Search Results (292)

Orthodontic tooth movement (OTM) is accompanied by sterile inflammation, a necessary biological process that facilitates tooth displacement but also contributes to adverse effects, including hyalinization and orthodontically induced external apical root resorption (OEARR). Despite advancements in orthodontic therapies, the inflammatory response—regulated by dynamic interactions between tissue-specific cells and their molecular mediators—remains a critical factor influencing treatment outcomes. This review summarizes the current understanding of the cellular and molecular mechanisms underlying OTM, with a focus on how these insights can support the development of targeted therapeutic strategies. These include cell- and molecule-based therapies, biomaterial-mediated delivery systems, and applications of artificial intelligence (AI). Notably, AI offers promising opportunities for modeling and simulating biological responses, enabling the optimization of individualized treatment planning. We further discuss current clinical practices and highlight emerging experimental findings, with an emphasis on unresolved research questions pivotal to improving therapeutic efficacy and reducing complications such as OEARR. This comprehensive overview aims to inform future directions in orthodontics by integrating mechanistic knowledge with technological innovation. Full article

Objective: To evaluate the concordance of automated 3D superimposition methods applied to digital models, with a focus on methods that consider stable palatal regions as geometric reference landmarks versus those that do not. Design and setting: This was a prospective, cross-sectional study using digital model files of patients undergoing orthodontic treatment in a university clinical setting. Participants: Sixty-one patients were prospectively enrolled and divided into three groups based on the type of orthodontic treatment they received: (20) non-extractive orthodontic treatment without intermaxillary elastics, (21) intermaxillary elastics, and (20) control subjects with no orthodontic movement. The inclusion criteria included the availability of complete pre- and post-treatment digital casts and the absence of significant craniofacial anomalies. Methods: Three superimposition methods were tested: (1) superimposition according to palate and palatal ridges, (2) best-fit superimposition of arches in occlusion, and (3) best-fit superimposition of individual arches. Discrepancies were identified by comparing the spatial positions derived from each method. Within three spatial axes, deviations of ±0.5 mm and ±1.15° were not considered significant. Bland–Altman plots were used to quantify palatal rugae based and non-based spatial differences between methods. Differences in the superimposition results between the three patient groups were evaluated using ANOVA tests. Results: Differences in spatial position between the superimposition methods often exceeded the acceptable range. The results were compared between the three patient groups with a statistical significance of α = 0.05. In the present study, the high reliability of the superimposition method based on the palate and palatal ridges was observed. Conclusion: Superimposition methods based on the palate and palatal rugae provide superior accuracy in determining treatment-related changes in upper arch digital models. These findings illustrate the need for appropriate selection of superimposition techniques based on the study objective of using clinically relevant techniques. Full article

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

Pain following orthodontic treatment is the chief complaint of patients undergoing this form of treatment. Although the use of diode lasers has been suggested for pain reduction, the mechanism of laser-induced analgesic effects remains unclear. Neuropeptides, such as substance P (SP) and calcitonin gene-related peptide (CGRP), contribute to the transmission and maintenance of inflammatory pain. Heat shock protein (HSP) 70 plays a protective role against various stresses, including orthodontic forces. This study aimed to examine the effects of diode laser irradiation on neuropeptides and HSP 70 expression in periodontal tissues induced by experimental tooth movement (ETM). For inducing ETM for 24 h, 50 g of orthodontic force was applied using a nickel–titanium closed-coil spring to the upper left first molar and the incisors of 20 male Sprague Dawley rats (7 weeks old). The right side without ETM treatment was considered the untreated control group. In 10 rats, diode laser irradiation was performed on the buccal and palatal sides of the first molar for 90 s with a total energy of 100.8 J/cm². A near-infrared (NIR) laser with a 808 nm wavelength, 7 W peak power, 560 W average power, and 20 ms pulse width was used for the experiment. We measured the number of facial groomings and vacuous chewing movements (VCMs) in the ETM and ETM + laser groups. Immunohistochemical staining of the periodontal tissue with SP, CGRP, and HSP 70 was performed. The number of facial grooming and VCM periods significantly decreased in the ETM + laser group compared to the ETM group. Moreover, the ETM + laser group demonstrated significant suppression of SP, CGRP, and HSP 70 expression. These results suggest that the diode laser demonstrated analgesic effects on ETM-induced pain by inhibiting SP and CGRP expression, and decreased HSP 70 expression shows alleviation of cell damage. Thus, although further validation is warranted for human applications, an NIR diode laser can be used for reducing pain and neuropeptide markers during orthodontic tooth movement. Full article

