The Angle Orthodontist[JOURNAL]
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200 papers
Facial esthetic perception between skeletal Class III patients treated with conventional and surgery-first orthognathic approaches.
Cunha A, Manso T, Faber J … +2 more , Artese F, Miguel JAM
Angle Orthod · 2026 Feb · PMID 41213519 · Full text
OBJECTIVES: To compare the profile attractiveness of skeletal Class III patients treated with either a surgery-first approach (SFA) or a conventional surgery approach (CSA), as perceived by surgeons, orthodontists, and l...
OBJECTIVES: To compare the profile attractiveness of skeletal Class III patients treated with either a surgery-first approach (SFA) or a conventional surgery approach (CSA), as perceived by surgeons, orthodontists, and laypersons. MATERIALS AND METHODS: Thirty-four patients were assigned to either the SFA or CSA group retrospectively based on the surgical protocol performed and were evaluated by three distinct groups: oral and maxillofacial surgeons, orthodontists, and laypersons (n = 23 per group). Profile images before (T1) and after orthodontic-surgical treatment (T2) were analyzed using a 5-point Likert scale. Then participants answered the following question: "Which surgical technique was used, CSA or SFA?" Statistical analyses including the Spearman correlation coefficient, the Friedman test, the κ test, independent t-tests, and one-way analysis of variance were conducted to assess correlations and comparisons among evaluator groups (P < .05). RESULTS: A high and positive correlation (r = 0.86, P < .001) was demonstrated for scores between surgeons and orthodontists, and a low correlation was demonstrated between laypeople and specialists (r = 0.55, P = .01 and r = 0.48, P = .03). No statistically significant relationships were found between esthetic perceptions and the surgical approach regardless of the level of expertise of the evaluators, and it was also not possible to differentiate between the surgical approaches used. CONCLUSIONS: In this study, we indicate that the choice of orthognathic surgical protocol, whether surgery-first or conventional, did not significantly influence the perceived facial profile attractiveness of skeletal Class III patients. These findings support the clinical viability of the SFA protocol, particularly in cases where treatment time or patient preference are factors in decision-making.
Approaches to correct lower lip sucking in preschool children: a clinical study on effectiveness, oral health-related quality of life impact, and malocclusion improvement.
Guo X, Deng J, Gao Y … +3 more , Huang S, Cheng Z, Huang L
Angle Orthod · 2026 Feb · PMID 41213513 · Full text
OBJECTIVES: To determine the most effective ways to correct lower lip sucking in preschool children, minimizing impacts on their Oral Health-Related Quality of Life (OHRQoL) and improving malocclusion. MATERIALS AND METH...
OBJECTIVES: To determine the most effective ways to correct lower lip sucking in preschool children, minimizing impacts on their Oral Health-Related Quality of Life (OHRQoL) and improving malocclusion. MATERIALS AND METHODS: 83 children aged 3-6 years were divided into behavioral therapy (Group A, n = 27), lip bumper therapy (Group B, n = 27), and Twin Block therapy (Group C, n = 29) groups. After 6 months of treatment, oral exams, model analysis, cephalometrics, and the Early Childhood Oral Health Impact Scale (ECOHIS) were used for assessment. RESULTS: Success rates in Groups A, B, and C were 33.33%, 73.08%, and 96.43%, respectively (P < .05). Groups A and B had no significant measurement differences (P > .05). Group C showed significant changes in overjet, SNA, SNB, ANB, U1SN, and L1MP (P < .05). The ECOHIS scores of all groups first rose, then fell (P < .05). CONCLUSIONS: Twin Block appliances are highly effective for correcting lower lip sucking. They have a higher success rate than other methods and can reduce skeletal malocclusion severity in children with specific dental conditions.
A standardized protocol for clear aligner thickness measurement using a 3D-printed auxiliary device.
Wang P, Liu Q, Leng J … +5 more , Zhou X, Li P, Han X, Bai D, Xue C
Angle Orthod · 2026 Feb · PMID 41093374 · Full text
OBJECTIVES: To develop and validate a standardized protocol for clear aligner (CA) thickness measurement using a three-dimensional (3D)-printed auxiliary device to improve measurement reliability. MATERIALS AND METHODS:...
