The Angle Orthodontist[JOURNAL]
Sun
200 papers
Impact of cone-beam computed tomography image quality on artificial intelligence-driven three-dimensional tooth segmentation and evaluation of external apical root resorption.
Senén-Carramolino R, Navarro-Fraile E, Dehesa-Santos A … +2 more , Paulsson L, Iglesias-Linares A
Angle Orthod · 2026 Jun · PMID 42349881 · Publisher ↗
OBJECTIVES: To assess the reliability of the diagnostic method using Diagnocat artificial intelligence (AI)-generated standard tessellation language (STL) files and Geomagic Wrap software and to evaluate whether cone-bea...
OBJECTIVES: To assess the reliability of the diagnostic method using Diagnocat artificial intelligence (AI)-generated standard tessellation language (STL) files and Geomagic Wrap software and to evaluate whether cone-beam computed tomography (CBCT) quality influences the consistency of AI-based segmentation and related measurements. MATERIALS AND METHODS: Forty orthodontic patients (20 from Spain and 20 from Sweden) were analyzed at two treatment time points (T0: beginning; T1: before using stainless-steel wires). STL files for each upper incisor were analyzed in Geomagic Wrap considering volume loss and tooth length. Reproducibility was assessed through repeated tooth reconstruction in an AI model, and the impact of the mesh correction tool and CBCT type was evaluated. RESULTS: Intraobserver and interobserver reliability was high (intraclass correlation coefficient = 0.93). AI reconstructions were highly consistent. No significant differences were found between STL generations, except in one case. Mesh correction significantly affected volume measurements in the teeth from higher-dose CBCT scans. No significant differences were found between CBCT types in either root volume (P = .861) or length loss (P = .082). Analysis of variance showed no significant differences between CBCT types. CONCLUSIONS: The method is reproducible and reliable for linear and volumetric external apical root resorption (EARR) measurements using AI-generated STL models. CBCT image quality does not appear to influence volume measurements. Mild EARR was observed between T0 and T1, with no significant differences.
Bracket transfer accuracy of two three-dimensionally printed lingual indirect bonding trays with different bracket frame designs.
Suvajac N, Hötzel L, Hoffmann L … +3 more , Keßler A, Wichelhaus A, Sabbagh H
Angle Orthod · 2026 Jun · PMID 42315190 · Publisher ↗
OBJECTIVES: To compare bracket transfer accuracy of two three-dimensionally (3D) printed indirect bonding tray designs for lingual indirect bonding. MATERIALS AND METHODS: Virtual bracket placement was performed using On...
OBJECTIVES: To compare bracket transfer accuracy of two three-dimensionally (3D) printed indirect bonding tray designs for lingual indirect bonding. MATERIALS AND METHODS: Virtual bracket placement was performed using OnyxCeph (OnyxCeph 3D Lab, Chemnitz, Germany). Tray design 1 was designed with a low bracket frame, while tray design 2 was designed with a high bracket frame. A total of 30 bonding trays and corresponding dental models were additively manufactured, 15 per design. After indirect bonding, achieved bracket positions were scanned. Linear and angular transfer errors were assessed. Statistical analysis of mean transfer errors and frequency of clinically acceptable errors (defined as < 0.5 mm and < 2°) were performed using Mann-Whitney U-test and χ2 test. RESULTS: Both tray designs demonstrated comparable transfer accuracy. Linear, tip, and rotation errors were mostly within clinical limits. All linear values were acceptable, except for vertical dimension in the incisors (98.3%). Rotation accuracy was high across all tooth groups (78.9-100%). Torque showed the greatest deviations, with only 11.9% of incisor brackets in the high-frame and 75.4% in the low-frame groups within acceptable limits. Overall, torque consistently had the lowest rate of clinically acceptable outcomes across both tray designs. CONCLUSIONS: Considering favorable transfer accuracy and improved handling characteristics of the low-frame tray design, its clinical application may be preferred. However, achieving high accuracy in the torque dimension remains a challenge with 3D-printed indirect bonding trays.
Biomechanical impact of beveling design on extrusion of a maxillary canine and a maxillary first molar: an in vitro and finite element analysis study.
Traversa F, Vollenweider P, Salvatori D … +1 more , Korunmuş E
Angle Orthod · 2026 Jun · PMID 42315186 · Publisher ↗
OBJECTIVES: To investigate the effect of beveling side (apical vs occlusal) on the extrusive biomechanics of clear aligners compared to unbeveled attachments when tracking issues occur. MATERIALS AND METHODS: An in vitro...
