Clinical oral investigationsLiang-Cheng Chen, Byron Fan, Hsiao-Hui Tsou, Shao-Yu Wang
OBJECTIVE: Impacted mandibular third molars pose significant clinical challenges, often leading to complications such as pericoronitis, adjacent tooth caries, and inferior alveolar nerve (IAN) injury during extraction. This study evaluates the effectiveness of the Kyola Distraction System, an innovative approach designed to gradually move impacted third molars away from the IAN, reducing surgical risks. METHODS: A retrospective analysis of 100 cases was conducted at Changhua Christian Hospital. Patients underwent Kyola Distraction, which combines coronectomy with orthodontic traction using an elastic-based anchorage system. The movement of the third molar relative to the inferior alveolar canal was assessed through panoramic radiographs. The study analyzed the distraction period, scooting distance, and potential nerve complications. RESULTS: Among 100 patients (57 male, 43 female, aged 18-60 years), 32 cases involved single-root third molars, and 68 cases had double-rooted teeth. The average distraction period was 61.3 days for single-root cases and 61.1 days for double-root cases. The estimated scooting distance was 1.38 mm for the mesial root and 1.59 mm for the distal root in double-root cases, while single-root molars moved an average of 1.42 mm. No cases of nerve damage were reported. CONCLUSION: The Kyola Distraction System presents a safe and effective alternative to conventional odontectomy for impacted mandibular third molars. By reducing the risk of IAN injury, minimizing postoperative complications, and promoting bone regeneration, this approach offers a promising advancement in third molar management. Further studies are recommended to evaluate its long-term clinical outcomes.
Clinical oral investigationsTiago Fialho, Christian Zamberlan Angheben, Eduardo Terumi Blatt Ohira, Paula Cotrin, Daniela Garib, Eduardo Prado, Karina Maria Salvatore Freitas, Marcos Robe…
INTRODUCTION: Orthodontic aligner attachments are crucial for enhancing dental movements that aligners alone cannot achieve. With recent advancements in design and materials, treatment precision and efficacy are improving. This study aimed to compare conventional and bulk-fill flowable composites in fabricating orthodontic attachments to determine their loss rate and clinical outcomes. METHODS: This split-mouth randomized clinical trial enrolled 50 participants (21 men and 29 women; mean age 37.86 ± 6.90 years), who were allocated to two treatment sequences (25 participants per group). In Group 1, the right side received 3 M Filtek Supreme Flowable and the left side received 3 M Filtek Bulk Fill Flowable; in Group 2, the allocation was reversed. This design allowed an intra-individual comparison between materials. RESULTS: After 140 days of follow-up, 150 of 800 attachments had been lost and rebonded, corresponding to an overall failure rate of 18.75%. No statistically significant differences were found between materials when evaluating individual teeth, contralateral teeth, or time to failure. Cox regression showed no significant difference between groups (HR = 0.84; 95% CI, 0.60-1.16; p = 0.293). CONCLUSION: Flowable and flowable bulk-fill composites showed similar clinical performance and attachment survival. REGISTRATION: This clinical trial was registered under UTN U1111-1303-5576 at the Brazilian Registry of Clinical Trials (ReBEC).
Progress in orthodonticsXiaofang Liu, Wewen Li, Dongna Li, Ke Xu, Liming Zhang, Yang Liu, Xia Qi, Ye Liu, Chunyan Liu
OBJECTIVE: This retrospective comparative cohort study aimed to evaluate the efficiency of maxillary anterior tooth retraction using clear aligners in patients with stable periodontitis compared to periodontally healthy individuals, addressing clinical concerns regarding the efficacy of aligner therapy in this population. METHODS: This retrospective study included 33 patients with stable periodontitis (SP) and 33 periodontally healthy (PH) individuals who underwent clear aligner treatment. Pre-treatment virtual setups and post-treatment actual models were superimposed in three dimensions using Geomagic Wrap 2021 software. Anterior tooth retraction efficiency was calculated as (actual tooth movement / predicted tooth movement) × 100%. Univariate analyses were performed, followed by multivariable analyses using Generalized Estimating Equations (GEE) to identify predictors influencing efficiency. RESULTS: No significant difference was detected in maxillary anterior retraction efficiency between the two groups (SP: 56.6%, PH: 52.0%, P = 0.245). However, the factors influencing efficiency differed significantly. In the SP group, efficiency was significantly correlated with treatment design parameters, including the number of aligner steps, amount of predicted tooth movement and auxiliary traction. In contrast, efficiency in the PH group was mainly associated with patient-related physiological factors, such as age and tooth type. CONCLUSION: Within the limitations of this retrospective study (crown-level measurement), anterior tooth retraction efficiency with clear aligners did not differ significantly between patients with stable periodontitis and periodontally healthy individuals under strict periodontal maintenance. Clinical planning should be individualized: precise biomechanical design is essential for patients with stable periodontitis, whereas physiological factors warrant greater consideration in periodontally healthy patients. These findings support the feasibility of clear aligner therapy in well-maintained periodontitis patients and highlight the need for differentiated treatment planning.
