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Digital Orthodontics: A New Era for Improved Diagnosis and Treatment...
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Digital Orthodontics: A New Era for Improved Diagnosis and Treatment Options

A special issue of Oral (ISSN 2673-6373).

Deadline for manuscript submissions: closed (20 September 2024) | Viewed by 12727

Special Issue Editor

Dr. Riccardo Nucera

E-Mail Website
Guest Editor
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, School of Dentistry, University of Messina, 98123 Messina, Italy
Interests: orthodontics; dentistry; oral surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The recent introduction of digital tools in orthodontics dramatically changed treatment planning and therapeutic approaches.

The spread of cone beam computer tomography (CBCT) offers a three-dimensional evaluation of malocclusion with a dose reduction exposition for the patient. This aspect enlarged the appropriate indication of 3D computer tomography evaluation in orthodontics, allowing significant improvements in the diagnosis of specific conditions such as impacted teeth, skeletal asymmetries, root resorption conditions, mandibular condyle dysplasia, and severe skeletal malocclusion.

Recently, the introduction of facial scanners and intra-oral scanners has allowed a more precise evaluation of facial and dental arch deformities, improving the evaluation of treatment results in orthodontics and dentofacial deformities treatment of adult and growing patients.

Moreover, the widespread use of intra-oral scanners allows the registration of dentoalveolar anatomy by the acquisition of a 3D model that can be saved as an STL (standard triangle language) file. These files can be processed by CAD (computer-aid design) software to generate a virtual set-up of the occlusion. Virtual set-up represents a virtual correction of the malocclusion and can be used by orthodontists to pre-visualize occlusal treatment objects and plan orthodontic treatment strategies.

Virtual set-up is a fundamental step of orthodontic treatment with clear aligners. Recently, the use of clear aligners to correct malocclusion is becoming very popular especially for adults. Specific CAD software can create intermediate models that represent intermediate steps from the original 3D model of dental arches to the virtual set-up representing the corrected malocclusion. These intermediate models are usually 3D printed, creating physical models that can are used for aligner creation by a thermoforming process performed on the 3D printed models.

Three-dimensional printing technology is used in orthodontics not only during aligner fabrication but also during orthodontic indirect bonding, surgical guide creation for guided orthodontic miniscrew insertion, and during autotransplantation.

The therapeutic options offered by new digital tools need to be scientifically validated and evaluated to quantify the real benefits offered by new technologies. Moreover, new digital tools allow the evaluation of treatment outcomes, which was not possible 10-15 years ago. This Special Issue collection aims to group scientific contributions that evaluate digital tools in contemporary orthodontic diagnosis and treatment.

Dr. Riccardo Nucera
Guest Editor

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Keywords

  • digital orthodontics
  • cone beam computer tomography
  • 3D printing
  • clear aligners
  • guided miniscrew insertion
  • dental CAD software
  • indirect bonding
  • guided autotransplantation

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Published Papers (6 papers)

