Search Results (26)

Background/Objectives: Multi-bracket appliances are essential in surgical orthodontic treatment, and perioperative oral management during orthognathic surgery is critical. Thorough plaque control, appropriate use of antibiotics, and shortening of operative time have been reported to be effective in preventing postoperative infections and ensuring surgical success. As highly invasive orthognathic surgery involving osteotomy may influence the postoperative oral microbiota, this study aimed to investigate the characteristics of and clarify the changes occurring in the salivary oral microbiota after orthognathic surgery. Methods: The study included 14 patients (Group S; mean age 29.3 ± 9.8 years) who underwent surgical orthodontic treatment and 15 control patients (Group C; mean age 27.1 ± 8.7 years) who received orthodontic treatment alone. Salivary samples were analyzed via 16S rRNA gene sequencing, and the relative abundances of bacteria were evaluated using the Linear Discriminant Analysis Effect Size. Results: The prevalence of Neisseria, which is associated with early biofilm formation, decreased over time in both groups. In contrast, Streptococcus exhibited an increase in prevalence. In Group S, members of Pseudomonas, the family Saccharimonadaceae, and the order Rhizobiales showed increases at 5–8 months post-surgery. Conclusions: Surgical orthodontic treatment may influence the oral microbiota and promote colonization by opportunistic pathogens. Instructions regarding oral hygiene and appropriately timed professional cleaning interventions are critical in preventing such colonization. Longitudinal monitoring of the microbiota using metagenomic analysis may be useful for future perioperative management and guidance of oral hygiene. 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

Background: Halitosis is frequently observed in patients undergoing orthodontic treatment with multibracket appliances, primarily due to volatile sulfur compounds (VSCs) produced by oral anaerobic bacteria. Cetylpyridinium chloride (CPC) is a widely used antimicrobial agent in oral care products and may help alleviate halitosis.This study aimed to evaluate the effects of 0.05% CPC mouthwash on halitosis, oral hygiene indices, and the tongue microbiota in orthodontic patients with elevated VSC levels. Methods: In this randomized, double-blind, placebo-controlled clinical trial, 30 orthodontic patients with elevated VSCs (≥150 ppb) were assigned to a CPC mouthwash group or a placebo group. Participants used the assigned mouthwash three times daily for 1 month. Halitosis was quantitatively assessed by gas chromatography (Oral Chroma™), and oral hygiene parameters including Plaque Index (PI), Gingival Index (GI), Tongue Coating Index (TCI), and unstimulated salivary flow rate were evaluated at baseline and after the intervention. The tongue microbiota was analyzed by 16S rRNA sequencing. Results: The CPC mouthwash group showed significant reductions in total VSCs, hydrogen sulfide, methyl mercaptan, PI, GI, and TCI (p < 0.05), while salivary flow rate and dimethyl sulfide remained unchanged. Microbiome analysis revealed decreases in halitosis-associated genera (Actinomyces, Corynebacterium, Tannerella) and increases in beneficial species such as Streptococcus salivarius. Conclusions: CPC mouthwash (0.05%) effectively reduced halitosis and improved oral hygiene parameters in orthodontic patients, likely through modulation of the tongue microbiota. This mouthwash may serve as a safe and practical adjunct to conventional oral hygiene practices during orthodontic treatment. Full article

Clear aligner treatment seems to be a good option for the periodontal patient by the reason of being removable. Multibracket appliances are more difficult to mantain clean and some bacteria might prefer to adhere on the archwire. A systematic review was carried out using 4 electronic databases (Pubmed-Medline, Scopus, Cochrane and Web of Science). The selected trials included quantitative (Shannon index, Simpson index, relative abundances) and/or qualitative (alpha and beta diversity) analysis in patients using clear aligners and multibracket appliances. Initially, a total of 123 articles were found after selecting clinical trials. The inclusion and exclusion criteria were applied by two authors. Finally, 20 articles were selected for the systematic review. The results showed that clear aligner treatment produced less dysbiosis in the selected bacteria compared to multibracket appliances. However, some microbiological changes were observed in some articles during clear aligner use. Oral dysibiosis was related with intestinal dysbiosis, inflammatory response and even cancer. The Firmicutes/Bacteroidetes ratio showed to have a very important role in this development. Periodontitis is also a bacterial disease and clear aligners were recommended to periodontal risk patients. Clear aligner treatment obtained less supra and subgingival biofilm changes compared with multibracket appliances but some bacteria were altered during treatment. Full article

