Intrusion of the maxillary posterior teeth with a single buccal mini-implant positioned bilaterally in young adults with a tendency towards hyperdivergence: A clinical study

Background: Skeletal anchorage systems have been used for intrusion of the posterior teeth with satisfactory results. To achieve this, mini-implants are placed at anatomically challenging sites such as the palate or require several mini-implants to produce the desired effect. Objective: To determine the magnitude of intrusion of the maxillary posterior teeth achieved on a continuous arch wire using a single buccal mini-implant placed bilaterally in young patients with a tendency towards hyperdivergence and to evaluate its influence on the skeletal, dental and soft-tissue structures. Methods: A total of 17 patients with proclination of the anterior teeth, tendency towards hyperdivergence and clockwise rotation of the mandible were selected. First premolars were extracted as part of treatment protocol. A 0.022-MBT bracket prescription was used. Mini-implants were placed bilaterally on the buccal aspect at the mucogingival junction or slightly gingival to it between the maxillary second premolar and first permanent molar. A total of 200 g of intrusive force was placed from a continuous 0.019 × 0.025 inch stainless-steel arch wire to the mini-implant by means of an elastomeric thread on both sides. Lateral cephalograms and study models were taken before the start of intrusion and six months later. Parametric and non-parametric tests were done to assess treatment results. Results: Significant intrusion was observed in the maxillary molar and premolar region with tendency towards intrusion in the anterior region. There was significant decrease in lower anterior facial height (LAFH) with anti-clockwise mandibular rotation, decrease in facial proportion index and total facial height. No changes were observed in the transverse plane. Conclusion: Intrusion of the permanent maxillary molar can be achieved on a continuous arch wire with a single buccal mini-implant placed bilaterally with improvement in facial aesthetics, especially in the vertical plane. This method may be beneficial in patients with borderline vertical discrepancy treated with conventional friction mechanics during space closure after first premolar extractions.

Construction of Customized Palatal Orthodontic Devices on Skeletal Anchorage Using Biomechanical Modeling

Orthodontic implants have been developed for the implementation of skeletal anchorage and are effectively used in the design of individual orthodontic devices. However, despite a significant amount of clinical research, the biomechanical aspects of the use of skeletal anchorage have not been adequately studied. The aim of this work was to numerically investigate the stress–strain state of the developed palatal orthodontic device supported by mini-implants. Four possible options for the placement of mini-implants in the bone were analyzed. The effect of a chewing load of 100 N on the bite plane was investigated. The study was carried out using biomechanical modeling based on the finite element method. The installation of the palatal orthodontic device fixed on mini-implants with an individual bite plane positioned on was simulated. The dependence of equivalent stresses and deformation changes on the number and location of the supporting mini-implants of the palatal orthodontic device was investigated. Two materials (titanium alloy and stainless steel) of the palatal orthodontic device were also investigated. The choice of a successful treatment option was based on the developed biomechanical criteria for assessing the surgical treatment success. Application of the criteria made it possible to estimate the stability and strength of fixation of each of the considered mini-implants installation options. As a result, options for the mini-implants optimal placement were identified (the first and the fourth which provide distributed front and side support of the device), as well as the preferred material (titanium alloy) for the manufacture of the palatal orthodontic device.

Periodontally Accelerated Osteogenic Orthodontics (PAOO) vs Osteoperforations (A Review on Periodontal Reactions to Orthodontic Tooth Movement)