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Research

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10 pages, 2587 KiB  
Article
Anatomical Bone Characteristics of the Buccal Step Insertion Site for Mini-Screw Placement in Orthodontic Treatment: A CBCT Study
by Nicola Derton, Angela Mirea Bellocchio, Elia Ciancio, Serena Barbera, Andrea Caddia, Niki Arveda and Riccardo Nucera
Oral 2024, 4(2), 196-205; https://doi.org/10.3390/oral4020016 - 1 May 2024
Viewed by 1170
Abstract
Background: To analyze the anatomical characteristics of a posterior area in the mandible localized distally to the second molars and extending in the vestibular direction toward the bony step, which we define as “buccal step”, in a patient with different skeletal patterns for [...] Read more.
Background: To analyze the anatomical characteristics of a posterior area in the mandible localized distally to the second molars and extending in the vestibular direction toward the bony step, which we define as “buccal step”, in a patient with different skeletal patterns for mini-screw insertion. Methods: The sample included 85 CBCT (cone beam computed tomography) records selected from the digital archive. Analysis focused on the buccal step area. Sections were obtained in axial view using reference lines, and measurements of cortical and total bone were taken at specific points M0 (starting point, 6 mm apical from CEJc—cementoenamel junction crest), M2 (located 2 mm posterior to M0 in the apical direction), and M4 (positioned 4 mm posterior to M0 in the apical direction) in both directions. Six measurements were recorded for each scan root plane, assessing cortical and total bone depth. Results: The thickness of the bone increases toward the inside of the mouth at all tested sites (M0, M2, M4), which is good for placing mini-screws. Cortical bone thickness decreases toward the inside of the mouth, with no significant differences among the sites except for M0 vs. M4. People with a particular jaw shape (hypo-divergent) have a thicker cortical bone, indicating that facial structure affects bone thickness. Conclusions: The posterior buccal step insertion site has biomechanical advantages and reduces the risk of damaging roots during mini-screw insertions. Full article
(This article belongs to the Special Issue Digital Orthodontics: A New Era for Improved Diagnosis and Treatment Options)
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10 pages, 1331 KiB  
Article
Effect of Aging of Orthodontic Aligners in Different Storage Media on Force and Torque Generation: An In Vitro Study
by Tarek M. Elshazly, Diva Nang, Bijan Golkhani, Hanaa Elattar and Christoph Bourauel
Oral 2023, 3(1), 67-76; https://doi.org/10.3390/oral3010007 - 1 Feb 2023
Cited by 7 | Viewed by 2530
Abstract
The aim of this study is to study the effect of aging in different media (deionized water and artificial saliva) on the force/torque generation by thermoplastic orthodontic aligners. Ten thermoformed aligners, made of Essix ACE® thermoplastic sheets, were aged in deionized water [...] Read more.
The aim of this study is to study the effect of aging in different media (deionized water and artificial saliva) on the force/torque generation by thermoplastic orthodontic aligners. Ten thermoformed aligners, made of Essix ACE® thermoplastic sheets, were aged in deionized water and in artificial saliva over two weeks at 37 °C, five in each medium. The force/torque generated on upper second premolar (Tooth 25) of a resin model was measured at day 0 (before aging), 2, 4, 6, 10, and 14, using a biomechanical test set-up. The results showed that aging of aligners by storage in aging agent has no significant impact on their force/torque decay. No significant differences were also found in force/torque between the aligners stored in deionized water nor artificial saliva. The vertical extrusion-intrusion forces were measured in the range of 1.4 to 4.6 N, the horizontal oro-vestibular forces were 1.3 to 2.5 N, while the torques on mesio-distal rotation were 5.4 to 41.7 Nmm. It could be concluded that the influence of saliva only on the mechanical properties can be classified as insignificant, and no significant difference between artificial aging in deionized water or artificial saliva was observed. Full article
(This article belongs to the Special Issue Digital Orthodontics: A New Era for Improved Diagnosis and Treatment Options)
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7 pages, 742 KiB  
Communication
Efficacy of Elastodontic Devices vs. Clear Aligners in Lower Intercanine Distance Changes Assessed by Computer-Aided Evaluation
by Eleonora Ortu, Davide Pietropaoli, Samuele Cova, Mario Giannoni and Annalisa Monaco
Oral 2023, 3(1), 31-37; https://doi.org/10.3390/oral3010003 - 15 Jan 2023
Viewed by 1843
Abstract
Background: This pilot study aimed to verify the efficacy of two orthodontic appliances in relation to changes in the lower intercanine distance in growing patients. Methods: Twenty patients aged 10–16 years were enrolled in the study and separated into test and control groups. [...] Read more.
Background: This pilot study aimed to verify the efficacy of two orthodontic appliances in relation to changes in the lower intercanine distance in growing patients. Methods: Twenty patients aged 10–16 years were enrolled in the study and separated into test and control groups. The test group included 10 patients (5 males, 5 females; mean age, 10.4 ± 1.57 years) who were treated with an elastodontic device. The control group included 10 patients (5 males, 5 females; mean age 10.8 ± 1.53 years) who were treated with clear aligners. The two groups exhibited the same orthodontic features. The orthodontic criteria were: skeletal class I relationship, molar class I relationship, and presence of lower crowding. Patients were evaluated as having mild or moderate crowding according to the Daniels and Richmond index. The lower intercanine distance was evaluated at three timepoints via intraoral scans: T0 (before starting therapy), T1 (after six months), and T2 (after 1 year). Data were analyzed using a nonparametric approach via the Wilcoxon signed-rank test. Results: There was no statistically significant difference between the two groups at T0, T1, or T2 (p < 0.05). Conclusions: elastodontic devices and clear aligners can successfully help the orthodontist conduct lower arch expansion treatment. These appliances are comfortable to wear, simple to clean every day, and reduce the number of dentist appointments. Finally, but not of least importance, these devices have allowed dentists to continue orthodontic treatments during the lockdowns of the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Digital Orthodontics: A New Era for Improved Diagnosis and Treatment Options)
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11 pages, 3309 KiB  
Article
Utilization of Machine Learning Methods for Predicting Orthodontic Treatment Length
by Mohammed H. Elnagar, Allen Y. Pan, Aryo Handono, Flavio Sanchez, Sameh Talaat, Christoph Bourauel, Ahmed Kaboudan and Budi Kusnoto
Oral 2022, 2(4), 263-273; https://doi.org/10.3390/oral2040025 - 29 Sep 2022
Cited by 2 | Viewed by 2152
Abstract
Treatment duration is one of the most important factors that patients consider when deciding whether to undergo orthodontic treatment or not. This study aimed to build and compare machine learning (ML) models for the prediction of orthodontic treatment length and to identify factors [...] Read more.
Treatment duration is one of the most important factors that patients consider when deciding whether to undergo orthodontic treatment or not. This study aimed to build and compare machine learning (ML) models for the prediction of orthodontic treatment length and to identify factors affecting the duration of orthodontic treatment using the ML approach. Records of 518 patients who had successfully finished orthodontic treatment were used in this study. Seventy percent of the patient data were used for training ML models, and thirty percent of the data were used for testing these models. We applied and compared nine machine-learning algorithms: simple linear regression, modified simple linear regression, polynomial linear regression, K nearest neighbor, simple decision tree, bagging regressor, random forest, gradient boosting regression, and adaboost regression. We then calculated the importance of patient data features for the ML models with the highest performance. The best overall performance was obtained through the bagging regressor and adaboost regression ML methods. The most important features in predicting treatment length were age, crowding, artificial intelligence case difficulty score, overjet, and overbite. Without patient information, several ML algorithms showed comparable performance for predicting treatment length. Bagging and adaboost showed the best performance when patient information, including age, malocclusion, and crowding, was provided. Full article
(This article belongs to the Special Issue Digital Orthodontics: A New Era for Improved Diagnosis and Treatment Options)
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Review

