Color changes of nanocomposites used for clear aligner attachments: an in vitro study.

PURPOSE: The purpose of this study was to compare the color changes of two different nanocomposites used for two different designs of clear aligner attachments. METHODS: In all, 120 human premolars were embedded in 12 upper dental models with 10 premolars in each model. Models were scanned and attachments were digitally designed. Conventional attachments (CA) were prepared for the first six models and optimized multiplane attachments (OA) were prepared for the other six models with packable composite (PC) on the right quadrant and flowable composite (FC) on the left quadrant of each model. The models were subjected to 2000 thermal cycles at 5 °C/55 °C and then consecutively immersed in the five different staining solutions each for 48 h to simulate external discoloration. Color measurements were taken with a spectrophotometer. Color changes (∆E*ab) of the attachments before and after immersion were compared with the Commission Internationale de l'Éclairage L*a*b* (CIELAB) color space approach. RESULTS: When ∆E*ab values were examined, no significant difference was observed between the groups according to the attachment type (P > 0.05). After the coloration process, the flowable composite group showed less coloration than the packable composite group for both attachment designs (P < 0.05). Color difference values after the staining procedure were significantly higher in the CA-PC and OA-PC groups compared to the CA-FC and OA-FC groups (P < 0.05). CONCLUSION: Color change of the packable nanocomposite was more pronounced than that of the flowable nanocomposite for both attachment designs. Therefore, clear aligner attachments created using flowable nanocomposite can be recommended, especially in the anterior region where esthetics are important for the patient.

Comparison of Pain Levels on Patients Undergoing Fixed Orthodontic Treatment with 2 Different Self-Ligating Bracket Systems.

Objective: Comparison of pain levels of patients treated with 2 different passive self-ligating bracket systems right after initial archwire placement. Methods: A total of 34 patients with mild crowding were allocated randomly to 2 groups to be treated using 2 different self-ligating brackets. 0.014 inch copper nitinol and 0.014 inch superelastic nitinol archwires were selected as the initial archwire for Damon Q and SmartClip SL3 systems respectively. Seven page questionnaires that consisted of 3 visual analogue scales were handled to patients to mark their pain levels while chewing, biting with anterior teeth, and biting with posterior teeth at 2nd hour, 6th hour, 2nd day, 3rd day, and 7th day time intervals. Pain scores were measured manually using a ruler and noted. Results: The SmartClip group reported less pain at the 2nd and the 6th hours while chewing. Pain levels were the highest at the 6th h and the 2nd day for the Damon Q and SmartClip SL3 groups respectively. The SmartClip group reported more pain for the first two days, and after the 2nd day, pain scores were very similar to the Damon group. No statistically significant differences were reported between the groups. Conclusion: The highest pain sensation was reported for the 2nd day and decreased toward the 7th day. The SmartClip SL3 group reported lower pain scores in the first two days, but the levels were equaled on the 2nd day and after.

A comparison of treatment results of adult deep-bite cases treated with lingual and labial fixed appliances.

OBJECTIVES: To compare the cephalometric treatment results of adult deep-bite cases after labial and lingual fixed orthodontic treatment. MATERIALS AND METHODS: A total of 102 patients underwent lingual orthodontic treatment and complete records were evaluated. The following inclusion criteria were used: patients who had Angle Class I or mild Class II malocclusion; comprehensive orthodontic treatment that did not include intrusion mechanics or any extractions; patients with an initial overbite of more than 3.7 mm. Thirteen patients met the inclusion criteria. These cases were matched with the same number of patients according to age with a labial orthodontic treatment group. Pre- and post-treatment cephalometric radiographs were evaluated. Independent t test or Fisher exact tests were performed to assess the differences between the groups. RESULTS: Proclination of the upper incisors was higher in the labial group. Incisor mandibular plane angle (IMPA) showed an increase of 1.2° in the lingual group and 9.7° in the labial group. Lower incisor edge was approximately in a stable sagittal position in the lingual group but significant lower incisor proclination was seen in the labial group. The lower incisors were intruded (-1 mm) in the lingual group but lower incisors were minimally extruded (0.3 mm) in the labial group. No significant difference was found in the movements of upper and lower molars for both groups. CONCLUSIONS: The nature of lower incisor movement involved less protrusion in lingual orthodontics than the labial treatment. Lingual orthodontic treatment is a better option in adult cases where intrusion of lower incisors without labial tipping is desired.