OBJECTIVES: To investigate the effect of beveling side (apical vs occlusal) on the extrusive biomechanics of clear aligners compared to unbeveled attachments when tracking issues occur. MATERIALS AND METHODS: An in vitro Orthodontic Force Simulator (OFS) was used to simulate extrusion of a maxillary canine and first molar. Three attachment designs (beveled apical, beveled occlusal, and conventional rectangular) were digitally designed on the target teeth and directly milled in zirconia material. Aligners were thermoformed for each design and target tooth. The tooth-aligner mismatch was created on the target tooth up to 1.0 mm to simulate the tracking issue. Finite Element Analysis (FEA) was conducted to simulate the OFS experiment and analyze stress distribution and deformation. RESULTS: The attachment designs yielded significant differences in extrusion forces and bucco-palatal moments on both teeth. Beveled apical attachments consistently produced the lowest forces and moments, especially as displacement increased. This was attributed to a sliding motion of the aligner along the tooth movement path, mitigating the negative effects of tracking errors. Rectangular and beveled occlusal attachments, while offering strong initial engagement, resulted in higher stress concentrations and variability in force delivery as the simulated aligner-tooth mismatch grew. CONCLUSIONS: The beveled apical design provides more predictable and consistent extrusion forces, reducing unwanted side effects, particularly for large movements and high risk of tracking issues.
Effectiveness of resin-modified glass ionomer vs composite bonding agents for orthodontic bonding: a single-center randomized controlled trial.
Östlund E, Ossoble RA, Malmvind D … +5 more , Merzo A, Rukiqi R, Algharbi M, Magnuson A, Bazargani F
Angle Orthod · 2026 Jun · PMID 42307562 · Publisher ↗
OBJECTIVES: To compare the incidence of bond failures and white spot lesions (WSLs) between brackets bonded with either light-cured resin-modified glass ionomer cement (GC Fuji Ortho LC) or light-cured composite resin (3...
OBJECTIVES: To compare the incidence of bond failures and white spot lesions (WSLs) between brackets bonded with either light-cured resin-modified glass ionomer cement (GC Fuji Ortho LC) or light-cured composite resin (3M Transbond Plus Color Change Adhesive) after 18 months of treatment. MATERIALS AND METHODS: 90 patients were allocated to the trial, and 84, with a mean age of 16.7 ± 2.6 years, were analyzed. The cross-mouth method was employed in each patient, in which two diagonal quadrants (e.g., upper right and lower left, or vice versa) were randomly assigned to the FujiOrtho group, and the opposite diagonal quadrants to the Transbond group. All patients were monitored for an average of 18 months for bond failure and WSL incidence. Multilevel mixed Poisson regression with robust standard errors was used to compare the groups. RESULTS: Overall, failure rates were 12.9% in the FujiOrtho group and 2.1% in the Transbond group, with an adjusted relative risk (aRR) of 6.21 (95% CI: 3.89-9.94), adjusted for age, sex, maxilla/mandible, tooth position, and treating orthodontist. Overall, WSL incidence was 8.3% in the FujiOrtho group and 8.8% in the Transbond group, with an aRR of 0.95 (95% CI: 0.80-1.13). CONCLUSIONS: Transbond Plus demonstrated a significantly lower bond failure rate compared to GC FujiOrtho LC, with a 3.6 times reduced risk of bracket failure. There were neither statistically nor clinically significant differences in the incidence of WSLs between the two groups.
Plastic deformation evaluation of clear aligners exposed to different cleaning solutions.
da Silva PCH, Faria TV, Galvani LD … +4 more , Gandini LG, Santos-Pinto AD, Vaz LG, Bianchi J
Angle Orthod · 2026 Jun · PMID 42276575 · Publisher ↗
OBJECTIVES: To evaluate the effect of different antimicrobial solutions on the mechanical properties of aligners (Invisalign, Align Technology Inc., San Jose, CA, USA). MATERIAL AND METHODS: Invisalign aligners were used...
