Effective contribution ratio of the molar during sequential distalization using clear aligners and micro-implant anchorage: a finite element study.

INTRODUCTION: This study aims to investigate the biomechanical effects of anchorage reinforcement using clear aligners (CAs) with microimplants during molar distalization. And also explores potential clinical strategies for enhancing anchorage in the sequential distalization process. METHODS: Finite element models were established to simulate the CAs, microimplants, upper dentition, periodontal ligament (PDL), and alveolar bone. In group set I, the 2nd molars underwent a distal movement of 0.25 mm in group set II, the 1st molars were distalized by 0.25 mm after the 2nd molars had been placed to a target position. Each group set consisted of three models: Model A served as the control model, Model B simulated the use of microimplants attached to the aligner through precision cuts, and Model C simulated the use of microimplants attached by buttons. Models B and C were subjected to a series of traction forces. We analyzed the effective contribution ratios of molar distalization, PDL hydrostatic stress, and von Mises stress of alveolar bone. RESULTS: The distalization of the 2nd molars accounted for a mere 52.86% of the 0.25-mm step distance without any reinforcement of anchorage. The remaining percentage was attributed to the mesial movement of anchorage teeth and other undesired movements. Models B and C exhibited an increased effective contribution ratio of molar distalization and a decreased loss of anchorage. However, there was a slight increase in the undesired movement of molar tipping and rotation. In group set II, the 2nd molar displayed a phenomenon of mesial relapse due to the reciprocal force produced by the 1st molar distalization. Moreover, the efficacy of molar distalization in terms of contribution ratio was found to be positively correlated with the magnitude of force applied. In cases where stronger anchorage reinforcement is required, precision cuts is the superior method. CONCLUSIONS: The utilization of microimplants in conjunction with CAs can facilitate the effective contribution ratio of molar distalization. However, it is important to note that complete elimination of anchorage loss is not achievable. To mitigate undesired movement, careful planning of anchorage preparation and overcorrection is recommended.

Biomechanical factors in the open gingival embrasure region during the intrusion of mandibular incisors: A new model through finite element analysis.

Introduction: Open gingival embrasure (OGE) is a common complication in adults following clear aligner therapy and the influence of gingival or alveolar bone biotype on OGE is of great concern. Unfortunately, due to the limited number of patients with clearaligner therapy and the clinical methods to distinguish the gingival biotype of patients being invasive, it is difficult to carry out clinical studies on the gingival or alveolar bone biotype of the OGE. In the meanwhile, the detailed biomechanics of the occurrence of OGE remains unknown. The goal of this study was to establish a new model to simulate the virtual space region, namely, the OGE region, to investigate the relationship between alveolar bone biotype and the occurrence of OGE, and explore potential biomechanical factors related to OGE. Methods: The OGE region in the interproximal space was established using a filler with a very low modulus of elasticity (1 × 10-6 MPa). To illustrate the biomechanics of OGE more exhaustively, a line was created at the top of the alveolar crest along the proximal tooth root. FEA was then used to analyze the biomechanics of the surrounding tissues, the OGE region and the line at the top of the alveolar crest along the proximal tooth root of the central incisor under two different labial bone thicknesses (thick and thin) with an axial inclination of 80°, 90° and 100°. Results: During intrusion of the incisors in clear aligner therapy, as inclination increased or bone tissue became thinner, the stress in the surrounding tissues [tooth root, alveolar crest, and periodontal ligament (PDL)] was greater. In the OGE region and interproximal alveolar crest, the strain increased with increasing inclination and labial bone thinning. The results from the line at the top of the alveolar crest along the proximal tooth root showed more detailed biomechanics: In all groups, stress and strain were focused on the mesial-labial alveolar crest. Interestingly, our results also demonstrated that when OGE occurs, other complications may arise, including root resorption and bone dehiscence.

IPR treatment and attachments design in clear aligner therapy and risk of open gingival embrasures in adults.

BACKGROUND: The incidence of open gingival embrasures (OGE) in patients after fixed appliance treatment is relatively high, while there are no detailed reports on patients after clear aligner therapy. Also, no clinical studies with large sample size have investigated whether interproximal enamel reduction (IPR) can actually avoid OGE. The purpose of this study was to determine the prevalence of OGE in adults after clear aligner therapy and to investigate the risk of OGE associated with IPR treatment and attachment design, focusing on the amount and distribution in mandibular anterior teeth. METHODS: Pre-treatment and post-treatment intraoral frontal photographs of 225 non-extraction patients were evaluated retrospectively for the occurrence and severity of OGE. The amount of IPR and the number of attachments in the anterior teeth from subjects after screening were recorded according to the first version of clear aligner software (Clincheck, San Jose, USA) and clinical medical documents. Logistic regression analysis was performed to identify the factors contributing to OGE. RESULTS: The incidence of OGE in non-extraction patients after clear therapy between maxillary and mandibular central incisors was 25.7% and 40.3%, respectively. IPR was not associated with the occurrence of OGE but was associated with severity (P < 0.05). The number of attachments in the anterior teeth or central incisors was significantly related to the incidence of OGE (P < 0.05) but was not associated with severity. CONCLUSION: A high rate of OGE occurs after clear aligner therapy. Clinicians should be aware of the application of IPR and the design of attachments during clear aligner therapy.

Strontium-loaded titanium implant with rough surface modulates osseointegration by changing sfrp4 in canonical and noncanonical Wnt signaling pathways.

A rough morphology and strontium (Sr) can activate the Wnt pathway to regulate bone mesenchymal stem cells (rBMSCs) osteogenic differentiation, but the mechanism remains unclear. We constructed smooth Ti (ST) surfaces, rough Ti (RT) surfaces subjected to hydrofluoric acid etching, strontium-loaded smooth Ti (ST-Sr) surfaces subjected to magnetron sputtering, and rough strontium-loaded Ti (RT-Sr) surfaces. We systematically studied thein vitroosteogenic differentiation of rBMSCs on these four surfaces by alkaline phosphatase measurement, Alizarin Red staining and polymerase chain reaction (PCR). We also investigated whether crosstalk of the canonical and noncanonical Wnt signaling pathways regulated by sfrp4, which is an inhibitor of canonical and noncanonical Wnt, is the underlying mechanism via PCR on rBMSCs in different stages of osteogenic differentiation. We confirmed the effect of sfrp4 through anin vivosfrp4-siRNA test. Thein vitroosteogenic differentiation of rBMSCs decreased in the order RT-Sr, RT, ST-Sr, and ST. Regarding the mechanism, rough morphology and Sr both enhanced the canonical Wnt pathway to promote osseointegration. Additionally, rough morphology can inhibit sfrp4 to activate the noncanonical Wnt pathway, and then, the activated noncanonical Wnt pathway can suppress the canonical Wnt pathway at the early stage of osteogenic differentiation. Sr continuously enhanced sfrp4 to inhibit the canonical Wnt pathway instead of activating the noncanonical Wnt pathway. Interestingly, the effect of rough morphology on sfrp4 changed from inhibition to enhancement, and the enhancing effect of Sr on sfrp4 was gradually attenuated. The results of thein vivosfrp4-siRNA test showed that osseointegration decreased in the order RT-Sr, RT-Sr-siRNA, and ST. Our results suggest that the lack of sfrp4 could suppress osseointegration, indicating that sfrp4 acts as a crucial regulatory molecule for the canonical and noncanonical Wnt pathways during the response of rBMSCs to rough morphology and Sr.