Comparison of the bond strength of five different composites used in the production of clear aligner attachments.

AIM: The aims of this study were to measure and compare shear bond strength (SBS) and manipulation time (MT) among five different composite resins (CR; two flowable and three highly viscous) which are used in the production of clear aligner attachments. MATERIAL AND METHODS: This in vitro experiment study comprised of 150 extracted premolars which were divided into 5 equal groups. Predictor variables were CRs; Tetric Evo Ceram (Ivoclar VivadentAG, Liechtenstein) (Group 1), Tetric NCeram; (Ivoclar VivadentAG, Liechtenstein) (Group 2), Tetric N-Flow (GC Dental Products, Tokyo, Japan) (Group 3), G-aenial Universal Injectable (GC Dental Products, Tokyo, Japan) (Group 4), GC Aligner Connect (GC Dental Products, Tokyo, Japan) (Group 5), respectively. Outcome variables were; SBS and MT for each CR attachment in each group of teeth. Oneway ANOVA was used to compare the groups. Levene's test was used to determine variance homogeneity. In terms of variance homogeneity, Bonferroni tests were used as a post-hoc test for multiple group comparisons. RESULTS: SBS was statistically different between study groups (p < 0.001). Average SBS values ​​are found to be 16.6 ± 3.6 MPa for Tetric Evo Ceram; 20.7 ± 5.4 MPa for Tetric NCeram; 21.0 ± 4.0 MPa for Tetric N-Flow; 18.9 ± 5.0 MPa for G-aenial Universal Injectable; and 17.4 ± 3.5 MPa for GC Aligner Connect. The values ​​in the Tetric Evo Ceram group were significantly lower than the Tetric N-Ceram group (p = 0.004) and the Tetric N-Flow group (p = 0.001). Mean value of shear bond strength in the GC Aligner connect group were significantly lower than in the Tetric N-Ceram group (p = 0.047) and in the Tetric N-Flow group (p = 0.017). Flowable composite had a significantly shorter manipulation time than the high viscous one; mean 1,08 ± 0,22 min to mean 4,57 ± 0,51 min, respectively. CONCLUSION: Although SBSs of CRs tested in the study was found to be statistically different, they all quite exceeded the accepted clinically sufficient value of 6-8 MPa. Besides, flowable composite required substantially less time to manipulate than the high viscosity composite.

Evaluation and comparison of smartphone application tracing, web based artificial intelligence tracing and conventional hand tracing methods.

AIM: The aim of this study was to compare and evaluate the reliability of three different cephalometric assessment methods: Smartphone Application Tracing Method CephNinja (SATM), Web Based Artificial Intelligence (AI) Driven Tracing Method WebCeph (WATM) and Conventional Hand Tracing Method (CHTM). METHODS: 110 lateral cephalometric radiographs were enrolled in the study and 4 linear and 7 angular parameters were traced and measured by one examiner using CephNinja, WebCeph and conventional hand tracing methods. Independent-samples Kolmogorov-Smirnov and Shapiro Wilks tests were used to compare the mean values of intra-examiner differences. Both intra-method and inter-method correlations were evaluated. RESULTS: There were statistically significant differences between the methods in terms of SNA (p:0.003; p < 0.05); SNB measurements (p:0.001; p < 0.05); SN-MP angle (p:0.001; p < 0.05); U1-SN angle (p:0.001; p < 0.05); L1-NB(mm) (p:0.007; p < 0.05) and E Line-Upper Lip(mm) measurements (p:0.013; p < 0.05). All intra-method correlation coefficients are 80% and above. In terms of inter-method coefficients the lowest coefficient of agreement is 0.170 and it is the coefficient of agreement between CHTM and SATM for measurement of U1-NA. The highest coefficient of agreement is 0.884 which is between WBTM and SATM for SNB measurement. CONCLUSIONS: The null hypothesis was rejected. There were statistically and clinically significant differences in various measurements among groups.

Management of Maxillary Deformity with Segmental Osteotomy followed by Implant Insertion in ß-Thalassemia Major Patient.

