How Efficient Are Clear Aligners? Clear Aligners vs Traditional Orthodontic Treatment: A Systematic Review

Purpose:The purpose of the present review is to update knowledge of the literature and better understand the efficiency and abilities of clear aligners and to clarify their indications for use.Materials and Method:The study question was defined as ‘‘How efficient is orthodontic treatment with clear aligners in comparison to fixed orthodontic treatment in patients with permanent dentition?’’ An Internet-based search was performed with 6 databases: Medline, PubMed, Clinical Key, ProQuest Dissertations and Theses, Dentistry and Oral Sciences Source (EBSCO Host), and the Cochrane Library. The final search was run in January 2014. Key words used were clear aligner, eCligner, Invisalign, and AsoAligner.Results:We retrieved 110 publications from the databases. After reviewing titles and abstracts, case reports and clinical studies reporting treatment outcomes on segmental dental arches (i.e., anterior dentition) were excluded. Finally, 3 studies that addressed the study question were included in the review.Conclusion:Not enough studies were available to arrive at definite conclusions to compare clear aligner and fixed orthodontic treatment. In simpler cases, Invisalign may result in treatment outcomes as good as those of traditional orthodontic treatment. However, controlled clinical studies are necessary to define and support the abilities and limits of clear aligner therapy with evidence

Does Maxillary Protraction with Alt-RAMEC Protocol Affect Inferior Sclera Exposure? A Controlled 3dMD Study

Objective: The purpose of this controlled retrospective study was to measure and evaluate the inferior sclera exposure changes using 3dMD stereophotogrammetric images in a prepubertal Class III patient sample that underwent maxillary protraction with alternate rapid maxillary expansions and constrictions protocol followed by facemask.Methods: The study group included 15 prepubertal patients (mean age: 9.85 ± 1.44 years) with Class III malocclusion due to maxillary retrognathism. Nine weeks of alternate rapid maxillary expansions and constrictions protocol was followed prior to 7 months of face mask treatment and 3 months of retention with Bionator. Pretreatment (T0) and post-retention (T1) lateral cephalometric radiographs and 3dMD images were retrieved from clinical archive. The same records were used for a control group of 15 well-matched, untreated patients (mean age: 9.4 ± 0.79 years). The distance between the upper eyelid margin and the lower eyelid margin was recorded as the overall eye height (E), and the distance between inferior limbus and the lower eyelid margin was recorded as inferior sclera exposure (S). The S : E ratio in percentage was calculated. Sella-nasion-A point angle (SNA) was used as the skeletal variable.Results: SNA angle, right S : E, and left S : E changed significantly in both groups at T1-T0. The intergroup comparison was highly significant for SNA angle but was not significant for right and left S : E variables.Conclusion: The S : E ratio decreased significantly in both alternate rapid maxillary expansions and constrictions/facemask and the control groups. However, the change in S : E ratio between groups was not significant

Mini-implant Usage in Orthodontic Practice

Objective:The present study was designed to investigate the general anchorage protocols and especially the tendencies during mini-implant usage among Turkish orthodontists. The main aim of the survey is to reveal if mini-implants are being used more than once and in different patients.Materials and Method:This is a cross-sectional study conducted with orthodontists who are members of the Turkish Orthodontic Society. The orthodontists were asked to click on a link to complete an automated questionnaire of 27 multiple-choice questions.Results:t was found that mini-implants are used by a great majority of the participants and in various cases. General tendencies during mini-implant usage show compatibility with the literature.Conclusion:This survey displays the preferences of Turkish orthodontists regarding mini-implant usage in their clinical practice. Moreover, it is especially important for documenting the fact that mini-implants are being used more than once and also in different patients

Does the Bone Cement Affect Miniscrew Stability?

Objective:The purpose of this study was to determine whether bone cement increased the resistance of miniscrews against pull-out and shear forces.Materials and Method:Sixty commercially available miniscrews were placed into bovine bone samples (one each) at a 90° angle, using a custom-made orientation jig and controlling torque (30 N-cm) and rotation (20 rpm) with a rechargeable screwdriver. The miniscrews were inserted using three different methods: self-drilling, predrilling, and predrilling with bone cement application. Pull-out strengths and shear tests were performed using a universal testing machine.Results:Nonparametric Kruskal-Wallis tests were used for comparisons between groups, and Bonferroni-adjusted Mann-Whitney U tests were used to detect different group(s) (α/3=0.016). There was a statistically significant difference between the pull-out strengths of the groups (p<0.01). The self-drilling group had a significantly lower pull-out strength at failure than the other groups (p<0.016). The pullout strengths of the miniscrews placed with bone cement had a significantly higher pull-out strength than the predrilling group. In shear tests, there was no statistically significant difference among the groups.Conclusion:This study is the first report demonstrating the effects of bone cement on stability and resistance to failure at the bone-miniscrew interface. These results show that the use of miniscrews with bone cement is a promising method that may extend the limits of force application