Comparative evaluation of periodontal effects and survival rates of Memotain and five-stranded bonded retainers : A prospective short-term study.

PURPOSE: To prospectively compare the short-term periodontal effects and survival rates of mandibular lingual canine-to-canine Memotain (CA-Digital, Mettmann, Germany) and five-stranded bonded retainers. METHODS: In all, 52 patients requiring retention after orthodontic treatment were assigned to 2 study groups (n = 26 in each group). Retention was provided by Memotain retainers which were fabricated digitally using CAD-CAM (computer-aided design and computer-aided manufacturing) technology in the first group and by five-stranded retainers which were fabricated manually using a conventional bending method in the second group. The patients were examined at the following time points: 1 week, 1 month, 3 months and 6 months. Plaque index, gingival index, probing depth, marginal recession, bleeding on probing, failure rate per tooth, and survival rate of retainer wires were analyzed by Mann-Whitney U, Friedman, Wilcoxon signed-rank, and χ2 tests. RESULTS: The differences between the groups were nonsignificant for plaque index, gingival index, probing depth, marginal recession, bleeding on probing, failure rate per tooth and survival rate of retainer wires. Significant differences were observed within the groups throughout the follow-up period for plaque index and probing depth. The survival rates of retainer wires were 77% for the Memotain retainers and 73% for the five-stranded retainers for the 6­month follow-up period. CONCLUSIONS: Periodontal outcomes and survival rates of Memotain and five-stranded mandibular lingual bonded retainers were similar. Furthermore, periodontal health was maintained and considerably high survival rates were achieved with both retainer types.

Quantitative analysis of biofilm formation on labial and lingual bracket surfaces.

OBJECTIVES: To evaluate and compare the biofilm formation between labial and lingual orthodontic brackets. MATERIALS AND METHODS: Twenty patients with a mean age of 24 ± 8.8 who had received labial or lingual orthodontic treatment were enrolled in the study. Biofilm formation on 80 brackets was analyzed quantitatively with the Rutherford backscattering detection method. Five micrographs were obtained per bracket with views from the vestibule/lingual, mesial, distal, gingival, and occlusal aspects. Quantitative analysis was carried out with surface analysis software (ImageJ 1.48). Data were analyzed by Mann-Whitney U and Kruskal-Wallis tests (α = 0.05). RESULTS: Total biofilm formation was 41.56% (min 29.43% to max 48.76%) on lingual brackets and 26.52% (min 21.61% to max 32.71%) on labial brackets. Differences between the two groups were found to be significant. No difference was observed in intraoral location. The biofilm accumulation was mostly located on gingival, mesial, and distal surfaces for both groups. CONCLUSIONS: The biofilm accumulation on lingual orthodontic therapy was found to be more than labial orthodontic therapy.

External apical root resorption after nonextraction orthodontic treatment with labial vs. lingual fixed appliances.

OBJECTIVES: The aim of this retrospective study is to compare external apical root resorption (EARR) after labial and lingual fixed orthodontic treatment, as detected with panoramic radiographs. MATERIALS AND METHODS: Sixty subjects were divided into two groups according to the treatment type: lingual (30 patients) and labial (30 patients) fixed orthodontic treatment. Panoramic radiographs which were obtained at the beginning of treatment (T0) and at the end of the treatment (T1) were evaluated. The maxillary and mandibular central and lateral incisors, as well as canine crown and root lengths were measured for T0 and T1. Crown to root ratios were used to determine EARR. Data were evaluated using analysis of variance and χ2 analysis. RESULTS: In all, 5 patients (16.7%) in the lingual group and 7 patients (23.3%) in the labial group had a minimum of one tooth with severe EARR, while 9 patients (30%) in the lingual group and 14 patients (46.7%) in the labial group had no EARR. A total of 26 teeth (7.2%) in the lingual group and 34 teeth (9.4%) in the labial group developed severe EARR; however, 184 teeth (51.1%) in the lingual group and 202 teeth (56.1%) in the labial group did not reveal any EARR. No statistically significant difference was found for the resorption rates between the treatment groups (p > 0.05). Although not statistically significant, there was a higher percentage of severe EARR in the mandible within the labial group. CONCLUSIONS: Both lingual and labial orthodontic techniques showed statistically similar root resorption rates. EARR is a multifactorial issue and individual predispositions must also be taken into consideration.