OBJECTIVES: To develop and validate a standardized protocol for clear aligner (CA) thickness measurement using a three-dimensional (3D)-printed auxiliary device to improve measurement reliability. MATERIALS AND METHODS: 24 pairs of digital dental models (D0s) were included and 3D-printed into physical models (P0s), from which CAs were thermoformed using 0.75-mm polymer sheets. Measurement auxiliary devices (MADs) were designed on D0s through measurement point selection, direction determination, electronic gauge mapping, and base shaping, and then 3D-printed. Two operators measured CA thickness (40 points per CA, 48 CAs) using an electronic gauge both directly (direct measurement, D-M) and with MADs (auxiliary measurement, A-M) across three sessions. Measurement precision (repeatability and reproducibility) of D-M and A-M were analyzed using intraclass correlation coefficients (ICCs) and repeated-measures analysis of variance (ANOVA) or Friedman tests. Bland-Altman plots were used to evaluate intersession agreement. RESULTS: A-M demonstrated superior intersession repeatability with ICC > 0.90 at all points and high intersession agreement with a narrow 95% limit of agreement (LoA) and minimal outliers. Interoperator reproducibility for A-M was also higher, with ICCs above 0.75 at all points, compared to D-M, which showed ICCs below 0.75 at almost all points. CONCLUSIONS: The 3D-printed auxiliary device-based protocol provides a precise and operator-independent method for CA thickness measurement, offering a tool for quality control and providing a foundation for future research on material advancement and design optimization to improve aligner functionality.
Postsurgical stability in mandibular prognathism patients undergoing a surgery-first approach: influence of postoperative orthodontic approach using clear aligners vs fixed appliances.
Lee KC
Angle Orthod · 2026 Feb · PMID 41038621 · Full text
OBJECTIVES: To compare the effect of postsurgical orthodontic treatment between using clear aligners (CA) or fixed appliances (FA) on the postsurgical stability of patients with mandibular prognathism in the surgery-firs...
OBJECTIVES: To compare the effect of postsurgical orthodontic treatment between using clear aligners (CA) or fixed appliances (FA) on the postsurgical stability of patients with mandibular prognathism in the surgery-first approach (SFA). MATERIALS AND METHODS: This retrospective study included 54 patients with mandibular prognathism who underwent surgical orthodontic treatment with isolated mandibular setback surgery. The patients were divided into two groups according to the mechanics of postsurgical orthodontic treatment: the CA group included 27 patients treated with clear aligners, and the FA group included 27 patients treated with brackets during postoperative orthodontic treatment. Cone beam computed tomography scans were taken before, immediately after, and at 3, 6, and 12 months postsurgery to assess mandibular relapse. The measurements of postsurgical mandibular relapse including horizontal and vertical positions were compared according to the treatment progress and groups. RESULTS: Total postsurgical mandibular relapse at pogonion was 3.2 mm in the CA group and 2.2 mm in the FA group. Relapse was higher at 3 months postsurgery in both groups, with an average forward movement of 1.4 mm in the CA group and 1.7 mm in the FA group. Relapse in the CA group showed no significant changes over time, indicating persistence beyond the initial period. In contrast, the FA group showed a significant reduction in relapse by 3 months. Overall, the CA group tended to have greater and more persistent relapse than the FA group. CONCLUSIONS: Careful consideration of skeletal relapse is needed in the postsurgical management of patients treated with clear aligners in SFA treatment.
The impact of orthodontic traction on outcomes in impacted canine management: a quantitative analysis.
Tarkan H, Gürbüz OÖ
Angle Orthod · 2026 Feb · PMID 41027613 · Full text
OBJECTIVE: To evaluate the effects of orthodontic traction of impacted maxillary canines on treatment duration, alveolar bone levels, white spot lesions (WSLs), root resorption, and the need for auxiliary appliances. MAT...
OBJECTIVE: To evaluate the effects of orthodontic traction of impacted maxillary canines on treatment duration, alveolar bone levels, white spot lesions (WSLs), root resorption, and the need for auxiliary appliances. MATERIALS AND METHODS: In this retrospective study, 116 patients were divided into two groups: 58 with unilaterally impacted maxillary canines and 58 controls without impaction. All patients received nonextraction treatment using labial fixed appliances. Pretreatment and posttreatment panoramic radiographs, intraoral photographs, and intraoral scans were analyzed. The collected data were used to compare the groups across five clinical parameters. Statistical analyses included the Mann-Whitney U-test, Wilcoxon signed-rank test, χ2 test, and Cochran's Q test, with significance set at P < .05. RESULTS: The impaction group had significantly longer treatment duration (mean = 2.64 ± 0.99 years) than controls (mean = 1.85 ± 0.60 years). Alveolar bone loss was significantly greater in teeth adjacent to the impacted canine and between the impacted and nonimpacted sides within the impaction group (P < .05). WSL incidence was higher in the impaction group, especially in posterior teeth (P = .0034). Root resorption patterns differed by region: maxillary incisors were more affected in the impaction group, whereas mandibular posterior teeth showed more resorption in controls. The use of auxiliary appliances was significantly greater in the impaction group. CONCLUSIONS: Impacted canine treatment is associated with increased treatment time, greater alveolar bone loss, higher risk of WSLs, and distinct root resorption patterns. These findings highlight the importance of individualized treatment planning, careful biomechanical control, and preventive strategies in managing impacted canines.
