Abstract : Objective: To assess the effectiveness of leukocyte–platelet-rich fibrin (L-PRF) compared with conventional treatment on canine retraction, rotation, pain, and soft tissue healing. Methods: Sixteen adult patients aged 18–25 years (10 females, and 6 males; mean age 22.25 ± 2.26 years) with Class I bimaxillary protrusion and Class II div 1 malocclusion participated in this single-center, split-mouth randomized controlled trial at the Orthodontics Department of a single hospital in SCB Dental College and Hospital, Cuttack, India. Randomization was performed using a computer-assisted function with a 1:1 allocation ratio. The intervention included the placement of L-PRF on the experimental side and follow-up for 90 days. The primary outcome measures were canine retraction, rotation, pain, and soft tissue healing. The range of tooth movement was evaluated at 15-day intervals: 0th day (T0), 15th day (T1), 30th day (T2), 45th day (T3), 60th day (T4), 75th day (T5), and 90th day (T6). Canine rotation was assessed at T0 and T6, and pain and soft tissue healing were evaluated on the 3rd, 7th, and 15th days of the treatment. Results: Cumulatively, the L-PRF group demonstrated a significantly greater tooth movement as compared to conventional treatment group (P < 0.001). Overall, canine retraction was 1.5 times greater on the L-PRF side than on the control side. Canine rotation showed no significant relationship, whereas pain and soft tissue healing were significantly better on the L-PRF side than on the control side. Conclusions: Local administration of L-PRF amplifies canine retraction while improving pain and soft tissue repair.
Abstract : Objective: To assess and compare changes in the dimension and position of the mandibular condyle after tooth-borne (Hyrax) and tooth-bone-borne (Hybrid Hyrax) expansion. Methods: Twenty-five patients who underwent expansion with either tooth-borne appliances (8 girls, 5 boys; mean age 14.3 ± 2.3 years) or tooth-bone-borne appliances (6 girls, 6 boys; mean age 13.8 ± 2.2 years) were examined. Condylar and glenoid fossa morphology before (T0) and 3 months after (T1) expansion were evaluated using cone-beam computed tomography. Condylar measurements (anterior, posterior, and superior joint spaces; condylar height, length, and width), along with sagittal and vertical skeletal and maxillary transversal measurements, were analyzed using Dolphin Imaging software. Wilcoxon and Paired t tests were used for T0 and T1 evaluations, and the Mann–Whitney U test for intergroup comparisons. Results: At both T0 and T1, no statistically significant differences were observed between the groups in terms of condylar dimensions or the position of the condyle within the glenoid fossa. Maxillary transversal measurements increased after expansion in both groups (P < 0.01), with a significantly greater increase in first premolar width in the Hyrax group (P < 0.05). The vertical position of the posterior teeth showed no noteworthy changes (P > 0.05), except for the right second premolar. Temporomandibular joint measurements did not significantly change in either group after treatment (P > 0.05). Conclusions: Neither tooth-borne nor tooth-bone-borne expansion caused significant changes in the condylar dimensions and position at the end of treatment.
Abstract : Objective: This study aimed to evaluate bone remodeling in gingival crevicular fluid (GCF) during canine distalization in obese individuals and compare it to that in normal-weight individuals. Additionally, the orthodontic tooth movement rates of obese individuals were measured and compared with those of normal-weight individuals. Methods: Thirty-six patients (18 obese and 18 normal-weight) aged 12–18 years who were candidates for maxillary first premolar extraction for Angle Class II malocclusion were included in the study. The two groups were formed according to World Health Organization guidelines. A normal-weight group (body mass index [BMI] 16–85%) and an obese group (BMI ≥ 95%). Gingival crevicular fluid samples were collected before, 24 hours after, and on the 7th, 14th, and 21st days after the application of the distalization force. Enzyme-linked immunosorbent assay was used to measure leptin, receptor activator of nuclear factor kappa-Β ligand (RANKL), osteoprotegerin (OPG) and interleukin-6 (IL-6) levels in GCF samples. In addition to the recorded GCF sampling times, the amount of canine tooth movement was calculated using digital models obtained on the 28th day and 3rd month. Results: Leptin, RANKL, OPG, and IL-6 levels were significantly higher in the obese group (P < 0.05). The digital model measurements displayed high rates of repeatability (ICC 0.990). The difference in the amount of tooth movement between groups was not statistically significant (P > 0.05). Conclusions: Although obese and normal-weight individuals showed different biomarker levels during tooth movement, there were no significant differences in the amount of movement.
