Modified Hyrax for Microimplant-Assisted Rapid Palatal Expansion

Temporary anchorage device-assisted rapid maxillary expansion has widened the horizon to treat adults having maxillary transverse deficiency without any surgical procedure. Three-dimensional custom modifications have also been developed, but they can be expensive. A modification of Hyrax screw with the use of lingual sheaths is suggested for microimplant-assisted rapid palatal expansion, which can be an easy to fabricate in-office and economical option.

Indication and uses of temporary anchorage device in orthodontic

Treating various types of malocclusion is dependant on providing a secure anchorage. In this context, it has been shown that teeth, intramaxillary, and/or extraoral appliances are required to achieve favorable outcomes regarding anchorage treatment. A Temporary anchorage device (TAD) has been introduced in the literature in this context. It has been described as a temporary device that can be used after completing treatment. The aim of the study was to review the indications and uses of TADs in orthodontic treatment. The current evidence shows that introducing TADs in the field of orthodontic treatment has been associated with favorable outcomes that encountered the previous multiple challenges reported with the conventional anchorage approaches. Contemporary orthodontic settings reported various uses for TADs, including corrections in transverse, vertical, and anteroposterior dimensions. Combined use of TADs and conventional approaches were also evaluated with favorable outcomes. These findings indicate the validity of TADs in orthodontic treatment and call for its future implications and clinical applications. However, it should be noted that post-treatment evaluation on a long-term basis was not adequately reported in the current literature, indicating the need for future investigations for further validation.

Guided Insertion of Temporary Anchorage Device in Form of Orthodontic Titanium Miniscrews with Customized 3D Templates—A Systematic Review with Meta-Analysis of Clinical Studies

(1) Background: Miniscrew insertion, using a surgical guide, aims to avoid possible adverse effects or complications. With the higher availability of both 3D imaging and printing, 3D surgical guides have been used more frequently in orthodontics. The aim of the present systematic review was to find scientific clinical evidence concerning the precision of the 3D guided insertion of miniscrews for temporary orthodontic anchorage. (2) Methods: Literature searches were performed in the following five search engines: Pubmed (Medline), Pubmed Central, Scopus, Web of Science and Embase on 10 September 2021 (articles from 1950 to 10 September 2021). A meta-analysis was performed using the random-effect model, with Standardized Mean Differences (SMD) and 95% confidence intervals (95% CI) calculated as effect estimates. The heterogeneity was assessed quantitatively. (3) Results: The search strategy identified 671 potential articles. After the removal of duplicates, 530 articles were analyzed. Subsequently, 487 papers were excluded, because they were not associated with the subject of the study. Of the remaining 43 papers, 34 were excluded because they did not meet the methodological criteria. Finally, only nine papers were subjected to a qualitative analysis. (4) Conclusions: The current literature concerning guided miniscrew insertion reveals, for the most part, a low methodological level. High-quality clinical trials are in the minority. The use of surgical guides increases insertion accuracy, stability and reduces the failure rate of orthodontic miniscrews. Tooth-borne insertion guides supported on the edges of the teeth ensure a higher insertion precision compared to mucosa-borne ones. The study protocol was registered in PROSPERO under the number CRD42021267248.

The VISTA Approach in Canine Disimpaction

Canine disimpaction is always a challenging orthodontic treatment overall, even when the impacted permanent canine is in a high position, especially when in tight relation with the upper incisors’ roots. Conventional treatment methods are usually not capable of performing the correct force direction, consisting of the contemporary movement in the distal and vestibular directions of the canine crown, often provoking, as side effects, the presence of decubitus on the mucous of the lips and cheeks or a poor final appearance of the periodontal support of the disimpacted canine. Among the different approaches, the vertical incision subperiosteal tunnel access (VISTA) technique shows good performance with regard to the direction of the forces and the canine’s periodontal conditions when erupted; it is usually realized through an elastic chain connected to a temporary anchorage device (TAD) in the posterior area. In this paper, a different protocol for the VISTA method is also presented, to be resorted to in cases of difficult miniscrew positioning due to the anatomic conditions or stage of dentitions. The new protocol also considers the use of nickel–titanium coil springs in order to avoid the need of frequent reactivation of the device and consequent patient discomfort, highlighting its advantages and indications with respect to the traditional approach.

ISW for the Treatment of Adult Skeletal Class II Case with Temporary Anchorage Device

Patients with a Class II malocclusion, proclination, severe crowding of the maxillary and mandibular anterior teeth, and high mandibular plane angles are a treatment-planning challenge. This case report describes an orthodontic treatment and maxillary premolar extraction without orthognathic surgery for a 18-year old man. Maximum anchorage is needed for upper anterior retraction by using Temporary Anchorage Device (TAD’s). The use of IME and ISW unilateral MEAW was important to relieve upper and lower anterior crowding. After treatment, the patient had a better profile, adequate overjet and overbite. This case report demonstrates that a minimally invasive treatment can successfully correct a severe skeletal Class II malocclusion with large overjet.

Mechanical Evaluation of the Stability of One or Two Miniscrews under Loading on Synthetic Bone

The aim of the present study was to evaluate the primary stability of a two-miniscrew system inserted into a synthetic bone and to compare the system with the traditional one. Forty-five bi-layered polyurethane blocks were used to simulate maxillary cancellous and cortical bone densities. Samples were randomly assigned to three groups—one-miniscrew system (Group A, N = 23), two-miniscrew system (Group B, N = 22) and archwire-only (Group C, N = 10). A total of 67 new miniscrews were subdivided into Group A (23 singles) and Group B (22 couples). 30 mm of 19″ × 25″ archwires were tied to the miniscrew. The load was applied perpendicularly to the archwire. Maximum Load Value (MLV), Yield Load (YL) and Loosening Load (LL) were recorded for each group. The YL of Group B and C had a mean value respectively of 4.189 ± 0.390 N and 3.652 ± 0.064 N. The MLV of Group A, B and C had a mean value respectively of 1.871 ± 0.318N, of 4.843 ± 0.515 N and 4.150 ± 0.086 N. The LL of Group A and B had a mean value respectively of 1.871 ± 0.318 N and of 2.294 ± 0.333 N. A two- temporary anchorage device (TAD) system is on average stiffer than a one-TAD system under orthodontic loading.