Search Results (282)

The aim of this study was to compare the forces and moments exerted by thermoformed aligners (TFMs) and direct printed aligners (DPAs) on the maxillary left central incisor (21) and adjacent teeth (11, 22) during lingual bodily movement of tooth 21. Methods: An in vitro setup was used to quantify forces and moments on three incisors, which were segmented and fixed onto multi-axis force/moment transducers. TFM were fabricated using 0.76 mm-thick single-layer PET-G foils (ATMOS; American Orthodontics, Sheboygan, WI, USA) and multi-layer TPU foils (Zendura FLX; Bay Materials LLC, Fremont, CA, USA). DPAs were fabricated using TC-85 photopolymer resin (Graphy Inc., Seoul, Republic of Korea). Tooth 21 was planned for bodily displacement by 0.25 mm and 0.50 mm, and six force and moment components were measured on it and the adjacent teeth. Results: TC-85 generated lower forces and moments with fewer unintended forces and moments on the three teeth. TC-85 exerted 0.99 N and 1.53 N of mean lingual force on tooth 21 for 0.25 mm and 0.50 mm activations, respectively; ATMOS produced 3.82 N and 7.70 N, and Zendura FLX produced 3.00 N and 8.23 N of mean lingual force for the same activations, respectively. Bodily movement could not be achieved. Conclusions: The force systems generated by clear aligners are complex and unpredictable. DPA using TC-85 produced lower, more physiological force levels with fewer side effects, which may increase the predictability of tooth movement and enhance treatment outcome. The force levels generated by TFM were considered excessive and not physiologically compatible. Full article

Primary teeth play a crucial role in a child’s development, particularly in maintaining space for permanent teeth. The premature loss of a primary tooth can lead to orthodontic issues, making the use of space maintainers essential to ensure proper growth and development of permanent teeth. To preserve space, the fabrication of a space maintainer is necessary. Since conventional space maintainers do not restore masticatory function, this study presents an innovative solution for space preservation following the extraction of the first primary molar through the design of the functional space maintainer KOS&MET (Key Orthodontic System and Materials Enhanced Therapy). The space maintainer was designed using the 3Shape Dental Designer 2023 version software tool and manufactured via additive 3D printing, utilizing a metal alloy with high resistance to masticatory forces. The crown is supported by the primary canine, while an intraoral window is created to monitor the eruption of the successor tooth. This design does not interfere with occlusion and enables bilateral chewing. Masticatory performance was assessed using two-color chewing gum, and the results showed improvement after cementing the space maintainer. This innovative approach not only preserves space for permanent teeth but also enhances masticatory function, contributing to the proper growth and development of the jaws and teeth. Full article

Objectives: Facial soft tissue imaging is crucial in orthodontic treatment planning, and the structured light scanning technology found in the latest iPhone models constitutes a promising method. Currently, studies which evaluate the accuracy of smartphone-based three-dimensional (3D) facial scanners are scarce. This study compares smartphone scans with cone-beam computed tomography (CBCT) images. Materials and Methods: Three-dimensional images of 23 screened patients were captured with the camera of an iPhone 13 Pro Max and processed with the Scandy Pro application; CBCT scans were also taken as a standard of care. After establishing unique image pairs of the same patient, linear and angular measurements were compared between the images to assess the scanner’s two-dimensional trueness. Following the co-registration of the virtual models, a heat map was generated, and root mean square (RMS) deviations were calculated for quantitative assessment of 3D trueness. Precision was determined by comparing consecutive 3D facial scans of five participants, while intraobserver reliability was assessed by repeating measurements on five subjects after a two-week interval. Results: This study found no significant difference in soft tissue measurements between smartphone and CBCT images (p > 0.05). The mean absolute difference was 1.43 mm for the linear and 3.16° for the angular measurements. The mean RMS value was 1.47 mm. Intraobserver reliability and scanner precision were assessed, and the Intraclass Correlation Coefficients were found to be excellent. Conclusions: Smartphone facial scanners offer an accurate and reliable alternative to stereophotogrammetry systems, though clinicians should exercise caution when examining the lateral sections of those images due to inherent inaccuracies. Full article

