Fixed and removable orthodontic retainers, effects on periodontal health compared: A systematic review.

The aim of this systematic review is to analyze the properties of the different types of orthodontic retainers, identify their differences and define which type of device is most effective and less harmful to periodontal health. Methods: A literature search was carried out by a reviewer by consulting PubMed, Lilacs, Embase, Medline full text, Scopus, Web of Science, Cochrane library, and Science Direct electronic databases for biomedical and health literature as well as the grey literature and setting up the search from December 2010 without any restriction about articles languages. Results: The results showed that patients who wear retainers for a long period have significant differences in clinical parameters compared to patients without retainers. The type of retainer chosen also significantly influences the overall periodontal health of patients. Fixed retainers, both glass-fibre reinforced and steel wire retainers, proved to be the retainer type with the highest plaque and calculus accumulation values compared to removable retainers. In addition, among fixed retainers, glass-fibre reinforced retainers proved to be those that mostly promote the plaque and calculus accumulation in the application site. Conclusion: Fixed retainers are the best devices to maintain the alignment of mandibular anterior teeth in the long term. Among these devices, stainless steel lingual retainers, plain or braided, should remain the first choice. Although they are also susceptible to periodontal complications, their effect on periodontal health can be considered statistically insignificant if compared to glass-fibre reinforced retainers which, showing worse periodontal complications, should not be used.

Fluorinated Agents Effects on Orthodontic Alloys: A Descriptive In Vitro Study.

Fluoride-based mouthwashes and gels are preventive measures in countering demineralization and caries but, modifying environmental acidity, can reduce the wet corrosion resistance of orthodontic alloys. To evaluate chemical stability, in vitro experiments were conducted on stainless steel and nickel-titanium wires, weighed before and after immersion in household fluorinated mouthwashes and gels, measuring weight variations and elution of metal ions from acid corrosion phenomena. Elution samples were analyzed by inductively coupled plasma mass spectrometry, detecting residual ion concentration, while surface changes were analyzed under scanning electron microscopy. Results showed stainless steel wires do not undergo significant erosion when exposed to most fluorinated mouthwashes but, at prolonged exposure, alloys elute gradually greater amounts of metals and Ni-Ti wires become more sensitive to some mouthwashes. Ions' elution varies considerably, especially for Ni-Ti wires, if exposed to household fluorinated gels, for which significant negative values were obtained. Changes, affecting wires' outer layer, negatively act on shiny appearance and luster, reducing corrosion resistance. Although examined orthodontic wires showed good chemical stability and low toxicity, surface corrosion from exposure to fluorinated agents was observed. Home use must be accompanied by clinician prescription and, for household dental gels, must follow manufacturers' recommendations, ensuring prophylactic action without damaging alloys surfaces.

Clear Aligner Treatments in Orthoperio Patients.

INTRODUCTION: Orthodontic treatment is a recognized approach to support specific periodontal issues thanks to its capability to manipulate periodontal tissues. This concept is certainly not new, but the use of aligners in certain clinical conditions can be considered as being innovative when a multidisciplinary treatment is necessary. Moreover, aligners enable to plan 3D tooth movements, root placement, staging, and range of dental movements, alongside the improvement of oral hygiene. Thus, aligners can be suitable for the treatment of periodontal issues. In this article, the authors present two clinical cases with different periodontal issues: one with superficial periodontal problems and the other with a deep one. Both cases were successfully treated with aligners, highlighting how this invisible and comfortable tool can simplify the management of complex adult treatments. CONCLUSION: Digital workflow is the key for success in the aligner technique. The possibility to design a virtual plan of treatment and to transfer it in the real clinical world represents a way to limit errors and to reduce the time of orthodontic therapy.

Cone beam CT evaluation of skeletal and nasomaxillary complex volume changes after rapid maxillary expansion in OSA children.