Abstract : Objective: This study aimed to compare the predicted and achieved labiolingual inclinations of the maxillary central incisors in adult Class II division 2 malocclusions treated with clear aligners using Power Ridges® and composite attachments. Methods: This retrospective study included 24 patients (mean age, 26.5 ± 3.3 years). The patients had Class II division 2 malocclusion and were treated with non-extraction with Invisalign® clear aligners with either Power Ridges® or composite attachments to enhance the predictability of required change in labiolingual inclination for the maxillary central incisors. Before treatment, treatment prediction and final digital models were exported as stereolithography files and superimposed using the eModel 9.0 “Compare” software. The predicted and achieved labiolingual incisor inclinations were compared. Results: The mean accuracies of the achieved inclination of the central incisors were 68.3% in the Power Ridges® group and 71.6% in the attachments group. No statistically significant differences in predictability were found between the groups (P > 0.05). A low positive correlation was observed between the predicted inclination change and the average absolute difference between the predicted and achieved inclinations (r = 0.19). Conclusions: Predicted labiolingual inclination is not fully achieved with clear aligners in both the Power Ridges® and attachment groups. Clinicians must take measures to counteract this limitation, specifically in Class II division 2 cases.
Abstract : Objective: Miniscrews are commonly utilized as temporary anchorage devices (TADs) in cases of maxillary protrusion and premolar extraction. This study aimed to investigate the effects and potential side effects of two conventional miniscrew configurations on the maxillary incisors. Methods: Eighty-two adult patients with maxillary dentoalveolar protrusion who had undergone bilateral first premolar extraction were retrospectively divided into three groups: non-TAD, two posterior miniscrews only (P-TADs), and two anterior and two posterior miniscrews combined (AP-TADs). Cone-beam computed tomography was used to evaluate the maxillary central incisors (U1). Results: The AP-TADs group had significantly greater U1 intrusion (1.99 ± 2.37 mm, n = 50) and less retroclination (1.70° ± 8.80°) compared to the P-TADs (–0.07 ± 1.65 mm and 9.45° ± 10.68°, n = 60) and non-TAD group (0.30 ± 1.61 mm and 1.91° ± 9.39°, n = 54). However, the AP-TADs group suffered from significantly greater apical root resorption (ARR) of U1 (2.69 ± 1.38 mm) than the P-TADs (1.63 ± 1.46 mm) and non-TAD group (0.89 ± 0.97 mm). Notably, the incidence of grade IV ARR was 16.6% in the AP-TADs group, significantly higher than the rates observed in the P-TADs (6.7%) and non-TAD (1.9%) groups. Multiple regression analysis revealed that after excluding tooth movement factors, the AP-TADs configuration resulted in an additional 0.5 mm of ARR compared with the P-TADs group. Conclusions: In cases of maxillary protrusion and premolar extraction, the use of combined anterior and posterior miniscrews enhances incisor intrusion and minimizes torque loss of the maxillary incisors. However, this approach results in more severe ARR, likely due to the increased apical movement and composite force exerted.
Abstract : Objective: This meta-epidemiological study aimed to determine whether optimal sample size calculation was applied in orthodontic cluster randomized trials (CRTs). Methods: Orthodontic randomized clinical trials with a cluster design, published between January 1, 2017 to December 31, 2023, in leading orthodontic journals were sourced. Study selection was undertaken by two independent authors. The study characteristics and variables required for sample size calculation were also extracted by the authors. The design effect for each trial was calculated using an intra-cluster correlation coefficient of 0.1 and the number of teeth in each cluster to recalculate the sample size. Descriptive statistics for the study characteristics, summary values for the design effect, and sample sizes were provided. Results: One-hundred and five CRTs were deemed eligible for inclusion. Of these, 100 reported sample size calculation. Nine CRTs (9.0%) did not report any effect measures for the sample size calculation, and a few did not report any power assumptions or significance levels or thresholds. Regarding the specific variables for the cluster design, only one CRT reported a design effect and adjusted the sample size accordingly. Recalculations indicated that the sample size of orthodontic CRTs should be increased by a median of 50% to maintain the same statistical power and significance level. Conclusions: Sample size calculations in orthodontic cluster trials were suboptimal. Greater awareness of the cluster design and variables is required to calculate the sample size adequately, to reduce the practice of underpowered studies.
Abstract : Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results: The two groups did not show significant difference in (1) body weight at birth and number of previous births; (2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.