Factors influencing the predictive performance of artificial intelligence for craniofacial growth.
Kwon N, Kim JH, Suh H … +2 more , Oh H, Lee SJ
Angle Orthod · 2025 Sep · PMID 41022398 · Full text
OBJECTIVES: To evaluate factors influencing the prediction error of artificial intelligence (AI) that predict craniofacial growth and to identify an optimal AI training condition to improve the predictive performance of...
OBJECTIVES: To evaluate factors influencing the prediction error of artificial intelligence (AI) that predict craniofacial growth and to identify an optimal AI training condition to improve the predictive performance of the AI model. MATERIALS AND METHODS: Original growth data were collected from the Mathews longitudinal serial growth study. From the original data consisting of 1257 datasets from 33 growing children of northern European descent, 60 data subsets were generated using random resampling procedures to include 12, 18, and 24 subjects, with data sizes of 100, 200, 300, 400, and 500 datasets. The resampling procedures were repeated four times. Each subset was used to train and create a total of 60 AI models. The prediction accuracy of these models was evaluated using growth prediction errors at the lower lip landmark, labrale inferius, as a benchmark indicator. The prediction errors of the 60 AI models were analyzed according to the number of subjects and data sizes. RESULTS: Prediction error decreased as the data size increased. However, increasing the number of subjects within the growth data led to higher prediction errors. Notably, the increase in prediction error caused by adding more subjects was more substantial than the improvement achieved by increasing the data size. CONCLUSIONS: The findings suggest that developing highly accurate AI-based craniofacial growth prediction models remains a significant challenge, even with extensive datasets.
Soft adhesives may cause more iatrogenic damage than hard adhesives during cleanup following bracket removal.
Butler TH, Nimrod PA, Tantbirojn D … +3 more , Al Dayeh A, Claro WI, Versluis A
Angle Orthod · 2026 Feb · PMID 41022396 · Full text
OBJECTIVES: To determine if adhesive remnants and enamel loss after debonding and cleanup with a finishing bur were affected by hardness properties of the adhesive resins. MATERIALS AND METHODS: Stainless steel orthodont...
OBJECTIVES: To determine if adhesive remnants and enamel loss after debonding and cleanup with a finishing bur were affected by hardness properties of the adhesive resins. MATERIALS AND METHODS: Stainless steel orthodontic brackets (American Orthodontics, Mini Master series) were bonded on facial surfaces of extracted premolars using a relatively soft bioactive resin (ACTIVA BioACTIVE-Restorative, Pulpdent) or harder traditional adhesive (Transbond XT, 3M; N = 20/group). Bracketed teeth underwent 5000 thermocycles before brackets were debonded. Debonding surfaces were examined qualitatively and categorized by three examiners. Remaining adhesive was removed with a carbide finishing bur. Teeth were scanned with an optical scanner before brackets were bonded (baseline), after debonding, and after cleanup. Surface changes (mean thickness or depth, affected surface area, and volume) were calculated quantitatively after aligning scans to the baseline. Differences between the two groups were analyzed statistically with Mann-Whitney U-test or pairwise comparison at a significance level of 0.05. RESULTS: Qualitative examination of debonded surfaces did not show a significant difference (P = .7949) in adhesive remnants between groups, which was confirmed by quantitative evaluation (P > .05). After cleanup, enamel loss was significantly higher in the softer bioactive resin group (mean depth = 91 ± 16 µm, area = 24.48 ± 9.88 mm2) than the harder traditional adhesive (mean depth = 66 ± 9 µm, area = 6.34 ± 4.41 mm2; P < .0001). CONCLUSIONS: The likelihood of adhesive remnants after debonding a bracket bonded with the bioactive resin was similar to traditional adhesive. However, enamel loss from cleaning up with a finishing bur was higher for the softer bioactive resin.
External apical root resorption assessment revisited: a scoping review.
Iber-Diaz P, Senen-Carramolino R, Otero-Pregigueiro A … +2 more , Palma-Fernandez JC, Iglesias-Linares A
Angle Orthod · 2025 Jul · PMID 41015429 · Full text
OBJECTIVES: To provide a comprehensive critique of the diagnosis of root resorption using panoramic and periapical radiography, including discussion of the various methods of measurement, severity spectrum, and to shed l...
