Search Results (167)

Amorphous calcium phosphate (ACP) is a well-established bioceramic material known to promote the remineralization of dental hard tissues. White spot lesions (WSLs) represent the initial stage of enamel demineralization and are frequently observed in patients with fixed orthodontic appliances or inadequate oral hygiene. Although recommendations for remineralizing agents include both the prevention of lesion progression and the stimulation of tissue remineralization, the clinical efficacy of ACP-based materials remains under debate. This systematic review, registered in the PROSPERO database (CRD42024540595), aims to evaluate the clinical efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-based products in the remineralization of WSLs and to compare these outcomes with those achieved using non-bioceramic approaches. Inclusion criteria comprised randomized clinical trials, prospective cohort studies, and pilot studies conducted on human subjects with WSLs affecting permanent teeth. Studies involving artificial WSLs or non-cariogenic enamel lesions were excluded. The quality of the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Fourteen articles met the inclusion criteria and were analyzed. The main findings indicate that CPP-ACP is clinically effective in promoting the remineralization of WSLs, although the results were inconsistent across studies. Comparisons with placebo and resin infiltration treatments revealed greater efficacy for CPP-ACP. The combination of CPP-ACP with fluoride appeared to further enhance the remineralizing effect on WSLs. Additional standardized clinical studies with longer follow-up periods are warranted to confirm these outcomes. Full article

Background and Objectives: Orthodontic treatment, whether fixed or removable, offers several benefits, including improved aesthetics, enhanced oral function, and increased self-confidence. However, it may also cause discomfort and pain, particularly following adjustment visits. This study aimed to assess pain characteristics (latency and continuity), food impairment, weight loss, and analgesic use in relation to treatment duration and appliance type. Methods: This observational study included 160 orthodontic patients who completed a structured questionnaire comprising 13 single-choice items. The questionnaire assessed age, gender, residential environment, educational status, type and duration of orthodontic treatment, pain characteristics (duration, latency, continuity), food impairment, and analgesic use. Inclusion criteria specified patients with moderate anterior crowding undergoing fixed orthodontic treatment or treatment with clear aligners on both arches, for at least one month. All fixed appliance cases involved 0.022-inch-slot Roth prescription brackets. Results: Patients undergoing fixed orthodontic treatment reported a higher frequency of pain (91.4%), greater need for analgesics (95.2%), and more food impairment compared to those with clear aligners. Patients treated for less than 6 months more frequently reported pain lasting 1 week (57.1%), while those treated for 1–2 years more commonly reported pain lasting several days (43.8%). Conclusions: Fixed orthodontic appliances are associated with greater discomfort, longer pain latency, more frequent analgesic use, and higher dietary impact compared to clear aligners. These findings emphasize the importance of personalized patient counseling and proactive pain management to improve compliance, enhance quality of life, and support informed decision-making in orthodontic care. Full article

Background: Surface electromyography (sEMG) enables the non-invasive assessment of muscle activity and is widely used in orthodontics for evaluating masticatory muscles. However, little is known about the dynamic changes in facial expression muscles during orthodontic treatment. This study aimed to investigate alterations in facial muscle tone during the leveling and alignment phase in adult female patients undergoing fixed appliance therapy. Methods: The study included 30 female patients aged 20–31 years who underwent sEMG assessment at four time points: before treatment initiation (T0), at the start of appliance placement (T1), three months into treatment (T2), and six months into treatment (T3). Muscle activity was recorded during four standardized facial expressions: eye closure, nasal strain, broad smile, and lip protrusion. Electrodes were placed on the orbicularis oris, orbicularis oculi, zygomaticus major, and levator labii superioris alaeque nasi muscles. A total of 1440 measurements were analyzed using Friedman and Conover-Inman tests (α = 0.05). Results: Significant changes in muscle tone were observed during treatment. During lip protrusion, the orbicularis oris and zygomaticus major showed significant increases in peak and minimum activity (p < 0.01). Eye closure was associated with altered orbicularis oris activation bilaterally at T3 (p < 0.01). Nasal strain induced significant changes in zygomaticus and levator labii muscle tone, particularly on the right side (p < 0.05). No significant changes were noted during broad smiling. Conclusions: Orthodontic leveling and alignment influence the activity of selected facial expression muscles, demonstrating a dynamic neuromuscular adaptation during treatment. These findings highlight the importance of considering soft tissue responses in orthodontic biomechanics and suggest potential implications for facial esthetics and muscle function monitoring. Full article