Lingual Treatment of an Adult Patient with a Simplified Extraction Protocol.

Successful orthodontic treatment of adult cases depends on the biological, mechanical, and esthetic requirements of patients. While customized lingual appliance systems meet the esthetic expectations of the patients, they provide improved patient comfort, have three-dimensional mechanical control, and can be used for the treatment of all types of malocclusions. This report demonstrated the use of fully customized lingual orthodontic brackets for treating an adult case with extraction.

Extraction Orthodontic Treatment in an Autistic Patient.

Autism is a condition that restricts brain development. Early diagnostic criteria are as follows: less responsive to social stimuli, inability to develop natural speaking skills, lack of communication skills, and limited and repetitive behaviors. Orthodontic treatment is a challenging process for doctors in autistic patients. The clinical and cephalometric examination of a 17-year and 7-month-old autistic patient revealed class I malocclusion, increased vertical dimensions, proclined upper and lower incisors, and inconsistent lip closure. The treatment plan involved four premolar extractions from each quadrant. Upper and lower 1. premolar extraction with fixed treatment caused reduction in vertical dimensions and significant improvement in lip closure and incisor inclination. Due to the increased metabolic activity in these patients, treatment was completed in 13 months. As a result, autistic patients can be successfully treated. In this process, it is important to include communication as a major part of treatment.

Indirect Bonding Revisited.

In recent years, the popularity of indirect bonding increased due to advantages such as reduction of chair time and enhancement of patient comfort. Although the indirect bonding technique has improved over the years, the literature has shown different techniques of bracket placement; furthermore, new materials were specially developed for this technique. The aim of this article is to provide a review of the literature, advantages, disadvantages, and laboratory and clinical stages of the indirect bonding technique.

Comparison of short-term effects of mini-implant-supported maxillary expansion appliance with two conventional expansion protocols.

OBJECTIVE: This study evaluates the dentoskeletal effects of a mini-implant-supported maxillary expansion (MISME) appliance in comparison with two types of conventional expansion methods. METHODS: Records of 42 patients with bilateral or unilateral posterior crossbite were included in this study. The patients were divided into three groups. In group 1, four miniscrews were placed to the palatal region and an acrylic expansion device was bonded on these screws. A bonded maxillary expansion appliance was used in group 2, while a banded expansion appliance was used in group 3. Measurements from cephalometric, postero-anterior radiographs, and dental casts taken before and after expansion were evaluated statistically. RESULTS: ANB angle increased significantly in group 1 and 3. MISME group also showed an increase of SNA angle. Measurements regarding the vertical dimension did not change with MISME but significant posterior rotation was found in group 2 and 3. Overbite value showed a significant decrease in group 2 and 3, but remained stable in group 1. The nasal, maxillary, maxillary intermolar widths showed significant increases in all groups. The difference between MISME group and other groups in maxillary width was significant indicating more skeletal expansion in MISME group. The maxillary molars showed significant buccal tipping in group 2 and 3, while lingual tipping of molars was found in MISME group. CONCLUSIONS: MISME can be a better alternative to bonded expansion particularly in patients with vertical growth patterns and lack of anchorage teeth.

Effects of different orthodontic adhesives and resin removal techniques on enamel color alteration.