OBJECTIVES: To provide a comprehensive critique of the diagnosis of root resorption using panoramic and periapical radiography, including discussion of the various methods of measurement, severity spectrum, and to shed light on a significant factor predisposing to resorption: treatment duration. MATERIALS AND METHODS: The articles reviewed involved human subjects undergoing buccal fixed orthodontic treatment, diagnosed by panoramic or intraoral radiographs at the beginning and end of treatment. Treatment duration and external apical root resorption (EARR) had to be recorded to be included in the study. Relevant sources were searched using various platforms including PubMed, Scopus, and WoS. All sources of evidence, regardless of language, were included in the study. RESULTS: The search strategy yielded 704 studies; screening by title and abstract yielded 389 articles for full-text review. Forty studies were finally included and categorized according to the type of radiograph used to diagnose EARR: authors of 18 studies used panoramic radiographs, and authors of 22 studies used intraoral radiographs. CONCLUSIONS: In this study, we revealed a lack of agreement among authors concerning the diagnosis and measurement methods of external apical root resorption, resulting in inconsistencies in the results. Additionally, patient- and treatment-related factors, including treatment duration, were found to be inconsistently associated with the development of EARR. Standardization of diagnostic protocols and refinement of measurement techniques are essential to improve the accuracy of orthodontic care.
Nonsurgical treatment of severe vertical maxillary excess with short roots, thin bone, and a low maxillary sinus floor.
Li B, Huang F, Wang P … +4 more , Xue C, Han X, Bai D, Xu H
Angle Orthod · 2025 Jul · PMID 41015428 · Full text
Severe vertical maxillary excess (VME) is a skeletal abnormality that typically requires orthognathic surgery for correction. Nonsurgical orthodontic treatment has been a fascinating but challenging alternative, especial...
Severe vertical maxillary excess (VME) is a skeletal abnormality that typically requires orthognathic surgery for correction. Nonsurgical orthodontic treatment has been a fascinating but challenging alternative, especially when adverse anatomic factors hamper or pose risks for intrusive tooth movement. Despite well-documented efficiency of temporary anchorage device (TAD)-aided nonsurgical treatment for VME, evidence is scarce regarding the treatment efficacy and safety for cases with adverse anatomic traits. In this case report, we present nonsurgical treatment of a patient with severe VME, maxillary protrusion, and retrognathism. Additional challenges included compromised periodontal health, low maxillary sinus floor, short roots with axes deviating from the center of basal bone, and thin labial cortical bone with partial deficiencies. With anchorage from a transpalatal arch (TPA) and TADs and elaborate biomechanical control strategies, significant maxillary full-arch intrusion and anterior retraction with adequate root torque control were achieved, resulting in counterclockwise mandibular rotation and notable profile improvement. One-year follow-up showed stable treatment results. This case provided evidence on how balance may be achieved between treatment efficacy and anatomical limitations using biomechanical control strategies.
Accuracy of a dynamic guided surgery system for orthodontic miniscrew placement: an experimental in vitro study.
Moya-Martínez T, Figueiredo R, Jorba-García A … +5 more , Bara-Casaus JJ, Rojas-Vizcaya F, de-la-Rosa-Gay C, Sánchez-Torres A, Valmaseda-Castellón E
Angle Orthod · 2025 Jul · PMID 41015427 · Full text
OBJECTIVES: To compare the accuracy and time required for orthodontic miniscrew placement using a dynamic computer-assisted surgery (d-CAS) system vs the conventional freehand (FH) approach. The effect of side, location,...
OBJECTIVES: To compare the accuracy and time required for orthodontic miniscrew placement using a dynamic computer-assisted surgery (d-CAS) system vs the conventional freehand (FH) approach. The effect of side, location, and operator experience was also evaluated. MATERIALS AND METHODS: A randomized, in vitro experimental study was conducted using 10 maxillary resin models. After virtual planning, 40 miniscrews were randomly placed by one experienced and one novice operator. Twenty miniscrews were placed using a d-CAS system (test group) and 20 using the conventional FH method (control group). Preoperative and postoperative cone beam computed tomography scans were superimposed to measure deviations between the planned and final miniscrew position, and placement time was recorded. RESULTS: The d-CAS group showed less deviation at the entry point (95% confidence interval [CI] = 1.79 mm to 0.16 mm; P = .019) and less angle deviation (95% CI = 8.5° to 1.7°; P = .004). No significant differences were observed in other variables. Both operators achieved similar accuracy. Placement time was significantly longer in the d-CAS group, with a mean difference of 6.3 minutes (P < .001). CONCLUSIONS: Dynamic computer-assisted surgery improves the accuracy of orthodontic miniscrew placement vs the traditional FH method. However, d-CAS takes significantly longer. Clinician experience does not seem to significantly affect accuracy.
Bullying in schoolchildren and its relationship to malocclusion accounting for demographic and psychosocial factors: a cross-sectional study of 10- to 14-year-olds in the United Kingdom.
DiBiase A, Cox Z, Rea M … +3 more , Cane J, Cameron L, Rutland A
Angle Orthod · 2025 Jul · PMID 41015426 · Full text
OBJECTIVES: To investigate the prevalence of bullying in schoolchildren and its relationship with malocclusion, accounting for demographic and psychosocial factors. MATERIALS AND METHODS: This was a cross-sectional study...