Objective: The present review aims to compare the oral microbial profile (OMP) of patients undergoing fixed orthodontic therapy (OT) versus clear aligner therapy (CAT) for the treatment of malocclusions. Methods: Clinical studies were included. Case-reports/-series, letters to the editor, reviews, perspectives, and expert opinions were excluded. Indexed databases (MEDLINE/PubMed, Embase, Scopus, and Web of Science) were searched up to the end point of May 2025, without time and language barriers. The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias (RoB) and quality of evidence were assessed. Results: Three randomized clinical trials (RCTs) and seven non-RCTs were included. In all RCTs and five non-RCTs, OMP was assessed using subgingival plaque samples. Periodontopathogenic bacteria and Gram-negative anaerobic microbes were more often identified in patients undergoing fixed OT than CAT. The biofilm mass was higher in patients undergoing fixed OT than CAT. In two RCTs, periodontopathogenic bacteria were dominant among patients undergoing fixed OT than CAT. All RCTs and two non-RCTs had a high RoB. The certainty of evidence was “moderate” in 70% of the studies. Conclusions: Due to a high RoB, variability in study designs, and lack of power analysis, direct comparisons remain limited. Full article

Background/Objectives: The aim of this systematic review was to identify the role of orthodontics in patients undergoing tumor-ablative surgery, in collaboration with maxillofacial prosthodontic rehabilitation in a multidisciplinary fashion. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024582050). The focused question was constructed using the PICO (participant, intervention, comparison, and outcome) approach. A three-stage search was performed in PubMed, Scopus, and Web of Science using Medical Subject Heading (MeSH) terms. To assess the risk of bias, the National Institute of Health (NIH) “Quality Assessment Tool for case series/reports” was used. All data was synthesized qualitatively, according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results: The initial search yielded 624 articles, of which 22 met the inclusion criteria after screening and eligibility assessment, with most being single-patient case reports and one case series involving 12 patients. The included studies primarily involved tumors in the mandible (64.5%) and maxilla (32.3%). Orthodontic treatment was initiated at various time points, ranging from one month pre-surgery to 19 years post-surgery, primarily utilizing fixed appliances (77.8%). In some studies, orthodontic appliances were used to enhance the stability of maxillofacial prostheses. The results of this study indicate that orthodontic treatment may facilitate prosthetic rehabilitation by improving conditions prior to prosthetic intervention and increasing the retention of the obturator prosthesis. Conclusions: Orthodontic treatment can enhance maxillofacial prosthetic rehabilitation after tumor-ablative surgery by optimizing jaw growth, improving occlusion, and facilitating prosthetic retention or space creation. Further research is needed to establish treatment guidelines. Orthodontic miniscrews may improve temporary prosthesis retention before final implant placement, when indicated. Full article

Background/Objectives: This systematic review examines the effectiveness and clinical indications of the 2 × 4 fixed orthodontic appliance for interceptive treatment in children with mixed dentition, aiming to simplify future orthodontic needs. Methods: Following the PRISMA guidelines, a search was conducted across PubMed, Web of Science, and Scopus (May 2000–May 2025). The inclusion criteria focused on open-access, in vivo/human studies, case–control studies, cohort studies, and RCTs in English. Risk of bias was assessed using Rob 2.0. Results: Out of 362 initial records, 7 studies were included. Most of the included studies showed a low risk of bias, with some moderate risk in terms of confounding variables and participant selection, but no high risk was identified. Conclusions: The 2 × 4 fixed orthodontic appliance is an effective interceptive therapy for mixed dentition. Clinicians can optimize outcomes by understanding its biomechanics and clinical applications. Further research is needed to understand long-term impacts and improve efficiency. Full article