OBJECTIVES: To evaluate the effect of different antimicrobial solutions on the mechanical properties of aligners (Invisalign, Align Technology Inc., San Jose, CA, USA). MATERIAL AND METHODS: Invisalign aligners were used, originating from an orthodontic treatment sequence to correct malocclusion in the upper arch. Specimens were obtained from the buccal surfaces extending from the upper right canine to the second molar and used for mechanical testing (n = 60). The test specimens were divided into seven groups: 0.5% sodium hypochlorite (HYP); sodium bicarbonate (BIC); neutral detergent (DET); 0.12% chlorhexidine digluconate (CX); white vinegar (VIN); Corega tabs (COR) and distilled water (DW) (control). RESULTS: After 7 days, significant intergroup differences in Young's modulus were observed, with HYP differing from DW and DET (P < .05). After 14 days, a significant difference was observed between CX and COR (P < .05). Significant changes related to immersion time were detected for DET, CX, and COR between 7 and 14 days (P < .05). No statistically significant differences were found in the maximum deformation values for any solution (P > .05). CONCLUSIONS: Stiffness of the materials was influenced by immersion in different solutions, with specific intergroup differences observed after 7 and 14 days. Significant changes over time were detected for DET, CX, and COR. However, immersion in the evaluated solutions did not significantly affect maximum deformation of the material.
Quantitative evaluation of an artificial intelligence-driven remote monitoring system for occlusion assessment using patient-captured images.
Bills D, Benton B, Dabney W … +1 more , Sellke TA
Angle Orthod · 2026 Jun · PMID 42225257 · Publisher ↗
OBJECTIVES: To evaluate the accuracy of an artificial intelligence (AI) model developed by DentalMonitoring for assessing occlusal parameters from patient-acquired intraoral images, using intraoral scanner (IOS)-derived...
OBJECTIVES: To evaluate the accuracy of an artificial intelligence (AI) model developed by DentalMonitoring for assessing occlusal parameters from patient-acquired intraoral images, using intraoral scanner (IOS)-derived three-dimensional (3D)measurements as the reference standard. MATERIALS AND METHODS: This multicenter prospective study included 430 orthodontic patients from three clinics in the United States. Each participant completed a DentalMonitoring scan using the DM ScanBox and a clinician-acquired IOS scan. Midline deviation, overbite, overjet, and canine class were measured on IOS-generated 3D models using metrology-grade software (ZEISS Inspect). Three independent, blinded technicians performed measurements, with the median value used as the reference. Agreement between AI-generated and reference measurements was assessed using Passing-Bablok regression and relative bias analyses at predefined clinical thresholds. RESULTS: All occlusal parameters demonstrated agreement within clinically acceptable limits. Midline deviation and overbite showed the highest concordance, with intercepts near 0.00 mm, relative biases below 3%, and mean biases of -0.01 ± 0.26 mm and -0.04 ± 0.39 mm, respectively. Overjet was modestly overestimated (mean bias = +0.29 ± 0.52 mm), while canine class showed increasing underestimation at higher values (mean bias = -0.31 ± 0.91 mm). CONCLUSIONS: The evaluated AI model demonstrated high agreement with IOS-based 3D measurements for midline deviation and overbite, with greater variability for overjet and canine classification. These results support the use of AI-assisted monitoring for screening and follow-up, while highlighting the need for further validation prior to routine clinical implementation.
The effect of anterior bite turbos on pulpal blood flow and mobility of the lower central incisors and pain perception.
Sotal R, Al-Nimri K, Taha N
Angle Orthod · 2026 May · PMID 42203226 · Publisher ↗
OBJECTIVES: To evaluate the biological response of mandibular central incisors to anterior bite turbos (ABTs) during fixed orthodontic treatment, focusing on pulpal blood flow (PBF), tooth mobility, and pain perception....
OBJECTIVES: To evaluate the biological response of mandibular central incisors to anterior bite turbos (ABTs) during fixed orthodontic treatment, focusing on pulpal blood flow (PBF), tooth mobility, and pain perception. MATERIALS AND METHODS: Fifty-five patients undergoing fixed appliance therapy were assigned to two groups: an experimental group (n = 29) and a control group (n = 26). All received 0.014-inch nickel-titanium arch wires. ABTs were bonded to the palatal surfaces of the maxillary central incisors in the experimental group. Lower incisor PBF was measured using laser Doppler flowmetry at baseline, 20 minutes, 1 week, and 1 month after bonding. Tooth mobility was recorded after 1 month using the Miller Index. Pain was assessed using a 10-cm Visual Analogue Scale over 7 days. RESULTS: PBF declined after 1 week in both groups and recovered after 1 month, with no significant differences between groups (P > .05). Tooth mobility was significantly greater in the bite turbo group (P < .001), with 74.1% of patients showing Grade 2 mobility compared with 25% in the control group. Pain peaked within 24 hours and declined significantly by day 7 (P < .001) in both groups, with no significant between-groups differences. CONCLUSIONS: ABTs do not adversely affect pulpal circulation or pain perception. The increase in tooth mobility in the bite turbo group is a normal adaptive response and remains within safe clinical limits. Using ABTs to correct deep overbite is biologically safe.
