Development and BiomechanicalInvestigation of a New Compound Palatal Arch

Abstract. : Background and Aim: : There are many advantages in using a transpalatal arch in orthodontic treatment. In addition to the active movement of individual teeth, such an arch can be used to provide additional anchorage. The aim of this study was to further develop and improve both the clinical and the biomechanical properties of the conventional transpalatal arch. Material and Methods: : Currently available compound material components form an established part of orthodontic therapy. The Compound palatal arch® broadens the scope of this treatment system. The biomechanical effects of the newly developed Compound palatal arch® were verified by comparing them with those of commercially available conventional transpalatal arches. The recently developed Compound palatal arch® is made of one compound element: nickel-titanium/stainless steel. The specific dimensions and design of the nickel-titanium element are aimed at exploiting its superelasticity, even during active molar movement. The biomechanical investigation was carried out using sixcomponent measuring sensors to register the forces and moments in the three spatial dimensions (x, y and z) at 37 °C. The following appliances were investigated: Goshgarian transpalatal arch, quad-helix appliance, Arndt memory expander®, and Compound palatal arch®. Results: : Transpalatal arches could not be inserted without the arch being under tension. This is particularly important when the arch is being used for anchorage purposes. The Goshgarian arch had to be classified as problematic for the movement of single teeth as the load/deflection rate was high. However, this can be utilized for anchorage purposes. The clinical advantage of a quad-helix appliance is the option for asymmetric tooth movement. Conclusions: : This study showed that the quad-helix was effective for both unilateral and bilateral derotation as well as for transversal tooth movement. However, expansions should be confined to ≤ 4 mm, and derotations to < 10°, as forces and moments are otherwise not within the physiologic range. The Arndt memory expander® displayed no advantages over either the quad-helix appliance or the Goshgarian transpalatal arch. Nor did it display any superelastic properties. The linear relationship, the relatively high forces and moments, and the lack of clinical adjustability cast doubts on the benefits of this appliance. The newly developed Compound palatal arch® showed substantial advantages in molar derotation compared with conventional transpalatal arches. Superelastic properties were achieved through the design and positioning of the nickel-titanium element. Expansion with the Compound palatal arch® was comparable with that with conventional transpalatal arches. The clinical advantage is in the fact that this appliance can be reactivated and that dental asymmetries can be treate

Dynamic Functional ForceMeasurements on an Anterior Bite Plane during theNight

Abstract. : Background: : Anterior bite planes are used in removable and fixed appliance treatment. In removable appliance treatment the question arising is whether the delivered forces can achieve active intrusion in terms of their amplitude and duration. In fixed appliance treatment, the force effect on the incisors and associated pathologic side effects, in particular under the application of intrusion mechanics, have to be considered. Subjects and Method: : The aim of the present study was to investigate the effects of an anterior bite plane during the night. For this purpose ten subjects underwent nocturnal sleep investigations by means of a telemetric system. A silicon force sensor was integrated into an anterior bite plane for continuous measurement of bite forces and of the frequency of occlusal contact with the plate. Results: : The occlusal forces exerted on the anterior bite planes ranged between 3 and 80 N. The average forces were 5.5-24 N. The number of occlusal contacts varied between 39 and 558, with forces of between 7 and 9 N being registered in most cases. Major interindividual differences were detected in the magnitude of the force as well as in bite frequency. The intraindividual pattern of arising occlusal forces showed an intermittent force effect. No significant differences were found with regard to gender or growth pattern. Conclusions: : In subjects with removable appliances, no active intrusion of teeth is possible during the night owing to the small number of occlusal contacts. Due to the partially very high forces in fixed appliance therapy, the integration of an anterior bite plane has to be assessed as critical in patients with unfavorable root geometry or bruxis

Influence of Enamel Conditioning on the Shear Bond Strength of Different Adhesives

Abstract : Background and Objective: : Phosphoric acid etching is the gold standard for enamel conditioning. However, it is possible that air abrasion or a combination of air abrasion and etching might result in enhanced adhesion. The aim of this study was to investigate the effect of different enamel conditioning methods on the bond strength of six adhesives. Material and Methods: : Three different enamel conditioning procedures (phosphoric acid etching, air abrasion, air abrasion + phosphoric acid etching) were evaluated for their influence on the shear bond strength of six different adhesives (Transbond™ XT, Cool-Bond™, Fuji Ortho LC, Ultra Band-Lok, Tetric® Flow, Light-Bond™). Each group consisted of 15 specimens. Shear forces were measured with a universal testing machine. The scores of the Adhesive Remnant Index (ARI) were also analyzed. Results: : There were no significant differences between phosphoric acid etching and air abrasion + phosphoric acid etching. Air abrasion as a single conditioning technique led to significantly lower shear forces. The ARI scores did not correlate with the shear strengths measured. There were greater variations in shear forces for the different adhesives than for the conditioning techniques. Conclusion: : The highest shear forces were found for the conventional composites Transbond™ XT and Cool- Bond™ in combination with conventional etching. Air abrasion alone and in combination with phosphoric acid etching showed no advantages compared with phosphoric acid etching alone and, therefore, cannot be recommende

