Invisalign System as a Treatment of a Skeletal Open Bite: A Case Report With a 5-Year Follow-up

Background: Orthodontic treatments of skeletal open bite are among the most challenging and at high relapse. Available therapies vary from behaviour-modifying appliances in growing patients to surgical approach in adults. Recently, clear aligners, such as Invisalign®, have also been proposed as a treatment modality, to be used alone or in combination with temporary anchorage devices. Case report: A 19-year-old female presented with 3-mm anterior open bite, peg-shaped upper lateral incisors, incorrect tongue posture at rest and during function. Due to aesthetic request, an orthodontic camouflage with Invisalign® was carried out for 17½ months, along with myofunctional therapy and composite veneers on upper lateral incisors. During the first months of retention, intermaxillary vertical elastics were maintained at night-time as positive feedback to the tongue. A 5-year follow-up confirmed stability of the results. Conclusions: A system of clear aligners in combination with myofunctional therapy was effective in the treatment of a skeletal open bite malocclusion, with stability at 5 years. The closure of the anterior open bite was obtained through a combination of lower molar intrusion, incisor extrusion and counterclockwise rotation of the mandible. In selected cases of optimal compliance, Invisalign® may constitute a feasible treatment option in management of open bite in non-growing patients.

Various methods of canine retraction in premolar extraction space: A case series

Following article is the review and presentation of various methodologies of canine retraction [e.g.– methods under sliding and friction less mechanics, facilitation with TADs (Temporary Anchorage Devices) and MOPs (Micro-Osteo-Perforations), and invasive procedures etc.] and comparison of these methods in terms of rate of canine retraction, and molar anchorage loss. Patient’s age ranges between 15y to 19y and only right maxillary canine was taken for comparison purpose.

A Brief Review on Micro-Implants and Their Use in Orthodontics and Dentofacial Orthopaedics

The aim of this study was to review the literature and evaluate the failure rates and factors that affect the stability and success of temporary anchorage devices (TADs) used as orthodontic anchorage. Data was collected from electronic databases: MEDLINE database and Google Scholar. Four combinations of term were used as keywords: “micro-implant”, “mini-implant”, “mini-screw”, and “orthodontics”. The following selection criteria were used to select appropriate articles: articles on implants and screws used as orthodontic anchorage, published in English, with both prospective and retrospective clinical and experimental investigations. The search provided 209 abstracts about TADs used as anchorage. After reading and applying the selection criteria, 66 articles were included in the study. The data obtained were divided into two topics: which factors affected TAD success rate and to what degree and in how many articles they were quoted. Clinical factors were divided into three main groups: patient-related, implant related, and management-related factors. Although all articles included in this meta-analysis reported success rates of greater than 80 percent, the factors determining success rates were inconsistent between the studies analyzed and this made conclusions difficult.

New and Recovered Temporary Anchorage Devices, In Vitro Assessment of Structural and Surface Properties

The orthodontic miniscrew (TADs) is a device that is fixed into bone in the short term for the purpose of enhancing orthodontic anchorage. The aim of our study was to investigate the structural and surface properties of recovered TADs after orthodontic treatment, and compare them to new TADs. TADs (n = 15) from the same manufacturer (Absoanchor; Dentos, Daegu, Korea) were assessed; n = 10 were recovered from patients after orthodontic treatment and n = 5 were new. We performed electrochemical investigations, scanning electron microscopy (SEM) and microbiological analysis. Qualitative analysis on general electrochemical polarization revealed that the TADs retrieved from the patients provided much lower current densities in the passivity zone, and the oxidative processes taking place on their surface were of lower intensity. The surface morphologies of the tips of the retrieved mini-implants showed less sharp tips and smooth surfaces. Defects in the form of pores or cracks could be identified in both evaluated TAD groups. All retrieved TADs showed signs of biological materials (SEM analysis) and contamination on their surfaces. In conclusion, these results can assist orthodontists in comprehending the complexities of TAD behavior with respect to their design and structure.

