Search Results (52)

Background/Objectives: The present study aims to assess the success rate of a CAD/CAM nickel–titanium wire (Memotain^®) used as a fixed orthodontic retainer, over a one-year period. Methods: A retrospective study was conducted on 338 CAD/CAM nickel–titanium (Memotain^®) fixed retention wires in 205 patients, bonded by a single experienced operator between January 2017 and December 2020. Follow-up visits were scheduled 6 (T1) and 12 months (T2) post-bonding. At each follow-up visit, events (defined as debonding, breakage, retainer loss, or tooth displacement) were classified by tooth, and success or failure of the retainer was determined based on the presence or absence of these events. Results: For the mandibular arch at T1 (6 months), the success rate was 85%, with debonding (n = 46) being the only event observed. At T2 (12 months), the success rate was 77%, with debonding (n = 30), wire breakage (n = 5) and retainer loss (n = 18) having occurred. For the maxillary arch, the overall success rate was 83% at T1 and 78% at T2. Debonding was the most common event observed over the 12-month observation period (n = 29), followed by retainer loss (n = 20) and wire breakage (n = 3). The overall success rates per type of tooth in the upper arch were 86% for the premolars, 96% for the canines, 95% for the lateral incisors and 93% for the central incisors. For the mandibular arch the success rates were 92% for the premolars, 97% for the canines, 96% for the lateral incisors and 94% for the central incisors. Conclusions: CAD/CAM nickel–titanium fixed retainers (Memotain^®) demonstrated promising 1-year survival rates in both arches, though long-term multicentre studies are needed to confirm their reliability. Full article

Background/Objectives: The accelerated digitalisation of dental practice is significantly influencing how patients perceive and accept modern treatments. This study uses a structured questionnaire to evaluate patients’ knowledge of, and attitudes towards, digital technologies in dentistry, adopting an original, patient-centred perspective within routine clinical settings. Methods: Non-parametric statistical methods (Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations) were employed to analyse the responses of 397 participants. To reduce selection bias, a systematic sampling technique was employed, and thorough validation ensured the consistency of the instrument. The questionnaire covered socio-demographic information, prior dental experience and opinions regarding specific digital applications (intraoral scanning (IOS), cone-beam computed tomography (CBCT), CAD-CAM workflows, 3D printing). Knowledge was operationalised as awareness; no keyed objective knowledge test was administered. Results: The findings show that patients generally accept digital technologies, with perceptions of costs, prior experience of digital dental procedures and educational level having a significant impact. The duration of the patient–clinician relationship, the patient’s dental health, and the history of orthodontic and prosthetic procedures also impacted the acceptance of digital technologies. Notably, clinical staff members were the main source of information, highlighting the importance of professional–patient communication. Conclusions: The results highlight the importance of patient-friendly communication in healthcare and provide a solid basis for the implementation of patient-centred digital dentistry. Future plans should focus on creating specialised educational materials, improving digital literacy, and promoting equal access to cutting-edge technologies in urban and disadvantaged communities. Full article

Robin sequence (RS) is a rare congenital anomaly characterized by micrognathia, glossoptosis, and upper airway obstruction (UAO), often accompanied by a cleft palate. The Tübingen Palatal Plate (TPP), also referred to as the pre-epiglottic baton plate (PEBP), offers a non-surgical, functional orthodontic solution that improves airway patency and feeding by advancing the tongue base. This paper outlines the semi-digital clinical and technical workflow used for TPP treatment at Tübingen University Hospital. The protocol combines intraoral scanning (IOS), computer-aided design and manufacturing (CAD/CAM), and manual refinement for patient-specific appliance production. Practical steps, modifications for special cases and follow-up procedures are detailed, aiming to support clinical implementation at other centres. Based on the published literature and over three decades of experience, the protocol emphasizes safety, quality control, and interdisciplinary collaboration, with practical guidance provided to support implementation in other centres. The potential of digital workflows for data sharing, training, and multicenter collaboration is highlighted, while challenges such as the need for specialized expertise and technical resources are acknowledged. This guideline provides the first comprehensive and reproducible description of the Tübingen approach and aims to facilitate wider adoption of TPP therapy for infants with RS. Full article