A high number of adult patients are undertaking orthodontic treatment now because of the newer methods, technology, and innovations available in the market. Orthodontic profession is continually looking for new ways to perform treatment effectively for such patients, as there are many differences in the biology, motivation, and treatment objectives between adults and children. Aligner therapy and mini-implants are some of the ways of managing orthodontic treatment for adult patients. Treatment time is a concern for adult patients and methods to accelerate the orthodontic tooth movement have been a focus in the orthodontic field. Periodontal accelerated osteogenic orthodontics (PAOO) is a surgical procedure that is performed with a combination of alveolar corticotomy, bone grafting, followed by orthodontic treatment. This procedure uses the principle of regional acceleratory phenomenon (RAP). Another procedure commonly used for accelerated orthodontic tooth movement is osteoperforations. This is a minimally invasive procedure, which does not include a flap surgery. The purpose of this article is to describe the differences between adult and children periodontal tissues, the use of different appliances for adult treatment, how orthodontic treatment has been modified for adult patients, and the detailed explanation of procedures for accelerating orthodontic tooth movement such as PAOO and osteoperforations and the potential complications

Efficacy of titanium brush, 915 nm diode laser, citric acid for eradication of Staphylococcus aureus from implant surfaces

Background This study aimed to assess the efficacy of titanium brush, 915 nm diode laser, citric acid and the combination of latter two with titanium brush for decontamination of SLA surface mini-implants. Methods Seventy-five mini-implants contaminated with Staphylococcus aureus (S. aureus) were randomly divided into five experimental groups (n = 12) of titanium brush (TiB), laser, citric acid (CA), brush-laser, and brush-acid, positive [n = 12; chlorhexidine mouthwash (CHX)] and negative [n = 2; phosphate buffered saline (PBS)] control groups and one no-treatment group (n = 1). After counting the colony forming units (CFUs), data were analyzed using the Kruskal–Wallis and Dunn post-hoc tests. Results Regardless of the no-treatment and negative control groups, maximum and minimum CFUs were noted in the titanium brush and positive control groups. After CHX, minimum CFUs were noted in brush-acid group followed by brush-laser, laser, and acid groups. Generally, the Kruskal–Wallis test revealed a significant difference between the groups regarding the colony count (P < 0.001). Dunn post-hoc test showed that the difference between the titanium brush and acid-brush group was significant (P < 0.001) while the differences between the brush and laser groups with the brush-laser group were not significant (P > 0.077). Conclusions Combined use of titanium brush and citric acid yielded superior results compared to other groups in reduction of S. aureus on implant surface.

Craniomaxillofacial Changes Using High-Pull J-Hook Headgear and Mini-Implant Anchorage in Adolescents: A Structural Superimposition Method

Objective: The aim of this study was to compare the craniomaxillofacial changes when using high-pull J-hook headgear (HPJH) and mini-implants (MIs) as maxillary anchorage in adolescents. Study Design: 40 female adolescents with dentoalvolar protrusion were divided into 2 groups; the HPJH group (n=20) and the MI group (n=20). Lateral cephalograms taken before treatment (T0) and after anterior tooth retraction (T1) were superimposed on the stable structures and then craniomaxillofacial changes were evaluated. Results: The cranial base angle, SNB, and facial angle decreased in the HPJH group but increased in the MI group. ANB decreased more in the MI group than in the HPJH group. Mandibular plane angle increased in the HPJH group but decreased in the MI group. Facial height index increased in the MI group while it showed no change in the HPJH group. Mandibular true rotation occurred clockwise in the HPJH group and counterclockwise in the MI group. Maxillary central incisors were intruded and retracted more in the MI group than in the HPJH group. Maxillary first molars were extruded in the HPJH group and were intruded in the MI group. Maxillary first molars were protracted more in the HPJH group than in the MI group. Mandibular central incisors were retracted more in the HPJH group than the MI group. Mandibular first molars were extruded more in the MI group than in the HPJH group. Conclusion: More favorable craniomaxillofacial changes occurred in the MI group than in the HPJH group.