Contributions of anterior and posterior components of cranial flexure on skeletal classification: a cone-beam computed tomography study.
Ng A, Pangrazio-Kulbersh V, Al-Qawasmi R … +1 more , Kaczynski R
Angle Orthod · 2026 May · PMID 42203217 · Publisher ↗
OBJECTIVES: To evaluate the relationship between skeletal classification and the anterior and posterior components of cranial base flexure and glenoid fossa position. MATERIALS AND METHODS: Pretreatment cone-beam compute...
OBJECTIVES: To evaluate the relationship between skeletal classification and the anterior and posterior components of cranial base flexure and glenoid fossa position. MATERIALS AND METHODS: Pretreatment cone-beam computed tomography records of 420 patients were stratified by sex, age, and skeletal classification based on standards for maxillomandibular differential for age-specific patients. Cephalometric measurements (Basion, Nasion, superior aspect of glenoid fossa) were recorded, and their angular deviation, horizontal, and vertical distance from Sella were measured using a 7° constructed plane (H-P) from S-N as a reference. Results were analyzed using regression analysis and analysis of variance, along with intraclass correlation coefficient for reliability. RESULTS: Cranial base flexure was found to be significantly smaller in Class III individuals than Class I or II, due to a larger deflection in posterior cranial base angle from the horizontal plane. The position of Basion relative to Sella was also noted to have a significantly shorter horizontal and significantly longer vertical length in these same individuals. The position of the glenoid fossa showed that Class II patients tended to have a more posterior horizontal displacement from Sella when than those in Class I or III. All measurements, except for cranial base flexure, were significantly larger in males than females. Statistical significance was measured at P < .05. CONCLUSIONS: Cranial base angle is significantly smaller in Class III individuals, due to an anteriorly positioned posterior cranial base. The posterior position of the glenoid fossa appears to contribute to the anteroposterior position of the condyle in Class II patients.
Assessment of different direct printed aligner resins for leaching of urethane dimethacrylate: an in vivo study.
Selvaraj A, Prabhu D, Krishnan B … +3 more , Tm P, Krishnakumaran M, Kumar M
Angle Orthod · 2026 May · PMID 42161396 · Publisher ↗
OBJECTIVES: To evaluate the release of urethane dimethacrylate (UDMA) from the direct printed aligners using Tera Harz TC-85 resin (Graphy, Seoul, Korea) and Clear A resin (Senertek, Türkiye) in saliva samples at differe...
OBJECTIVES: To evaluate the release of urethane dimethacrylate (UDMA) from the direct printed aligners using Tera Harz TC-85 resin (Graphy, Seoul, Korea) and Clear A resin (Senertek, Türkiye) in saliva samples at different time intervals. MATERIALS AND METHODS: This prospective quasiexperimental study included 2 groups: Group A Tera Harz TC-85 (Graphy, Seoul, Korea) and Group B Clear A resin (Senertek, Izmir, Türkiye), each with 13 participants. Patients wore aligners for more than 20 hours a day for 14 days. Whole saliva samples were obtained at several time intervals: T0 before aligners were inserted and T1, T2, and T3 after 24 hours, 7 days, and 14 days of usage, respectively. High-performance liquid chromatography was used to analyze the samples, and the average results were computed. RESULTS: Results showed significant variations in UDMA leaching between groups A and B at all postintervention periods. Group B had a significantly greater mean UDMA release than Group A at T1, T2, and T3. Intragroup analysis revealed time-dependent increases in UDMA release in both groups. CONCLUSIONS: The findings revealed significant differences in UDMA release rates between the two materials, with Tera Harz TC-85 consistently showing lower levels of leaching than Clear A resin over the 14-day study period. Tera Harz TC-85 has superior performance in minimizing UDMA leaching, while both materials maintained acceptable profiles under the study conditions.
Comparison of outcomes in adolescents treated with aligners versus fixed appliances.
Oki DS, Bayirli B, Randall CL … +2 more , Mancl LA, Huang GJ
Angle Orthod · 2026 May · PMID 42150768 · Publisher ↗
OBJECTIVES: To compare treatment efficacy and efficiency, presence and extent of new white spot lesions (WSL), and quality of life in adolescent patients treated with aligners vs fixed appliances (FA) in an academic clin...