Background: Distalization is a fundamental orthodontic strategy for correcting Class II and Class III malocclusions, particularly in cases where specific dental or skeletal conditions favor its application. Recent technological advances have enabled complex dental movements to be performed using clear aligners, aided by digital planning platforms such as ClinCheck^®. Methods: This retrospective study aimed to evaluate the accuracy of ClinCheck^® in predicting molar and canine distalization outcomes with the Invisalign^® system and to identify clinical factors influencing treatment predictability. Thirty patients with complete permanent dentition and at least 2 mm of programmed distalization were selected. Planned movements were extracted from the Invisalign^® Doctor Site and compared to achieved outcomes using Geomagic^® Control X™ software. Occlusal improvements were assessed using the Peer Assessment Rating (PAR) index. Results: The results revealed significant discrepancies between the programmed and achieved distalization, with mean deviations greater than 1 mm in both arches. Skeletal anchorage with mini-screws significantly improved distalization outcomes in the maxillary arch; however, no significant effect was observed in the mandibular arch. Additionally, no significant associations were found between distalization outcomes and skeletal pattern (ANB angle) or facial biotype. Conclusions: Clear aligners are effective in achieving substantial occlusal improvements, particularly when combined with personalized digital planning and supplementary strategies such as skeletal anchorage. Mandibular cases demonstrated greater reductions in PAR scores, emphasizing the potential of aligners in complex distalization treatments. Full article

Background: Artificial intelligence (AI) is increasingly integrated into orthodontic workflows, including digital model analysis modules embedded in orthodontic software. While these systems offer efficiency and automation, the accuracy and clinical reliability of AI-generated measurements and diagnostic assessments remain unclear. Therefore, to use AI systems safely and effectively in clinical orthodontics, it is important to check their results by comparing them with those of experienced orthodontists. Methods: Digital models of 48 patients were analyzed by the Orthodontist group and two AI platforms: Titan (full) and SoftSmile (Bolton only). Three orthodontists independently measured all variables using 3Shape OrthoAnalyzer, and group means were used for comparison. A subset of models was reanalyzed after two weeks to assess consistency. Data distribution was evaluated, and appropriate statistical tests were applied. Reliability was assessed using intraclass correlation coefficients (ICC) and Cohen’s kappa. Results: Almost perfect agreement was observed between the orthodontists and Titan AI in molar classification (κ = 0.955 right, κ = 0.900 left; p < 0.001), with perfect agreement reported across all groups—including between the orthodontists themselves—for Angle classification (κ = 1.00). In anterior and overall Bolton analyses, no meaningful agreement was found between the orthodontists and AI platforms. However, in a subset of patients where all three methods identified the tooth size discrepancy in the same arch (either maxilla or mandible), no significant differences were found in anterior (p = 0.226) or overall Bolton values (p = 0.795). Overjet, overbite, and space analysis values showed significant differences between the orthodontist and Titan groups (p < 0.001). ICC analysis indicated good to excellent intra- and inter-rater reliability within the orthodontist group (≥0.77), while both AI systems demonstrated excellent internal consistency, with ICC values exceeding 0.95. Conclusions: AI-based platforms showed high agreement with orthodontists only in Angle classification. While their performance in Bolton analysis was limited, significant differences were observed in other linear measurements, indicating the need for further refinement before clinical use. Full article

Background: Adhesive systems are important for achieving reliable and durable bracket bonding in orthodontic treatments. The purpose of this study is to compare the outcomes of a new one-step orthodontic bonding system that combines the primer and adhesive solutions. Methods: In this study, four groups were formed, each consisting of 20 first premolar teeth. Acid etching was applied to all teeth for 30 s, except in Group II. Group I included teeth where a single layer of primer was applied using the Transbond XT system before bracket bonding. Group II consisted of teeth bonded with brackets after using a self-etching primer with the Transbond XT system. Group III used GC Ortho Connect, a single-step adhesive that incorporates the primer within the adhesive itself. Group IV, a single layer of primer was applied before bonding with GC Ortho Connect. Shear bond strength (SBS) was assessed using one-way ANOVA and the Tukey-HSD test, while Adhesive Remnant Index (ARI) scores were analyzed using the Chi-square test at a significance level of p < 0.05. Results: SBS measurements were recorded as 13.28 ± 2.15 MPa for Group I, 11.06 ± 2.26 MPa for Group II, 10.37 ± 1.92 MPa for Group III, and 16.02 ± 2.17 MPa for Group IV. Statistical analysis using the Tukey test revealed significant differences in SBS values between Groups II and IV, as well as Groups III and IV (p < 0.05). All groups showed clinically acceptable bond strength, with Group IV demonstrating superior adhesion. Additionally, the chi-square test indicated a statistically significant variation in the ARI scores across all four groups (p < 0.05). Conclusions: The adhesive performance of the one-step GC Ortho Connect system is clinically comparable to Transbond XT. However, primer application is necessary to achieve optimal bond strength. Full article

