Synthesis and Characterization of a Sustained Nitric Oxide-Releasing Orthodontic Elastomeric Chain for Antimicrobial Action.

The acidic byproducts of bacteria in plaque around orthodontic brackets contribute to white spot lesion (WSL) formation. Nitric oxide (NO) has antibacterial properties, hindering biofilm formation and inhibiting the growth of oral microbes. Materials that mimic NO release could prevent oral bacteria-related pathologies. This study aims to integrate S-nitroso-acetylpenicillamine (SNAP), a promising NO donor, into orthodontic elastomeric ligatures, apply an additional polymer coating, and evaluate the NO-release kinetics and antimicrobial activity against Streptococus mutans. SNAP was added to clear elastomeric chains (8 loops, 23 mm long) at three concentrations (50, 75, 100 mg/mL, and a control). Chains were then coated, via electrospinning, with additional polymer (Elastollan®) to aid in extending the NO release. NO flux was measured daily for 30 days. Samples with 75 mg/mL SNAP + Elastollan® were tested against S. mutans for inhibition of biofilm formation on and around the chain. SNAP was successfully integrated into ligatures at each concentration. Only the 75 mg/mL SNAP chains maintained their elasticity. After polymer coating, samples exhibited a significant burst of NO on the first day, exceeding the machine's reading capacity, which gradually decreased over 29 days. Ligatures also inhibited S. mutans growth and biofilm formation. Future research will assess their mechanical properties and cytotoxicity. This study presents a novel strategy to address white spot lesion (WSL) formation and bacterial-related pathologies by utilizing nitric oxide-releasing materials. Manufactured chains with antimicrobial properties provide a promising solution for orthodontic challenges, showing significant potential for academic-industrial collaboration and commercial viability.

Management of Anterior Open Bite and Skeletal Class II Hyperdivergent Patient with Clear Aligner Therapy.

In orthodontics, patients with hyperdivergent facial types or problems in the vertical dimension are often challenging to treat with predictable treatment results. Conventionally along with fixed appliances, a headgear, posterior bite block, extraction, temporary anchorage devices, or orthognathic surgery are preferable approaches to treat such patients. This case report illustrates a non-extraction, non-surgical orthodontic treatment of 5 mm anterior open bite in a non-growing adult patient, utilizing clear aligner therapy.

Racial and gender differences of cervical vertebral maturation staging between African Americans versus Caucasian patients of various age groups: A retrospective study.

BACKGROUND AND OBJECTIVE: The primary purpose of this study was to compare CVM staging between African American (AA) and Caucasian (CC) subjects, grouped based on gender. The secondary objectives were to conduct a CVM comparison of (1) male vs. female subjects, grouped based on their race, and (2) AA vs. CC subjects, categorized based on their age group. MATERIALS AND METHODS: All patients between 8-18 years of age (University of XXX), meeting the criteria, were included between the period of the year 2007 to 2020. Three blinded independent evaluators analysed the lateral cephalograms for a 6-stage CVM system (CS1 to CS6) as described by McNamara and Franchi. Samples were divided based on race, gender, and age to conduct the statistical analysis for racial and gender comparisons. RESULTS: Out of the initial 1,300 lateral cephalograms, 1,276 with the mean age: 12.7 years SD 2.5 years, and median CVM: 4 (IQR: 25% percentile- 2 and 75% percentile- 4) were included. Gender-specific racial age comparison showed no significant differences for male subjects for most of the CVM stages (P>0.05). Overall and race-specific gender comparison of age showed significant differences for almost all CVM stages (P<0.05). No significant difference of CVM was found on racial comparison for overall, females (P=0.6131) or males (P=0.0825) subjects. On age-specific racial comparison, AA girls (8-10 years) were skeletally more mature than CC girls (P=0.0143); over 14-year-old CC girls (P<0.0001) and over 16-year-old CC boys (P=0.0008), being skeletally more mature than AA boys of the same age. CONCLUSIONS: There was no significant difference between AA and CC subjects on gender-specific comparisons for most of the CVM stages. A significant difference of age was observed for most of the CVM stage between male and female subjects on race-specific comparisons. Female patients were ahead in skeletal maturity as compared to males for each CVM stage. The CVM for 8-12-year-old AA females was significantly higher than that of the CC females, whereas the CVM for>14-year-old CC females was significantly higher than AA females.