Lasers in medical scienceMarcela Letícia da Silva Azevedo, Francisco Leonardo da Silva Júnior, Tasso Ehm Martins, Ádylla Rominne Lima Barbosa, Valkleidson Santos de Araújo, Régia Carla…
To evaluate the efficacy of photobiomodulation (PBM) on primary wound healing and patient-centered outcomes following esthetic clinical crown lengthening with osteotomy over a three-month follow-up period. Twenty-seven systemically healthy patients presenting < 10% bleeding on probing and altered passive eruption were enrolled in a split-mouth, triple-blind, randomized controlled clinical trial. Each patient underwent esthetic crown lengthening surgery in two hemi-arches: a control group (CG), treated with surgery alone, and a test group (TG), treated with surgery followed by PBM (660 nm, 100 mW, 30 J, 5 min, sweeping motion). Laser irradiation was performed immediately after surgery and on postoperative days 4, 7, 11, and 14. Clinical assessments were conducted at baseline and at 4, 7, 11, 14, 45 days, and three months postoperatively. Outcomes included bleeding on probing, probing depth, gingival phenotype, width of keratinized mucosa, wound healing assessed by the modified Landry Healing Index, postoperative pain measured by a numerical visual scale, oral health-related quality of life (OHIP-14), patient satisfaction, and esthetic outcomes assessed by the Pink Esthetic Score. Statistical analyses were performed with a significance level set at p < 0.05. All patients completed the study and remained periodontally healthy throughout the follow-up period. No statistically significant intergroup differences were observed for wound healing, postoperative pain, or professional esthetic outcomes at any evaluation time point (p > 0.05). However, esthetic crown lengthening surgery resulted in significant improvements in patient satisfaction and oral health-related quality of life from baseline to three months of follow-up (p < 0.001). Photobiomodulation did not enhance primary wound healing or reduce postoperative pain following esthetic clinical crown lengthening with osteotomy. Nevertheless, the surgical procedure significantly improved patient satisfaction and quality of life over a three-month follow-up period.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineWanxin Zhang, Min Yu, Xu Gong, Weijing Dang, Xuemei Gao
OBJECTIVES: To evaluate objective and subjective adherence to oral appliance (OA) therapy in obstructive sleep apnea (OSA) and identify predictors of adherence. METHODS: Forty-nine adults with OSA (27 males, 22 females) underwent baseline polysomnography, sleep questionnaires, craniofacial measurements, and personality assessment. Objective adherence was monitored for 3 months using an embedded thermal microsensor. Subjective adherence was self-reported at 3 and 12 months. Predictors of adequate adherence (mean nightly use ≥ 4 h) were identified using multivariate logistic regression under a modified intention-to-treat approach. RESULTS: OA therapy reduced AHI from 16.6 ± 10.3 to 4.16 ± 3.05 events/h. Forty-three participants (87.8%) completed the 3-month follow-up, and were all contacted at 12 months. During the first 3 months, mean use was 7.05 h on nights worn and 3.85 h/night overall, with OA used on 3.7 days/week and ≥ 4 h on 55.7% of nights. Participants overestimated use frequency (P < 0.001) but not nightly duration. At 3 months, 49% were adherent, showing stable use, whereas non-adherent users wore the appliance on fewer nights; at 12 months, 44% remained adherent, while most non-adherent users discontinued therapy. Older age and lower baseline ESS predicted 3-months adherent, while older age and smaller mandibular plane angle predicted 12-months adherent. CONCLUSION: Adherence to this type of OA was suboptimal in this study, with patients overestimating use frequency but accurately reporting nightly duration. Older age predicted adherence at both 3 and 12 months, while lower baseline sleepiness and smaller mandibular plane angle were associated with 3- and 12-month adherence, respectively. CURRENT KNOWLEDGE/STUDY RATIONALE: Subjective adherence to oral appliance (OA) therapy in patients with obstructive sleep apnea (OSA) may overestimate actual device use, whereas longitudinal adherence patterns and their clinical implications remain poorly understood. STUDY IMPACT: Objective adherence to OA therapy was substantially lower than self-reported adherence, particularly among poorly adherent patients. Early adherence patterns may help clinicians identify patients who require additional adherence support. In the absence of regular adherence reminders, OA use frequency remained insufficient, potentially limiting the systemic benefits of OA therapy for OSA. Long-term, objective, and individualized adherence care and monitoring may be important in routine clinical practice.