Background/Objectives: Diabetes mellitus is defined as a group of metabolic diseases characterized by chronically elevated blood glucose levels. This condition influences the course of orthodontic treatment, as it affects various clinical aspects of the patient that must be taken into consideration prior to initiation. Therefore, achieving adequate control and management of diabetic patients undergoing orthodontic therapy is essential. This article presents a qualitative synthesis of studies addressing how diabetes affects orthodontic treatments, emphasizing the importance of understanding the necessary considerations prior to initiating treatment and how to manage potential complications. Methods: This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A database search was performed on 5 May 2025, in PubMed, Scopus, Scielo, and The Cochrane Library, using terms related to “diabetes mellitus” and “orthodontic treatments”. Studies meeting the search criteria were included, particularly those that were published in the past ten years and reported on the influence of diabetes on orthodontic treatment. The quality of the case–control studies was assessed using the Newcastle–Ottawa Scale (NOS); for cross-sectional studies, the Joanna Briggs Institute (JBI) critical appraisal checklist was used; and for experimental studies, the SYRCLE’s Risk of Bias Tool was applied. Results: Fourteen studies ultimately met the inclusion criteria. The evidence showed that diabetes increases gingival bleeding due to elevated levels of advanced glycation end-products (AGEs) and pro-inflammatory cytokines; reduces the efficiency of tooth movement; increases root resorption and affects bone remodeling; and compromises both periodontal and pulpal responses, thereby hindering tissue regeneration. It was also observed that the use of insulin or antidiabetic agents such as metformin may partially mitigate these adverse effects. Conclusions: This systematic review reveals a clear relationship between diabetes and various clinical aspects that influence the progression of orthodontic treatments. Nonetheless, further studies are needed to better understand the impact of this systemic condition on dental treatment outcomes. Full article

With the growing use of high-intensity LED units in orthodontics, the effect of ultra-fast curing protocols on polymerization efficiency remains unclear. This study aimed to evaluate the influence of conventional and rapid high-intensity light curing protocols on the degree of conversion (DC) of orthodontic adhesive systems. Three commercially available materials were tested under two conditions, without bracket interference (control group, CG) and with a metal bracket present during curing (metal bracket group, MBG). Two light-curing protocols were employed: conventional curing, using two consecutive 10 s exposures at 1100 mW/cm², and rapid curing, with two consecutive 3 s exposures at 2900 mW/cm². The DC was assessed via Fourier-transform infrared (FTIR) spectroscopy at short-term intervals (2, 6, and 10 min) and after 24 h. The results showed that rapid high-intensity curing yielded significantly lower DC values at both the short term and 24 h period compared to the conventional protocol. Short-term DC values ranged from 44.4% to 64.4% for conventional curing and from 43.0% to 60.0% for rapid curing. At 24 h, DC values increased for all materials, reaching 54.4–82.8% in the conventional group and 49.7–81.4% in the rapid curing group. The largest difference in DC values between curing protocols was observed in the MBG, with reductions of up to 5.9% (short-term) and 4.7% (24 h). The 24 h DC values were mostly material-dependent, while external factors (curing protocol and the presence of a bracket) had more impact on the short-term DC values. 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