Evaluation of the three-dimensional (3D) position of cervical vertebrae in individuals with unilateral posterior crossbite.

OBJECTIVE: To evaluate the three-dimensional (3D) position of the cervical vertebrae of growing subjects with unilateral posterior crossbite (UPC). MATERIALS AND METHODS: In this cross-sectional study, cone beam computed tomography (CBCT) scans of 1455 patients were screened, and ultimately 58 scans (26 patients with UPC and 32 controls with normal occlusion) were included after imposing inclusion/exclusion criteria. Roll, yaw, and deviation of the geometric center of C1, C2, and C3 vertebrae were measured and compared between groups. A correlation between these parameters and different variables on mandibular positioning was also carried out. RESULTS: A statistically significant difference (p < 0.05) was observed between groups for the deviation of pogonium (Pog), mandibular plane roll, and C3 roll, and patients with UPC showed higher cant or deviation. A significant correlation was reported for the roll of C2 and C3 with the deviation of Pog, a roll of the occlusal plane, and roll of the mandibular plane (p < 0.05). The greater the deviation of the Pog to one side, the greater the roll of the vertebrae with this same side up. The same tendency was observed between the roll of the occlusal plane or the mandibular plane with the roll of these cervical vertebrae. CONCLUSIONS: There is a positive correlation between transverse occlusal changes and positional deviations of the cervical vertebrae, especially C2 and C3. CLINICAL RELEVANCE: The study results do not allow us to infer the clinical/functional consequences of these deviations, as well as if malocclusion's treatment would result in an improvement of intervertebral relationships.

Comparison of anterior maxillary and mandibular alveolar parameters in African American and Caucasian women: A retrospective pilot study.

PURPOSE: The primary objective of this study was to analyze the thickness and height of alveolar bone around the maxillary and mandibular incisors. Additionally, this study aimed to compare bone parameters between Caucasian (CC) and African American (AA) female patients. MATERIALS AND METHODS: In this retrospective pilot study, 50 female subjects (25 CC and 25 AA) were included. The inclusion criteria were AA or CC women between the ages of 18 and 50 with a normo-divergent facial pattern and Angle's class I, end-on class II, or mild class III malocclusion. The distance from the cementoenamel junction (CEJ) to the buccal and lingual alveolar crest; the alveolar ridge thickness at the mid-root and apex; and the buccal and lingual bone thickness at 3, 6, and 9 mm from the CEJ were measured. RESULTS: No significant difference was found (P>0.05) in the cortical bone thickness at 3 mm, 6 mm, or 9 mm from the alveolar crest between CC and AA populations for most measurements. A significant difference in bone thickness was found (P<0.05) for the lingual surface of the central incisor, with maxillary bone thickness found to be higher than mandibular bone thickness. The measurements of lingual thickness were larger than those of buccal thickness for both races. CONCLUSION: There were no differences in maxillomandibular anterior alveolar bone measurements between normo-divergent adult AA and CC women, except for a few parameters at varying locations. However, future studies can be planned based the current pilot study data, which may provide valuable information.

Orthodontic and surgical management of a patient with severe mandibular deficiency and asymmetry with condylar hypoplasia using 3-dimensional surgical planning in combination with a modified surgery-first approach.

Progressive improvements in digital technology and surgical techniques have synergized the speed, predictability, and favorable outcomes for patients undergoing surgical-orthodontic treatment with handicapping dentofacial deformities. This case report will demonstrate the management of a patient with severe mandibular hypoplasia, condylar hypoplasia, and mandibular asymmetry. The dentofacial deformity, and consequently, the unaesthetic facial appearance, led to psychosocial stress, symptoms of excessive daytime sleepiness, and functional limitations, especially related to mandibular movements. A modified surgery-first approach was used, which was successfully performed using computer-assisted surgical planning. Postsurgical orthodontics was accomplished with the aid of temporary skeletal anchorage mini-plates. An additional alloplastic enhancement of the chin addressed the severe microgenia, which the osseous advancement could not achieve. This resulted in a total advancement of the pogonion by 26 mm yielding a remarkable improvement in the patient's facial esthetics. Furthermore, a considerable improvement in mandibular function and reduction in daytime sleepiness occurred. The severe malocclusion with a discrepancy index value of 47 was treated to a successful final occlusion in 21 months of treatment time.