Pain Perception Associated with Mini-Implants and Interventions for Pain Management: A Cross-Sectional Questionnaire-Based Survey

Background. Orthodontists use mini-implants temporarily as an effective mode of skeletal anchorage devices. The placement of mini-implants can cause pain and discomfort to the patients. Patients often develop swelling, and the pain could interfere with their daily activities. Practitioners tend to prescribe antibiotics and pain medication for management. Objectives. The main objectives of this study are to evaluate the pain perception and discomfort due to mini-implant placement experienced by the patient and evaluate the interventions for pain management commonly practiced among orthodontists. Materials and Methods. The study was designed as a questionnaire-based cross-sectional study. A total of 271 patients were assessed, for whom 625 mini-implants (ranging from 1.2 to 2 mm diameter and length 8-14 mm) were placed. Pain scores were assessed using the VAS and the “Faces” pain rating scale to collect data about discomfort in daily activity and function. Data was collected from 244 patients. A total of 155 orthodontists were questioned regarding the prescription of medications and the interventions for managing pain and adverse effects. Results. Average pain score among female subjects was 16.71 and among men was 13.5. The highest pain scores were recorded for palatal mini-implants with an average score of 36.29 and the least for interradicular mini-implants with an average score of 9.02. Among the subjects, 47.9% of them took analgesics, and the most commonly prescribed analgesics were paracetamol (39%). Swelling at the site is where the mini-implants were placed, and ulceration due to implants were commonly dealt with the excision of the surrounding soft tissue, composite placement, and palliative care with oral analgesic gels. Conclusion. Female subjects had more mini-implants placed, and female subjects had also given more pain scores than their male counterparts. Palatal mini-implants caused the highest pain, followed by mini-implants placed at the infrazygomatic crest and the buccal shelf region. Palatal mini-implants caused maximum discomfort during speech and eating, followed by the mini-implant in the buccal shelf and the infrazygomatic crest region that also caused difficulty in yawning and laughing. Infiltration anesthesia was commonly given for the placement of interradicular implants and extra-alveolar mini-implants. Paracetamol was the most prescribed by the orthodontists, and more than half the doctors did not regularly prescribe antibiotics.

Smart distalization of the upper arch with an easy, efficient and no-compliance procedure

In conventional Class II treatment, distalisation of the maxillary arch usually requires multiple phases of tooth movement during which anchorage loss can occur. In order to solve this issue, a rational and simple technique has been developed. Instead of using intraoral distalisers along with palatal mini-implants, Ni-Ti superelastic loops are used to obtain molar distalisation while buccal interradicular miniscrews (BIM), preferably placed between the roots of upper premolars, supply the necessary anchorage. Once the distalisation of molars and second premolars is performed, miniscrews are placed between the roots of first molars and second premolars after removing the previous miniscrews. Elastic chains or tie-backs, which go from the new miniscrews to the hooks of a 0.019×0.025-inch stainless-steel archwire, produce the retraction of incisors, canines and first premolars with optimal control of anchorage. Clinical cases are shown to illustrate the technique.

Effectiveness of platelet rich fibrin versus demineralized bone xenograft in periodontally accelerated osteogenic orthodontics: A pilot comparative clinical study

ABSTRACT Objectives To compare the rate of extraction space closure between periodontally accelerated osteogenic orthodontics (PAOO) using platelet-rich fibrin (PRF) (Group 1) and PAOO using demineralized bone xenograft (DMBM) (Group 2) and to compare the level of wound healing between the PRF group vs the DMBM group after PAOO. Materials and Methods A two-arm prospective single blind pilot study with a split-mouth design was used in which 14 patients requiring premolar extraction were divided into two groups: PRF and DMBM. En-masse space closure was carried out with using mini implants after the PAOO procedure. The amount of space closure was measured at five time points with 2-week intervals within 2 months. The gingival healing levels were assessed using early wound healing scores on the first postoperative day. Results The rate of extraction space closure was faster in the experimental quadrant at all time points (T1-T4) in the PRF group and at time points (T3, T4) in the DMBM group. Comparison between experimental quadrants showed a significant increase in the rate of space closure in the PRF group T1 to T3 (P &lt; .05). The PRF group showed higher total early healing scores than the DMBM group. Conclusions PRF, when used in the PAOO procedure, produces a faster rate of space closure with better early wound healing than DMBM.