Mandibular second molar (MM2) impaction presents a relatively rare but complex orthodontic challenge, with potential consequences for occlusal function, periodontal health, and adjacent teeth. The aim of the article is to share data on the design and protocols of working with digitally designed systems for Printed Dento-alveolar Anchorage (PDaA) used in orthodontic traction of MM2. Accuracy in design comes from incorporating intraoral scans with CBCT files when planning the support system. The customized PDaA has an extension in the retention area of MM2 and allows multiple points of force application and vector control for precise tooth movement. The clinical flow includes surgical exposure and button placement on MM2, orthodontic traction using elastic elements attached to the PDaA, periodic activation every 3–4 weeks until the introduction of MM2 into the dental arch, and continuing with complete treatment of the entire orthodontic malocclusion. The clinical results demonstrated successful eruption and vertical leveling of MM2, stable anchorage, and absence of adverse effects on supporting teeth. Therapy with PDaA was well tolerated by patients, and did not disrupt aesthetics. This study highlights the potential of digital orthodontics to deliver personalized, biomechanically efficient solutions for molar impaction cases. Full article

Introduction: Digital planning and evolution of technology is allowing dentistry to be more efficient in time than before. In orthodontics the main purpose is to obtain fewer patient visits and to reduce the bonding time. For that, indirect bonding planned with CAD-CAM softwares is used to obtain a shorter treatment period, in general, and less chair-time. This waste of chair-time should also be reduced in other fields of dentistry such as endodontics, surgery, prosthodontics, and aesthetics. Methods: A total of 504 teeth were embedded into epoxy resin models mounted as a dental arch. Customized lingual multibracket appliances were bonded by a current adhesion protocol. After that, they were debonded, the polishing of cement remnants was performed with three different burs and two drills. The polishing time of each group was recorded by an iPhone 14 chronometer. Results: Descriptive and comparative statistical analyses were performed with the different study groups. Statistical differences (p < 0.005) between diamond bur and tungsten carbide and white stone burs and turbine were obtained, with the first being the slowest of them. Discussion: Enamel roughness was widely studied in orthodontics polishing protocol as the main variable for protocols establishment. However, in lingual orthodontics, due the difficulty of the access to the enamel surfaces, the protocol is not clear and efficiency should be considered. It was observed that the tungsten carbide bur is the safest bur. It was also recommended that a two-step protocol of polishing by tungsten carbide bur be followed by polishers. Conclusions: A tungsten carbide bur mounted in a turbine was the most efficient protocol for polishing after lingual bracket debonding. Full article

This study determined the influence of surface treatment and protracted ageing on the shear bond strength (SBS) of orthodontic brackets bonded to CADCAM (milled) and 3D-printed polymethylmethacrylate (PMMA) provisional crowns (PCs). Eighty disc-shaped specimens [forty milled (CopraTemp WhitePeaks) [group (Gp) M] and forty printed (Asiga DentaTooth) (Gp P)] were divided into eight subgroups (Gp) based on surface treatment [no treatment (control) (Gp MC and Gp PC), coarse diamond (Gp MCD and Gp PCD), fine diamond (Gp MFD, and GP PFD) and sandblast (Gp MSB and Gp PSB)]. Orthodontic brackets were bonded (Assure Plus, Transbond XT), thermocycled (2200 cycles), and tested for SBS and failure (Adhesive Remnant Index) (ARI). Statistical tests included analysis of variance (ANOVA); Kruskal–Wallis (ARI ranks); and post hoc (Tukey, Dunn, and Bonferroni) for determining group differences at predetermined probability p-values less than 0.05. SBS was significantly increased in Gp MSB (15.51 Mpa) and Gp PSB (14.11 Mpa), while the coarse diamond subgroups yielded the lowest mean SBS values [Gp MCD (11.28 Mpa) and Gp PCD (11.62 Mpa)]. The SBS of subgroups MFD, MSB, PCD, and PSB showed significant differences from those of their respective controls (Gp MC and Gp PC). Low ARI scores were observed in Gp MC (0.40) and Gp MSB (0.80), while higher scores were observed in Gp PCD (2.10). Both milled and printed PCs fulfil the clinical criteria of the minimum SBS for orthodontic brackets for long-term use. However, milled PC has better SBS and low ARI scores, which make it more clinically feasible for orthodontic treatments. Full article