Corrosion of Orthodontic Pliers Using Different Sterilization Procedures

Abstract : Aim: : The aim of this study was to investigate the corrosion resistance of orthodontic pliers from several manufacturers following different sterilization procedures, namely heat sterilization and the use of a disinfectant agent (Sekusept Extra N®) in an ultrasonic bath. Material and Methods: : Employed in this study were ten distal-end cutters and ten Weingart pliers manufactured by Aesculap®, ETM and Hu-Friedy®, examined under electron microscopy for evidence of corrosion following 500 sterilization cycles. The corrosion data were recorded photographically and graphically. Metallographic microsections were prepared from each pair of pliers and were then analyzed by means of EDX measurements to assess the chemical alloy composition. Results: : The light and electron microscopic evaluation showed that both heat sterilization and high level disinfection caused corrosive changes on the pliers. However, the type of corrosion differed between the two sterilization methods. The main type of corrosion with Sekusept Extra N® was pitting, while with heat sterilization it was surface corrosion. Heat sterilization was the type of corrosion that caused the most corrosive changes, regardless of which type of corrosion was considered. However, these results must be viewed critically, because pitting corrosion is obviously a more severe problem than surface corrosion. In comparing the pliers of various manufacturers, differences were noted. However, it was difficult to rank them when the correct maintenance regime was adhered to. The soldered joint gap was revealed to be a specific weak point, and that area proved to be inadequate due to qualities related to their production, particularly in the Hu-Friedy® pliers. Conclusions: : This study showed that heat sterilization leads to less corrosion than cold disinfection. Corroded pliers can be restored to a useable condition by re-polishing, though it is important that the instructions for their care be strictly adhered t

Roughness of enamel surfaces after different bonding and debonding procedures: An in vitro study

Background and Aim: Maintaining an intact enamel surface is an essential aspect of orthodontic therapy; however, various therapeutic measures can affect this surface. The aim of our study was to evaluate roughness of the enamel surface after different conditioning and polishing procedures. Materials and Methods: 42 bovine incisors were submitted to conventional abrasion (using 37% phosphoric acid), to air abrasion, and a combination of the two. Brackets were put in place and then debonded, and the remaining adhesive removed with a carbide bur or via air abrasion. The enamel surface's roughness was assessed using a confocal laser scanning microscope (CLSM). Results: Mean roughness (Ra) was 33.1. There were no statistically significant differences among the six groups, or in Rq values. Under CLSM, the roughness after polishing via air abrasion appeared even. Although it was macroscopically smoother after polishing with a carbide bur, the surface showed a wave-like pattern. Conclusion: The method of enamel conditioning revealed no significant effect on the enamel surface after debonding. Neither polishing via air abrasion nor carbide bur resulted in differences in superficial roughness. However, the carbide bur left a wave-like pattern on the enamel surfac

Effective Disinfection of Orthodontic Pliers

Objective:: Pathogenic microbes may be transmitted directly from the orthodontist to the patient or from the patient to the doctor, and indirectly from patient to patient. The latter may occur via contaminated instruments or surfaces, and is referred to as cross-contamination. The objective of this study was to evaluate the extent of bacterial contamination of orthodontic pliers and the efficacy of the disinfection techniques applied after clinical use. We also sought to examine under standardized conditions the virucidal, bactericidal and fungicidal effects of disinfection techniques used in practice. Materials and Methods:: The efficacy of various disinfection methods was determined after clinical use in-vivo on 10 test subjects and in-vitro with deliberate contamination. The following disinfection methods were tested: 1. Iso-Septol spray 2. Incidur® spray 3. Trough disinfection in combination with 5% Sekusept® Plus solution 4. Ultrasound bath in combination with 5% Sekusept® Plus solution 5. Thermal disinfection For in-vitro contamination we used the test organisms Staphylococcus aureus, Escherichia coli, Candida albicans, Coxsackie virus B4, HSV 1, and Adenovirus type 5. The tests were carried out six to eight times for each organism. The Weingart pliers and distalend cutters were tested. The criteria for effective disinfection were a reduction in infectiosity of five log steps (for bacteria and fungi) or four log steps (viruses). Statistical analysis was carried out using the Wilcoxon and Whitney U-test. Results:: The presence of contamination following clinical use was not adequately eliminated with all disinfection methods. The spray methods exhibited shortcomings in disinfection. For the type of contamination defined, trough disinfection with 5% Sekusept® Plus and the Incidur® and Iso-Septol spray disinfection methods provided insufficient disinfection. Conversely, the ultrasound bath with 5% Sekusept® Plus solution and steam disinfection met the criteria for effective disinfection for all microbes. No statistically significant difference was found between the oiled and unoiled states. In some cases, there were slightly higher rates of contamination with the Weingart pliers as with the distalend cutters. However, these were not statistically significant. Conclusions:: It should be possible to disinfect lipophilic viruses and the usual bacterial infections adequately with all methods, provided that the use of sprays and trough disinfection is preceded by cleaning with brush and water, followed by drying. With hydrophilic viruses, however, the spray and trough disinfection methods are limited in their efficacy and cannot be considered adequate. Exclusively chemical methods are therefore less effective than thermal or physical-chemical methods. Thermal disinfection and the ultrasound bath in combination with 5% Sekusept® Plus are clearly superior to spray disinfection and trough disinfection alone. The ultrasound bath and thermal disinfection can therefore be recommended for the disinfection of orthodontic pliers. We recommend that the pliers be cleaned beforehand due to their uneven surface