Background and Objectives: To systematically map and evaluate the current literature on the application of artificial intelligence (AI) in teleorthodontics, focusing on clinical use, technological approaches, outcomes, and limitations. Materials and Methods: A scoping review was conducted following a formal and recognized methodological framework. Three databases (PubMed, Scopus, Web of Science) were searched until 30 April 2025. Studies were included if they reported original data on AI applications in orthodontic remote monitoring or virtual care. Data extraction focused on study design, type of AI, clinical setting, reported outcomes, and main findings. Results: Nine studies met the inclusion criteria. Most research focused on the use of the Dental Monitoring™ (DM) system, which employs deep learning algorithms to analyze intraoral scans captured via smartphones. Reported benefits included reduced in-office visits (up to 33%), accurate 3D tracking of tooth movement, improved hygiene compliance, and high patient engagement. However, significant variability was observed in the repeatability and precision of AI decisions, especially in GO/NO-GO aligner progression instructions. One study explored an alternative system, StrojCHECK™, based on a decision tree algorithm, showing improved compliance with personalized feedback. Conclusions: AI-powered teleorthodontic systems show potential to enhance treatment efficiency and patient engagement, particularly in aligner therapy. However, their current clinical application remains narrowly focused on commercial monitoring platforms, with limited validation and transparency. This review highlights the early stage of real-world AI integration in orthodontics, underlining the need for independent validation, broader applications beyond monitoring, and robust ethical frameworks. In this context, AI should be used as a complementary tool, never a substitute, for clinical judgment. Full article

Objective: This in vitro study evaluated the effectiveness of three laser systems—diode, CO₂, and Er:YAG—for debonding composite attachments used in aligner orthodontic therapy. Materials and Methods: Fifty extracted human premolars with composite attachments were divided into five groups (n = 10): control, RT (rotary tools), diode laser (980 nm, irradiance was 4811 W/cm²), CO₂ laser (10.6 µm, irradiance 1531 W/cm²), and Er:YAG laser (2940 nm, irradiance 471.7 W/cm²). Shear bond strength (SBS) testing measured debonding forces. Enamel surface changes were evaluated using micro-CT, optical profilometry, and stereomicroscopy. The Adhesive Remnant Index (ARI) assessed residual bonding material. Results: Laser treatment increased enamel roughness (p < 0.05). Er:YAG laser caused the highest roughness (Sa = 2.03 µm) and up to 0.17 mm enamel loss but left minimal adhesive remnants and no fractures. Diode laser preserved surface smoothness with moderate bond weakening. CO₂ laser had intermediate effects. RT showed the highest SBS but resulted in greater enamel alteration. SBS was significantly reduced in the laser groups, lowest for Er:YAG (81.7 ± 45.5 MPa vs. control 196.2 ± 75.3 MPa). ARI indicated better adhesive removal in the laser-treated groups, with Er:YAG showing the highest percentage of clean enamel surfaces (67% vs. 25%). Conclusions: Er:YAG demonstrated the best balance between effective debonding and enamel preservation. Diode and CO₂ lasers also offer viable alternatives to rotary tools. Further clinical studies are recommended. Full article

Background: AI has been adopted in dentistry for diagnosis, decision making, and therapy prognosis prediction. This systematic review aimed to identify AI models in dentistry, assess their performance, identify their shortcomings, and discuss their potential for adoption and integration in dental practice in the future. Methodology: The sources of the papers were the following electronic databases: PubMed, Scopus, and Cochrane Library. A total of 20 out of 947 needed further studies, and this was encompassed in the present meta-analysis. It identified diagnostic accuracy, predictive performance, and potential biases. Results: AI models demonstrated an overall diagnostic accuracy of 82%, primarily leveraging artificial neural networks (ANNs) and convolutional neural networks (CNNs). These models have significantly improved the diagnostic precision for dental caries compared with traditional methods. Moreover, they have shown potential in detecting and managing conditions such as bone loss, malignant lesions, vertical root fractures, apical lesions, salivary gland disorders, and maxillofacial cysts, as well as in performing orthodontic assessments. However, the integration of AI systems into dentistry poses challenges, including potential data biases, cost implications, technical requirements, and ethical concerns such as patient data security and informed consent. AI models may also underperform when faced with limited or skewed datasets, thus underscoring the importance of robust training and validation procedures. Conclusions: AI has the potential to revolutionize dentistry by significantly improving diagnostic accuracy and treatment planning. However, before integrating this tool into clinical practice, a critical assessment of its advantages, disadvantages, and utility or ethical issues must be established. Future studies should aim to eradicate existing barriers and enhance the model’s ease of understanding and challenges regarding expense and data protection, to ensure the effective utilization of AI in dental healthcare. Full article