OBJECTIVES: To investigate the prevalence of bullying in schoolchildren and its relationship with malocclusion, accounting for demographic and psychosocial factors. MATERIALS AND METHODS: This was a cross-sectional study on 10-14-year-old schoolchildren in the United Kingdom. Clinical examination was undertaken measuring Index of Orthodontic Treatment Need (IOTN), overjet, overbite, and crowding or spacing. Questionnaires were used to measure bullying, oral health-related quality of life (OHRQoL), self-esteem (SE), loneliness, and behavioral and emotional difficulties. RESULTS: Of 698 participants, 68 reported being bullied (9.7%). No difference was found in prevalence for gender, ethnicity, or age. Increased prevalence was found in participants with overjet > 6 mm (P = .02) and great need for treatment (IOTN Dental Health Component 5 P < .001, Aesthetic Component 9-10 P = .008). Bullied participants reported lower OHRQoL (P < .001) and SE (P < .001) and higher levels of loneliness (P < .001), emotional symptoms (P < .001), conduct problems (P = .002), and peer problems (P < .001). Multivariate analysis showed that being bullied was related to higher levels of loneliness (P = .007), poor peer relations (P < .001), and increased overjet (P = .032). CONCLUSIONS: Accounting for psychosocial factors, risk of being a victim of bullying was related to malocclusion, specifically an increased overjet.
Relation of maxillary permanent central incisor rotations with the primary palatal margin and overjet in repaired complete unilateral cleft lip and palate.
Suri S, Disthaporn S, Lou W … +1 more , Fisher D
Angle Orthod · 2025 Aug · PMID 41015425 · Full text
OBJECTIVES: To examine the relation of maxillary permanent central incisor rotation with the primary palatal margin (PPM) and overjet in the mixed dentition in complete unilateral cleft lip and palate (cUCLP). MATERIALS...
OBJECTIVES: To examine the relation of maxillary permanent central incisor rotation with the primary palatal margin (PPM) and overjet in the mixed dentition in complete unilateral cleft lip and palate (cUCLP). MATERIALS AND METHODS: Dental casts and preorthodontic records taken before alveolar bone grafting were examined to exclude patients having permanent teeth distal to the cleft side maxillary central incisor (CS1) and mesial to the cleft. Maxillary central incisor rotation, the angle between PPM and midline, proximity of the lingual surface of the central incisor to PPM, and overjet were measured from standardized occlusal photographs of the dental casts of 54 children with repaired cUCLP (38 M, 16 F; aged 8.7 ± 1.0 years). Descriptive analysis and correlation statistics were performed. RESULTS: Rotations were noted in 92.6% of the CS1. Their magnitude (111.2 ± 24.2°) was significantly greater than the noncleft side maxillary central incisor (NCS1) rotations (76.7 ± 15.7°). Rotations were predominantly distolabial for the CS1 and distopalatal for the NCS1. The PPM was located within 2 mm of the lingual surface of the CS1 in 35.2% of the sample. Severe CS1 rotation existed in 48.2% of the sample and was significantly correlated with the PPM angle (r = 0.3; P = .046) and when its proximity to the PPM was within 2 mm (φ = 0.3; P = .028). Overjet was not significantly correlated with the magnitude of rotation. CONCLUSIONS: The angle between PPM and the midline and its proximity to CS1 are associated with the severity of CS1 rotation in repaired cUCLP. Orthodontic implications are discussed.
Effect of aging and mechanical brushing on color stability and translucency of three-dimensionally printed and thermoformed aligners of different thicknesses.
Fidan M, Gelgor IE
Angle Orthod · 2025 Aug · PMID 41015424 · Full text
OBJECTIVES: The aim of this study was to evaluate the effect of aging and mechanical brushing on the color stability and translucency of three-dimensionally (3D) printed and thermoformed transparent aligners (clear align...
OBJECTIVES: The aim of this study was to evaluate the effect of aging and mechanical brushing on the color stability and translucency of three-dimensionally (3D) printed and thermoformed transparent aligners (clear aligners [CAs]) of different thicknesses. MATERIALS AND METHODS: Three types of CAs (Dentsply Sirona Essix [Group 1], Scheu-Dental Thermoforming Foils [Group 2], and 3D-printed Nexdent [Group 3]) in two thicknesses (0.75 mm and 1.0 mm) were used. Each group was divided into cleaned and noncleaned subgroups (n = 10). Samples were aged in artificial saliva and subjected to mechanical brushing. Color differences (ΔE00) and relative translucency parameter values (RTP00) were recorded at 1-week intervals over 4 weeks. Statistical analyses included generalized linear models and repeated measures analyses of variance (ANOVAs) for normally distributed parameters, and robust ANOVAs and Friedman tests for nonnormally distributed parameters (P < .05). RESULTS: Group 1 had the highest mean RTP00 values, while Group 3 had the lowest mean RTP00 values. Noncleaned CAs exhibited higher RTP00 values than cleaned CAs (P < .05). RTP00 values decreased significantly over time, with Group 3 showing notable differences between cleaned and noncleaned subgroups. Thinner materials (0.75 mm) displayed greater color changes than thicker ones (1 mm). CONCLUSIONS: 3D-printed CAs demonstrated more significant color variation and less translucency in comparison to thermoformed CAs. Regular cleaning helps maintain translucency and color stability, but the choice of aligner material is crucial.