Miniplate-Aided Mandibular Dentition Distalization as a Camouflage Treatment of a Class III Malocclusion in an Adult.

This case report describes orthodontic camouflage treatment for a 32-year-old African American male patient with Class III malocclusion. The treatment included nonextraction, nonsurgical orthodontic camouflage by en masse distalization of the mandibular teeth using skeletal anchorage devices. The total treatment time was 23 months. Normal overjet and overbite with Class I occlusion were obtained despite the compensated dentition to the skeletal malocclusion. His smile esthetics was significantly improved at the completion of his treatment.

Autotransplantation: A biological treatment alternative for a patient after traumatic dental injury.

Traumatic dental injury is considered a public dental health problem because of a high childhood incidence, high treatment costs, and prolonged treatment time. Although management guidelines for traumatized teeth have been outlined, tooth loss following trauma is occasionally unavoidable. Here, we describe the successful interdisciplinary management of a traumatized central incisor in an 11-year old boy that was extracted because of a poor prognosis and restored by the autotransplantation of an immature donor tooth into the site. The patient underwent orthodontic treatment in order to close the donor site space and bring the autotransplanted tooth to an ideal position. Postorthodontic treatment radiographs and photographs revealed an esthetic and functional natural tooth replacing the lost tooth. The findings from this case suggest that autotransplantation offers unique advantages as a treatment modality for the restoration of missing teeth, particularly in growing children.

Maxillary incisors changes during space closure with conventional and skeletal anchorage methods: a systematic review.

PURPOSE: The objective of this systematic review was to compare the antero-posterior, vertical and angular changes of maxillary incisors with conventional anchorage control techniques and mini-implant based space closure methods. MATERIALS AND METHODS: The electronic databases Pubmed, Scopus, ISI Web of knowledge, Cochrane Library and Open Grey were searched for potentially eligible studies using a set of predetermined keywords. Full texts meeting the inclusion criteria as well as their references were manually searched. The primary outcome data (linear, angular, and vertical maxillary incisor changes) and secondary outcome data (overbite changes, soft tissue changes, biomechanical factors, root resorption and treatment duration) were extracted from the selected articles and entered into spreadsheets based on the type of anchorage used. The methodological quality of each study was assessed. RESULTS: Six studies met the inclusion criteria. The amount of incisor retraction was greater with buccally placed mini-implants than conventional anchorage techniques. The incisor retraction with indirect anchorage from palatal mini-implants was less when compared with buccally placed mini-implants. Incisor intrusion occurred with buccal mini-implants, whereas extrusion was seen with conventional anchorage. Limited data on the biomechanical variables or adverse effects such as root resorption were reported in these studies. CONCLUSION: More RCT's that take in to account relevant biomechanical variables and employ three-dimensional quantification of tooth movements are required to provide information on incisor changes during space closure.

Management of severely impacted mandibular canines and congenitally missing mandibular premolars with protraction of autotransplanted maxillary premolar.

Transmigrated mandibular canines increase the treatment complexity in terms of both anchorage and biomechanical planning. Additionally, a Class II malocclusion with a deep overbite and associated dental anomalies such as hypodontia can further increase the treatment complexity and the overall treatment time. This case report describes the successful interdisciplinary treatment of a patient, aged 12.5 years, with transmigrated and severely impacted mandibular canines and congenitally missing mandibular second premolars. The transmigrated mandibular right canine was extracted, and a maxillary second premolar was autotransplanted to the missing mandibular right second premolar site with the aid of a stereolithographic donor tooth replica fabricated with 3-dimensional cone-beam computed tomography and a rapid prototyping technique. Furthermore, the autotransplanted tooth was protracted by 4 to 5 mm to close the space caused by the extraction of the mandibular right canine. The impacted mandibular left canine was orthodontically guided into its normal position in the arch. Good esthetic outcome and functional occlusion were achieved.