A challenge in orthodontic treatment is the long time taken to move teeth, which extends the long treatment period. Accordingly, various treatment protocols and orthodontic materials have been developed to shorten the orthodontic treatment period. However, controlling biological reactions is considered necessary to further shorten this treatment period. Orthodontic force results in compression of the periodontal ligament in the direction of tooth movement, resulting in various reactions in the periodontal ligament that induce osteoclast development, alveolar bone absorption, and teeth movement. The aforementioned reactions include immune reactions. Cytokines are substances responsible for intercellular communication and are involved in various physiological actions, including immune and inflammatory reactions. They cause various cellular responses, including cell proliferation, differentiation, cell death, and functional expression. Various cytokines are involved in biological reactions during orthodontic tooth movement (OTM). It is important to understand the role of cytokines during OTM in order to elucidate their biological response. This review discusses the role of cytokines during OTM. 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

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

The aim of this study was to analyze the biomechanical effects of a conventional molar uprighting spring on a mesially tilted mandibular second molar through a novel iterative finite element (FE) approach in order to estimate clinical treatment duration. A new model was developed utilizing data from previous canine retraction experimental studies to aid in correlating each individual FE iteration with its real-time value. Another model consisting of a 30° mesially titled mandibular second molar and a conventional molar uprighting spring was developed to evaluate kinetic and kinematic responses. The iterative FE simulation of the treatment was then carried out. The molar uprighting simulation was completed in 180 iterations, which was equivalent to almost 12 weeks of clinical treatment time. The average stress-normalized bone remodeling velocity was found to be ~0.9 μm/(KPa·day). During the simulation, the spring initially produced a 15 N·mm (∼1530 g·mm) counterclockwise moment responsible for molar uprighting. The mandibular second molar showed 3.75 mm of distal movement, 2.15 mm of vertical extrusion, and a 22° counterclockwise rotation at the end of the treatment. This study provides a foundation for the future estimation of biomechanical responses as a function of treatment time in various orthodontic applications using iterative FE simulations. 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

(1) The aim was to evaluate the predictability of treatment outcomes using clear aligner therapy (CAT) and ClinCheck Web 1.4 (Align Technology, Inc., San Jose, CA, USA) software in mandibular incisor intrusion in both children and adults with deep bite malocclusion. (2) This study included healthy children and adults with skeletal Class I or mild to moderate Class II/III malocclusions, mild to moderate dental crowding (<5 mm), and deep overbite (OB) who underwent CAT. Pre-treatment (T1) and post-treatment (T2) orthodontic treatment records were assessed and compared to initial planned ClinCheck movements. The cephalometric parameters evaluated included bodily intrusion (Centroid-C point), IMPA, L1-NB, and L1-A-Po. Clinical expression of CAT was compared to ClinCheck predictions using paired sample t-tests, and differences between growing and non-growing groups were assessed using a repeated measures ANOVA with Tukey post hoc analysis. (3) The sample included 48 patients (mean age 19.79 ± 11.78 years), including 18 adults (mean age 30.28 ± 13.79 years) and 30 children (mean age 13.5 ± 2.05 years). The predicted vertical mandibular incisor movement (intrusion) was significantly higher using ClinCheck (2.32 mm) compared to clinical treatment (0.22 mm). The angular movements of IMPA, L1-NB, and L1-APo were all significantly higher using ClinCheck (4.6°) compared to clinical expression of 0.79°, 0.55°, and 1.21°, respectively. There were no significant differences between children and adults with respect to vertical or angular tooth movements. (4) CAT and ClinCheck software significantly overpredicts orthodontic tooth movements related to mandibular incisor intrusion in both adults and children with no statistical difference between the groups. Full article

This systematic review analyzed the combined use of aligners and orthodontic temporary anchorage devices (TADs) in orthodontic treatment. The aim was to evaluate the effectiveness, benefits, and potential challenges of integrating the use of miniscrews with aligners. This review was conducted according to the PRISMA statement, and the protocol was registered at PROSPERO under the ID CRD42024576712. A comprehensive search on PubMed, Scopus, and Web of Science was conducted to identify relevant papers involving patients treated with aligners and TADs, dating from 1 January 2004 to 17 July 2024. The electronic database search identified a total of 458 articles. After eligibility, 14 records were selected for qualitative analysis. The findings suggest that the combination of aligners and miniscrews significantly enhances treatment precision and control, especially in cases requiring complex tooth movements, such as intrusion, extrusion, and distalization. The use of miniscrews allows greater control of movement and stability. The integration of these two techniques presents challenges, such as the need for precise miniscrew placement and potential discomfort during insertion. However, there was high satisfaction due to the aesthetic and comfort benefits of aligners. Further research is desirable to delve deeper into the topic to optimize clinical outcomes. Full article