Background: The aim of the present study was to assess the accuracy, repeatability and reproducibility of a novel digital technique to analyze the remaining cement after debonding lingual multibracket appliances and after polishing the remaining cement. Methods: Thirteen teeth were embedded in an epoxy resin simulating a dental arch and subsequently a digital impression was taken using an intraoral scanner; obtaining a standard tessellation language (STL1) digital file. Lingual multibracket appliances were bonded and debonded on the lingual surfaces of all teeth and another digital impression was made (STL2). Finally, the polishing procedure of the remaining cement was performed and a digital impression was taken (STL3). The teeth were individually segmented from the digital files and an alignment was performed between STL1 and STL2 and between STL1 and STL3 digital files using specific cephalometric 2D/3D software to assess the remaining cement after debonding and after polishing lingual multibracket appliances. The reproducibility and repeatability capacity of the measurement digital method was assessed using a Gage R&R statistical analysis. Results: The results were assessed by a statistical program and showed a statistically significant (p < 0.001) decrease in weight, thickness, and height of the cement remaining after polishing, with a mean decrease of 2.09 mm in width (X plane), 0.12 mm in thickness (Y plane), and 1.87 mm in height (Z plane). Conclusions: The use of novel digital diagnosis software is a repeatable, reproducible, and accurate measurement technique to analyze the remaining cement after debonding lingual multibracket appliances and after polishing the remaining cement. Practical Implications: The diagnosis cephalometric software evaluation of the polishing technique with different materials, burs or polishing sequences brings the research closer to the clinical field. This methodology allows the orthodontist to clinically measure the cement remnants after polishing without the need for teeth extraction and with current clinic objects such as intraoral scanning and orthodontic cephalometric software. This might give orthodontics more clearance in terms of better burs or protocols for polishing. Full article

Periodontal patients may face orthodontic problems because of bone support loss, such as maxillary incisor proclination, spacing, rotation, extrusion, pathologic tooth migration (PTM) or traumatic occlusion. Orthodontic treatment is therefore an element within the comprehensive treatment of periodontitis after the periodontal condition has stabilized. The presence of fixed appliances (FAs) promotes the accumulation of bacterial biofilm and impedes hygiene procedures. The increasing popularity of clear aligner (CA) treatment is due to the convenience of use, less discomfort, better esthetics, easier hygiene, lower failure rate, and shorter, less frequent visits. Therefore, the question arises whether treatment with aligners is a good solution for periodontal patients. To answer this question, the PubMed/Medline, Cochrane Library and EMBASE databases were searched using the following keywords: periodontitis, orthodontic treatment, clear aligners, multibracket orthodontic appliances, fixed appliance, root resorption, gingival recession and pathologic tooth migration. The search strategy identified 18 relevant studies. A total of 1090 participants took part in the analyzed studies. The available literature was analyzed in terms of the occurrence of root apex resorption, the possibility of treating pathologic tooth migration, the occurrence of gingival recession, periodontal health status and occlusal stability in patients treated with CAs and FAs. Despite statistically significant differences in terms of Plaque Index (PI), probing depth (PD), apical root resorption and gingival recession favor the use of CAs. However, these values are mostly of no clinical significance. It is possible to treat PTM with CAs, but it is limited by the high degree of tooth mobility and incisor inclination. Obtaining perfect occlusion is comparably difficult in both CA and FA treatment. When planning orthodontic treatment in patients with reduced periodontium, the use of both CAs and FAs should be considered. The choice of method would ultimately depend on the patient’s dental condition. Full article