JMIR research protocolsLoon Han Tan, Siti Hajjar Nasir, Joo Ming Cheong, Kumeran Mohan
BACKGROUND: Laceback ligatures are passive stainless-steel auxiliaries tied from the first permanent molar hook to the canine bracket during the alignment phase of orthodontic fixed appliance treatment, predominantly in premolar extraction cases. Despite equivocal evidence on their effectiveness in controlling anterior tooth position, lacebacks are routinely used to stabilize flexible nickel-titanium archwires against masticatory forces. Their effects on 3 clinically important outcomes, oral hygiene, appliance complication rates, and patient-reported pain, have never been investigated in a randomized trial, representing gaps explicitly identified in a prior systematic review. OBJECTIVE: This study aims to evaluate the clinical and patient-reported outcomes of passive laceback ligatures during the alignment phase of orthodontic fixed appliance treatment, specifically oral hygiene status, archwire and laceback complication rates, and pain. METHODS: This is a single-center, single-blind, split-mouth randomized controlled trial conducted at the Orthodontic Clinic, International Islamic University Malaysia. Eligible participants are patients aged 15 years and older, medically fit with Basic Periodontal Examination scores of 0-2, requiring full fixed appliance treatment with bilateral premolar extractions and no prior orthodontic treatment. Those with craniofacial deformities, systemic illness, or disability affecting oral hygiene compliance are excluded. Each participant's oral cavity is randomly allocated using a minimization method, so that one side receives a passive 0.010-inch stainless-steel laceback from the first molar hook to the canine bracket, while the contralateral side receives identical standard fixed appliance treatment (McLaughlin, Bennett, and Trevisi prescription brackets, 0.014-inch superelastic nickel-titanium archwires, and elastomeric modules) without laceback. Outcomes are assessed at baseline (T0), 4 weeks (T1), and 8 weeks (T2) after laceback placement. The primary outcome is the orthodontic plaque index. Secondary outcomes include archwire and laceback complication frequencies and pain assessed by visual analog scale area under the curve. A total of 38 participants provided 85% power to detect a 1-unit orthodontic plaque index difference (α=.05). Mixed-model repeated-measures analysis is applied to plaque scores; paired parametric or nonparametric tests to other outcomes. Plaque and archwire assessors are blinded to treatment allocation. RESULTS: Ethical approval and funding were secured in January 2026. Participant recruitment commenced in February 2026 with a target completion of June 2027. Pretrial examiner calibration achieved satisfactory agreement (interrater Cohen kappa=0.801-0.804; intrarater reliability=0.806-0.862). As of paper submission, 24 participants have been enrolled, and 14 have completed all data collection visits, with no protocol deviations recorded. Primary analysis is scheduled for October 2027; the results are targeted for submission by June 2028. CONCLUSIONS: This protocol describes the first randomized controlled trial to simultaneously evaluate oral hygiene, appliance complication rates, and patient-reported pain associated with laceback use during orthodontic alignment. The split-mouth design controls for interparticipant confounders, and the incorporation of patient-reported outcomes will ensure that findings directly support evidence-based, patient-centered orthodontic practice.
Acta odontologica ScandinavicaMatti Hannula, Mimmi Tolvanen, Pertti Pirttiniemi, Kirsi Pirilä-Parkkinen, Anna-Sofia Silvola, Johanna Julku
OBJECTIVE: To analyze the effects of cervical headgear (CHG) timing on costs and orthodontic outcome. MATERIAL AND METHODS: Sixty-seven participants with Class II malocclusion were randomized into two groups. In the early group (EG, n = 33), CHG treatment began after the eruption of first upper molars. In the later-timed group (LG, n = 34), CHG treatment began nearly 2 years later. Orthodontic outcome was evaluated when CHG ended and at the end of follow-up using the Peer Assessment Rating (PAR) index and Little's Irregularity Index (LII). Costs were calculated using medical records, estimated chairside times and average personnel and material costs. RESULTS: The mean total costs including personnel and material costs during the follow-up were higher in the EG (€416) compared with the LG (€364) (p = 0.043). No statistically significant differences between the groups were found in the PAR and in the LII scores at the end of follow-up. The number of visits during CHG treatment was higher in the EG (13.3) compared with the LG (10.4) (p = 0.01). CONCLUSIONS: Earlier initiation of CHG treatment increased the personnel and material costs, number of appointments, and chairside time. Based on the PAR and in the LII scores, the orthodontic outcome of CHG treatment was equal regardless of the timing of the treatment. If orthodontic treatment during mixed-dentition stage is considered, it would be justified from an economic perspective to favor treatment during late mixed-dentition.
