Search Results (7)

Polyetheretherketone (PEEK), an organic thermoplastic polymer, has gained interest in dentistry due to its excellent mechanical strength, flexibility, and biocompatibility. Furthermore, the ability to utilize CAD/CAM in the fabrication of PEEK enhances accuracy, reliability, and efficiency while also saving time. Hence, several orthodontic studies have explored the utilization of PEEK in various applications, such as archwires, brackets, fixed lingual retainers, palatal expansion devices, transpalatal arches, Tübingen palatal plates, different types of space maintainers, mini-implant insertion guides, and more. However, a complete systematic review of the available data comparing the performance of PEEK with traditional orthodontic materials has not yet been conducted. Therefore, this systematic review seeks to assess if PEEK material meets the required mechanical criteria to serve as an alternative to conventional orthodontic appliances. To ensure clarity and precision, this review will specifically concentrate on fixed appliances. This systemic review followed the PRISMA guidelines and utilized databases including PubMed/MEDLINE, Embase, Springer, Web of Science, and Wiley. Searches were restricted to English language articles from January 2013 to February 2024. Keywords such as “Polyetheretherketone” or “PEEK” and “Orthodontic” or “Orthodontic device” or “Orthodontic materials” were employed across all databases. Nine studies were incorporated, covering orthodontic archwires, brackets, and fixed lingual retainers. Based on the reviewed literature, PEEK demonstrates promising potential in orthodontic fixed appliances, offering advantages in force delivery, friction reduction, and aesthetic appeal. Further research is needed to fully explore its capabilities and optimize its application in clinical practice. Full article

The Tübingen Palatal Plate (TPP) is a minimally invasive yet highly effective functional orthodontic treatment for upper airway obstruction in infants with Robin Sequence (RS). It consists of a palatal plate to cover the cleft and a velar extension that shifts the root of the tongue forward. We review our practical experience with this approach. First, upon admission, our local orthodontists perform an (3-D) intraoral scan of the maxilla. Based on the scan data, the TPP is manufactured in a semi-digital workflow. The length and angulation of its extension is checked via awake laryngoscopy and the effectiveness confirmed by a sleep study. Plates are kept in place by adhesive cream. When inserting the TPP, the tip of the tongue must be visible. Next, metal fixation bows should be secured to the forehead using tape and elastic bands. Plates are removed daily for cleaning, and the oral mucosa is then checked for pressure marks. Feeding training (initially only via finger feeding) may even start before plate insertion. Breathing often normalizes immediately once the plate is inserted. For isolated RS, we have never had to perform a tracheostomy. This has largely been possible through our highly dedicated and competent team, particularly the nursing staff, and the early involvement of parents. Full article

Background: To assess the long-term functional orthodontic outcome of the Tübingen palatal plate (TPP) in children with Robin sequence (RS) in comparison to age- and sex-matched healthy controls. Methods: Between 09/2019 and 10/2020, we performed orthodontic assessments in 41 children at our Department of Orthodontics. Included were patients with RS (17 non-syndromic; four syndromic) and healthy controls (n = 22, average age in both groups 9.9 y). Facial analyses of 2D images, digital study casts and cephalometric measurements were made. Results: The orthodontic examinations showed no statistically significant group differences regarding functional extraoral, intraoral and pharyngeal parameters, or in skeletal patterns. The relationship between the upper and lower incisors was significantly increased (overjet 4 (2–10) vs. 3 (0–9) mm; p = 0.01) with a significant deficit in the lower face proportions (Jaw Index 4.15 (1.9–9.6) vs. 2.98 (0–9); p = 0.02; Facial convexity angle 157 (149–173) vs. 159 (149–170); p = 0.01). Conclusion: Children with RS treated with the TPP showed normal long-term functional orthodontic outcomes, thanks to the functional adaption of the stomatognathic system. However, soft tissue growth did not completely match skeletal growth, resulting in a more convex facial profile. Full article