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (&lt;4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Hounsfield Units: A new indicator showing maxillary resistance in rapid maxillary expansion cases?

Objective: To determine if density measurements of several maxillary regions in Hounsfield Units (HU) and outcomes of rapid maxillary expansion (RME) are correlated. Is correlation powerful enough to give us direct information about maxillary resistance to RME? Materials and Methods: Twenty-two computed tomographic (CT) scans (14 years) are used in this archive study. Two CT records were collected, one before RME (T-1) and one after 3 months of retention period (T-2). Maxillary measurements were made using dental and skeletal landmarks in first molar and first premolar slides to measure the effects of RME. Density of midpalatal suture (MPSD) and segments of maxillary bone is measured in HU at T-1. Correlation analysis was conducted between density measurements and maxillary variables. Regression analysis was then performed for variables that showed positive correlation. Results: There was no correlation between density and skeletal measurements. Intermolar angle (ImA) in molar slice showed statistically significant correlation with density measurements. The ImA variable showed the highest correlation with MPSD in frontal section (r = 0.669, P < .01). Conclusions: There is correlation of 32.1-43.3% between density measurements and ImA increase. Our density measurements explain a certain percentage of ImA increase, but density is not the only and definitive indicator of changes after RME

Treatment outcome and long-term stability of class II correction with forsus fatigue resistant device in non-growing patients

Objectives Forsus (TM) Fatigue Resistant Device (FRD) is one of the commonly used semirigid fixed functional devices. Purpose of the present study was to investigate effects and long-term stability of Class II correction following use of Forsus FRD in a retrospective clinical study. Setting and Sample Population Records of 20 patients (mean age 18.3 +/- 2.5 years) with Class II malocclusion, who had undergone fixed functional treatment protocol with Forsus FRD, were collected from our clinical archive. Materials and Methods Lateral cephalometric radiographs at pre-treatment (T0), end of comprehensive treatment (T1) and post-retention period (T2, mean duration: 19 +/- 3 months) were analysed and superimposed to assess skeletal and dental changes on the long-term. Repeated measurement one way ANOVA was used for the study of the significant differences among the mean values of cephalometric parameters at T0, T1, and T2. To analyse the nature of the bilateral significant differences between two different time points, Bonferroni test was used. Results Sagittal and vertical skeletal changes at T0-T1 were statistically insignificant while all dentoalveolar parameters exhibited highly significant changes. At T1-T2, all skeletal and dentoalveolar parameters were stable except the slight relapse in overjet (0.3 +/- 0.5 mm;P < .05). At T0-T2 interval, no significant skeletal changes were recorded while the dentoalveolar changes remained significantly improved. Conclusion Correction of Class II malocclusion achieved with Forsus FRD was dentoalveolar and treatment effects were stable in the 19 +/- 3 months follow-up period

Hızlı üst çene genişletme tedavisi uygulanan vakalarda sutural ve kemiksel yoğunluk ile hastanın kortikotomi ihtiyacı arasındaki ilişkinin bilgisayarlı tomografi görüntüleri kullanılarak değerlendirilmesi