OBJECTIVE: To investigate the color alterations in enamel following the use of different orthodontic bonding resins and adhesive residue-removal burs. MATERIALS AND METHODS: Metal brackets were bonded to extracted human premolars (n  =  175) by using an etch-and-rinse adhesive system, a self-etch adhesive system (SEP), or a resin-modified glass ionomer cement (RMGIC). After 24 hours of photoaging, the brackets were removed and the adhesive residue on the tooth surfaces was cleaned with either a tungsten carbide bur or a Stainbuster bur. Tooth colors were measured with a spectrophotometer at baseline, after adhesive removal, and after additional photoaging. Color evaluation was made, and color differences induced by photoaging were calculated. Statistical evaluation was made using the Kruskal-Wallis test and the Mann-Whitney U-test, with Bonferroni correction. RESULTS: All specimens showed discoloration at varying levels. The highest color change was observed in the etch-and-rinse adhesive/tungsten carbide bur group. When the etch-and-rinse and self-etch adhesives were used, adhesive-remnant removal with Stainbuster burs resulted in significantly lower discoloration. The type of bur did not affect the extent of enamel discoloration in the RMGIC group. CONCLUSIONS: Orthodontic treatment alters the original color of enamel, and both the adhesive system and the resin-removal methods are responsible for this change. When brackets are bonded with the etch-and-rinse system or the SEP, cleaning the adhesive residuals with Stainbuster burs is recommended for minimal change. RMGIC can be safely cleaned with tungsten carbide burs.

Effects of various analgesics on the level of prostaglandin E2 during orthodontic tooth movement.

AIM: The aim of this double-blind, randomized, placebo-controlled clinical study was to evaluate the analgesic effects of preoperative/postoperative ibuprofen and acetaminophen use after bonding and to find a relation between the pain level and the amount of prostaglandin released. MATERIALS AND METHODS: Forty-eight patients were included and randomly divided to three equal groups that received either ibuprofen, acetaminophen or placebo for pain relief. The pain levels were measured before bonding, after bonding, at first, second, third, and seventh days on a 100 mm visual analogue scale (VAS) and gingival crevicular fluid (GCF) samples were collected at the same time intervals to measure the amount of prostaglandin E2 (PGE2) released. PGE2 levels were determined with ELISA test. The results were evaluated with Wilcoxon and Kruskal­Wallis tests with Bonferroni correction. RESULTS: Acetaminophen and placebo groups showed similar pain levels during the first 2 days, whereas ibuprofen group showed lower pain levels during the first day after bonding. PGE2 levels did not show statistically significant difference in time within the analgesic groups. No significant relation between the pain perceived and PGE2 released was found. LIMITATIONS: The biggest limitation of this study is the subjective nature of pain and its method of evaluation. CONCLUSIONS: The perception of pain by patients taking ibuprofen and acetaminophen at pre/post appliance placement was not different from patients taking placebo. No time-related differences in PGE2 level were found between the groups and no significant correlation was found between the perception of pain and PGE2 levels.

Palatal implant versus zygoma plate anchorage for distalization of maxillary posterior teeth.

This study aimed to examine the skeletal, dental, and soft tissue effects of the implant-supported pendulum (ISP) and the zygoma anchorage system (ZAS) used for the distalization of maxillary posterior teeth. Among 30 patients showing Angle class II malocclusion, 15 patients with a mean age of 14.3±1.6 years and treated with ISP were included in the first group; 15 patients with a mean age of 14.7±2.5 years and treated with ZAS were included in the second group. The predistalization and postdistalization lateral cephalograms were analysed. Statistical evaluation was carried out using SPSS. Point A and upper incisors protruded in the ISP group, retruded in the ZAS group. Upper posterior teeth were distalized in both groups, but more in the ZAS group. Significant differences were observed between the groups for the sagittal movements of Point A, incisors, and posterior teeth. Overbite decreased in the ISP group, overjet decreased in the ZAS group, upper and lower lips retruded only in the ZAS group. Both methods provided absolute anchorage for distalization of posterior teeth, but the skeletal and soft tissue outcome and distalization obtained was greater in the ZAS group. Both methods can be used as alternatives to extraoral traction and conventional molar distalization appliances with different patient requirements.

Comparison of two implant-supported molar distalization systems.

OBJECTIVE: To examine skeletal, dental, and soft tissue effects of the Miniscrew Implant Supported Distalization System (MISDS) and the Bone-Anchored Pendulum Appliance (BAPA). MATERIALS AND METHODS: Among 28 patients displaying Angle Class II malocclusion, 14 patients with a mean age of 14.8 ± 3.6 years treated with MISDS were included in the first group, and 14 patients with a mean age of 14.5 ± 1.5 years treated with BAPA were included in the second group. The pretreatment and posttreatment lateral cephalograms were analyzed. Statistical evaluation was carried out using the paired Shapiro-Wilk test, the paired-sample t-test, and the unpaired t-test. RESULTS: Upper posterior teeth were distalized successfully in both groups. Nearly bodily distalization was seen in the MISDS group, whereas significant distal tipping of the upper first molars was observed in the BAPA group (P < .001). There were no statistically significant changes in the sagittal position of the maxilla and mandible and in the position of the upper incisors as a result of treatment in either group. CONCLUSIONS: Both methods provided absolute anchorage for distalization of posterior teeth; however, almost translatory distal movement was encountered in the MISDS group, and substantial distal tipping of the maxillary molars accompanied distalization in the BAPA group.

