Search Results (13)

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

Due to dental diseases, anatomical restrictions, and mixed dentition, the reduction in the number of teeth and the displacement of tooth germs pose challenges in orthodontic treatment, limiting anchorage options. The presented case demonstrates an advanced treatment solution using digital CAD/CAM-technologies and medical imaging for the creation of a mini-implant template. A 12-year-old male patient experiencing delayed tooth eruption, multiple impacted germs, and maxillary constriction underwent intraoral scanning and CBCT. Utilizing coDiagnostiX^TM Version 10.2 software, the acquired data were merged to determine the mini-implant placement and to design the template. The template was then manufactured through stereolithography using surgical-guide material. Mini-implants were inserted using the produced appliance, enabling safe insertion by avoiding vital structures. Surgically exposed displaced teeth were aligned using a Hyrax screw appliance anchored on the mini-implants for rapid palatal expansion (RPE) and subsequently used as fixed orthodontics to align impacted teeth. The screw was activated daily for 10 weeks, resulting in a 7 mm posterior and 5 mm anterior maxillary transversal increase. Skeletal anchorage facilitated simultaneous RPE and tooth alignment, ensuring accuracy, patient safety, and appliance stability. The presented case shows a scenario in which computer-aided navigation for mini-implant positioning can enhance precision and versatility in challenging anatomical cases. Full article

Background: Temporary anchorage devices (TADs) are broadly used in orthodontic treatment. TADs must be placed accurately to avoid collision against tooth roots. To place miniscrews with a higher accuracy, a digitally designed surgical guide was proposed in previous studies. However, to our knowledge, there have been no articles that have assessed the minimal required length to achieve good drilling accuracy. The objective of the present study was to evaluate the accuracy of pre-drilling using computer-aided designed surgical guides with different lengths. Methods: A typodont model was scanned, and surgical guides of 3.0, 4.5, and 6.0 mm were designed. Duplicated typodonts and the surgical guides were printed with a 3D printer. Using these models and surgical guides, pre-drillings were performed. Freehand drilling was also conducted for the control. The drilled models were scanned with micro-computed tomography to evaluate the accuracy. Results: The mean errors at the tip of the drill were 0.44 mm, 0.61 mm, 0.41 mm, and 0.24 mm for the freehand drilling, and 3.0, 4.5, and 6.0 mm for the surgical guide, respectively. Conclusion: The results suggested that a longer surgical guide was recommended to achieve good insertion accuracy for a narrow interradicular space, and that 3.0 mm was enough when an error of 1.0 mm was acceptable for the insertion site. Full article

The optimal insertion torque (IT) for orthodontic anchoring screws (OASs) was hypothesized to vary with OAS features and insertion methods. This review examines the indexed English literature, to determine the appropriate IT range for OAS success based on area of insertion and OAS features. Eleven original articles with OAS placement in humans including IT and success rate were selected and were used to evaluate the relationships among IT, success rates, screw design, and placement methods at different sites. The ITs and success rates ranged from 6.0 ± 3.2 to 15.7 ± 2.3 Ncm and from 62.5 to 100.0% in the upper and lower buccal alveolar areas, respectively. For the mid-palatal area, the range was 14.5 ± 1.6 to 25.6 ± 5.5 Ncm and 83.0 to 100.0%, respectively. ITs of 5–12 and 6–14 Ncm were found to be optimal for the commonly used φ1.5–1.7 mm OASs in the upper and lower interproximal areas, respectively. In the mid-palatal suture area, ITs of 11–16 and 20–25 Ncm were considered suitable for tapered φ1.5 mm and φ2.0 mm OASs, respectively. Although identified optimal IT ranges deserve the recommendations, care must be taken to monitor the IT during placement constantly. Full article

A lateral load was applied to anchor screws that had undergone surface treatment, and the structure, cellular dynamics, and quality of the bone surrounding anchor screws were analyzed to investigate the effect of this surface treatment on the peri-implant jawbone. In addition, bone microstructural characteristics were quantitatively evaluated for each site of loading on the bone around the anchor screw. Rats were euthanized after observation on days 3, 5, or 7, and bone quality analyses were performed. Bone–implant contact rate increased more rapidly at an early stage in the treated surface group than in the untreated surface group. Bone lacuna morphometry showed that the measured values adjacent to the screw at the screw neck on the compressed side (A) and at the screw tip on the uncompressed side (D) were significantly lower than those at the screw tip on the compressed side (B) and at the screw neck on the uncompressed side (C). Collagen fiber bundle diameter showed that the measured values adjacent to regions A and D were significantly higher than those at regions B and C. Anchor screw surface activation facilitates initial bone contact of the screw, suggesting that early loading may be possible in clinical practice. Full article