Background: This longitudinal prospective study aimed to assess orthodontic patients’ immune system response to metal ion release in saliva. Methods: Thirty adult patients (18–35 years) were equally divided into three groups: groups at the end (G1) and beginning (G2) of multibracket appliances (MBA) treatment and a non-treated control group (G3). Participants were evaluated at four timepoints within 21 days, with saliva samples being analyzed for metal ion concentrations and blood for the lymphocyte transformation test (LTT). Results: There were no significant differences between groups or timepoints for saliva. LTT analyses revealed hypersensitivity in one-third of all patients and 50% of G2 for nickel, with three developing sensitizations after MBA insertion. All nickel-sensitized patients exhibited varying elevated saliva nickel concentrations. The most nickel-sensitized patients had low ion saliva loads. In borderline nickel-sensitization cases, saliva ion concentrations were up to 20 times higher than the reference. Hypersensitivity to palladium, gold, and mercury was also observed. Conclusions: These findings indicate that increased MBA ion release was not inherently linked to the immune response (Type-IV sensitization), as reactions occurred even with ion levels below thresholds. This underlines the need for a comprehensive evaluation of the immune response to metal ion release in orthodontic patients. Full article

Background: Rapid maxillary expansion is a common therapy when a palatal transversal discrepancy occurs. Different anchorage solutions have been proposed to obtain an effective skeletal expansion, even for adult patients. The aim of the present research was to evaluate the dentoskeletal effects of a hybrid expander and multi-bracket therapy, considering three groups of patients with different cervical vertebral maturation (CVM) stages. Materials and Methods: The study evaluated 68 consecutively treated patients. The age of the patients varied from 7 to 27 years old (mean age 13.45). The sample was divided into the following three groups based on CVM stage at the start of treatment: Group 1 (CS1–CS2) included 21 patients (mean age 10.21, SD 1.34), Group 2 (CS3–CS4) included 28 patients (mean age 13.37, SD 1.37) and Group 3 (CS5–CS6) was composed of 19 patients (mean age 17.14, SD 3.48). Each patient underwent orthodontic therapy where the first step was a palatal expansion by means of a hybrid expander; afterwards, the therapy was completed with a multi-bracket appliance. Expansion and torque values were observed at the end of treatment on digital models. Results: Significant intragroup differences in transversal expansion were found over time for all parameters in all groups. No significant differences were found among groups for longitudinal changes. No significant differences were found among groups for longitudinal changes of torque. Conclusions: The tooth–bone-borne maxillary expander and multi-bracket produced a significant clinical expansion with negligible dental compensation. The effect of the maxillary expansion and multi-bracket therapy showed no differences among the maturation groups in regard to transversal diameter changes and torque values. Full article

Multi-bracket appliances have long been established as tools for treating malocclusions. However, the complex construction and difficulty in cleaning due to their long-term intraoral retention have hindered the prevention of caries and periodontitis. In this study, professional mechanical tooth cleaning (PMTC), including tooth-brushing instructions, was continuously performed for 3 months in 24 patients who had worn multi-bracket appliances for more than 6 months, and changes in the oral and gut microbiota were examined using one-way repeated-measures analysis of variance. Additionally, changes in bacterial flora associated with different treatment durations were verified using the Pearson correlation coefficient. The results showed that continuous PMTC significantly reduced the amount of plaque in the oral cavity. No significant changes were observed in the oral or gut microbiota and no significant increase in pathogenic bacteria was observed. Therefore, our results suggest that continuous PMTC during orthodontic treatment with multi-brackets may inhibit the growth of pathogenic bacteria by maintaining a clean oral environment and avoiding dysbiosis in both the oral and gut microbiota. Significant changes in the gut microbiota with different treatment durations suggested that differences in food intake and food choices at each treatment stage of orthodontic treatment may affect the gut microbiota. Full article