A comparative study of qualitative and quantitative methods for the assessment of adhesive remnant after bracket debonding.

The amount of the residual adhesive after bracket debonding is frequently assessed in a qualitative manner, utilizing the adhesive remnant index (ARI). This study aimed to investigate whether quantitative assessment of the adhesive remnant yields more precise results compared to qualitative methods utilizing the 4- and 5-point ARI scales. Twenty debonded brackets were selected. Evaluation and scoring of the adhesive remnant on bracket bases were made consecutively using: 1. qualitative assessment (visual scoring) and 2. quantitative measurement (image analysis) on digital photographs. Image analysis was made on scanning electron micrographs (SEM) and high-precision elemental maps of the adhesive remnant as determined by energy dispersed X-ray spectrometry. Evaluations were made in accordance with the original 4-point and the modified 5-point ARI scales. Intra-class correlation coefficients (ICCs) were calculated, and the data were evaluated using Friedman test followed by Wilcoxon signed ranks test with Bonferroni correction. ICC statistics indicated high levels of agreement for qualitative visual scoring among examiners. The 4-point ARI scale was compliant with the SEM assessments but indicated significantly less adhesive remnant compared to the results of quantitative elemental mapping. When the 5-point scale was used, both quantitative techniques yielded similar results with those obtained qualitatively. These results indicate that qualitative visual scoring using the ARI is capable of generating similar results with those assessed by quantitative image analysis techniques. In particular, visual scoring with the 5-point ARI scale can yield similar results with both the SEM analysis and elemental mapping.

Effects of a fluoride-containing casein phosphopeptide-amorphous calcium phosphate complex on the shear bond strength of orthodontic brackets.

The purpose of this study was to investigate the effects of enamel pre-treatment with a new fluoride-containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complex on the shear bond strength (SBS) of brackets bonded with etch-and-rinse or self-etching adhesive systems. The material comprised 66 extracted human premolars randomly divided into six equal groups with respect to the enamel pre-treatment and adhesive system employed: 1. No pre-treatment and brackets bonded with the etch-and-rinse adhesive system (Transbond XT). 2. Pre-treatment with fluoride-containing CPP-ACP paste (MI Paste Plus) and Transbond XT. 3. Pre-treatment with non-fluoride CPP-ACP paste (MI Paste) and Transbond XT.4. No pre-treatment and brackets bonded with the self-etching adhesive system (Transbond Plus). 5 and 6. Enamel pre-treated as for groups 2 and 3, respectively, and the Transbond Plus. Bonded specimens were subjected to thermal cycling (×1000) before SBS testing. The residual adhesive on the enamel surface was evaluated after debonding with the adhesive remnant index (ARI). Data evaluation was made using one-way analysis of variance and Tukey test for SBS results, and Kruskal-Wallis test for ARI results. The results showed that enamel pre-treatment with either fluoride or non-fluoride CPP-ACP paste had no significant effect on the SBS of the self-etching adhesive system (P > 0.05). Enamel pre-treatment with non-fluoride CPP-ACP in group 3 significantly reduced the SBS of the etch-and-rinse adhesive (P < 0.001), while pre-treatment with fluoride-containing CPP-ACP paste (groups 2 and 5) did not affect debonding values (P > 0.05). The fluoride-containing CPP-ACP did not compromise the SBS of brackets bonded with the tested etch-and-rinse and self-etching systems, but its non-fluoride version significantly decreased the SBS of the etch-and-rinse adhesive system.

Comparison of the intrusive effects of miniscrews and utility arches.