Background/Objectives: This systematic review analyzed the epidemiologic and macro/microscopic features of manifestations of hypersensitivity reactions with oral and extra-oral involvement in orthodontic patients with fixed (FAs) or removable (RAs) appliances or clear aligners (CAs), and evaluated them based on patient and treatment characteristics to provide clinical recommendations. Methods: The study protocol followed the PRISMA guidelines and was registered on PROSPERO (CRD42024517942). Results: Thirty-one studies were qualitatively assessed and synthetized, involving 858 subjects (114 males and 714 females, 9–49 years old), of whom there were 86 with a history of allergy, and 743 wearing recorded appliances (FAs = 656, FAs and RAs = 81, intra- and extra-oral RAs = 3, CAs = 3), with a mean treatment duration of 21.5 months (6 weeks–40 months). Among 75 reports, 29 (38.67%), describing burning, gingival hyperplasia, erythema, and vesicles, had oral involvement, while 46 (61.33%) had skin, eye, and systemic involvement, with erythema, papules, conjunctival hyperemia, and vertigo. Positive allergy tests concomitant with the manifestations identified nickel 451 times, cobalt 6 times, titanium 5 times, and chromium 4 times. Management included antihistamines or corticosteroids and removing the offending materials, with treatment discontinuation/appliance substitution. Conclusions: Pre-treatment evaluations, including patient histories and allergy testing, are essential to identify potential allergens and select hypoallergenic materials like titanium or ceramic brackets; regular monitoring and early intervention during treatment are crucial to prevent severe outcomes. Full article

Fixed orthodontic appliances, which are cemented to tooth surfaces, complicate the maintenance of oral hygiene and create a rough surface that is favorable for bacteria attachment. Additionally, the presence of orthodontic appliances may conceive a unique environment that interacts with cariogenic microorganisms, fostering a distinct microbial ecosystem compared to that of the patients without orthodontic appliances, thus increasing the vulnerability of tooth surfaces to demineralization and caries formation. Silver (Ag) has shown strong antimicrobial effects and has been extensively investigated in the medical field. Here, we aim to review the antibacterial properties and potential side effects of silver nanoparticles (AgNPs) when incorporated into orthodontic bonding reagents. This valuation could contribute to the development of novel bonding reagents designed to prevent the formation of white spot lesions and caries during orthodontic treatments. Full article

Background: This study aimed to evaluate the long-term stability of maxillary molar distalization in the treatment of Class II malocclusion. Methods: This study included 40 patients (31 males and 9 females) who received fixed orthodontic treatment after maxillary molar distalization. Orthodontic models and lateral cephalograms were evaluated at three time points: pre-treatment (T1), after orthodontic treatment (T2), and long-term follow-up (T3). The mean ages of the patients’ ages at T1, T2, and T3 were 13.02, 15.97, and 22.05 years, respectively. The statistical analysis included paired t-tests and Wilcoxon signed-rank tests. The statistical significance was set at p < 0.05. Results: The statistical analysis indicated no gender-related differences. A significant distalization of maxillary first molars was observed at T2 compared to T1 (p < 0.001). Despite a minor relapse, a statistically significant distalization was observed in T3-T1 (p < 0.001). The vertical skeletal angles, which increased during the treatment period, decreased at T3-T2. The molar relationship was almost maintained after long-term follow-up (p < 0.001). Conclusions: The maxillary molar distalization achieved in the Class II treatment was maintained in the long term. The vertical skeletal measurements decreased to their initial values in the long term. The Class I molar relationship did not change during the completion of the growth. This study hypothesized that the maxillary molar distalization achieved during fixed orthodontic treatment can be maintained in the long term without significant relapse. Full article

Background and Objectives: Anterior open-bite malocclusion remains a challenging orthodontic condition where achieving a positive overbite necessitates precise control of incisor extrusion and molar intrusion. With recent advances in clear aligner therapy—improved materials, attachment techniques and digital treatment planning—the potential for non-invasive treatment has increased. This scoping review systematically maps the evidence on the efficacy of clear aligners in treating anterior open bite among adult patients, outlines treatment protocols and highlights gaps in the literature. Materials and Methods: A systematic search was conducted in PubMed/Medline, Embase/ScienceDirect and Clarivate/Web of Science for literature published in English between January 2000 and December 2024. Studies involving adult patients treated with clear aligners (predominantly Invisalign^®) were included. A two-step screening process was applied, and data were charted according to pre-specified criteria. The review adheres to the PRISMA-ScR checklist guidelines. Results: From an initial pool of 802 articles, 30 met the inclusion criteria following duplicate removal and full-text screening. The evidence suggests that clear aligners can achieve measurable incisor extrusion and posterior intrusion when appropriate auxiliary techniques (e.g., attachments and mini screws) are used. However, digital treatment planning software may overestimate movement predictions, necessitating iterative refinement phases. Patient compliance, clinician expertise and technological limitations are key factors influencing outcomes. Conclusions: Clear aligner therapy represents a promising alternative to fixed appliances for anterior open-bite correction in adults, although challenges remain in achieving precise vertical control. Further high-quality randomized controlled trials and standardized outcome measures are needed to confirm long-term stability and efficacy. Full article