OBJECTIVES: To compare treatment efficacy and efficiency, presence and extent of new white spot lesions (WSL), and quality of life in adolescent patients treated with aligners vs fixed appliances (FA) in an academic clinic. MATERIALS AND METHODS: This cohort study included 29 adolescents (18 male and 11 female; mean age: 14) treated with aligners who were matched with 29 adolescents treated with FA. Pretreatment characteristics were collected, and consented subjects completed a modified OHIP-14 (Oral Health Impact Profile) questionnaire. Treatment efficacy was assessed comparing the peer-assessment rating (PAR) and efficiency was assessed comparing emergency visits, debonded appliances, appointments, and treatment time. Maxillary incisors were assessed for presence and extent of new WSLs. RESULTS: Both groups had similar demographic, pretreatment parameters, post-treatment PAR scores, and treatment time, while having a trend for less debonded appliances in the aligner group (P = .07). However, aligner patients had significantly less appointments (mean A = 15.7 vs FA = 21.3 visits; P < .001), emergency visits (mean A = 0.4 vs FA = 1.0 visits; P = .01), new or larger WSLs (P = .021), and oral hygiene counselling (mean A = 0.9 vs FA = 3.2 times; P = .006). The two groups also had similar OHIP-14 scores, but only 26% of aligner patients reported interruption of meals vs 70% of FA patients (P = .015). CONCLUSIONS: Both groups had similar PAR outcomes and treatment times. However, aligner patients had fewer emergency visits, appointments, debonded appliances, new or larger WSLs, and interruption of meals compared to FA patients.
Management of upper third molars in Class II patients undergoing orthodontic distalization: a systematic review.
Boggio A, Ruggieri A, Paolone MG … +4 more , Gastaldi G, Castellana F, Manni A, Cozzani M
Angle Orthod · 2026 May · PMID 42107975 · Publisher ↗
OBJECTIVES: To update previous findings, assess the impact of third molar presence or absence on distalization outcomes, and provide evidence-based clinical guidance in the management of upper third molars in Class II pa...
OBJECTIVES: To update previous findings, assess the impact of third molar presence or absence on distalization outcomes, and provide evidence-based clinical guidance in the management of upper third molars in Class II patients. MATERIALS AND METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines and applied Participants, Exposure, Comparison, Outcomes, Study design criteria to define eligibility. A literature search across four databases was conducted, up to April 2025, limited to indexed studies. Two reviewers independently screened articles, resolving disagreements with a third reviewer. Included studies were categorized based on whether authors recommended extraction of upper third molars (eg, surgical germectomy) before distalization. Risk of bias was evaluated using the Newcastle-Ottawa Scale for nonrandomized studies and certainty of evidence was assessed using Grade of Recommendations, Assessment, Development, and Evaluation reporting system criteria. RESULTS: Eleven studies met the inclusion criteria: 10 nonrandomized retrospective trials and one nonrandomized prospective trial. Authors of all studies reported a significant reduction in the upper retromolar space during distalization. Most found that absence or prior extraction of upper third molars facilitated improved bodily movement of first and second molars and reduced treatment duration. CONCLUSIONS: Current evidence, though low in quality, suggests that the presence of upper third molars may hinder the efficiency of orthodontic distalization and affect the spontaneous eruption path of these teeth. Strategic third molar management may enhance treatment outcomes and should be considered in treatment planning.
Functional orthopedic treatment for mandibular asymmetry in a giant panda with amputation.
Fan Q, Li J, Alkam E … +8 more , You M, Luo L, Li B, Huang W, Chen X, Han X, Lai W, Long H
Angle Orthod · 2026 May · PMID 42097622 · Full text
OBJECTIVES: To apply human orthodontic principles in treating malocclusion with dentofacial asymmetry for a juvenile male giant panda in which a developmental anomaly was potentially attributable to accidental maternal i...
OBJECTIVES: To apply human orthodontic principles in treating malocclusion with dentofacial asymmetry for a juvenile male giant panda in which a developmental anomaly was potentially attributable to accidental maternal injury to the mandible and left forelimb, as well as subsequent amputation of the left forelimb. MATERIALS AND METHODS: Custom orthodontic appliances were designed using intraoral scanning and bonded under general anesthesia. Treatment involved fixed appliances and elastic tractions over a 6-month period. Pretreatment and posttreatment evaluation included clinical examination and computed tomography (CT) scanning. RESULTS: Functional orthopedic treatment successfully corrected the mandibular deviation, improving facial symmetry and masticatory function. CT scans demonstrated correction of mandibular deviation and compensatory growth of the left cranial base. CONCLUSIONS: This case demonstrates successful application of orthodontic principles in treating developmental asymmetry in a giant panda through interdisciplinary collaboration between veterinary and orthodontic specialists.