Objective: To evaluate the cytotoxicity and endocrine-disrupting potential of materials used in removable orthodontic retainers. Methods: A literature search (2015–2025) covered in vitro cytotoxicity, estrogenicity, in vivo tissue responses, and clinical biomarkers in PMMA plates, thermoplastic foils, 3D-printed resins, PEEK, and fiber-reinforced composites. Results: Thirty-eight in vitro and ten clinical studies met inclusion criteria, identified via a structured literature search of electronic databases (2015–2025). Photopolymer resins demonstrated the highest cytotoxicity, whereas thermoplastics and PMMA exhibited predominantly mild effects, which diminished further following 24 h water storage. Bisphenol-type compound release was reported, but systemic exposure remained below regulatory limits. No statistically significant mucosal alterations or endocrine-related effects were reported in clinical studies. Conclusions: Retainer materials are generally biocompatible, though data on long-term endocrine effects are limited. Standardized biocompatibility assessment protocols are necessary to enable comparative evaluation across diverse orthodontic materials. Single-use thermoplastics contribute to microplastic release and pose end-of-life management challenges, raising concerns regarding environmental sustainability. Full article

Lateral cephalometric analysis is commonly used in orthodontics for skeletal classification to ensure an accurate and reliable diagnosis for treatment planning. However, most current research depends on analyzing different type of radiographs, which requires more computational time than 3D analysis. Consequently, this study addresses fully automatic orthodontics tracing based on the usage of artificial intelligence (AI) applied to 2D and 3D images, by designing a cephalometric system that analyzes the significant landmarks and regions of interest (ROI) needed in orthodontics tracing, especially for the mandible and maxilla teeth. In this research, a computerized system is developed to automate the tasks of orthodontics evaluation during 2D and Cone-Beam Computed Tomography (CBCT or 3D) systems measurements. This work was tested on a dataset that contains images of males and females obtained from dental hospitals with patient-informed consent. The dataset consists of 2D lateral cephalometric, panorama and CBCT radiographs. Many scenarios were applied to test the proposed system in landmark prediction and detection. Moreover, this study integrates the Grad-CAM (Gradient-Weighted Class Activation Mapping) technique to generate heat maps, providing transparent visualization of the regions the model focuses on during its decision-making process. By enhancing the interpretability of deep learning predictions, Grad-CAM strengthens clinical confidence in the system’s outputs, ensuring that ROI detection aligns with orthodontic diagnostic standards. This explainability is crucial in medical AI applications, where understanding model behavior is as important as achieving high accuracy. The experimental results achieved an accuracy exceeding 98.9%. This research evaluates and differentiates between the two-dimensional and the three-dimensional tracing analyses applied to measurements based on the practices of the European Board of Orthodontics. The results demonstrate the proposed methodology’s robustness when applied to cephalometric images. Furthermore, the evaluation of 3D analysis usage provides a clear understanding of the significance of integrated deep-learning techniques in orthodontics. Full article

Background: The segmentation of individual teeth in three-dimensional (3D) dental models is a key step in orthodontic computer-aided design systems. Traditional methods lack robustness when handling challenging cases such as missing or misaligned teeth. Objectives: to semantically segment maxillary teeth and palatal rugae in 3D textured scans using Convolutional Neural Networks (CNNs) and assess tooth movement after orthodontic treatment using stable rugae references. Methods: Building on the robustness of two-dimensional image semantic segmentation, we developed a method to convert 3D textured palate scans into two-dimensional images for segmentation, then back projected them onto the original 3D meshes. A dataset of 100 textured scans from 100 patients seeking orthodontic treatment was manually segmented by orthodontic experts. The proposed 3D segmentation method was applied to these scans. Finally, each pair of segmented 3D scans from the same patient, before and after treatment, was aligned by superimposing them on the stable rugae region. Results: The 3D segmentation method achieved an accuracy of 98.69% and an average Intersection over Union (IoU) of 84.5%. The common stable coordinate frame for both scans using the rugae area as a stable reference enabled the computation of the 3D translational and rotational motions of each maxillary tooth. Neither pre- nor post-processing of the data was required to enhance segmentation. Conclusions: The proposed method enabled successful motion measurement of teeth using the rugal area as a stable reference and providing rotation and translational measurements of the maxillary teeth. Full article