Accuracy of 3D Tooth Movements in the Fabrication of Manual Setup Models for Aligner Therapy

Background: The clinical outcome of aligner therapy is closely related to the precision of its setup, which can be manually or digitally fabricated. The aim of the study is to investigate the suitability of manual setups made for aligner therapy in terms of the precision of tooth movements. Methods: Six dental technicians were instructed to adjust each of eleven duplicate plaster casts of a patient models as follows: a 1 mm pure vestibular translation of tooth 11 and a 15° pure mesial rotation of tooth 23. The processed setup models were 3D scanned and matched with the reference model. The one-sample Wilcoxon signed-rank test (p < 0.05) was used for evaluation. Results: The overall precision of the translational movement covers a wide range of values from 0.25 to 2.26 mm (median: 1.09 mm). The target value for the rotation of tooth 23 was achieved with a median rotation of 9.76° in the apical-occlusal direction. Unwanted movements in the other planes also accompanied the rotation. Conclusions: A manual setup can only be fabricated with limited precision. Besides the very high variability between technicians, additional unwanted movements in other spatial planes occurred. Manually fabricated setups should not be favored for aligner therapy due to limited precision

Effect of Tension on Human Periodontal Ligament Cells: Systematic Review and Network Analysis

Orthodontic tooth movement is based on the remodeling of tooth-surrounding tissues in response to mechanical stimuli. During this process, human periodontal ligament cells (hPDLCs) play a central role in mechanosensing and mechanotransduction. Various in vitro models have been introduced to investigate the effect of tension on hPDLCs. They provide a valuable body of knowledge on how tension influences relevant genes, proteins, and metabolites. However, no systematic review summarizing these findings has been conducted so far. Aim of this systematic review was to identify all related in vitro studies reporting tension application on hPDLCs and summarize their findings regarding force parameters, including magnitude, frequency and duration. Expression data of genes, proteins, and metabolites was extracted and summarized. Studies’ risk of bias was assessed using tailored risk of bias tools. Signaling pathways were identified by protein-protein interaction (PPI) networks using STRING and GeneAnalytics. According to our results, Flexcell Strain Unit® and other silicone-plate or elastic membrane-based apparatuses were mainly adopted. Frequencies of 0.1 and 0.5 Hz were predominantly applied for dynamic equibiaxial and uniaxial tension, respectively. Magnitudes of 10 and 12% were mostly employed for dynamic tension and 2.5% for static tension. The 10 most commonly investigated genes, proteins and metabolites identified, were mainly involved in osteogenesis, osteoclastogenesis or inflammation. Gene-set enrichment analysis and PPI networks gave deeper insight into the involved signaling pathways. This review represents a brief summary of the massive body of knowledge in this field, and will also provide suggestions for future researches on this topic

Bracket Transfer Accuracy with the Indirect Bonding Technique—A Systematic Review and Meta-Analysis