Development of a Systematic Course On Orthodontic Temporary Anchorage Devices (TADs) for Orthodontic Residency Program

Background: Orthodontic temporary anchorage devices (TADs) offer absolute anchorage for clinical orthodontics. No systematic course on TADs has been described so far. The objectives of this study were to develop a systematic course on orthodontic TADs and to determine its teaching outcome.Methods: Five modules (fundamentals, anatomic sites, clinical applications, complications and insertion techniques, FACCI) were designed in this FACCI course on TADs. A total of 61 orthodontic graduate students from Department of Orthodontics, West China Hospital of Stomatology, Sichuan University were enrolled in this study. Baseline levels on the use of TADs were surveyed through a before-course questionnaire and the teaching outcomes were assessed through an after-course questionnaire.Results: After the course, significantly more students were willing to insert TADs by themselves (p<0.001). Students were significantly more familiar with the clinical applications of TADs for different types of tooth movements (p<0.001) and the insertion techniques of TADs at different anatomic sites (p<0.001). Before the course, most of the students had no knowledge on addressing TADs-associated complication and they were significantly more familiar with the techniques and skills of addressing TADs-associated complication after the course (p<0.001).Conclusions: The FACCI course on orthodontic TADs was effective and promoted the clinical applications of TADs in clinical practice among orthodontic graduate students.

Analysis of Oral Microbiome on Temporary Anchorage Devices Under Different Oral Hygiene Conditions

Background: Temporary anchorage devices (TADs) are maximum anchorages that have been widely used in orthodontic treatment. Poor oral hygiene might result in inflammation and decreased stability of the TADs. In this study, we aimed to unveil the differences in the microbiome between TADs under different oral hygiene conditions.Methods: Oral hygiene condition was stratified by Oral Hygiene Index- Simplified (OHI-S), Plaque Index (PLI), and Gingival Inflammation. Scanning electron microscopy (SEM) was used to analyze the existence of biofilm on the surface of 8 TADs, Ten TADs from the good oral hygiene group (GOH), and 10 TADs from the poor oral hygiene group (POH) were analyzed by 16S rRNA gene sequencing. Results: Principal coordinate analysis (PCoA) based on β diversity revealed differential sample clusters depending on oral hygiene conditions. When comparing specific genera, Veillonella, Streptococcus, Neisseria, were more enriched in the poor oral hygiene group. Conversely, Fusobacterium, Porphyromonas exhibited more richness in the good oral hygiene group. TADs in the good oral hygiene group demonstrated enriched microbial activities involved with signal transduction, cell mobility and energy metabolism. TADs in poor oral hygiene demonstrated enriched functions in membrane transport, transcription and signaling molecules and interactions. Conclusions: In summary, this analysis elucidated the difference in total composition and function of TADs oral microorganisms between patients with good oral hygiene and patients with poor oral hygiene, which highlighted the importance of maintaining good oral hygiene in TADs treatment.

An Innovative Procedure for Lip Lengthening in a Patient with a Short Upper Lip and High-Angle Skeletal Class II Pattern: A Case Report

Skeletal class II malocclusion in adult patients with severe gummy smile is challenging for orthodontist and often requires surgical intervention. The difficulty increases when patients refuse orthognathic surgery, and orthodontists have limited treatment alternatives. This report describes the case of a patient with severe dento-skeletal class II malocclusion with excessive gingival display while smiling. The patient was treated with temporary anchorage devices, and an innovative method of lip repositioning was devised to correct the irregularity.

Trends in orthodontic management strategies for patients with congenitally missing lateral incisors and premolars

ABSTRACT Objectives To identify changes in orthodontic management strategies in patients with hypodontia seen in 2000, 2010, and 2017/2018 (during a 1-year period). Materials and Methods An assessment of the panoramic radiographs of 3701 patients from a Western Australian private practice identified 276 individuals demonstrating hypodontia. The location of missing teeth, age, sex, type of malocclusion, and the management strategies (space closure or opening) for each patient were noted. Results Most hypodontia involved agenesis of three or fewer teeth (90%). Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. Female preponderance was noted. When considering treatment, the odds ratio for orthodontic space opening and prosthetic replacement in 2000 was 3.266 (P value = 7e-04; 95% confidence interval [CI], 1.464–4.633) compared with patients seen in 2010 and 1.632 (P value = 7e-04; 95% CI, 0.811–2.434) compared with patients in 2017/2018. For patients demonstrating bilateral absence of maxillary lateral incisors, the odds ratio for orthodontic space opening was 3.185 (P value = 0.0215; 95% CI, 1.182–9.243) compared with counterparts with unilateral agenesis. None of the factors investigated were significantly associated with the types of treatment planned/provided for the patients with missing mandibular second premolars. Conclusions Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. A trend away from space opening and prosthetic replacement toward orthodontic space closure was observed from 2000 to 2017/2018. This may reflect a change in attitude toward prosthetic replacement options and/or greater optimism with biomechanical strategies since the implementation of temporary anchorage devices to assist in space closure.