AIM: The aim of this report is to present the management of the maxillary deformity and subsequent implant therapy of a case with ß-thalassemia major. BACKGROUND: ß-thalassemia is a hematologic disorder that results from the abnormality of the ß-globulin chain synthesis. The best known thalassemia-induced dentofacial problem is the maxillary enlargement, and this undesirable growth of maxilla affects not only the facial esthetics but also dental occlusion, and leads to functional deficiency. CASE DESCRIPTION: A 16-year-old female patient with ß-thalasse-mia major was referred with the complaints of severe facial deformity and malocclusion, resulting in psychosocial and functional problems for her. The dentofacial deformity was characterized by an excessive premaxillary growth both in sagittal and vertical planes. Anterior maxillary osteotomy was performed with bilateral canines extraction, and dental implants were inserted to the canine regions, following bone healing. Postoperative course was free of problems with the crown restorations in function. Recurrence has not been occurred at 6 years follow-up. CONCLUSION: With maintaining hemoglobin level over 10 gm/dl, correction of maxillary defects is stable for long-term in ß-thalassemia major patient. Implant application to these patients may lead to unforeseeable results. CLINICAL SIGNIFICANCE: Although having some difficulties, such as overbleeding and stability problems, maxillary enlargement can be treated by segmental osteotomies successfully in ß-thalassemia major patient. Implant failure frequency may be higher, but many other studies are needed for determining implant survival rate in ß-thalassemia major patients.

Interdisciplinary management of an adult patient with a class III malocclusion.

The coexistence of a skeletal class III deformity and partial edentulism poses a clinical challenge and requires a comprehensive evaluation followed by a multidisciplinary approach. This clinical report presents the integrated management of a class III malocclusion in a 50-year-old woman with partial edentulism. The patient received adjunctive orthodontic treatment with a rigid temporary anchorage device, a Le Fort I maxillary osteotomy, and prosthodontic rehabilitation with removable maxillary copings, an overdenture, and a mandibular partial removable dental prosthesis with precision attachments.

Enamel surface roughness after debonding.

OBJECTIVE: To test the hypotheses that (1) there is no significant difference between the effects of two burs on the surface roughness of enamel after orthodontic debonding, and (2) there is no difference between resin removal times of the two burs. MATERIALS AND METHODS: The crowns of 20 premolars were embedded in acrylic blocks, and the buccal surfaces were subjected to atomic force microscopy (AFM), with measurement of initial roughness values. The brackets were bonded with a light-cured adhesive and were debonded with a debonding plier. In half of samples, adhesive remnants were removed with a tungsten carbide bur, whereas a fiber-reinforced composite bur was used in the other half. The second AFM measurements were made after resin removal. Duration of removal procedures was also recorded. Results of roughness and duration measurements were analyzed with the use of repeated measurements analysis of variance and independent t-tests, respectively. RESULTS: The two resin removal instruments had significantly different effects on enamel roughness; higher average roughness (Sa) (P < .001), root mean square roughness (Sq) (P = .046), and maximum roughness depth (Smax) (P < .001) values were obtained with use of the tungsten carbide bur. Time required for resin removal with the composite bur was significantly greater than time required with the carbide bur (P < .001). CONCLUSION: The hypothesis is rejected. The composite bur used for resin removal creates smoother surfaces after orthodontic bonding; however, the process takes longer than it does when the tungsten carbide bur is used.

Regeneration of multiple adjacent bone dehiscences with guided tissue regeneration after orthodontic proclination: a corrective treatment approach.

Transverse expansion or proclination of the teeth are valid alternatives to extraction in cases of crowding, but lack of stability and development of bone dehiscences have been demonstrated as side effects subsequent to anterior displacement of the incisors. The aim of this study was to repair the osseous dehiscence associated with incisor proclination. The multiple adjacent bone dehiscences were treated with a titanium membrane and bone matrix. Exposed root surfaces were covered with newly formed tissues. The patients in this study are the first to demonstrate the treatment of bone dehiscences that may occur as a result of orthodontic proclination.

Correction of septal and midface hypoplasia in maxillonasal dysplasia (Binder's syndrome) using high-density porous polyethylene.

BACKGROUND: Maxillonasal dysplasia (Binder's syndrome) is a congenital malformation characterized by an extremely flat and retruded nose. METHODS: This report describes an 18-year-old woman with maxillonasal dysplasia (Binder's syndrome). The septal deficiencies and maxillary retrusion of the patient were corrected by using an L-shaped implant and a crescent-shaped high-density porous polyethylene implant through the oral vestibular sulcus via an external rhinoplasty approach. RESULTS: After the operation, the tip of the nose had moved 5.5 mm anteriorly in the sagittal plane and 11.9 mm coronally in the vertical plane. Also, the nasolabial angle had increased after the surgery. Follow-up evaluation at 24 months showed good correction of the nasal and midface projection. CONCLUSIONS: High-density porous polyethylene implants are a good alternative for patients with Binder's syndrome, especially those who will not accept costal cartilage grafts or orthognathic surgery and who have tendency for hypertrophic scarring.