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20 pages, 5498 KiB  
Review
Digital Model in Orthodontics: Is It Really Necessary for Every Treatment Procedure? A Scoping Review
by Ioanna Pouliezou, Anastasia Panagiota Gravia and Michail Vasoglou
Oral 2024, 4(2), 243-262; https://doi.org/10.3390/oral4020020 - 3 Jun 2024
Cited by 2 | Viewed by 1926
Abstract
Digital models and three-dimensional technology in orthodontics have become an integral part of everyday clinical practice. Nevertheless, there is currently no consensus regarding in which cases a digital model is really necessary. Therefore, this scoping review aims to identify and assess which orthodontic [...] Read more.
Digital models and three-dimensional technology in orthodontics have become an integral part of everyday clinical practice. Nevertheless, there is currently no consensus regarding in which cases a digital model is really necessary. Therefore, this scoping review aims to identify and assess which orthodontic procedures require a digital model. This review’s reporting was based on PRISMA guidelines. A literature search was undertaken using five electronic databases on 17 February 2024. A total of 87 studies met the inclusion criteria and were qualitatively analyzed by three reviewers. The following aspects of orthodontic treatment were identified and discussed with regard to digital model application: diagnosis, treatment procedures, retention, and outcome evaluation in orthodontics. Based on the studies assessed, despite some limitations regarding radiation exposure justification and the accuracy of the integration methods of 3D data, there is evidence that digital models lead to more accurate orthodontic diagnosis and treatment planning. In cases of impacted canines, aligner treatment, mini-implants insertion (when angle definition and orientation are essential), and primary care for cleft lip and palate, a partial digital model produced by an integration of some of the 3D data (face scan, intraoral scan, CBCT) that we can acquire is beneficial. A full digital model that combines all the 3D information should be used in orthognathic surgery cases, in which prediction and accurate performance are highly advocated. Full article
(This article belongs to the Special Issue Digital Orthodontics: A New Era for Improved Diagnosis and Treatment Options)
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Other

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22 pages, 12221 KiB  
Case Report
Hybrid Orthodontics for Aesthetic Deep Bite Correction—Case Series and General Clinical Considerations
by Akila Aiyar, Giuseppe Scuzzo, Giacomo Scuzzo and Carlalberta Verna
Oral 2024, 4(2), 126-147; https://doi.org/10.3390/oral4020011 - 30 Mar 2024
Cited by 1 | Viewed by 1577
Abstract
Background: A range of psychosocial and aesthetic factors motivate patients to undergo orthodontic treatment. The appliance choice depends not only on the type of malocclusion, but also on the aesthetic and functional demands of the patients themselves. Nowadays, digital planning enables the manufacture [...] Read more.
Background: A range of psychosocial and aesthetic factors motivate patients to undergo orthodontic treatment. The appliance choice depends not only on the type of malocclusion, but also on the aesthetic and functional demands of the patients themselves. Nowadays, digital planning enables the manufacture of individualised and customised orthodontic appliances. However, the predictability of movements with aligner treatment has long been under discussion. This article illustrates, through a series of case reports, how a hybrid approach combining individualised aesthetic orthodontic appliances can improve the predictability of tooth movements, thereby providing additional tools for clinicians charged with choosing the best indicated and biomechanically advantageous technique. To this end, three patients with different malocclusions were treated via a hybrid approach involving clear aligners in the upper arch followed by lingual fixed appliances in the upper and lower arches. All patients were treated using ALIAS lingual PSL 0.018 × 0.018-inch slot brackets and in-house 3D-printed aligners. Findings: The hybrid approach combining aligners and fixed lingual appliances led to the successful resolution of all three complex cases in the series without prolonging treatment time. The superimpositions demonstrate the predictability of even traditionally difficult movements. In particular, the Alias PSL lingual system, used from the beginning, enabled good control of both the torque and inclination of the lower incisors. Conclusions: Combining clear aligners and fixed lingual appliances provides a highly efficient means of treating malocclusions aesthetically. In our cases, the aligners offset the lack of bite-plate effect from the lingual brackets and appliances, providing advantageous biomechanics for rotation correction and control of tip, torque and root movements. Understanding how to exploit the strengths of each appliance enables the clinician to treat adult patients efficaciously, efficiently and aesthetically. Full article
(This article belongs to the Special Issue Digital Orthodontics: A New Era for Improved Diagnosis and Treatment Options)
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