OBJECTIVES: This study evaluated participants' ability to differentiate AI-enhanced orthodontic outcome images from real post-treatment images, and examined the demographic and behavioral factors associated with detection accuracy and with perceived attractiveness. MATERIALS AND METHODS: In a cross-sectional online survey (N = 252), participants viewed three sets of smile images-pre-treatment, real post-treatment, and AI-enhanced outcomes generated via ChatGPT with DALL·E 3-and rated each image's authenticity and attractiveness using a Visual Analogue Scale (VAS). A custom seven-item questionnaire assessed AI use and trust across daily and professional contexts. Generalized estimating equations were used to account for repeated image evaluations within participants, with logistic GEE models for misclassification outcomes and Gaussian GEE models for attractiveness ratings. RESULTS: A total of 63.2% of participants misclassified AI-enhanced images as real, whereas 18.5% misclassified real images as AI-generated. AI-enhanced images received significantly higher attractiveness ratings (mean VAS = 69.2; 95% CI: 67.5-70.9) than actual post-treatment results (mean VAS = 53.9; 95% CI: 51.9-56.0; p < 0.001). Greater trust in AI-generated content was associated with higher odds of misclassifying AI-enhanced images as real (OR = 1.38; 95% CI: 1.13-1.69), and older age showed a small association in the same direction (OR = 1.02; 95% CI: 1.00-1.05). CONCLUSIONS: In this sample, AI-generated orthodontic images were frequently misclassified as real and were perceived as more attractive than real post-treatment photographs. As generative AI tools become more accessible, understanding how demographic and behavioral factors affect human trust and perception is critical for developing responsible AI policies and digital literacy interventions. CLINICAL RELEVANCE: Clinicians should be aware that AI-generated smile simulations may create unrealistic patient expectations. This study provides empirical evidence supporting the need for transparent patient communication regarding the limitations of AI-generated content in orthodontic practice.
Clinical oral investigationsHengyu Hu, Zhaowei Cen, Shuai Huang, Lang Lei
OBJECTIVE: Arch width (AW) affects space availability and shifts the anchorage balance in extraction cases. This study aimed to investigate whether AW differs between patients treated with clear aligners (CAs) and those treated with conventional fixed appliances (FAs) following the extraction of four first premolars. METHODS: This retrospective study included 60 Class I patients who underwent extraction of four first premolars and were treated with either CAs (Invisalign, Align Technology) or FAs (MBT prescription, 0.022-inch slot). The CAs group consisted of 3 males and 27 females (mean age, 24.53 ± 4.58 years), and the FAs group included 4 males and 26 females (mean age, 22.60 ± 3.92 years). In the CAs group, patients were instructed to change the aligners every 10 days and to wear them for at least 22 h per day. Digital dental casts and lateral cephalometric radiographs were obtained at the beginning (T1) and completion (T2) of treatment. Maxillary and mandibular intercanine, interpremolar, and intermolar widths were measured. Paired t-tests were used for intragroup comparisons, and independent t-tests were used for intergroup comparisons. Statistical significance was set at P <.05. RESULTS: Maxillary and mandibular incisors in the CAs group exhibited significantly greater retroclination than those in the FAs group (P <.05). No significant intergroup differences in AW were identified before treatment (P >.05). However, post-treatment measurements demonstrated significantly greater AW in the CAs group at the cusp level of the maxillary and mandibular canines (P <.05). Both groups exhibited statistically significant reductions in maxillary and mandibular interpremolar widths (P <.05), with a more pronounced decrease in the FAs group (P <.05). In the CAs group, intermolar AW remained stable (P >.05), whereas the FAs group showed a significant post-treatment reduction (P <.05). Moreover, following treatment, the achieved AW exceeded the ClinCheck-predicted values at the gingival level of both maxillary and mandibular molars (P <.05). CONCLUSIONS: In extraction cases, patients treated with CAs demonstrated a larger AW and greater lingual inclination of the anterior teeth than those treated with FAs. CLINICAL RELEVANCE: The relatively wider dental arches observed in the CAs group may have implications for space management during treatment. Additionally, the combination of a larger AW and greater incisor retroclination could impose excessive mechanical demands on the flexible aligner trays. Therefore, careful case selection is essential when considering extraction-based treatment with CAs.