Response of the maxillary dentition to a statically determinate one-couple system with tip-back mechanics: A prospective clinical trial.

OBJECTIVE: To quantify the effects of tip-back mechanics on the maxillary first molars and incisors. MATERIALS AND METHODS: Sixteen subjects with Class II end-on malocclusion were treated with an intrusion arch to achieve distalization of the maxillary molar through tip-back mechanics. Lateral cephalograms were taken prior to molar tip-back (T1), after molar tip-back (T2), and after molar root uprighting (T3). Data were analyzed using the Friedman's and Wilcoxon signed rank tests to evaluate differences in time points (P ≤ .016). RESULTS: The maxillary first molar distalized 1.53 mm (P = .001) with 6.65° (P = .001) of distal tipping and 0.86 mm (P = .001) of extrusion at T2. Minor relapse of the first molar (mesial direction) was seen at T3. The maxillary incisors flared labially 0.4 mm, and the incisor root apex moved palatally 1.19 mm (P = .005) at T2. At T3, the incisor root apex moved palatally 1.5 mm (P = .003) from T1. An angular change from T1 of 3.31° (P = .008) and 3.53° (P = .014) was seen at T2 and T3, respectively, as a result of palatal root movement of the maxillary incisors. CONCLUSIONS: A significant amount of distalization of maxillary molars was attained at the crown level with tip-back mechanics. Palatal root angulation change was significant in the incisors with minimal anteroposterior movement of the incisal edge.

Integration of 3-dimensional surgical and orthodontic technologies with orthognathic "surgery-first" approach in the management of unilateral condylar hyperplasia.

Recent innovations in technology and techniques in both surgical and orthodontic fields can be integrated, especially when treating subjects with facial asymmetry. In this article, we present a treatment method consisting of 3-dimensional computer-aided surgical and orthodontic planning, which was implemented with the orthognathic surgery-first approach. Virtual surgical planning, fabrication of surgical splints using the computer-aided design/computer-aided manufacturing technique, and prediction of final orthodontic occlusion using virtual planning with robotically assisted customized archwires were integrated for this patient. Excellent esthetic and occlusal outcomes were obtained in a short period of 5.5 months.

Failure rates of mini-implants placed in the infrazygomatic region.

BACKGROUND: The purpose of this pilot study was to evaluate the failure rates of mini-implants placed in the infrazygomatic region and to evaluate factors that affect their stability. METHODS: A retrospective cohort study of 30 consecutive patients (55 mini-implants) who had infrazygomatic mini-implants at a University Clinic were evaluated for failure rates. Patient, mini-implant, orthodontic, surgical, and mini-implant maintenance factors were evaluated by univariate logistic regression models for association to failure rates. RESULTS: A 21.8 % failure rate of mini-implants placed in the infazygomatic region was observed. None of the predictor variables were significantly associated with higher or lower odds for failed implants. CONCLUSIONS: Failure rates for infrazygomatic mini-implants were slightly higher than those reported in other maxilla-mandibular osseous locations. No predictor variables were found to be associated to the failure rates.

Treatment duration and factors associated with the surgery-first approach: a two-center study.

BACKGROUND: The aim of this study was to evaluate treatment duration and number of appointments in orthognathic surgery using the surgery-first approach (SFA) and to evaluate the factors associated to these outcomes. METHODS: This was a retrospective chart review of consecutively treated patients with SFA at a University clinic and a private practice setting. Treatment duration, number of appointment, and factors associated to this duration such as patient demographics, type of surgery, use of 3D planning, and treatment center among others were evaluated. Multivariable linear regression models were used to examine the simultaneous association between all predictor variables and outcomes. RESULTS: Median treatment duration for patients undergoing SFA was 9.6 months [6.1 (25 % percentile); 13.4 (75 % percentile)] with a median number of 13.8 appointments [9 (25 % percentile); 17 (75 % percentile)]. Transverse maxillary expansion was associated with longer treatment duration and number of appointments. There was also a significant difference in number of appointments between the two treatment centers. CONCLUSIONS: SFA significantly reduces treatment duration in orthognathic surgery. Transverse expansion is associated with longer treatment duration and number of appointments.