Precision in diagnosis is essential for achieving optimal outcomes in prosthodontics, orthodontics, and orthognathic treatments. Virtual articulators provide a sophisticated digital alternative to conventional methods, integrating intraoral scans, facial scans, and cone beam computed tomography (CBCT) to enhance treatment predictability. This review examines advancements in virtual articulator technology, including digital workflows, virtual facebow transfer, and occlusal analysis, with a focus on Artificial Intelligence (AI)-driven methodologies such as machine learning and artificial neural networks. The clinical implications, particularly in condylar guidance and sagittal condylar inclination, are investigated. By streamlining the acquisition and articulation of digital dental models, virtual articulators minimize material handling errors and optimize workflow efficiency. Advanced imaging techniques enable precise alignment of digital maxillary models within computer-aided design and computer-aided manufacturing systems (CAD/CAM), facilitating accurate occlusal simulations. However, challenges include potential distortions during digital file integration and the necessity for robust algorithms to enhance data superimposition accuracy. The adoption of virtual articulators represents a transformative advancement in digital dentistry, with promising implications for diagnostic precision and treatment outcomes. Nevertheless, further clinical validation is essential to ensure the reliable transfer of maxillary casts and refine digital algorithms. Future developments should prioritize the integration of AI to enhance predictive modeling, positioning virtual articulators as a standard tool in routine dental practice, thereby revolutionizing treatment planning and interdisciplinary collaboration. This review explores advancements in virtual articulators, focusing on their role in enhancing diagnostic precision, occlusal analysis, and treatment predictability. It examines digital workflows, AI-driven methodologies, and clinical applications while addressing challenges in data integration and algorithm optimization. Full article

Background/Objectives: Condylectomy is a delicate and intricate procedure commonly employed in the management of temporomandibular joint (TMJ) disorders, osteochondromas, condylar hyperplasia, hemimandibular hyperplasia, and other pathologies affecting the condylar region. The advent of surgical cutting guides has introduced a new dimension to condylectomy procedures as they enable surgeons to plan and execute precise cuts with a heightened level of accuracy. In the literature already exists cases of cutting guide-based condylectomy, but they only depend on the mere mirroring procedure in virtual planning, which has accuracy limitations because it does not consider asymmetry of peri-condylar structures at the level of the ramus, body, and mandibular angle. Methods: CAD-CAM orthodontic preparation through the NEMOFAB Software was performed to correct the canting of the occlusal plane, following the “orthodontic first” technique. The same software was used for VSP of the surgical cutting guide to perform the condylectomy, basing not to the mere mirroring of the opposite side but considering the whole condylar-TMJ-glenoid fossa structure. Results: At 6 months follow-up, the patient showed good occlusion and an almost totally recovered lower third symmetry as median-upper and lower interincisive lines coincide with each other and with the chin median. A good occlusal and masticatory outcome was obtained. The joint structure was preserved with remodeling of the glenoid cavity caused by the presence of the joint disc, which was preserved during surgery. Conclusions: The goal of this study is to propose a method of therapeutic management of condylar hyperplasia that benefits from accurate pre-operative orthodontic treatment (orthodontics first) to maximize the results of proportional condylectomy, reducing post-operative orthodontic care as well as any need for any adjuvant orthognathic surgery. A new virtual surgical planning method is also proposed for creating a cutting guide that not only takes advantage of the mirroring technique to accurately calculate the amount of condyle to be cut but also considers the entire condyle–TMJ complex to perform a condylectomy that is more precise. Full article