OBJECTIVES: This study evaluated the 1-year clinical performance of polyethylene fiber-reinforced direct composite restorations placed in different orientations in endodontically treated premolars and molars. MATERIALS AND METHODS: Eighty-five patients with 90 endodontically treated posterior teeth (32 premolars, 58 molars) received direct composite restorations using Clearfil SE Bond (Kuraray Noritake Dental Inc., Japan), G-aenial Universal Injectable and G-aenial A'CHORD (GC Corp., Japan), and polyethylene fiber (Ribbond, Ribbond Inc., USA). According to cavity configuration, fibers were placed in circumferential (O), mesiodistal (MD), or buccolingual (BL) orientations. Clinical performance was assessed using modified USPHS criteria at 7 days, 6 months, and 12 months. RESULTS: All restorations maintained Alpha scores for color match and secondary caries throughout the study period. At 12 months, limited Bravo scores were observed for retention, marginal discoloration, marginal adaptation, anatomical form, and surface texture. One restoration in the MD group received a Charlie score for retention and required replacement. No statistically significant differences were detected among the three fiber-orientation groups for any evaluated parameter (p > 0.05). CONCLUSIONS: Polyethylene fiber-reinforced direct composite restorations demonstrated favorable short-term clinical performance in endodontically treated posterior teeth. Fiber orientation did not significantly influence clinical outcomes.
Clinical oral investigationsJulia Krohn, Peter Proff, Helmut Hösl, Michael Arzt, Eva Paddenberg-Schubert, Sebastian Krohn
OBJECTIVES: Dentally worn mandibular advancement devices (MAD) represent a second-line treatment option in patients with mild to moderate obstructive sleep apnea (OSA). Greater MAD adherence is associated with improved treatment success, but with increasing wearing time (WT) dental side effects might become more pronounced. Thus, objective assessment of WT and sophisticated methods for early detection of resulting adverse effects are necessary. MATERIALS AND METHODS: In this cross-sectional study 29 patients (8 female and 21 male) showing mild to moderate OSA were treated with Thornton Adjustable Positioners (TAP-T) modified with an intraoral sensor to objectively assess WT. Prior to (T0) and after 12 months of treatment (T1) cephalometric X-rays and intraoral scans (IOS) were obtained. IOS were superimposed by using iterative closest point algorithm to analyze dental changes within specific subregions in relation to individual WT. X-rays were taken to assess potential skeletal changes. Linear mixed-effects modelling (LMM) and Spearman's Rho were utilized for statistical analyses. RESULTS: The present cohort showed a mean nocturnal WT of 5.52 h (± 1.75 h). Scan superimposition revealed minor dental side effects in all regions, with a greater percentage of adverse effects in the mandible. Along with labial displacement of lower and oral movement of upper incisors, we also found elongations and transverse widening of posterior teeth. WT showed significant influence on the magnitude of dental side effects, whereas Spearman's Rho revealed correlations of specific dental side effects with craniofacial morphology. CONCLUSIONS: Dental adverse effects increase with treatment duration necessitating early detection. Greater susceptibility might appear in hyperdivergent craniofacial phenotypes, as well as more antero-positioned, horizontally oriented, prognathic mandibles. CLINICAL RELEVANCE: It is well known that strict case selection and careful MAD titration reduce the risk of dental side effects. However, monitoring of WT enables reliable observation of adherence to treatment instructions, such as reduction of application time or intermittent use, to avoid severe occlusal changes.
PloS oneCintia Ronchi Lemos, Daniela Bianchini Orlandi, Anna Carolina Pereira Thimoteo, Helena Polmann, Patrícia Pauletto, Cristine Miron Stefani, Eliete Neves Silva G…
INTRODUCTION: Patient adherence to orthodontic treatment depends on comfort, absence of pain, and improved quality of life. Pain and discomfort from procedures like interproximal separation or appliance activation are often underestimated by professionals. Low-level laser therapy, with minimal side effects, shows potential for pain relief in orthodontics, though its efficacy remains uncertain. OBJECTIVES: To investigate the efficacy of low-level laser therapy in controlling pain in orthodontic patients. METHODS: A systematic review of randomized controlled trials with orthodontic patients assessing low-level laser therapy will be done. Studies with specific treatments, such as hybrid orthodontics with skeletal anchorage or intermaxillary elastics, will be excluded. The intervention will compare low-level laser therapy alone versus sham therapy, no treatment, or other interventions. No restrictions will apply regarding publication date, language, or patient age. Primary outcomes will be pain; secondary outcomes will be quality of life and adverse effects. Searches will be performed in Cochrane, Embase, LILACS, MEDLINE (via PubMed), and Scopus, plus gray literature (Google Scholar, ProQuest), reference lists, expert consultations, and ClinicalTrials.gov. Retrieved records will be merged in a reference manager, with duplicates removed, and imported into LASER AI software. Calibrated authors will independently select studies in two phases: title/abstract screening and full-text screening. Included studies will undergo narrative synthesis, and, if sufficiently homogeneous, meta-analysis. Risk of bias will be assessed with RoB 2, and certainty of evidence graded with GRADE.