This study aimed to determine whether the positional relationship between the underside of the screw head and the surface of the alveolar bone could alter the stress on the two surfaces and affect the stability of implanted anchor screws. First, in order to confirm the extent of the gap between the mini-screw and the bone surface, a mini-screw was placed in the palate of rabbits and examined histologically. As a result, in the conventional screw implantation procedure, oral mucosa between the base of the screw head and the bone creates a spatial gap. Removal of the oral mucosa eliminates this gap. Then, we compared the positional difference of the screw in a contact and gap group by analyzing stress distribution on the bone and screw. Analysis using the finite element method showed that more stress was loaded on both the bone and screw in the gap group than in the contact group. Cortical bone thickness did not affect stress in either group. The effects of different load strengths were similar between groups. A surgical procedure in which mucosal coverings are removed so that implanted anchor mini-screws are in contact with the bone surface was found to reduce the stress load on both the bone and screw. This procedure can be used to prevent undesirable dislodgement of implanted mini-screws. Full article

Purpose: In recent years, a method for improving gummy smiles in adults using an orthodontic anchor screw has been reported, but there is yet to be a treatment for the gummy smiles of those in the growth period. Methods: We improved the gummy smiles of three class II patients with vertical excessive growth of the upper jaw, during their growth period, using a simple bite jumping appliance (SBJA) and a high pull J-hook headgear. Results: It was found that SBJA promoted mandibular growth and the high-pull J-hook headgear inhibited the vertical growth of the maxillary anterior teeth. Conclusion: It is suggested that a combined use of high-pull J-hook headgear and SBJA is an effective way of improving gummy smiles in class II patients with vertical excessive growth of the upper jaw during their growth period. Full article

Background: More efficient molar distalization is demanded in orthodontics to shorten treatment times. In the present study, we propose a novel technique to improve force distribution to distalize molars more efficiently by using open-coil springs and an anchor screw. We conducted a finite element analysis to assess the efficiency of the proposed technique. Methods: A three-dimensional finite element model of an upper dental arch with brackets and an archwire was constructed based on cone-beam computed tomography. We analyzed two distalization methods: a conventional grouped distalization technique (NoSp model), and our proposed technique using open coils (Sp model). Finite element analyses were performed to evaluate long-term tooth movement in both techniques. Results: The distalization force was more evenly distributed in the Sp model than in the NoSp model. Moreover, less concentration of compressive stress in the periodontal ligament (PDL) was observed in the Sp model. The force systems of the two models became more similar as the distalization progressed. However, the NoSp model still showed higher stress concentration at the end of the simulation. Conclusions: Inserting open-coil springs between distalized teeth improved the distribution of the force significantly. The conventional grouped distalization method might cause stress concentration at the first premolar, indicating risks of the hyalinization of the PDL and root resorption. Full article

(1) Background: Mandibular deficiency is one of the most common growth disorders of the facial skeleton. Recently, distraction osteogenesis has been suggested as the treatment of choice for overcoming the limitations of conventional orthognathic surgery; (2) Methods: A new custom-manufactured dental-anchored distractor was built and anchored in the first molar and lower canine. It consists of a stainless-steel disjunction screw, adapted and welded to the orthodontic bands through two 1.2 mm diameter connector bars with a universal silver-based and cadmium-free solder; (3) Results: The distractor described can be a useful tool to correct mandibular retrognathia and is better tolerated by patients, especially in severe cases; (4) Conclusions: The dental-anchored distractor increases the anterior mandibular bone segment without affecting the gonial angle or transverse angulation of the segments and avoids posterior mandibular rotation, overcoming the limitations of conventional surgical treatment. Full article

