II cases had maxillary first premolars extracted. Occlusal contact areas were measured using a three-dimensional scanner and RapidForm 2004. Independent t-tests were used to validate comparison values between class I and II finishings. Repeated measures analysis of variance was used to compare initial, set up, and final models. RESULTS: Molars from cases in the class I finishing for the set-up model showed significantly greater contact areas than those from class II finishing (p < 0.05). The final model class I finishing showed significantly larger contact areas for the second molars (p < 0.05). The first molars of the class I finishing for the final model showed a tendency to have larger contact areas than those of class II finishing, although the difference was not statistically significant (p = 0.078). CONCLUSIONS: In set-up models, posterior occlusal contact was better in class I than in class II finishing. In final models, class I finishing tended to have larger occlusal contact areas than class II finishing.

Distalization pattern of whole maxillary dentition according to force application points.

OBJECTIVE: The purpose of this study was to observe stress distribution and displacement patterns of the entire maxillary arch with regard to distalizing force vectors applied from interdental miniscrews. METHODS: A standard three-dimensional finite element model was constructed to simulate the maxillary teeth, periodontal ligament, and alveolar process. The displacement of each tooth was calculated on x, y, and z axes, and the von Mises stress distribution was visualized using color-coded scales. RESULTS: A single distalizing force at the archwire level induced lingual inclination of the anterior segment, and slight intrusive distal tipping of the posterior segment. In contrast, force at the high level of the retraction hook resulted in lingual root movement of the anterior segment, and extrusive distal translation of the posterior segment. As the force application point was located posteriorly along the archwire, the likelihood of extrusive lingual inclination of the anterior segment increased, and the vertical component of the force led to intrusion and buccal tipping of the posterior segment. Rotation of the occlusal plane was dependent on the relationship between the line of force and the possible center of resistance of the entire arch. CONCLUSIONS: Displacement of the entire arch may be dictated by a direct relationship between the center of resistance of the whole arch and the line of action generated between the miniscrews and force application points at the archwire, which makes the total arch movement highly predictable.

Molar uprighting by a nickel-titanium spring based on a setup model.

Molar uprighting is an important adjunctive treatment in orthodontics: repositioning the tilted molar eliminates the potentially pathologic condition and simplifies the ultimate restorative procedure. Although various methods for molar uprighting have been applied successfully, they still have some limitations and disadvantages in tooth movement. This article reports on a new clinical technique for molar uprighting with nickel-titanium springs based on a setup model. Two patients treated with this system are shown.

Effects of retraction force and anchorage reinforcement on occlusal force: a model study.

OBJECTIVES: The aim of this study was to investigate the effects of retraction force and anchorage reinforcement with orthodontic mini implants on occlusal force. MATERIALS AND METHODS: A strain gauge was attached to the palatal surface of the maxillary right first molar on an en masse retraction model. RESULTS: Occlusal forces were measured from this model, according to different retraction forces that were generated by elastic chain, under varied compressive forces (simulating masticatory forces). This retraction experiment was then performed again, after using anchorage reinforcement with an orthodontic mini implant. Occlusal force decreased as retraction force increased. The decrease showed a significant difference above 150g of retraction force (P < 0.05) and was more definite under compressive force higher than 150 N (P < 0.001). After anchorage reinforcement with the orthodontic mini implant, however, occlusal force did not significantly decrease with increasing retraction force. Significant differences in occlusal force were noted between the conditions with and without anchorage reinforcement when the applied retraction force was greater than 200g. CONCLUSION: Occlusal force tends to decrease during retraction, and this decrease can be prevented by anchorage reinforcement with orthodontic mini implants. LIMITATIONS: Further investigation on the actual masticatory process in humans is required for more clear clinical implication.