1. Çalışma bir retrospektif bir arşiv çalışmasıdır. Çalışmanın amacı kemiksel ve sutural yoğunluk ölçümleri ile hızlı üst çene genişletmesi sonrası elde edilen iskeletsel genişleme miktarı arasındaki ilişkinin incelenmesidir. Çalışmada hızlı üst çene genişletmesine ihtiyacı olan ve yaş ortalaması 14 olan 11'i kız ve 11'i erkek toplam 22 hastadan hızlı üst çene genişletmesi öncesi ve 3 aylık pekiştirme sonrası alınan bilgisayarlı tomografi verileri kullanılmıştır. Ölçümler bilgisayar ortamında 3-boyutlu tomografik modelleme programı (Mimics v.15.0, Materialise, Belçika) kullanılarak gerçekleştirilmiştir. Hızlı üst çene genişletmesine direnç gösteren alanlardan olan midpalatal sutur, ve maksiller kemik üzerinde çeşitli kemiksel yapıların Hounsfield birimi (HU) cinsinden yoğunlukları ölçüldü. Ayrıca dişsel ve iskeletsel genişleme miktarını belirlemeye yönelik ölçümler yapıldı. Dişsel ve iskeletsel genişleme miktarı ile yoğunluk ölçümleri arasındaki korelasyon incelendi. Regresyon analizi ile denklem modelleri oluşturuldu. Anahtar Kelimeler: Bilgisayarlı Tomografi, Hızlı Üst Çene Genişletmesi, Hounsfield Birimi, Midpalatal SuturYoğunluk 2. SUMMARY Computed Tomography Evaluation of the Relationship Between The Need for Corticotomy and Bone and Suture Density in Cases of Rapid Maxillary Expansion This is a retrospective archieve study. Aim of the study is to investigate the effects of bony and sutural densities on the results of rapid maxillary expansion. In this study, computed tomography data before RME and 3 months after the completion of expansion of 22 patients (11 boys and 11 girls with a mean age of 14) who needed maxillary expansion is included. Measurements are made in computer with a 3 dimensional tomography modelling software (Mimics v.15.0, Materialise, Belgium). Densities of several areas that show resistance to maxillary expansion (such as maxillary suture and several areas on the maxillary bone) is measured in Hounsfield units (HU). Other measurements that aim to measure dental and skeletal expansion amounts are also made. Correlation between density measurements and dental and skeletal expansion amounts is examined. Equation models are obtained with regression analysis. Key words: Computed Tomography, Density, Hounsfield Units, Rapid Maxillary Expansion, Midpalatal Sutur

DIRECT USAGE OF MINISCREW ANCHORAGE TO INTRUDE OVERERUPTED MAXILLARY POSTERIOR TEETH BEFORE PROSTHODONTIC PREPARATION: A CASE REPORT

Overeruption of maxillary molars due loss of opposing teeth creates occlusal and functional interferences. Before reconstruction can be initiated, intrusion of overerupted molars becomes essential. This report illustrates treatment of overerupted maxillary premolar and molar via direct use of miniscrew anchorage. A 24-year old female had lost first and second left mandibular molars due to pulpal necrotizing agents, resulting with a large alveolar bone defect and overerupted maxillary premolar and molar. She had a history of unsuccessful alveolar distraction of mandibular left premolars to increase the alveolar bone height prior to implant placement. Patient was satisfied with her smile and refused comprehensive orthodontic treatment. Maxillary premolar and molar were intruded segmentally for 4mm in 8 months, using a combination of a mini-implant and partialfixed edgewise appliances. Biological responses of teeth and surrounding bony structures to intrusion appeared normal and acceptable in radiographic and clinical examination

In-vitro evaluation of the effects of insertion and sterilization procedures on the mechanical and surface characteristics of mini screws

Purpose The aim of the present study was to investigate the effects of insertion and sterilization on primary stability and to examine the mechanical and surface characteristics of mini screws. Materials and methods 140 miniscrews (70 Dual-Top; 70 Ortho-Easy) were divided into 3 groups. Group 1: control group, 10 miniscrews of each brand, evaluated without any primary procedure. Group 2: 30 miniscrews of each brand, each inserted into the sawbone once, then sterilized and tested. Group 3: 30 miniscrews of each brand, each inserted into the sawbone twice, sterilized after each insertion and then tested. The miniscrews were evaluated for changes in primary stability, mechanical and surface characteristics with scanning electron microscopy (SEM) analysis, torsion tests, maximum insertion-removal torques and vertical-horizontal pull out strength tests. Results The maximum insertion torque values of the unused miniscrews (Group 1) were found to be significantly higher than those of the reused (Groups 2, 3) mini screws (p<0.05). Removal torque, vertical-horizontal pull-out strength and torsional strength value changes were found to be statistically insignificant. In SEM analysis, wear and atrophy were seen on the threads of used miniscrews especially in the apical region and the oxide layer was seen to have disappeared from some regions of the coated miniscrews. Conclusion Although wear and atrophy were detected in SEM analysis of used miniscrews, the overall primary stability and fracture torque resistance tests did not show any significant changes after the first and second insertion and sterilization procedures