Artificial Intelligence (AI) is rapidly transforming orthodontic care by providing personalized treatment plans that enhance precision and efficiency. This narrative review explores the current applications of AI in orthodontics, particularly its role in predicting tooth movement, fabricating custom aligners, optimizing treatment times, and offering real-time patient monitoring. AI’s ability to analyze large datasets of dental records, X-rays, and 3D scans allows for highly individualized treatment plans, improving both clinical outcomes and patient satisfaction. AI-driven aligners and braces are designed to apply optimal forces to teeth, reducing treatment time and discomfort. Additionally, AI-powered remote monitoring tools enable patients to check their progress from home, decreasing the need for in-person visits and making orthodontic care more accessible. The review also highlights future prospects, such as the integration of AI with robotics for performing orthodontic procedures, predictive orthodontics for early intervention, and the use of 3D printing technologies to fabricate orthodontic devices in real-time. While AI offers tremendous potential, challenges remain in areas such as data privacy, algorithmic bias, and the cost of adopting AI technologies. However, as AI continues to evolve, its capacity to revolutionize orthodontic care will likely lead to more streamlined, patient-centered, and effective treatments. This review underscores the transformative role of AI in modern orthodontics and its promising future in advancing dental care. Full article

Orthodontic treatment is commonly associated with pain, leading to reduced patient compliance and treatment adherence. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in reducing this pain by inhibiting prostaglandin synthesis. However, this mechanism may also interfere with orthodontic tooth movement (OTM) by affecting bone remodeling. This narrative review investigates the existing literature published between 2004 and 2024 to assess the impact of various NSAIDs on OTM and identify those that balance pain relief with minimal impact on tooth movement. Evidence shows that NSAIDs such as aspirin, ketorolac, diclofenac, and nimesulide significantly reduce OTM. The results for ibuprofen, meloxicam, and celecoxib were inconsistent with both no influence or a reduction in OTM, depending on dosage, mode, and duration of administration. Conversely, tenoxicam, nabumetone, etoricoxib, and parecoxib appear to have no effect on OTM. Among these, etoricoxib appears particularly promising due to its favorable gastrointestinal profile, high COX-2 selectivity, and negligible influence on OTM in clinical doses. However, the limited number of human trials highlights the need for further research to develop evidence-based guidelines for pain management that preserve treatment efficiency in orthodontics. Full article

Purpose: This paper investigates the biomechanical effect of thermoformed aligners equipped with complementary biomechanical attachments (CBAs) on periodontal ligaments (PDLs) during the expansion process of the maxillary arch. The analysis was conducted using advanced simulations based on the finite element method (FEM). Methods: High-resolution 3D CAD models were created for four tooth types: canine, first premolar, second premolar, and first molar. Additional 3D models were developed for aligners, CBAs, and PDLs. These were integrated into a comprehensive FEM model to simulate clinical rehabilitation scenarios. Validation was achieved through comparative analysis with empirical medical data. Results: The FEM simulations revealed the following: for canine, the displacement was 0.134 mm with a maximum stress of 4.822 KPa in the amelocemental junction. For the first premolar, the displacement was 0.132 mm at a maximum stress of 3.273 KPa in the amelocemental junction. The second premolar had a displacement of 0.129 mm and a stress of 1.358 KPa at 1 mm from the amelocemental junction; and first molar had a displacement of 0.124 mm and a maximum stress of 2.440 KPa. Conclusions: The inclusion of CBAs significantly reduced tooth tipping during maxillary arch expansion. Among the models tested, the vestibular CBA demonstrated superior performance, delivering optimal tooth movement when combined with thermoformed aligners. Significance: FEM techniques provide a robust and cost-effective alternative to in vivo experimentation, offering precise and reliable insights into the biomechanical efficacy of CBAs in thermoformed aligners. This approach minimizes experimental variability and accelerates the evaluation of innovative orthodontic configurations. Full article

Background: The immune reactions of patients suffering from chronic allergies and asthma are associated with systemic imbalances that may lead to the overexpression of mediators potentially involved in bone remodeling during orthodontic tooth movement. Aim: The aim of this systematic review was to evaluate the existing evidence from animal studies with regard to the effects of allergen sensitization on the phenomena correlated with orthodontically induced tooth movement. Materials and Methods: This systematic review was based on PRISMA 2020 guidelines. A search without restrictions and hand searching were performed from inception to December 2024. The investigation focused on the impact of allergen sensitization on phenomena associated with orthodontic tooth movement. After the retrieval and selection of relevant studies, data extraction was performed, and the data’s risk of bias was evaluated with the SYRCLE’s Risk of Bias Tool. Results: From the detected records, the inclusion criteria were met by only three studies. At the beginning of tooth movement, periodontal ligament was found to be more compressed in the stress area and more stretched in the tension area in sensitized animals. The amount of tooth movement after 14 days of force application was also greater. However, there were conflicting outcomes regarding root resorption. The risk of bias in the retrieved studies was assessed as high overall. Conclusions: Despite the fact that existing evidence is not directly related to human beings and is based on a limited number of animal studies, allergen sensitization could potentially influence the phenomena associated with orthodontic tooth movement, and orthodontists should be aware of the relevant implications. Full article