According to the World Health Organization, malocclusion type III is third, most important oral health problem. It may be the least prevalent malocclusion, but it is the most noticeable and challenging for orthodontic therapy. With this narrative review, we wanted to give a summation of the most current knowledge about diagnostics, different therapy options, limitations, and additional factors that can influence the therapy of class III malocclusion to help clinicians and researchers focus on the specific approaches. Therapy options were divided into the following groups: orthopedic, orthodontic, and surgical. The SNA, SNB, and ANB angles (cephalometric values) are the best ones to examine improvements in different skeletal improvements, while dentoalveolar improvements were also described, emphasizing the limitation of orthopedic therapy to change the skeletal discrepancy. Eruption-guided appliances and chin cups are more effective in early childhood, mixed dentition, during permanent teeth eruption, with no significant skeletal discrepancy. If a discrepancy exists, a face mask is the first therapy choice. The therapy of an underdeveloped maxilla can be solved with different palate expanders. Bulkiness, lack of long-term results, and duration of therapy make fixed orthodontic appliances with braces and elastic traction favorable nowadays. If the skeletal discrepancy is major, a surgical approach should be considered. One of the main limitations in articles is the combination of different therapy approaches, ages, and dentition preferred for device application, duration of therapy, and lack of information about long-term outcomes. On the other hand, the lack of original articles is noticeable, so further research should be done. Full article

Background and Objectives: Halitosis is a persistent oral health issue that can undermine self-esteem and social interactions, particularly in younger populations who may be more vulnerable to peer judgment. Orthodontic retainers—both removable and fixed—can alter oral microbiota and salivary parameters, potentially influencing malodor development. This study aimed to compare halitosis severity and oral-health-related quality of life (OHRQoL) in adolescents and young adults (aged 12–25) wearing removable retainers, fixed retainers, or no orthodontic appliances, with an additional focus on salivary pH as a possible modifying factor. Methods: A total of 88 participants were allocated into three groups: removable retainer (n = 28), fixed retainer (n = 30), and no orthodontic treatment (n = 30). Halitosis severity was measured via organoleptic evaluation (0–5 scale) and the Halitosis Associated Life-Quality Test (HALT, 0–100). Salivary pH was determined using a digital pH meter. OHRQoL was assessed through the Oral Health Impact Profile–14 (OHIP-14, 0–56). One-way ANOVA with Tukey’s post hoc test and chi-square analyses were employed to compare outcomes among groups. Spearman’s correlation explored relationships among HALT, organoleptic scores, OHIP-14, and salivary pH. Results: Fixed retainer wearers exhibited higher mean organoleptic scores (2.2 ± 0.6) compared to removable retainer users (1.7 ± 0.5, p = 0.003). HALT results similarly showed that the fixed retainer group (35.6 ± 6.4) reported more halitosis-related burdens than the removable group (31.4 ± 5.9, p = 0.015). Low salivary pH (<6.8) was linked to greater malodor indices in all cohorts (p < 0.05). Correlations revealed moderate positive associations between HALT and OHIP-14 (r = +0.52, p < 0.001). Conclusions: Adolescents and young adults wearing fixed orthodontic retainers reported more severe halitosis and a correspondingly lower oral-health-related quality of life than those with removable retainers or no orthodontic appliances. Salivary pH emerged as an influential factor, indicating that maintaining a neutral oral environment could mitigate malodor. Targeted interventions emphasizing hygiene and saliva management may improve overall well-being in this vulnerable age group. Full article