Objectives: Mandibular molar distalization is a complex orthodontic movement due to anatomic and biomechanical limitations. The opportunity to use a custom-made appliance with skeletal anchorage should be an advantageous alternative to traditional solutions: multiple extractions, interproximal reductions, vestibular inclination of incisal group. Methods: A 14-year-old female patient with Class II malocclusion and ectopic upper and lower canines was treated in the lower arch with a custom-made appliance anchored on a mini-screw in the right buccal-shelf where the ectopy and crowding was severe. The miniscrew was connected to a rigid arm with a rail equipped with a coil that activated promoted the distalization of first and second molars bonded with metallic bands. Results: After 8 months of treatment with activations repeated every 4 weeks, an effective distalization has been reached. Conclusions: Mandibular molars’ distalization is a challenging orthodontic result to achieve. When the need to obtain space cannot be beneficially obtained with conventional approaches, and distalization of the lower molars could be desirable, a custom distalization device with skeletal anchorage and biomechanics based on a pressed coil sliding on a rigid arm is an efficient solution. Full article

The aim of the study is to assess the impact of mechanical surface treatments on the shear bond strength (SBS) of orthodontic brackets bonded to three-dimensional (3D) printed and milled CAD/CAM provisional materials. Sixty cylindrical samples were fabricated for each provisional material. Samples were treated with one of the following surface treatments: aluminum oxide airborne particle abrasion, diamond bur rotary instrument roughening, and phosphoric acid etching (control). Stainless steel brackets were bonded to the samples, and then SBS was tested using a universal testing machine. SEM and digital microscopy were utilized to examine the bonding interface and the failure modes. Two-way ANOVA, one-way ANOVA, Tukey’s HSD, and independent sample t-tests were used for statistical analysis. Results revealed significant differences in SBS between 3D printed and milled samples and significant differences in SBS among most surface treatments, with rotary instrument roughening resulting in the highest values for 3D printed, while airborne particle abrasion leading for milled samples. Digital microscopy indicated that more adhesive remained on 3D-printed samples. SEM analysis revealed varying surface roughness across treatments. Based on the findings of this study, it can be concluded that different surface treatments improve the bonding of orthodontic brackets to provisional crowns. Full article

This scoping review aims to provide a comprehensive summary of the current literature on 3D-printed orthodontic aligners. It was conducted following the Preferred Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. An electronic literature search was conducted across the PubMed, Embase, and Web of Science databases. After applying the inclusion criteria, a total of 46 eligible studies published until September 2024 were selected for qualitative synthesis. To date, scientific evidence is primarily available for Tera Harz TC (Graphy, Seoul, Republic of Korea), which is the only studied material approved for orthodontic tooth movements. Although additional materials were identified during the literature search, there is a lack of scientific studies regarding their characteristics and clinical use. This review highlights that while material properties and biocompatibility are of critical importance, the clinical efficacy and long-term safety of 3D-printed aligners require further investigation. Many studies exhibit significant variability in testing methodologies, making substantiated comparisons challenging. Moreover, the existing literature primarily comprises in vitro studies, with limited clinical trials assessing the effectiveness of 3D-printed aligners. Given the current gaps in knowledge and the evolving nature of this field, further well-designed controlled clinical studies are necessary to evaluate the clinical performance and safety of 3D-printed aligners. The findings underscore the need for standardized protocols and comprehensive reporting to enhance the reliability of future research in this area. Full article

Objective: The objective of this study was to evaluate the effect of different surface treatment methods on the shear bond strength (SBS) of metal brackets bonded to two types of CAD/CAM composite restorations: milled and 3D-printed. Materials and Methods: A total of 160 flat-shaped specimens (10 × 10 × 2 mm³) were prepared from four different CAD/CAM composites; two milled (Lava Ultimate™ [LU] and Grandio™ [GR]) and two 3D-printed (Crowntec™ [CT] and C&B Permanent™ [CB]). These specimens underwent thermocycling (5000 cycles at 5–55 °C), then were categorized based on the surface treatment into four groups (n = 10): Group C (control, no surface treatment), Group HF (treated with 9.6% hydrofluoric acid), Group DB (mechanical roughening by a diamond bur), and Group SB (sandblasting using aluminum oxide). Metal brackets were bonded using Transbond XT Primer and universal adhesive, stored in artificial saliva for 24 h, then thermocycled again. Shear bond strength (SBS) was tested using a universal testing machine until bracket debonding occurred. The adhesive remnant index (ARI) was assessed using a stereomicroscope to quantify the residual adhesive following debonding. Result: Regarding material, GR and LU restorations had significantly higher SBS values compared to CT and CB, ranging from 13.90 MPa to 20.35 MPa. Regarding surface treatment, SB and HF groups showed significantly higher SBS values. The ARI scores showed different adhesive modes of failure, with higher instances of scores 0 and 1, which indicate no or minimal adhesive remaining. Conclusions: Both milled and 3D-printed materials had adequate SBS for clinical use, with milled materials showing superior results. Surface treatments like sandblasting and HF significantly improved bond strength, with adhesive failure being common. Full article