PloS oneNguyen Viet Anh, Nguyen Thi Thu Huong, Trinh Khanh Linh, Le Thi Lan Anh, Dao Ngoc Linh Chi, Nguyen Thi Thu Huong, Nguyen Thi Trang
INTRODUCTION: Although various bracket recycling methods have been studied, the combined influence of bracket reconditioning methods and primer protocols on the bonding performance of debonded orthodontic brackets remains unclear. This study aimed to evaluate the effects of three reconditioning methods and three primer protocols on the bond strength of rebonded orthodontic brackets to enamel. MATERIALS AND METHODS: One hundred stainless steel brackets were bonded to extracted premolars and divided into 10 groups (n = 10). Ninety brackets were debonded, reconditioned using OneGloss bur, flaming, or sandblasting, and rebonded with Mani Bond, Denu Bond, or no primer. Ten new brackets served as controls. Bracket bases were examined using scanning electron microscopy (SEM). Bond strength, adhesive remnant index (ARI), and bonding reliability were evaluated using SBS testing, ARI scoring, and Weibull analysis. RESULTS: Bond strength was significantly influenced by the interaction between reconditioning method and primer protocol (p < 0.001). Sandblasting combined with Mani Bond produced the highest bond strength (9.33 ± 3.02 MPa), whereas OneGloss and sandblasting combined with Denu Bond achieved bond strengths comparable to new brackets and higher reliability, reflected by greater Weibull moduli (4.74 and 4.72). SEM demonstrated more effective mesh cleaning after sandblasting than after OneGloss bur treatment or flaming. ARI distributions differed significantly among groups (p = 0.01), with failures occurring predominantly at the bracket-adhesive interface. CONCLUSIONS: The bonding performance of rebonded orthodontic brackets is influenced by the interaction between reconditioning and priming protocols. Appropriate combinations of these procedures may improve the rebonding outcome.
Medical science monitor : international medical journal of experimental and clinical researchBetul Yuzbasioglu Ertugrul, Ilknur Veli, Abdullah Seckin Ertugrul
BACKGROUND Total oxidant status (TOS) and total antioxidant status (TAS) can provide information about oxidative damage in tissues. This study aimed to evaluate changes in TOS and TAS in saliva among patients with gingivitis undergoing orthodontic treatment with either conventional brackets (CBs) or clear aligners (CAs) over a 30-day period. MATERIAL AND METHODS Thirty patients undergoing non-extraction orthodontic treatment were enrolled and divided into 2 groups (CB group, 15 patients; CA group, 15 patients). Saliva samples were collected at baseline (T0), day 7 (T1), and day 30 (T2) of treatment. Clinical periodontal parameters were recorded, and TAS and TOS levels were assessed using ELISA. RESULTS In results, when clinical indices were examined, GI and PI increased, BOP decreased, and PD and CAL showed minimal change between T0 and T2. In saliva samples, TAS and TOS values increase at T1 and then decline toward T2 but remained close to baseline values. Similarly, in the CB group, TAS and TOS values increased at T1 and then decreased toward T2 but remain closed to baseline values. The changes of TAS and TOS at the time intervals within the CA group and CB group were significantly different. Although there was more change in the group CB, no significant difference was found between the groups. CONCLUSIONS Orthodontic treatment with CAs can cause oxidative tissue stress similar to that with CBs. Given similar oxidative stress data, both treatment methods could be considered for use in orthodontic treatment.
BMC oral healthShimaa Mohamed G Ahmed, Nada O El-Zawahry, Fouad Aly El-Sharaby
BACKGROUND: Fixed orthodontic appliances are widely used for the correction of malocclusions in adolescents. Although effective in achieving optimal dental alignment and occlusion, they may influence patients' daily life experiences. This study aimed to assess the impact of fixed orthodontic appliances on oral function, pain, discomfort, and social and emotional well-being among adolescents. MATERIALS AND METHODS: A cross-sectional observational study was conducted on 364 Egyptian adolescents aged 13-18 years (242 females, 122 males). Participants were categorized according to the type of orthodontic appliance: fixed labial appliances only (n = 235), labial appliances with mini-screws (n = 67), labial appliances with palatal/lingual components (n = 44), combined mini-screws and palatal/lingual appliances (n = 12), and fixed retainers (n = 6). All participants completed the Arabic version of the Orthodontic Treatment Impact Questionnaire (OTIQ), which evaluates oral function, pain, discomfort, and social-emotional well-being. Data were analyzed using Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests. RESULTS: Most participants reported minimal impairment in oral function. Social and emotional well-being was largely unaffected, with 90.1% expressing no concern about appearance and 87.4% reporting no experience of teasing. Pain and discomfort were generally moderate, with 40.7% reporting jaw ache and 60.7% experiencing food impaction. Appliance type significantly influenced outcomes: combined labial appliances with mini-screws and palatal/lingual components were associated with the highest levels of discomfort, whereas fixed retainers showed the lowest impact. Labial appliances were more frequently associated with social concerns. No significant gender differences were observed. A significant negative correlation was found between age and social well-being (p < 0.001), while treatment duration was positively correlated with pain and discomfort (p = 0.018). CONCLUSION: Fixed orthodontic appliances had minimal impact on oral function and social-emotional well-being in adolescents. Patients with labial appliances combined with mini-screws and palatal/lingual appliances reported more pain than those with retainers. Longer treatment duration was linked to greater pain.