Maxillary sinus volume and dimensions in patients with and without impacted canines: a systematic review and meta-analysis.
Sulaiman MA, Spaičytė N, Trakinienė G … +1 more , Vasiliauskas A
Angle Orthod · 2026 May · PMID 42091125 · Publisher ↗
OBJECTIVES: To analyze differences in maxillary sinus volume (MSV) and dimensions (length, width, height) in patients with and without impacted canines. MATERIALS AND METHODS: Five databases were searched up to August 20...
OBJECTIVES: To analyze differences in maxillary sinus volume (MSV) and dimensions (length, width, height) in patients with and without impacted canines. MATERIALS AND METHODS: Five databases were searched up to August 2025 for studies analyzing MSV and/or dimensions in impacted canine patients using cone-beam computed tomography. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies. Certainty of evidence was determined using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Meta-analysis was performed in MedCalc. RESULTS: Five articles met the criteria: three graded "Good" and two "Moderate." The meta-analysis showed a significant MSV difference in unilateral palatally impacted canines (PICs), but not in buccally impacted canines (BICs). No significant maxillary sinus dimension (MSD) differences were observed, though bilateral PICs had fluctuating values. From pre- to post-treatment, MSV tended to increase in PICs. In PICs and BICs, the MS extended more frequently into the incisor/canine regions. A 1000 mm3 decrease in MSV was associated with a 1.7 × increase in PIC odds, and opposite for BICs. Each 1 mm increase in MS height tended to raise PIC odds by 22%. CONCLUSIONS: MSV tends to be smaller in PICs but not in BICs. Bilateral PICs suggest a reduced MSD, whereas unilateral PICs and BICs do not. MSV tended to increase after the treatment of PICs. PICs may be more common in either smaller or higher sinuses, whereas BICs may occur more frequently in larger sinuses.
Clinical implications of recall visit ligature-tie activation on alignment efficiency in premolar extraction cases: a randomized controlled trial.
Karinghat J, Ammayappan P, Mano Dhandayuthapani S … +1 more , Divvi A
Angle Orthod · 2026 May · PMID 42061912 · Publisher ↗
OBJECTIVES: To determine whether replacing stainless steel ligature ties during recall visits accelerates anterior tooth alignment (decrowding) in extraction cases. MATERIALS AND METHODS: Twenty-four patients with a Litt...
OBJECTIVES: To determine whether replacing stainless steel ligature ties during recall visits accelerates anterior tooth alignment (decrowding) in extraction cases. MATERIALS AND METHODS: Twenty-four patients with a Little's Irregularity Index (LII) > 4, indicated for bicuspid extraction, were randomly assigned to two groups. All patients received preadjusted edgewise appliances and 0.016 Cu-NiTi initial archwires. Group 1 had ligature ties left in place until alignment completion; Group 2 had ties replaced every 4 weeks. Decrowding was quantified, until the LII score of 0 was achieved, measured at each 4-week interval using digital calipers on study models. Outcome assessors were blinded, and intraobserver and interobserver reliability was established. RESULTS: No significant difference was noted in overall decrowding rate between groups (P = 0.765; Group 1: 68.7 ± 29.0 days; Group 2: 65.3 ± 24.9 days). In Group 2, the maxillary arch showed a faster decrowding rate than the mandibular arch (P = 0.012; 42.0 ± 16.2 vs 77.0 ± 19.8 days). No significant arch difference was found in Group 1. CONCLUSIONS: Changing stainless steel ligatures at each recall visit offers no substantial benefit in the overall rate of anterior alignment. Scheduling recall visits every 8 weeks may be recommended for efficient time management during the alignment phase.
Influence of thermoforming techniques on thickness distribution of in-office aligners: a micro-computed tomography analysis.
Cupolillo MD, Barreto LSDC, de Araújo OMO … +5 more , Lopes RT, Marassi C, de Castro ACR, Araújo MTS, Sant'Anna EF
Angle Orthod · 2026 Apr · PMID 42061909 · Publisher ↗
OBJECTIVES: To evaluate the impact of three thermoforming methods on the resulting thickness of clear aligners (CAs). MATERIALS AND METHODS: A sample of 30 clear aligners (CAs) from the upper jaw was produced with polyet...