(1) Background: After more than a decade since their first description, Inadvertent Tooth Movements (ITMs) remain an adverse effect of orthodontic retainers without a clear etiology. To further investigate the link between ITMs and the mechanical properties of different retainers, the response upon vertical loading was compared in three retainer types (two stainless steel and one nickel–titanium). The influence of different reference teeth was also considered. (2) Methods: Three retainers (R1, R2, R3) were tested in a newly developed biomechanical analysis system (FRANS). They were bonded to 3D-printed models of the lower anterior jaw and vertically displaced up to 0.3 mm. Developing forces and moments were recorded at the center of force. (3) Results: The vertical displacement caused vertical forces (Fz) and labiolingual moments (My) to arise. These were highest in the lateral incisors (up to 2.35 ± 0.59 N and 9.27 ± 5.86 Nmm for R1; 1.69 ± 1.06 N and 7.42 ± 2.65 Nmm for R2; 3.28 ± 1.73 N and 15.91 ± 9.71 Nmm for R3) for all analyzed retainers and with the R3 retainer for all analyzed reference teeth, while the lowest Fz and My values were recorded with the R1 retainer. (4) Conclusions: Displacements of 0.2 mm and larger provided forces and moments which could be sufficient to cause unwanted torque movements, such as ITMs, in all analyzed retainers. Clinicians must be mindful of these risks and perform post-treatment checkups on patients with retainers of all materials. Full article

Deciding on the implementation or modification of steps in daily clinical care is a nuanced process that demands careful evaluation. This is crucial not only for selecting the most appropriate solution but also for achieving the best treatment outcome. Thus, implementing a workflow for treating cleft lip and/or palate patients with a presurgical orthodontic cleft-covering plate needs to consider objective factors, prioritized from most to least important: safety and quality level, user-friendliness, feasibility, and, finally, efficiency and cost. The goal of this workflow is to integrate CAD/CAM technologies into daily clinical routine to enhance technical and clinical efficiency, reduce the burden of cleft care, and simplify the implementation of these technologies in other facilities. To achieve this, a methodology based on intraoral scanning and additive manufacturing is employed to produce patient-specific passive palatal plates. The approach describes possible pitfalls and their resolution within the routine of a cleft centre, along with an exemplary case scenario. Comparative analysis between the digital workflow and the conventional process demonstrated the digital approach to be safer, higher in quality, more user-friendly, feasible, and cost- and time-effective than the conventional process. Full article

The rise of computer-aided design and computer-aided manufacturing (CAD/CAM) and 3D printing technologies in orthodontics has revolutionized the development of customized labial and lingual bracket systems with a variety of materials, which offer potential advantages over traditional orthodontic brackets. To highlight the current state of knowledge regarding the mechanical and clinical properties of CAD/CAM and 3D-printed custom bracket systems, we conducted a comprehensive search across the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases to identify relevant articles published before April 2024. Mechanical (including fracture toughness, hardness, modulus of elasticity, frictional resistance, slot accuracy, torque transmission, and shear bond strength) and clinical (including treatment efficiency and duration, cost, and comfort) properties were compared between traditional and customized orthodontic bracket systems in the current review. Our findings suggest that customized brackets have the potential to increase bracket slot precision, reduce treatment time, and offer cost-efficiency. However, it is worth noting that the advantages and disadvantages of customized bracket systems vary depending on the bracket material and the manufacturing methods, warranting comprehensively controlled investigations in the future. Full article