BMC oral healthMona M Eissa, Mai Akah, Heba Hamza, Elhassan Hassanein
BACKGROUND: Among the most common complications after orthodontic treatment are enamel microcracks. These issues arise either from enamel demineralization or during bracket debonding or adhesive remnant removal after bracket removal; thus, the current investigation attempts to assess the impact of S-PRG comprising coat on the shear bond strength of the bonded resin composite and the prevention of enamel microcrack formation following orthodontic bracket removal. METHODS: Fourteen sound, intact human premolars recently extracted were collected. A scanning electron microscope (SEM) was used to assess the enamel surface to exclude teeth with micro-cracks. The teeth were divided randomly into two groups (n = 7). In group 1 (control group), the metal bracket was bonded to the etched enamel with (Beauti-Bond xtreme, SHOFU, Japan) adhesive and a thin layer of (Beautifil II Giomer, SHOFU, Japan). In group 2 (intervention group), PRG BarrierCoat® (SHOFU, Japan) was applied on the etched enamel prior to adhesive application. The teeth were then subjected to shear bond strength (SBS) testing using a universal testing machine. SEM and quantitative elemental analysis (weight%) by EDX spectrometry were performed by a calibrated examiner to all teeth to determine the enamel microcrack formation after debonding. The data were analyzed using Fisher's exact test, independent t-test and the point biserial correlation coefficient. The significance level was set at p < 0.05 within all tests. RESULTS: For SBS, Ca weight, and Ca/P, group (2) had significantly higher mean values than group (1). In contrast, the difference in P weight was not statistically significant. Additionally, the percentage of crack formation in group (1) was higher than that of group (2); however, the difference was not statistically significant. For Ca weight and Ca/P, there was a strong negative correlation with crack formation, with higher mean values significantly associated with the absence of cracks. For P weight, the correlation was not statistically significant. CONCLUSIONS: PRG BarrierCoat® shows promise in enhancing shear bond strength with metal brackets. The high mineral content of PRG BarrierCoat® enhances the integrity of enamel and helps in the prevention of microcrack formation. However, additional long-term clinical trials are required to confirm these findings under dynamic oral conditions.
BACKGROUND: This study aimed to investigate the correlation between the occurrence and development of temporomandibular disorders (TMDs) and the history of orthodontic treatment. METHODS: Randomized controlled trials and non-randomized controlled studies investigating the correlation between the occurrence and development of TMDs and the history of orthodontic treatment were included in this study. A comprehensive search was conducted in the 5 databases of PubMed, Scopus, Web of Science, Embase, and The Cochrane Library to collect the literature published from the establishment of each database to March 2025. Meanwhile, other manual retrieval methods were also adopted to search for additional pertinent literature. The corresponding bias risk assessment tools were used to evaluate the quality of the included studies. Meta-analysis was performed for data combination to obtain the odds ratio of the correlation between the 2. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence of the outcome indicators. RESULTS: 5 studies finally met the inclusion criteria: 2 were prospective cohort studies, 2 were case-control studies, and 1 was a cross-sectional study. The total sample size comprised 6971 people, with 3165 males and 3806 females, respectively. The results of the Meta-analysis showed that there was no statistically significant correlation between TMDs and the history of orthodontic treatment (I2 = 71%, odds ratio = 1.12, 95% confidence interval = 0.67 to 1.89, P = .66). The evaluation result of the certainty of evidence was of very low quality. CONCLUSION: Based on the current limited evidence, this study shows that there is no significant correlation between TMDs and the history of orthodontic treatment. Due to the limited certainty of the evidence, the interpretation of the result must be approached with caution. High-quality clinical studies are still needed in the future to supplement this research topic, so as to formulate high-level evidence-based clinical guidelines and optimize clinical decision-making and diagnosis and treatment services for patients. In order to prevent needless doctor-patient conflicts, orthodontists should closely monitor the potential risk of TMDs in patients with malocclusion in clinical practice.