Recovery bone formation over radiographic lingual bone dehiscence after mandibular molar distalization with microimplants.
Kim HJ, Noh HK, Park HS
Angle Orthod · 2025 Jul · PMID 41015423 · Full text
OBJECTIVES: To assess mandibular lingual bone thickness changes after molar distalization with microimplants and during retention. MATERIALS AND METHODS: Twenty-one patients (10 men, 11 women; mean age: 20.5 ± 4.9 years)...
OBJECTIVES: To assess mandibular lingual bone thickness changes after molar distalization with microimplants and during retention. MATERIALS AND METHODS: Twenty-one patients (10 men, 11 women; mean age: 20.5 ± 4.9 years) who underwent mandibular molar distalization with microimplants were included. Cone-beam computed tomography images at pretreatment (T0), posttreatment (T1), and retention (T2) were used to measure posterior space available and lingual bone thickness distal to the mandibular second molar at 0-, 2-, 4-, and 6-mm levels apical to the root furcation. Repeated measures analysis of variance with Bonferroni correction was applied to compare T0, T1, and T2 measurements. Pearson's correlation analysis assessed the relationship between lingual bone thickness change and other variables. RESULTS: The mandibular second molar moved distally by 3.0 mm at crown level, and 1.2-1.8 mm at root level, after treatment. Posterior space available decreased significantly with root-cortex contact or radiographic lingual bone dehiscence observed at 6-mm root level. After retention, reduced cortical bone thickness increased significantly; however, T2 lingual bone thickness was less than T0. Although the decrease in lingual bone thickness at 6-mm root level correlated with crown and root distal movement after treatment, the increase in bone thickness during retention was not associated with tooth movement, patient age, or retention duration. CONCLUSIONS: Mandibular lingual bone thickness noticeably decreased after molar distalization with microimplants. After retention, significant bone recovery formation was observed at the thinned lingual cortex or radiographic bone dehiscence.
Comparative evaluation of accuracy between dynamic navigation and freehand method during orthodontic implant placement: a split-mouth study.
Farheen M, Anoosha M, Satyanarayana Raju M … +3 more , Padmapriya CV, Praveen Kumar Varma D, Sai Keerthi V
Angle Orthod · 2025 Jul · PMID 41015421 · Full text
OBJECTIVES: To assess and compare the accuracy of infrazygomatic crest screws (IZC) placed with and without a dynamic navigation system. MATERIALS AND METHODS: Preoperative cone-beam computed tomography (CBCT) and intrao...
OBJECTIVES: To assess and compare the accuracy of infrazygomatic crest screws (IZC) placed with and without a dynamic navigation system. MATERIALS AND METHODS: Preoperative cone-beam computed tomography (CBCT) and intraoral scan of the maxillary arch were obtained for 12 patients requiring therapeutic first premolar extraction after leveling and alignment. Virtual planning of the final IZC screw position on both sides was done using Evalunav software. Maxillary left and right arches for each patient were randomized into experimental and control sides. A 12 × 2 mm dimension IZC screw was positioned with and without use of a dynamic navigation system randomly on either side. A postoperative CBCT was taken immediately to assess the final screw position. Preoperative and postoperative CBCTs were compared for deviation in the entry point, apical point, and angular point for experimental and control sides. Mean value deviations obtained were subjected to statistical analysis using SPSS 20.0 to describe the data. RESULTS: Paired t-tests were used to analyze the comparisons. Dynamic navigation showed a statistically significant difference in entry point and angular point compared to the freehand approach during implant placement. CONCLUSIONS: IZC screws implanted with the dynamic navigation system offered better control with less deviation and greater accuracy in all three planes of space. However, further studies are necessary to determine the stability and anchor value of implants placed with a dynamic navigation system.
Influence of lip protrusion and thickness on the perception of facial profile attractiveness among subjects with different ethnic backgrounds.
Sadek MM, Alali MB
Angle Orthod · 2025 Jun · PMID 41015420 · Full text
OBJECTIVES: To evaluate the influence of lip protrusion and thickness on the perception of facial profile attractiveness among subjects with different ethnic backgrounds. MATERIALS AND METHODS: 424 participants were divi...