Measuring the dimensions of personalized devices can provide relevant information for the production of future such devices used in various medical specialties. Difficulties with standardizing such measurement and obtaining high accuracy, alongside cost-intensive measuring methodologies, has dampened interest in this practice. This study presents a methodology for automatized measurements of personalized medical appliances of variable shape, in this case an orthodontic appliance known as Tübingen Palatal Plate (TPP). Parameters such as length, width and angle could help to standardize and improve its future use. A semi-automatic and custom-made program, based on Rhinoceros 7 and Grasshopper, was developed to measure the device (via an extraoral scanner digital file). The program has a user interface that allows the import of the desired part, where the user is able to select the necessary landmarks. From there, the program is able to process the digital file, calculate the necessary dimensions automatically and directly export all measurements into a document for further processing. In this way, a solution for reducing the time for measuring multiple dimensions and parts while reducing human error can be achieved. Full article

This paper introduces a complex novel concept and methodology for the creation of personalized biomedical appliances 3D-printed from certified biocompatible photopolymer resin Dental LT Clear (V2). The explained workflow includes intraoral and CT scanning, patient virtualization, digital appliance design, additive manufacturing, and clinical application with evaluation of the appliance intended for patients with cranio-facial syndromes. The presented concept defines virtual 3D fusion of intraoral optical scan and segmented CT as sufficient and accurate data defining the 3D surface of the face, intraoral and airway morphology necessary for the 3D design of complex personalized intraoral and extraoral parts of the orthopedic appliance. A central aspect of the concept is a feasible utilization of composite resin for biomedical prototyping of the sequence of marginally different appliances necessary to keep the pace with the patient rapid growth. Affordability, noninvasiveness, and practicality of the appliance update process shall be highlighted. The methodology is demonstrated on a particular case of two-year-old infant with Pierre Robin sequence. Materialization by additive manufacturing of this photopolymer provides a highly durable and resistant-to-fracture two-part appliance similar to a Tübingen palatal plate, for example. The paper concludes with the viability of the described method and material upon interdisciplinary clinical evaluation of experts from departments of orthodontics and cleft anomalies, pediatric pneumology and phthisiology, and pediatric otorhinolaryngology. Full article

Different approaches for digital workflows have already been presented for their use in palatal plates for newborns and infants. However, there is no evidence on the accuracy of CAD/CAM manufactured orthodontic appliances for this kind of application. This study evaluates trueness and precision provided by different CAM technologies and materials for these appliances. Samples of a standard palatal stimulation plate were manufactured using stereolithography (SLA), direct light processing (DLP) and subtractive manufacturing (SM). The effect of material (for SM) and layer thickness (for DLP) were also investigated. Specimens were digitized with a laboratory scanner (D2000, 3Shape) and analyzed with a 3D inspection software (Geomagic Control X, 3D systems). For quantitative analysis, differences between 3D datasets were measured using root mean square (RMS) error values for trueness and precision. For qualitative analysis, color maps were generated to detect locations of deviations within each sample. SM showed higher trueness and precision than AM technologies. Reducing layer thickness in DLP did not significantly increase accuracy, but prolonged manufacturing time. All materials and technologies met the clinically acceptable range and are appropriate for their use. DLP with 100 µm layer thickness showed the highest efficiency, obtaining high trueness and precision within the lowest manufacturing time. Full article

CAD/CAM technologies and materials have the potential to improve the treatment of Robin Sequence with orthodontic appliances (Tübingen palatal plate, TPP). However, studies on the provided suitability and safety are lacking. The present study evaluates CAD/CAM technologies and materials for implementation into the workflow for producing these orthodontic appliances (TPPs), manufactured by different techniques and materials: additive manufacturing (AM) and subtractive manufacturing (SM) technologies vs. conventional manufacturing. The fracture load was obtained in a universal testing machine, and the breaking behavior of each bunch, as well as the necessity of adding a safety wire, was evaluated. The minimum fracture load was used to calculate the safety factor (SF) provided by each material. Secondary factors included manufacturing time, material cost and reproducibility. Dental LT clear showed the highest fracture load and best breaking behavior among AM materials. The highest fracture load and safety factor were obtained with Smile polyether ether ketone (PEEK). For the prototyping stage, the use of a Freeprint tray (SF = 114.145) is recommended. For final manufacturing, either the cost-effective approach, Dental LT clear (SF = 232.13%), or the safest but most expensive approach, Smile PEEK (SF = 491.48%), can be recommended. Full article