OBJECTIVE: The first objective of this study was to evaluate skeletal changes and changes in dimensions and volume of the upper airways before and after rapid maxillary expansion (RME) therapy in children with obstructive sleep apnoea (OSA), by Cone Beam computed tomography (CBCT). The second objective was to evaluate if RME therapy could improve both the patency of the nasal airways and the Obstructive Sleep Apnoea Syndrome (OSAS). METHODS: 19 children with OSA and malocclusion took CBCT scans with a Dentascan and 3D reconstruction program before (T0) and 4 months after (T1) RME. Patients underwent an ENT visit with auditory and respiratory tests, including a daytime sleepiness questionnaire, a 19-channel polysomnography, and an orthognatodontic examination before orthodontic therapy (T0), after 2 months (T1) with the device still on, and 4 months after the end of the orthodontic treatment (T2). RESULTS: In all cases opening of the mid-palatal suture was demonstrated. Nasal osseous width, volume of the total upper airways, nasal cavity and nasopharynx and oropharynx increased significantly (P, .001). The increased W-ANS, W-mid and WPNS were closed linked to the enlarged midpalatal suture (P, .001). The increased WPNS were closed linked to the enlarged pterygoid processes (P, .001). The increased V-NC and V-NPA was closely linked to the enlarged W-PNS (P, .001) as well as VOPA and consequently to the enlarged midpalatal suture and pterygoid processes. CONCLUSION: RME treatment had a positive effect on children affected by chronic snoring and OSA, causing an increase in volume of the nasal cavity and nasopharynx, with expansion of the nasal osseous width and maxillary width. Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed a direct correlation to increased airways volume, bringing a functional improvement. The results show that the RME therapy can restore and improve a normal nasal airflow with disappearance of obstructive sleep breathing disorder.

Treatment of impacted canines with aligners: An alternative and viable option.

To recover impacted canines without esthetic issues, the aligners can be a resolutive tool allowing by pontics the camouflage of absent canines during orthodontic treatment. Knowledge of biomechanics, correct staging of dental movements, and surgery planification are strategic to achieve a good result.

In Vitro Evaluation of Structural Factors Favouring Bacterial Adhesion on Orthodontic Adhesive Resins.

Bacterial adhesion to the surface of orthodontic materials is an important step in the formation and proliferation of plaque bacteria, which is responsible for enamel demineralization and periodontium pathologies. With the intent of investigating if adhesive resins used for bracket bonding are prone to bacteria colonization, the surface roughness of these materials has been analyzed, combining information with a novel methodology to observe the internal structures of orthodontic composites. Scanning electron microscopy, combined with focus ion bean micromachining and stylus profilometry analyses, were performed to evaluate the compositional factors that can influence specific pivotal properties facilitating the adhesion of bacteria to the surface, such as surface roughness and robustness of three orthodontic adhesive composite resins. To confirm these findings, contact angle measurements and bacteria incubation on resin slide have been performed, evaluating similarities and differences in the final achievement. In particular, the morphological features that determine an increase in the resins surface wettability and influence the bacterial adhesion are the subject of speculation. Finally, the focused ion beam technique has been proposed as a valuable tool to combine information coming from surface roughness with specific the internal structures of the polymers.

SEM characterization and ageing analysis on two generation of invisible aligners.

BACKGROUND: The purpose of the in vitro study is to investigate and compare the morphological features and the chemical stability in weight of two different polyurethane-based blends, Smart Track (LD30) and Exceed30 (EX30), used for orthodontic aligners manufacture before and after the oral usage. METHODS: Twenty orthodontic aligners were randomly selected: 10 LD30 and 10 EX30, each group was divided in two subgroups, never used and intra-orally aged. By the employment of a Stereomicroscope, a section of 5 × 5 mm was cut from the buccal surface of the incisal region of each aligner. All samples were subjected to Scanning Electron Microscopy and Ageing tests in different solutions to simulate the hostility of the oral environment. The statistical method used was t-test. RESULTS: At SEM images, LD30 appears more homogeneous in texture respect to EX30. However, after clinical usage, both materials show significant structural alterations: findings have been supported by higher magnifications at SEM, by which it is clearly to observe many superficial cracks cross through the polymer structures of LD30U, absent in never used samples. LD30U surface becomes also smoother due to the disappearance of most of the conglomerates, but at the same time also rougher while EX30U shows a greater irregularity and porosity in which large and deep cracks are also highlighted. Although these changes occur persistently, in the aging tests no significant weight loss from both materials has been found, confirming the initial hypothesis of a good chemical stability and safety of both polyurethane mixtures even in conditions of severe hostility. CONCLUSION: LD30 is the expression of the technological evolution of EX30, this is made evident above all by its morphological architecture, more homogeneous and defined but also by the chemical stability that can be appreciated even in evident critic situations.

Comparison of the abrasive properties of two different systems for interproximal enamel reduction: oscillating versus manual strips.