OBJECTIVES: To evaluate the influence of lip protrusion and thickness on the perception of facial profile attractiveness among subjects with different ethnic backgrounds. MATERIALS AND METHODS: 424 participants were divided into four groups (European, Black African, Far Eastern, and Middle Eastern) and further subdivided into two subgroups according to age (18 to 40 and 41 to 60 years). An idealized female profile silhouette image was manipulated to generate 18 images with three different lip thicknesses and six sagittal lip positions. To assess perception of facial profile attractiveness, participants completed the developed questionnaire. RESULTS: Statistically significant differences were found among subjects with different ethnic backgrounds for all images (P < .01). Percent agreement averaged 13.89%. Within each group, scores varied with lip thickness and protrusion, with significant interaction between the two factors. Gender and age had a significant impact on profile attractiveness mean scores. CONCLUSIONS: Ricketts norms for the most favorable lip position to E-line need to be updated. Middle Eastern and Europeans regarded lips positioned + 1 mm to the norm in relation to E-line as the most attractive. Thick lips that were mildly protruded were preferred by Africans. Far Eastern participants preferred normal thickness and thin lips that were protrusive; thick lips were ranked lowest. Among the thick lips, protrusive lips were ranked higher. More personalized and culturally sensitive orthodontic treatment planning is needed to help patients achieve their desired facial esthetic outcome.
Synergistic effects of high-frequency vibration and orthodontic force on osteoclast numbers and root resorption in a rat model.
Luangthamma L, Suttapreyasri S, Thammanichanon P … +1 more , Leethanakul C
Angle Orthod · 2025 Jul · PMID 41015419 · Full text
OBJECTIVE: To evaluate how high-frequency vibration (125 Hz) combined with light or optimal orthodontic forces affects osteoclast numbers and root volume during tooth movement in Wistar rats. MATERIALS AND METHODS: Using...
OBJECTIVE: To evaluate how high-frequency vibration (125 Hz) combined with light or optimal orthodontic forces affects osteoclast numbers and root volume during tooth movement in Wistar rats. MATERIALS AND METHODS: Using a split-mouth design, 96 sites in male Wistar rats were randomly assigned to six groups: control, high-frequency vibration (HFV), light force (LF, 5g), light force with vibration (LF/HFV), optimal force (OF, 10g), and optimal force with vibration (OF/HFV). First maxillary molars were moved mesially using nickel-titanium (NiTi) closed coil springs. Root volume and osteoclast numbers were measured using Micro-CT and histomorphometry at Days 1, 7, 14, and 21. RESULTS: After 21 days, osteoclast numbers increased significantly in HFV (5.25 ± 0.48, P =. 002), LF/HFV (10.00 ± 0.41, P < .0001), OF (13.75 ± 0.48, P <.0001), and OF/HFV (15.25 ± 0.85, P < .0001) groups. Root volume decreased significantly in LF/HFV (7.75 ± 0.18 mm3), OF (6.68 ± 0.24 mm3), and OF/HFV (6.28 ± 0.14 mm3) groups compared to control (all P < .0001). HFV alone increased osteoclast numbers but did not affect root volume. The OF/HFV group showed the highest osteoclast numbers and root volume reduction. Three-way analysis of variance revealed that time, vibration, and force significantly reduced root volume (P < .0001). Notably, the interaction effects on osteoclast numbers were significant in LF group (P < .0001), but not OF group (P = .338). CONCLUSIONS: Combined high-frequency vibration and orthodontic forces increased osteoclast numbers and root resorption. Light forces with high-frequency vibration promoted osteoclast formation while minimizing root resorption compared to optimal forces. Additionally, the duration of this combined treatment significantly affected the extent of root resorption.
Usefulness of an artificial intelligence-assisted indirect bonding method for optimizing orthodontic bracket positioning.
Bachour PC, Klabunde RT, Grünheid T
Angle Orthod · 2025 Aug · PMID 41015418 · Full text
OBJECTIVES: To compare the bracket positioning accuracy of a traditional and an artificial intelligence (AI)-assisted digital indirect bonding (IDB) method to explore the current usefulness of AI for optimizing orthodont...