OBJECTIVES: To evaluate the impact of three thermoforming methods on the resulting thickness of clear aligners (CAs). MATERIALS AND METHODS: A sample of 30 clear aligners (CAs) from the upper jaw was produced with polyethylene terephthalate glycol and divided into three groups according to thermoforming technique: pressure thermoforming (PRT; n = 10), digital air vacuum thermoforming (DVT; n = 10), and conventional air vacuum thermoforming (CVT; n,=,10). Micro-computed tomography scans and thickness values at reference points were obtained in resulting images. Intrainvestigator reliability was assessed, and statistical analysis of data was performed with nonparametric analysis of variance tests (P < .05). RESULTS: Thickness decrease was detected among the three groups, which showed statistically significant differences. CVT presented the lowest mean thickness of 380 µm (±72.3 µm), with teeth in the anterior region thicker overall than the first molar. Also, this group had the greatest variability. DVT recorded a mean of 429 µm (±67.2 µm), with more uniform anteroposterior thickness distribution. Meanwhile, PRT had less substantial thinning with a mean thickness of 467 µm (±81.7 µm). CONCLUSIONS: Thermoforming method influences the surface thickness of thermoformed CAs. The findings provide clinically relevant evidence to guide orthodontists in selecting thermoforming protocols that ensure aligner structural stability, thickness uniformity, and more predictable force delivery.
When the tables are turned….
Schindel RH
Angle Orthod · 2026 Apr · PMID 42014097 · Full text
Abstract loading — click title to view on PubMed.
Comparative evaluation of ChatGPT and Gemini artificial intelligence in patient education on clear aligner therapy.
Kurnaz M, Tortop T, Kan H … +2 more , Ocakoğlu G, Kaygısız E
Angle Orthod · 2026 Apr · PMID 41980745 · Publisher ↗
OBJECTIVES: To compare the performance of ChatGPT-4 Turbo and Gemini 1.5 Pro in the domain of Clear Aligner Therapy (CAT). MATERIALS AND METHODS: A total of 36 standardized questions on CAT were created based on consent...
OBJECTIVES: To compare the performance of ChatGPT-4 Turbo and Gemini 1.5 Pro in the domain of Clear Aligner Therapy (CAT). MATERIALS AND METHODS: A total of 36 standardized questions on CAT were created based on consent forms from aligner companies and frequently asked patient questions. Responses were generated by ChatGPT-4 Turbo and Gemini 1.5 Pro. A reference answer key was developed from current literature. Two orthodontic professors independently evaluated the responses using a six-point accuracy scale and a three-point completeness scale. Questions were also categorized by topic. Readability was assessed using Flesch-Kincaid Grade Level (FKGL) and Simplified Measure of Gobbledygook (SMOG) scores. Independent samples t-tests were used to compare readability, whereas the Mann-Whitney U test was used for accuracy and completeness. Interrater reliability was assessed with intraclass correlation coefficient (ICC). Significance was set at P < .05. RESULTS: Interrater reliability was high for both models. ChatGPT showed excellent agreement for accuracy (ICC = 0.91) and good for completeness (ICC = 0.89). Gemini also showed excellent accuracy (ICC = 0.93) and moderate-to-good completeness (ICC = 0.78). No significant differences were found between models in accuracy, completeness, or readability. Both produced content with FKGL scores indicating university-level reading and SMOG scores suggesting high school-level comprehension. CONCLUSIONS: The readability of the content may present challenges for general audiences due to its complexity. The models used in this study may assist in patient education; however, the results implied the importance of professional consultation and careful interpretation of artificial intelligence-generated information.
Orthodontic literature maintains strong scientific and editorial integrity: a cross-sectional study of orthodontic publication retractions.
Hassan MG, Khalifa AR, Hassan DG … +1 more , Abdelrahman HH
Angle Orthod · 2026 Apr · PMID 41956482 · Publisher ↗
OBJECTIVES: To determine the rate, characteristics, and reasons for retraction of orthodontic publications, and how often these articles continued to be cited after retraction. MATERIALS AND METHODS: Retracted orthodonti...