BACKGROUND: The aim of the present investigation was to evaluate enamel reduction efficiency, abrasive property decay, and enamel effects between oscillating mechanical and manual systems for interproximal enamel reduction (IPR). METHODS: Three oscillating strips and three manual strips were tested on twelve freshly extracted premolars blocked in an acrylic cylinder pot by means of a material testing machine. Each strip underwent one test of 8 cycles (30 s each). Both abrasive tracks and teeth surfaces were qualitative evaluated before and after IPR by means of SEM analysis. Efficiency and abrasive property decay of both IPR systems were investigated by the amount of enamel reduction within the eight-cycle testing. Independent t-test was used to evaluate differences in variables between the two systems. RESULTS: Mechanical IPR system showed higher efficiency in terms of enamel reduction (p < 0.005) when compared with manual IPR system (0.16 mm and 0.09 mm, respectively). Quantity of removed enamel decreased throughout the 8 cycles for both systems. Less presence of enamel debris and detachment of abrasive grains were observed on mechanical strips rather than manual strips. SEM analysis revealed more regular surface of teeth undergone mechanical IPR procedures. CONCLUSION: Oscillating diamond strips showed more controlled efficiency when compared with the manual IPR system leading to a more regular enamel surface.

Periodontal condition in growing subjects with Marfan Syndrome: a case-control study.

BACKGROUND: Marfan's syndrome (MFS) is a systemic disorder of connective tissue caused by mutations in the extracellular matrix protein fibrillin-1. Orofacial characteristics may be useful in identification of the syndrome. Severe periodontitis is sometimes observed in MFS patients, but no in-depth information has been reported in Italian groups of growing subjects with MFS. The aim of this study was to analyze the periodontal condition on a group of growing subjects affected by MFS, in comparison with a typically developed control group. METHODS: A group of 16 subjects with diagnosed MFS were recruited from the Centre for Rare Diseases for Marfan Syndrome and Related Disorders of Tor Vergata University Hospital. The Marfan Group (MG) was compared with a Control Group (CG) composed by 20 nonsyndromic subjects. The periodontal clinical parameters like Marginal Gingival Thickness (GT), Plaque Index (PI), Bleeding On Probing (BOP) and Modified Periodontal Screening and Recording (PSR) were assessed. RESULTS: The mean value of PI in MG was 59%, instead in CG it reached 21%. Analysis showed a significant difference between MG and CG also for the BOP. In MG the mean value of BOP attained 36% and in CG it reached 16%. A statistical significant difference of distribution of PSR index between the two groups was found for all sextant examined. DISCUSSION: Patients with Marfan syndrome reveal a higher presence of plaque and consequently a generalized inflammation in the oral cavity when compared with a control group.

Use of clear aligners in open bite cases: an unexpected treatment option.

In open bite case treatments, a proper diagnostic differentiation is essential in determining the appropriate corrective procedures. Dental open bites are generally more responsive to treatment with orthodontics alone, whereas skeletal open bites often require a combination of orthodontics and orthognathic surgery. Patient selection and treatment principles for non-surgical open bite treatment routinely include fixed appliances both labial or lingual. However, removable clear aligners have gained a consistent popularity in the treatment of complex cases including open bite malocclusions. In this article, the authors describe three different clinical cases in which open bite cases had been satisfactorily treated by using clear aligners.

Lower incisor extraction treatment with the Invisalign® technique: three case reports.

The extraction of a lower incisor can lead to satisfactory orthodontic results for patients with moderate to severe lower incisor crowding. Invisalign(®) is a treatment modality for such treatments, moving teeth with precision and reducing inconvenience for the patient. Three case reports are presented in this article supporting the above statements.

Invisalign technique in the treatment of adults with pre-restorative concerns.

The Invisalign method is gaining an increasing interest as an alternative treatment option in adult patient in multidisciplinary complex cases to simplify the treatment plan. The aim of this work is to show the importance of planning a multidisciplinary approach to respond at the esthetic requests of adult patients and to treat complex cases with high predictability.

Unilateral canine crossbite correction in adults using the Invisalign method: a case report.

The aim of this paper is to present and debate the treatment of a unilateral canine crossbite using clear aligners (Invisalign). The possibility of combining partial fixed appliances with removable elastics to optimize the final outcome is also described. The advantages of protected movement, due to the presence of the aligners, to jump the occlusion during crossbite correction is also highlighted.

Extraction treatment using Invisalign Technique.

The Invisalign method is gaining an increasing interest as an alternative treatment option in adult patients and in difficult orthodontic cases. The aim of this work is to show a class II malocclusion with severe crowding in the upper and lower arches treated with the extraction of the upper first premolars performed by means of Invisalign. The alignment phase was successfully completed but the space closure achieved with crown tipping and without correct root inclination making a further fixed appliance phase necessary.