OBJECTIVES: To compare the bracket positioning accuracy of a traditional and an artificial intelligence (AI)-assisted digital indirect bonding (IDB) method to explore the current usefulness of AI for optimizing orthodontic bracket positioning. MATERIALS AND METHODS: Twenty-five clinicians positioned brackets using traditional and AI-assisted digital IDB methods. Bracket positioning differences were quantified using digital superimposition of bracket setups and compared with an optimal setup. A total of 1800 bracket positioning differences were evaluated. One-tailed t-tests were used to determine whether these differences were within limits of 0.5 mm in mesial-distal and occlusal-gingival dimensions and within 2° for tip. RESULTS: Overall mean bracket position differences between the traditional and digital setups were 0.28 mm for mesial-distal placement and 0.32 mm for occlusal-gingival placement; both were significantly below the 0.5-mm limit. In contrast, differences in tip were 3.4°, which was significantly greater than the 2° limit. Comparisons with an optimal setup showed overall statistically significant differences in mean bracket positioning for tip but not for the mesial-distal or occlusal-gingival measurements for both the traditional and AI-assisted digital IDB methods. However, the digital method was more accurate for bracket tip. CONCLUSIONS: Bracket positioning is consistent and highly accurate in linear dimensions with both traditional and digital IDB methods; however, AI may be useful for improving accuracy of bracket angulation. Clinicians who currently use traditional IDB methods may adopt AI-assisted digital IDB without compromising bracket positioning accuracy.
Comparison between two bone anchored force systems for correction of skeletal Class II malocclusion in growing patients: a randomized controlled clinical trial, part 1: short-term skeletal changes.
Mahmoud YM, Abdel-Haffiez SH, Marzouk ES … +2 more , El Ashwah AA, Ismail HA
Angle Orthod · 2025 Jul · PMID 41015417 · Full text
OBJECTIVES: To compare the treatment effects of pushing or pulling force mechanics applied to bimaxillary miniplates with those of deferred treatment control patients to evaluate mandibular skeletal growth changes in gro...
OBJECTIVES: To compare the treatment effects of pushing or pulling force mechanics applied to bimaxillary miniplates with those of deferred treatment control patients to evaluate mandibular skeletal growth changes in growing patients with skeletal Class II malocclusion due to mandibular deficiency. MATERIALS AND METHODS: Thirty-nine patients (24 males, 15 females; mean age = 11.59 ± 0.56 years) were equally and randomly assigned to one of three groups: Group A, skeletally anchored fixed-functional appliance (pushing mechanics); Group B, skeletally anchored Class II spring (pulling mechanics); and Group C, deferred treatment skeletal Class II control patients. Pretreatment and posttreatment cone-beam computed tomography scans were used for assessment of measurements (time interval: 11.52 ± 0.32, 11.53 ± 0.31, and 9.63 ± 0.22 months for groups A, B, and C, respectively). RESULTS: Relative to the control group, both intervention groups showed significant increases in effective mandibular length (Co-Gn), with mean differences of 5.08 ± 2.25 mm in Group A, and 3.83 ± 2.79 mm in Group B. A significant improvement in the sagittal relationship was observed in both groups, with reductions in ANB angle by 4.31° in Group A, and 5.5° in Group B. The mandibular plane angle was increased significantly in Group B by 1.83 ± 0.72°. CONCLUSION: Mandibular growth was enhanced using either pushing or pulling skeletally anchored force mechanics. The use of pulling force mechanics, specifically, was associated with increases in lower facial height.
Effectiveness and accuracy of clear aligners in non-extraction Class II correction: a systematic review of maxillary molar distalization and rotation in the permanent dentition.
Disthaporn S, Allareddy V, Atsawasuwan P … +1 more , Lee MK
Angle Orthod · 2025 Aug · PMID 41015416 · Full text
OBJECTIVES: To evaluate the effectiveness and accuracy of clear aligners (CA) in maxillary molar distalization and rotation for nonextraction Class II correction in the permanent dentition. MATERIALS AND METHODS: This sy...
OBJECTIVES: To evaluate the effectiveness and accuracy of clear aligners (CA) in maxillary molar distalization and rotation for nonextraction Class II correction in the permanent dentition. MATERIALS AND METHODS: This systematic review of the literature (2015-2024) followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies included orthodontic patients in the permanent dentition with dental Class II, mild or no skeletal discrepancies, 2-6 mm crowding, treated with CA without extractions (except maxillary third molars) or adjunctive therapies beyond Class II elastics. Data focused on maxillary molar distalization, rotation, accuracy, and complications. Risk of bias was assessed using ROBIN-I, with evidence level graded per the SBU protocol. RESULTS: Sixteen studies were categorized into Group A (initial aligner or distalization outcomes) and Group B (including refinements). Group B reported greater accuracy and distalization due to sequential distalization protocols, Class II elastics, and refinements. After refinements, CA achieved 1.84-2.98 mm of maxillary molar distalization with 85% maximum accuracy. First-molar rotation reached 8.09°, with 78.4% maximum accuracy. No significant vertical skeletal changes were observed. Challenges included anterior anchorage loss, buccolingual tipping of upper molars, and patient compliance monitoring. Methodological variability and participant demographics prevented a meta-analysis. CONCLUSIONS: CA effectively achieves maxillary molar distalization and rotation in nonextraction Class II patients. Sequential distalization protocols and refinements improve treatment outcomes, whereas early incorporation of Class II elastics, combined molar movements, and compliance monitoring may enhance treatment efficiency.
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