Objective: Intermaxillary elastics, anchored skeletally, represent a promising concept for treatment in adolescent patients with skeletal Class III anomalies. A challenge in existing concepts is the survival rate of the miniscrews in the mandible or the invasiveness of the bone anchors. A novel concept, the mandibular interradicular anchor (MIRA) appliance, for improving skeletal anchorage in the mandible, will be presented and discussed. Clinical case: In a ten-year-old female patient with a moderate skeletal Class III, the novel MIRA concept, combined with maxillary protraction, was applied. This involved the use of a CAD/CAM-fabricated indirect skeletal anchorage appliance in the mandible, with interradicularly placed miniscrews distal to each canine (MIRA appliance), and a hybrid hyrax in the maxilla with paramedian placed miniscrews. The modified alt-RAMEC protocol involved an intermittent weekly activation for five weeks. Class III elastics were worn for a period of seven months. This was followed by alignment with a multi-bracket appliance. Discussion: The cephalometric analysis before and after therapy shows an improvement of the Wits value (+3.8 mm), SNA (+5°), and ANB (+3°). Dentally, a transversal postdevelopment in the maxilla (+4 mm) and a labial tip of the maxillary (+3.4°) and mandibular anterior teeth (+4.7°) with gap formation is observed. Conclusion: The MIRA appliance represents a less invasive and esthetic alternative to the existing concepts, especially with two miniscrews in the mandible per side. In addition, MIRA can be selected for complex orthodontic tasks, such as molar uprighting and mesialization. Full article

This study aimed to investigate the transfer accuracy and required time for digital full-arch impressions obtained from intraoral scanners (IOSs) versus conventional alginate impressions (CAIs) in patients with multibracket appliances (MBA). Thirty patients with buccal MBAs (metal brackets, archwire removed) were examined using an established reference aid method. Impression-taking using four IOSs (Primescan, Trios 4, Medit i700, Emerald S) and one CAI with subsequent plaster casting were conducted. One-hundred-twenty (n = 30 × 4) scans were analyzed with 3D software (GOM Inspect) and 30 (n = 30 × 1) casts were assessed using a coordinate measurement machine. Six distances and six angles were measured and compared to the reference aid values (ANOVA; p < 0.05). Except for the intermolar distance, transfer accuracy was significantly higher with IOSs than with CAIs (p < 0.05). No such difference was found regarding the six angles. In patients with MBAs, digital impression-taking using IOSs can be recommended. For all measured variables except one, the transfer accuracy of IOSs was better than or at least equivalent to the data from CAIs. In addition, significantly (p < 0.001) less time was necessary for all IOSs in comparison to CAIs plus plaster casting. Full article

Objective: This integrative review aimed to identify studies comparing the periodontal health in patients wearing multibracket orthodontic appliances and clear aligners. Materials and methods: An integrative literature search was performed through different databases, PubMed/Medline, PMC, and the Cochrane Library. This work was submitted to a search strategy following the PICO method and included the focus question: “Could the chosen orthodontic appliance change significantly the oral hygiene of the patient, impairing the periodontal health?” This work included analytical and controlled studies on humans published between 2005 and 2020, in the English language, establishing a comparison of the periodontal status in patients undergoing orthodontic multibracket and clear aligners therapies. The main periodontal indexes assessed were plaque index (PI), pocket depth (PD), gingival index (GI), and bleeding on probing (BoP). Results: The electronic research displayed 386 articles on PMC, 106 on PubMed, and 40 on the Cochrane Library. After removal, just 25 articles were selected for full-text screening, but just eight studies were eligible for this integrative review. It was enumerated that 204 patients were treated with aligners and 294 with multibracket orthodontic appliances, mainly elastomeric ligated brackets. Only the plaque index displayed a significant difference between the two groups and general data obtained showed a better control for periodontal health in the clear aligners. Limitations such as age, malocclusion severity, therapeutic choice, and different time measure was observed. In addition, the oral hygiene instruction and follow-up by a professional were different, and the role of malocclusion was not present in the studies. Conclusions: Within the limitations of this study, better results for periodontal health were found in the clear aligners. Therefore, more studies are necessary to affirm that aligners are synonymous with better gingival conditions in comparison with multibracket appliances. Other variables such as oral hygiene instructions, motivation, and supportive treatment tend to be more prevalent than the type of appliance itself in the periodontal evaluation. Full article