INTRODUCTION: The aim of this prospective study was to compare the effects of incisor intrusion obtained with the aid of miniscrews and utility arches. METHODS: Twenty-four patients (10 male, 14 female) with a deepbite of at least 4 mm were divided to 2 groups. In group 1, 13 patients (3 male, 10 female; mean age, 20.90 ± 7.12 years) in the postpubertal growth period were treated by using miniscrews; in group 2, 11 patients (7 male, 4 female; mean age, 15.25 ± 3.93 years) were treated with utility arches. Lateral cephalometric headfilms were taken at the beginning of treatment and after intrusion for the evaluation of the treatment changes. Statistical analyses of the data were performed with a significance level of P <0.05. RESULTS: Intrusion lasted 6.61 ± 2.95 months for group 1 and 6.61 ± 2.46 months for group 2. The changes in the center of resistance of the incisors were 1.75 ± 0.4 mm (P <0.05) for group 1 and 0.86 ± 0.5 mm (P >0.05) for group 2; the difference between the groups was significant (P <0.05). In the miniscrew group, the incisors were protruded 0.79 ± 1.4 mm (P >0.05) relative to pterygoid vertical and 3.85° ± 2.4° (P >0.05) relative to the palatal plane. In group 2, the incisors showed 3.91 ± 0.7 mm (P <0.05) of protrusion relative to pterygoid vertical and 13.55° ± 2.4° (P <0.05) relative to the palatal plane. The maxillary first molars showed significant distal tipping in group 2 (P <0.05). CONCLUSIONS: Unlike with utility arches, true maxillary incisor intrusion can be achieved by application of intrusive forces close to the center of resistance by using miniscrews with no counteractive movements in the molars.

Effects of mandibular incisor intrusion obtained using a conventional utility arch vs bone anchorage.

OBJECTIVE: To compare the dentofacial effects of mandibular incisor intrusion using mini-implants with those of a conventional incisor intrusion mechanic, the utility arch. MATERIALS AND METHODS: Twenty-six deep-bite patients were enrolled to one of the two groups. In group 1 the mandibular incisors were intruded using a 0.16 × 0.22-inch stainless-steel segmental wire connected to two mini-implants. In group 2 the mandibular incisor intrusion was performed using a conventional utility arch. Conventional lateral cephalometric radiographs were taken at pretreatment and at the end of intrusion. Thirty landmarks were identified to measure 23 linear and 20 angular measurements. Intragroup comparisons were made using a paired t-test or a Wilcoxon test. Intergroup comparisons were made using a Student's t-test or a Mann-Whitney U-test. RESULTS: The duration of intrusion was 5 months for group 1 and 4 months for group 2. In the implant group, the mean amount of change was 0.4 mm/mo for the incisor tip and 0.3 mm/mo for the center of resistance, and in the utility arch group, the mean amount of change was 0.25 mm/mo for the incisor tip and 0.2 mm/mo for the center of resistance. The mandibular incisors showed an average protrusion of 7° in the implant group and 8° in the utility arch group. CONCLUSIONS: Incisor intrusion that was achieved using an implant-supported segmented archwire was no different than the movement achieved with a conventional intrusion utility arch. The only difference between the two methods was in the molar movement.

Self-reported pain associated with the use of intermaxillary elastics compared to pain experienced after initial archwire placement.

OBJECTIVE: To evaluate the pain during the use of intermaxillary elastics and to compare it with that of initial archwire placement. MATERIALS AND METHODS: Sixteen orthodontic patients who underwent initial bonding (7 girls, 13 boys; mean age 16.75 ± 2.61 years) and 19 patients who would be using intermaxillary elastics for the first time (13 girls, 7 boys; mean age 16.21 ± 3.01 years) were enrolled in this prospective study. A visual analog scale form was given to each patient to measure the pain levels, and these were measured by the same investigator using a digital caliper. Data were evaluated using Mann Whitney U-test. RESULTS: The pain started to increase 2 hours after the application of elastics. The highest levels were achieved at the sixth hour and the same night. The pain levels started to decrease at day 2. Although the pain levels of the elastic group started to decrease after the second day, the pain levels of the initial bonding group were still significantly high. CONCLUSIONS: Intermaxillary elastics cause similar amounts of pain compared with initial archwire placement, but the pain of the elastics did not last as long as the pain felt after initial bonding.