OBJECTIVES: To determine the rate, characteristics, and reasons for retraction of orthodontic publications, and how often these articles continued to be cited after retraction. MATERIALS AND METHODS: Retracted orthodontic publications were identified via PubMed and the Retraction Watch Database up to January 2025. Each article was screened and categorized using standardized taxonomy. Data collected included journal type, publisher, research design, study theme, country, and gender of the corresponding author, reasons for retraction, and post-retraction citation counts. Retraction rates were calculated using orthodontic output indexed in Scopus from 2010 to 2024. RESULTS: A total of 39 retracted articles were identified, yielding a retraction rate of 0.08%. Nearly 28% (n = 11) occurred in 2023. Most retractions (66.7%, n = 26) came from multidisciplinary journals; only 15.4% appeared in orthodontic (n = 5) or dental journals (n = 5). Authors from Asian countries contributed to 76.9% (n = 30) of the retractions, with male corresponding authors making up 80% (n = 32). Clinical and in vitro/in vivo studies were the most affected. Retractions were primarily related to data integrity and editorial misconduct. About 60% (n = 23) continued to be cited after retraction. CONCLUSIONS: Orthodontic journals show relatively strong integrity but require continued vigilance. Although retractions in orthodontics are rare, they are increasing, particularly in multidisciplinary journals. Persistent citation of retracted research highlights the need for better editorial oversight and researcher awareness.
Patient-associated and treatment-related predictive factors influencing the duration of orthodontic treatment with fixed appliances.
Anagnostou C, Zogakis IP, Tsimtsiou Z … +2 more , Matiakis A, Haidich AB
Angle Orthod · 2026 Apr · PMID 41956480 · Publisher ↗
OBJECTIVES: To examine various patient- and treatment-related factors contributing to prolonged therapy. MATERIALS AND METHODS: This retrospective study analyzed clinical records of consecutively treated patients from a...
OBJECTIVES: To examine various patient- and treatment-related factors contributing to prolonged therapy. MATERIALS AND METHODS: This retrospective study analyzed clinical records of consecutively treated patients from a private orthodontic clinic. Univariate and multivariable linear regression were conducted to investigate patient- and treatment-related factors associated with increased orthodontic treatment duration. RESULTS: A total of 357 patients, with a median age of 14 years (IQR = 13, 17), females (n = 220, 61.6%), was included. Orthodontic treatment lasted a mean of 28.5 ± 10 months. Multivariable linear regression revealed that significant patient-related factors for increased duration were Angle Class II-Class I (B = 4.78; 95% CI = 2.74, 6.81; P < .001) and impacted (B = 9.68; 95% CI = 5.41, 13.94; P < .001), while treatment-related factors were dental arch (B = -9.89; 95%CI = -13.14, -6.64; P < .001), molar attachment (B = 3.05; 95% CI = 0.35, 5.76; P = .027), and extraction (B = 3.73; 95% CI = 1.52, 5.94; P = .001). Investigation in Class II cases indicated that Class II subdivision exhibited significantly shorter duration than bilateral Class II (P = .033). CONCLUSIONS: Class II compared with Class I and the presence of at least one impacted tooth were significant patient-related factors, while dual-arch orthodontic treatment, preferring bands over tubes, and including at least one extraction in the treatment plan were significant treatment-related factors for prolonged therapy. Class II (nonsubdivision) was associated with extended duration in contrast with Class II subdivision.
Systematic inconsistency in human and machine scoring of indices of malocclusion: the "Lazy-S Curve".
Chambers DW
Angle Orthod · 2026 Apr · PMID 41921988 · Publisher ↗
OBJECTIVES: To demonstrate systematic patterns relating "subjective" and "objective" measurement when scoring the American Board of Orthodontics Discrepancy Index (DI) and Objective Grading System (OGS) and Peer Assessme...
OBJECTIVES: To demonstrate systematic patterns relating "subjective" and "objective" measurement when scoring the American Board of Orthodontics Discrepancy Index (DI) and Objective Grading System (OGS) and Peer Assessment Rating (PAR) indices. MATERIALS AND METHODS: Digitized records of study models from 108 subjects scored by three trained raters were compared with scores from a proprietary digital scanning system with a built-in algorithm for producing these indices. RESULTS: Repeat measures of consistency using the digital system were perfect. Interrater consistency was typically moderately high (median ICC = 0.866). Correlations between human and digital measurement methods for the 33 component and index scores ranged from median intraclass correlation coefficients of 0.826 for DI, 0.568 for OGS, and 0.775 for PAR pretreatment and 0.636 for post-treatment PAR. The relationship between subjective and objective assessments showed common relationships: slopes significantly less than 1.00, and overestimation of small values and underestimation of large values. This pattern, known as the "lazy-S" curve, is characteristic of orthodontic and general measurement systems. The consistency for overjet and overbite indices was better between human and digital systems than across the two indices proportion to measure the same features. CONCLUSIONS: The inconsistency between human and machine measurements of occlusal characteristics does not necessarily reflect inadequacy of either approach and may be interpreted instead as reflecting features of judgment orthodontists use to focus on the clinically most relevant data.
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