Background/Objectives: The growing demand for esthetic, less painful, and more comfortable orthodontic treatment has led to increasing use of aligner systems. Initially used for less complicated malocclusions, aligners are now being incorporated into complex treatment plans, including cases involving impacted teeth. While aligners are a popular alternative to traditional fixed appliances, they still have limitations. This study aims to evaluate the effectiveness of aligner-based orthodontic treatment in patients with impacted or significantly ectopic canines. Methods: This study was conducted in accordance with the PRISMA guidelines. The search terms used were as follows: ‘Clear Aligner’ OR ‘Invisalign’ AND ‘Impacted Canine’ OR ‘Impacted Tooth’ OR ‘Ectopic Tooth’ OR ‘Ectopic Canine.’ A total of 1101 records were identified, of which 170 articles underwent screening. Fifteen articles were assessed for eligibility, and ultimately six case reports and one three-dimensional finite element analysis (FEA) study were included for both quantitative and qualitative synthesis. Results: According to the studies, additional appliances are often required to achieve favorable outcomes when treating impacted canines with aligner systems. Temporary anchorage devices (TADs) were used in 5 out of 9 reported cases for canine traction into the dental arch. In three cases, TADs were combined with sectional wires implemented as cantilevers. Elastics were used in 6 out of 9 cases for traction to the opposite arch, and in 5 out of 9 cases as interarch elastics attached to the aligners. Interarch elastics were applied in various ways, either directly to the aligners or to primary canines using hidden buttons inside pontics or dovetail hooks. Elastics were also anchored to the lower arch with class II, class III, or cross-arch (criss-cross) mechanics. Conclusions: This review highlights the promising potential of aligner systems in the treatment of impacted canines. However, additional auxiliaries, such as TADs, sectional wires, or elastics remain nearly essential for initial canine traction. Aligner systems offer versatile treatment options, and the possibility of reduced treatment time represents a valuable area for future research. Full article

Background and Objectives: The most common method for treating malocclusions today is fixed orthodontic therapy, during which brackets and tubes are bonded to the surface of the teeth, which makes oral hygiene difficult to maintain. Increased plaque retention, gingival bleeding, and gingivitis can be diagnosed in the early phases of treatment. The periodontal response to plaque accumulation can be explained by quantitative and qualitative changes in the subgingival microbiota. The aim of our research was to investigate the changes in the subgingival microbiota that occurred within 6–8 weeks after bonding when two different orthodontic adhesives were used. Materials and Methods: Thirty patients were followed; molar tubes were bonded with a composite (C) in fifteen cases, and in the other fifteen cases, they were bonded with glass ionomer cementum (GIC). A microbiological sample was taken from the gingival sulcus of the maxillary first molars at the time of appliance placement (T1) and 6–8 weeks (T2) after bonding. Bacterial DNA detection was performed using the micro-IDent^®plus11 (Hain Lifescience GmbH, Germany) PCR (polymerase chain reaction) method. The statistical analysis included McNemar’s test to analyze the paired binary data and Fisher’s Exact Test to compare the prevalence of each of the 11 bacteria at T1 and, ultimately, T2 between the two studied groups. The Bonferroni correction was also applied. Results: When analyzing GIC vs. C at T1 and T2, none of the studied pathogens showed significant differences. Conclusions: Given the lack of statistical significance, these trends do not confirm a definitive impact of the procedure on bacterial presence. The increased presence of periodontal pathogens might suggest that bonding does not reduce the bacterial loading of subgingival microbiota. Less protective effects of the GIC intervention against Tannerella forsythia and Eubacterium nodatum bacteria were detected. Full article

Nickel-containing orthodontic archwires, particularly those made of nickel-titanium (NiTi) and stainless steel (SS), play a crucial role in orthodontic treatment using the fixed technique due to their mechanical properties. However, concerns regarding nickel-induced allergic reactions, cytotoxicity, and metal ion release, especially nickel-related ones, persist. This narrative review aims to explore recent findings on nickel release from orthodontic appliances, building upon prior systematic reviews by analyzing both in vitro and in vivo studies under various environmental conditions. The databases Web of Science, Scopus, and PubMed were searched for relevant studies that examined the relationship between nickel ion release from nickel-containing archwires and various environmental conditions. The studies found indicate that while metal ion release occurs during short-term treatment, the levels are lower than harmful thresholds, with factors such as pH, corrosion, length of treatment, and environmental influences affecting release rates. Despite this, long-term studies are few and are usually conducted only in an in vitro or in vivo environment, but not both. To establish causal relationships regarding metal ion release, in vivo monitoring of ions like Ni is critical, with further research needed to assess its prolonged effects. Furthermore, collaborative efforts among practitioners, researchers, and regulatory bodies are vital for developing evidence-based guidelines for orthodontic material selection, prioritizing patient safety and addressing metal ion release risks. Full article