Osteoprotegerin in gingival crevicular fluid under long-term continuous orthodontic force application.

OBJECTIVE: To investigate the level of osteoprotegerin (OPG) in gingival crevicular fluid (GCF) during tooth movement. MATERIALS AND METHODS: Twelve patients (13-17 years of age) requiring canine distalization participated in the study. GCF sampling was done at baseline, 1 hour, 24 hours, 168 hours, 1 month, and 3 months from the distal sites of the test and with control teeth after the application of mechanical stress. OPG concentration was detected by enzyme-linked immunosorbent assay. RESULTS: OPG concentrations in distal sites of the test teeth were decreased in a time-dependent manner. Decreasing is significant when compared with the baseline measurements (P = .038). Variability was detected in the levels of OPG concentration in the distal sites of the control tooth throughout the experimental period. CONCLUSION: OPG is one of the key mediators responsible for alveolar bone remodeling during tooth movement.

Alveolar cleft closure by distraction osteogenesis with skeletal anchorage during consolidation.

Intraoral distraction osteogenesis (DO) has been widely used for the reconstruction of various dentoalveolar defects. However, its use in the management of alveolar clefts is relatively new. This method allows the closure of the cleft via the regeneration of new alveolar bone and attached gingiva through the distraction of a dento-osseous segment. It eliminates the need for a donor site for autogenous bone grafting and possible graft failure. However, the relatively long consolidation period required for the use of intraoral DO devices may result in soft tissue irritation that would compromise patient cooperation, especially in children. In the case presented, the intraoral DO technique was used for the treatment of a unilateral residual alveolar cleft and an implant was subsequently placed in the regenerated bone. A miniplate was also placed to serve as a skeletal anchor to enable the early removal of the distractor device. The distractor was removed before the beginning of the consolidation phase.

Pendulum appliances with 2 anchorage designs: conventional anchorage vs bone anchorage.

INTRODUCTION: The aim of this retrospective study was to compare the dentoalveolar and skeletal effects obtained with 2 types of pendulum appliance with different anchorage designs: bone-anchored pendulum appliance (BAPA) and conventional pendulum appliance (CPA). METHODS: The sample consisted of 39 patients (25 girls, 14 boys) with Angle Class II molar relationships. Correction of the molar relationship was achieved with the BAPA with palatal intermaxillary fixation screws for anchorage in the first group (n = 22) and with the CPA in the second group (n = 17). Lateral cephalograms before treatment and at the end of distalization were measured, and changes in the groups and the differences between the groups were analyzed statistically. RESULTS: The average distalization times were 6.8 months for the BAPA group and 5.1 months for the CPA group. The maxillary first molars were tipped 9.1 degrees in the BAPA group and 5.3 degrees in the CPA group; the molars moved distally 4.8 mm in the BAPA group and 2.7 mm in the CPA group. Despite mesialization of the premolars and proclination of the incisors with the CPA, both premolars were spontaneously distalized, and the incisors were retruded with the BAPA. CONCLUSIONS: The amount of distal molar movement was similar between the BAPA and the CPA. No anchorage loss or spontaneous distal premolar and incisor movement, which might decrease total treatment time, was seen with the BAPA.

Midfacial protraction with skeletally anchored face mask therapy: a novel approach and preliminary results.

INTRODUCTION: The purpose of this pilot study was to investigate the effects of facemask treatment with a rigid skeletal anchor. METHODS: Miniplates were placed on the lateral nasal wall of the maxilla in 6 subjects (mean age, 11.8 +/- 1.1 years). No dental tissue was incorporated into the anchorage system. Lateral cephalograms of each patient were evaluated at the beginning of treatment (T1), at the end of active treatment (T2), and at the end of follow-up (T3). RESULTS: In the horizontal plane, mean A-point movement was 4.8 +/- 2.0 mm in a mean of 10.8 +/- 2.4 months. The infraorbital region showed significant anterior movement (mean, 3.3 +/- 1.1 mm) at T2. At T3, advancement of the maxilla and the infraorbital region was well maintained (mean follow-up time, 15.2 +/- 0.9 months). Miniplate stability was excellent in all patients throughout treatment. CONCLUSIONS: Remarkable advancement in the middle face and consequent fullness in the soft-tissue profile can be achieved by using skeletal anchorage in conjunction with facemask therapy in the late mixed-dentition period.