MedicineViet Anh Nguyen, Thi Minh Anh Ha, Viet Hoang, Anand Marya
RATIONALE: Adult skeletal class III patients who decline orthognathic surgery may be treated with nonsurgical dentoalveolar camouflage. Extra-alveolar anchorage on the mandibular buccal shelf enables en-masse total-arch distalization and clinically meaningful sagittal correction without relying on patient compliance. PATIENT CONCERNS: A 19-year-old male presented with an edge-to-edge anterior relationship and generalized spacing. He was satisfied with his facial appearance and declined surgery. DIAGNOSES: The patient was diagnosed with a borderline adult skeletal class III malocclusion characterized by a mildly hypodivergent pattern, concave profile, bilateral angle class III canine and molar relationships, edge-to-edge anterior relationship, anterior spacing, maxillary incisor proclination, and mild mandibular incisor lingual inclination. INTERVENTIONS: Fixed self-ligating brackets were used with proactive torque control including lower incisor brackets inversion to express positive torque and 0.019 × 0.025-in stainless-steel archwires with added torque. After extraction of the mandibular third molars, 2 buccal-shelf miniscrews with power arms delivered distalizing forces. OUTCOMES: Bilateral class I relationships, space closure, and positive overjet were achieved. Cephalometric changes indicated approximately 4 to 5 mm of mandibular dentoalveolar distalization with controlled tipping and lingual root movement, while the Wits appraisal improved substantially despite slight changes in anteroposterior skeletal measures. Favorable sagittal changes were interpreted cautiously because they may reflect mandibular clockwise rotation and dentoalveolar effects rather than true basal skeletal correction. LESSONS: In carefully selected borderline adult class III patients, buccal-shelf miniscrew-anchored en-masse mandibular distalization can deliver upper-range camouflage when torque- and vertical-control biomechanics are actively maintained. Soft-tissue improvements remain limited compared with orthognathic surgery.
International dental journalJing Hu, Ni An, Sheng Chang, Song Zhao, Rongjian Su, Jin Huang
OBJECTIVES: This study aimed to investigate the role of BMP9-Smad1/5/9 in the osteogenic differentiation and alveolar bone remodelling of Human periodontal ligament fibroblasts (hPDLFs) under the action of cyclic tensile stress (CTS). METHODS: An orthodontic tooth movement (OTM) model was established in Sprague-Dawley (SD) rats, the expression status of OCN and BMP9 was measured using immunohistochemistry. hPDLFs were subjected to CTS treatment (10% elongation, 0.5 Hz) to simulate the mechanical microenvironment during orthodontic treatment. The activity of ALP was detected by colorimetric assay and azo coupling staining, respectively. Mineralized nodules were visualized by Alizarin red staining. The expression levels of osteogenesis-related genes including RUNX2, ALP, and OCN were evaluated. To determine the role of BMP9-Smad1/5/9 in CTS-induced osteogenic differentiation, BMP9-Smad1/5/9 signalling was diminished by small RNA against BMP9 and the inhibitor of Smad signalling, the potential of osteogenic differentiation was assessed. RESULTS: BMP9 expression was upregulated in the tension-side periodontal ligament tissues of SD rats, as well as in hPDLFs stimulated by CTS. hPDLFs exhibited increased osteogenic differentiation potential under CTS induction, as evidenced by increased ALP activity, upregulated expression of osteogenesis-related genes, increased mineralized nodule formation and ALP staining. Mechanistically, CTS elevated the phosphorylation levels of Smad1/5/9. Silencing BMP9 attenuated CTS-induced osteogenic differentiation and reduced Smad1/5/9 phosphorylation. Moreover, inhibition of BMP9-Smad1/5/9 signalling pathway suppressed the osteogenic potential of hPDLFs. CONCLUSIONS: CTS increased the osteogenic potential of hPDLFs. Silencing of BMP9 and inhibition of the BMP9-Smad1/5/9 signalling inhibited the osteogenic differentiation of hPDLFs induced by CTS. CLINICAL RELEVANCE: These findings provide mechanistic insights into periodontal tissue remodelling and may contribute to the development of strategies to accelerate orthodontic tooth movement in clinical practice.
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)Priscilla Sosa, Maria L Geisinger, Ramzi V Abou-Arraj
Surgically facilitated orthodontic therapy (SFOT) has emerged as an interdisciplinary approach to address the limitations of conventional orthodontics in patients with moderate to severe malocclusion. This article reviews the biologic rationale, indications, diagnostic considerations, and clinical protocols underlying SFOT, with emphasis on regional acceleratory phenomenon-mediated bone remodeling and its impact on treatment efficiency. Integration of cone-beam computed tomography, intraoral scanning, and digital treatment planning enables precise evaluation of dentoalveolar boundaries and periodontal phenotype, guiding case selection and surgical design. Techniques including corticotomy, decortication, and adjunctive hard- and soft-tissue grafting are discussed in the context of expanding the envelope of tooth movement while mitigating risks such as dehiscence and gingival recession. Interdisciplinary collaboration is highlighted as essential for optimizing esthetic, functional, and long-term outcomes.