Purpose: To investigate the bracket transfer accuracy of the indirect bonding technique (IDB). Methods: Systematic search of the literature was conducted in PubMed MEDLINE, Web of Science, Embase, and Scopus through November 2021. Selection Criteria: In vivo and ex vivo studies investigating bracket transfer accuracy by comparing the planned and achieved bracket positions using the IDB technique were considered. Information concerning patients, samples, and applied methodology was collected. Measured mean transfer errors (MTE) for angular and linear directions were extracted. Risk of bias (RoB) in the studies was assessed using a tailored RoB tool. Meta-analysis of ex vivo studies was performed for overall linear and angular bracket transfer accuracy and for subgroup analyses by type of tray, tooth groups, jaw-related, side-related, and by assessment method. Results: A total of 16 studies met the eligibility criteria for this systematic review. The overall linear mean transfer errors (MTE) in mesiodistal, vertical and buccolingual direction were 0.08 mm (95% CI 0.05; 0.10), 0.09 mm (0.06; 0.11), 0.14 mm (0.10; 0.17), respectively. The overall angular mean transfer errors (MTE) regarding angulation, rotation, torque were 1.13° (0.75; 1.52), 0.93° (0.49; 1.37), and 1.11° (0.68; 1.53), respectively. Silicone trays showed the highest accuracy, followed by vacuum-formed trays and 3D printed trays. Subgroup analyses between tooth groups, right and left sides, and upper and lower jaw showed minor differences. Conclusions and implications: The overall accuracy of the indirect bonding technique can be considered clinically acceptable. Future studies should address the validation of the accuracy assessment methods used

Edelstahl- und NiTi-Torquesegmentbogen und apikale Wurzelresorption

OBJECTIVE The amount of apical root resorption when using the torque-segmented archwire (TSA) was investigated as well as the extent and direction of the therapeutically indicated apical movement and the treatment duration. MATERIALS AND METHODS The degree of apical root resorption in 18 randomly chosen Class II and Class I patients treated with the TSA, as well as in 18~conventionally treated patients were evaluated using pre- and posttreatment panoramic radiographs. The sagittal and vertical apical movements and inclination changes were determined based on pre- and posttreatment lateral cephalograms. Nonparametric tests were applied to test between treatment groups and steps. The Mann-Whitney U test, Kruskal-Wallis, Pearson correlation and Wilcoxon signed-rank test were applied for statistical analysis (p < 0.05). RESULTS The incidence of root resorptions was 89-94.4% in low or moderate level. The relative root-crown ratio (rRCR) was not statistically different between the TSA and control groups except tooth~12. The axis of the incisors in the TSA group was significantly improved. The main direction of movement of the apices of the central incisors was retrusion and extrusion. No interdependence between the amount of resorption and the parameters of treatment duration, extent and direction of apical movement were found. CONCLUSION The results of the study showed that the amount of apical root resorption with the TSA is slight to moderate and can be compared to conventional orthodontic treatment. The TSA is hence a~suitable method for applying targeted torques to the incisors. ZUSAMMENFASSUNG ZIEL: Der Umfang der apikalen Wurzelresorption ebenso wie das Ausmaß und die Richtung der therapeutisch angenommenen apikalen Bewegung sowie die Behandlungsdauer wurden bei Anwendung des Torquesegmentbogens (TSB) untersucht. METHODEN Das Ausmaß der apikalen Wurzelresorption wurde an 18 willkürlich ausgewählten Klasse-II- und -I-Patienten, die mit dem TSB behandelt wurden, und an 18 konventionell behandelten Patienten anhand von prä- und posttherapeutisch erstellten Panoramaschichtaufnahmen beurteilt. Die sagittalen und vertikalen apikalen Bewegungen sowie die Änderungen der Inklination wurden anhand der FRS(Fernröntgenseitenbilder)-Aufnahmen bestimmt. Unterschiede zwischen Behandlungsgruppen und -schritten wurden mit nichtparametrischen Tests bestimmt. Mann-Whitney-U-, Kruskal-Wallis\hbox-, Pearson-Korrelation- und Wilcoxon-Rangsummen-Tests wurden zur statischen Analyse verwendet (p < 0.05). ERGEBNISSE Die Inzidenz der Wurzelresorption betrug 89–94,4 % für geringes bis moderates Ausmaß. Es gab keinen statistisch signifikanten rRCR („relative root–crown ratio“)-Unterschied zwischen der TSB- und der Kontrollgruppe bis auf Zahn 12. Die Inzisivusachse in der TSB-Gruppe wurde signifikant verbessert. Die Hauptbewegungsrichtung der Apices der zentralen Schneidezähne waren Retrusion und Extrusion. Es fand sich keine Interdependenz zwischen dem Umfang der Resorption und den Parametern Behandlungsdauer, Ausmaß und Richtung der apikalen Bewegung. SCHLUSSFOLGERUNG Die Studienergebnisse zeigen, dass der Umfang der apikalen Wurzelresorption mit TSB leicht bis moderat ist und mit der konventionellen orthodontischen Behandlung vergleichbar. Der TSB ist daher geeignet, Torque auf die Schneidezähne zu übertragen