Bone-anchored maxillary protraction (BAMP) is effective for skeletal Class III malocclusion. However, infection, screw and plate loosening, and device failures occur with conventional plates. This pilot prospective study analyzed the feasibility of individualized BAMP using preoperative simulation and 3D titanium printing in patients referred by the orthodontic department for four BAMP miniplates. Preoperative cone beam computed tomography data were analyzed using CAD/CAM software to fabricate the individualized 3D-printed BAMP device. The customized plates were printed using selective laser sintering and inserted onto the bone through an adjunct transfer jig. The accuracy of preoperative simulation and actual placement of the BAMP device were tested by superimposing simulated positioned digital images and postoperative computed tomography data. The growth modification effect depended on superimposition of lateral cephalograms and comparative changes in SNA, SNB, ANB, and Wits. Two male patients were finally included in the study. BAMP decreased the ANB difference (−4.56 to −1.09) and Wits appraisal (−7.52 to −3.26) after 2 years. Normal measurement indices for sagittal and vertical growth indicated successful growth modification. The mean accuracy between preoperative simulation and actual surgery was 0.1081 ± 0.5074 mm. This treatment modality involving preoperative simulation and 3D titanium printing for fabricating and placing customized BAMP devices precisely at planned locations is effective for treating skeletal Class III malocclusion. Full article

The main objective of this research is to establish a connection between orthodontic mini-implant design, pull-out force and primary stability by comparing two commercial mini-implants or temporary anchorage devices, Tomas^®-pin and Perfect Anchor. Mini-implant geometric analysis and quantification of bone characteristics are performed, whereupon experimental in vitro pull-out test is conducted. With the use of the CATIA (Computer Aided Three-dimensional Interactive Application) CAD (Computer Aided Design)/CAM (Computer Aided Manufacturing)/CAE (Computer Aided Engineering) system, 3D (Three-dimensional) geometric models of mini-implants and bone segments are created. Afterwards, those same models are imported into Abaqus software, where finite element models are generated with a special focus on material properties, boundary conditions and interactions. FEM (Finite Element Method) analysis is used to simulate the pull-out test. Then, the results of the structural analysis are compared with the experimental results. The FEM analysis results contain information about maximum stresses on implant–bone system caused due to the pull-out force. It is determined that the core diameter of a screw thread and conicity are the main factors of the mini-implant design that have a direct impact on primary stability. Additionally, stresses generated on the Tomas^®-pin model are lower than stresses on Perfect Anchor, even though Tomas^®-pin endures greater pull-out forces, the implant system with implemented Tomas^®-pin still represents a more stressed system due to the uniform distribution of stresses with bigger values. Full article

This study aims to compare the torque values for various lengths of the titanium-based orthodontic anchor screw (OAS), different anchorage methods and varying artificial bone densities after predrilling. Furthermore, the effects of these parameters on bone stability are evaluated. A total of 144 OASs were prepared with a diameter of 1.6 mm and heights of 6, 8 and 10 mm. Artificial bones were selected according to their density, corresponding to Grades 50, 40 and 30. Torque values for the automatic device and manual anchorage methods exhibited a statistically significant difference for the same-sized OAS, according to the bone density of the artificial bones (p < 0.05). However, when insertion torque was at the maximum rotations, there was no significant difference in the torque values for the Grade 30 artificial bone (p > 0.05). When the torque values of both anchorage methods were statistically compared with the mean difference for each group, the results of the manual anchorage method were significantly higher than those of the automatic device anchorage method (p < 0.05). A statistically significant difference was observed in the bone stability resulting from different OAS anchorage methods and artificial bone lengths. These findings suggest that the automatic anchorage method should be used when fixing the OAS. Full article

Maxillary expansion is a common orthodontic treatment used for the correction of posterior crossbite resulting from reduced maxillary width. Transverse maxillomandibular discrepancies are a major cause of several malocclusions and may be corrected in different manners; in particular, the rapid maxillary expansion (RME) performed in the early mixed dentition has now become a routine procedure in orthodontic practice. The aim of this study is to propose a procedure that reduces the patient cooperation as well as the lab work required in preparing a customized Haas-inspired rapid maxillary expander (HIRME) that can be anchored to deciduous teeth and can be utilized in mixed dentition with tubes on the molars and hooks and brackets on the canines. This article thus presents an expander that is completely digitally developed, from the first moment of taking the impression with an optical scanner to the final solidification phase by the use of a 3D printer. This digital flow takes place in a CAD environment and it starts with the creation of the appliance on the optical impression; this design is then exported as an stl extension and is sent to the print service to obtain a solid model of the device through a laser sintering process. This “rough” device goes through a post-processing procedure; finally, a commercial expansion screw is laser-welded. This expander has all the advantages of a cast-metal Haas-type RME that rests on deciduous teeth; moreover, it has the characteristic of being developed with a completely digitized and individualized process, for the mouth of the young patient, as well as being made completely of cobalt-chrome, thus ensuring greater adaptability and stability in the patient’s mouth. Full article