Soft tissue profile after distal molar movement with a pendulum K-loop appliance versus cervical headgear.

OBJECTIVE: To evaluate the soft tissue changes associated with the pendulum appliance that was supported with a K-loop buccally and to compare these treatment changes with a cervical headgear group. MATERIALS AND METHODS: The records of 30 patients having skeletal Class I, dental Class II malocclusions were divided to two groups. Group 1 consisted of 7 girls, 8 boys (mean age, 15.0 +/- 3.4 years), and Group 2 consisted of 10 girls, 5 boys (mean age 14.2 +/- 2.9 years). The first group was treated with a pendulum appliance that was supported with a K-loop buccally, and the second group was treated with cervical headgear. Lateral cephalograms were taken at the beginning of treatment and at the end of distal molar movement. Treatment changes within the groups were analyzed using the paired t-test, and between group changes were analyzed with the independent t-test. RESULTS: The results showed that the pendulum/K-loop appliance had no significant effect on skeletal and dental variables and soft tissue A point, upper lip thickness, and sagittal upper lip position relative to the E plane. A significant difference for the change in Vp-Ls distance was found in patients in the pendulum/K-loop group (P < .05). Patients in the cervical headgear group showed significant retrusion in skeletal, dental, and soft tissue measurements (P < .05). CONCLUSIONS: The pendulum/K-loop appliance produces distal molar movement without causing any significant changes in the sagittal or vertical positions of either the jaw or the soft tissue profile.

Displacement of tooth fragments to the lower lip: a report of a case presenting an immediate diagnostic approach.

Dentoalveolar injuries are common and are caused by many factors with falls accounting for the most frequent one. Dental trauma requires a special consideration when dental fractures accompany soft-tissue lacerations. Dental fragments occasionally penetrate into soft tissues and may cause severe complications. A thorough clinical examination with soft-tissue radiographs could provide an early diagnosis and surgical removal. This case report presents an immediate diagnosis and management of displaced tooth fragments to the lower lip following a dental trauma.

Maxillary molar distalization with a bone-anchored pendulum appliance.

To obtain an effective and compliance-free molar distalization without an anchorage loss, we designed the bone-anchored pendulum appliance (BAPA). The aim of this study was to evaluate the stability of the anchoring screw, distalization of the maxillary molars, and the movement of teeth anterior to maxillary first molars. The study group comprised 10 patients (mean age 13.5 +/- 1.8 years) with Class II molar relationship. A conventional pendulum appliance was modified to obtain anchorage from an intraosseous screw instead of the premolars. The screw was placed in the anterior paramedian region of the median palatal suture. Skeletal and dental changes were measured on cephalograms, and dental casts were obtained before and after distalization. A super Class I molar relationship was achieved in a mean period of 7.0 +/- 1.8 months. The maxillary first molars distalized an average of 6.4 +/- 1.3 mm in the region of the dental crown by tipping distally an average of 10.9 degrees +/- 2.8 degrees . Also, the maxillary second premolar and first premolar moved distally an average of 5.4 +/- 1.3 mm and 3.8 +/- 1.1 mm, respectively. The premolars tipped significantly distally. No anterior incisor movement was detected. The BAPA was found to be an effective, minimally invasive, and compliance-free intraoral distalization appliance for achieving both molar and premolar distalization without any anchorage loss.

Orthopedic protraction with skeletal anchorage in a patient with maxillary hypoplasia and hypodontia.

Multipurpose titanium miniplates were placed on the lateral nasal wall of the maxilla as anchorage for face mask protraction in an 11-year-old girl presenting with severe maxillary hypoplasia and hypodontia. Applying orthopedic forces directly to the maxilla resulted in an eight mm maxillary advancement. Intraosseous titanium screws were also placed on the palatal bone, near the alveolar crests, to provide anchorage for the expansion appliance. The maxilla was expanded from the median palatal suture, and seven mm of expansion was achieved across the buccal segments. No other tooth support was used for the expansion or the protraction of the maxilla.