The aim of this study was to evaluate the oral-health-related quality of life (OHRQoL) and anxiety levels of adult patients undergoing orthodontic treatment with fixed multibracket appliances. Materials and Methods: The study was carried out at the Dental Clinic of the University of Salamanca in 2021. It included 120 adult patients between 19 and 45 years of age undergoing orthodontic treatment with conventional metal brackets. The data collection instruments chosen were the state–trait anxiety inventory (STAI) to assess anxiety levels and the OHIP-14 questionnaire to measure the OHRQoL. Anxiety levels and OHRQoL were analyzed one month after starting treatment. Results: The mean age was 31.7 years ± 6.5 years; 68 patients were women (56.7%) and 52 were men (43.3%). Psychological disability was the dimension of the OHIP-14 questionnaire that was found to have the greatest impact (3.20 ± 1.08) on patients, as compared to the dimension of disability, which had the lowest impact on the oral-health quality of life (0.37 ± 0.56). The mean total score of the OHIP-14 questionnaire was 11.93 (±2.19). There was no statistically significant influence from either sex or age on the anxiety and oral-health quality of life of the participants; however, there was a significant relationship between the dimensions of physical disability and anxiety traits. Conclusions: The physical disability dimension of the OHIP-14 questionnaire increased the anxiety level of adult patients treated with conventional brackets. The impact of orthodontic treatment on adult patients may negatively influence their levels of anxiety. Full article

One of the risks that we find after orthodontic treatment is the secondary appearance of white spot lesions (WLS) after the removal of fixed multi-bracket appliances. Today, there are several treatment methods, resin infiltration being the most used in the most serious cases. The objective of this study is to carry out a systematic review and meta-analysis to determine the efficacy and stability in the variables of color and gloss, six months after resin infiltration. A comprehensive search was performed in the following databases: PubMed, Embase, Google Scholar, Scopus, Medline, and Web of Science. Articles published in the last 10 years were selected, including in vivo studies with a six-month follow-up. PRISMA guidelines were followed to carry out this systematic review. All studies where the application of resin was performed on carious lesions were discarded. Once the inclusion and exclusion criteria were applied, a final sample of four articles was obtained, on which the review and meta-analysis were carried out. Once examined, all authors considered that there was an immediate improvement in both variables. However, statistically significant differences were obtained in the color change outcome, but not in the brightness outcome in the subgroup analysis after six months of icon resin infiltration. Full article

Background. Coronavirus disease has subjected the whole of humanity to two years of social isolation and a series of restrictions. These circumstances have led to the use of information technology in an increasingly widespread manner. Even in the dental field, telematic means have been used to respond to emergencies. The aim of this systematic review of the literature is to evaluate the types of orthodontic emergency that occurred most often and how they were managed by teleorthodontics during the COVID-19 pandemic. The secondary aim is that clinicians will use teleorthodontics not only during pandemics but as an additional tool to manage orthodontics. Materials and Methods. Out of 1695 articles available on PubMed, Science Direct, Cochrane and SciELO, eight articles were selected for this systematic literature review. Google Scholar was used as a secondary source to confirm that there were no additional articles. The screened papers comprised editorials, clinical studies, cross-sectional studies and retrospective studies in Italian, English or Spanish language. Results. The articles showed that the means by which patients most often communicated with their orthodontists were voice calls and smartphone applications such as WhatsApp^® Messenger. Through these media, patients communicated their orthodontic emergencies. These mainly involved fixed multibracket appliances and the most common issues were discomfort and pain, fracture or loss of the appliance, protruding distal ends of archwires, brackets, tubes and bands or retainer detachment. Through teleorthodontics, patients could solve these issues by using orthodontic relief wax, cutting the protruding distal ends of the archwire with a nail clipper or a stronger cutter and removing or replacing detached bands, brackets, tubes or metallic ligature with a clean tweezer. Conclusions. In situations where personal contact is limited, teleorthodontics represents a valuable aid for professionals and patients facing orthodontic emergencies. The hope is that it may continue to represent a valuable aid for patients with difficulties in planning an in-office visit. Full article