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This study evaluated the clinical, radiographic, and histological outcomes of alveolar ridge preservation (ARP) using collagen sponge with xenografts (CS + Xenografts) versus collagen sponge (CS) alone, compared to spontaneous healing. 36 extraction sockets were randomly allocated into three groups: Group I (CS + Xenografts), Group II (CS alone), and Group III (control) spontaneous healing. Soft tissue assessment and CBCT imaging were conducted before tooth extraction (baseline) and 6 months post-extraction, followed by histologic and histomorphometric analysis of bone biopsies. Groups I and II exhibited minimal vertical and horizontal soft tissue changes compared to the control group (P < 0.001), with no statistically significant difference between Group I and II (P ≥ 0.05). Vertical and horizontal bone resorption was significantly lower in Groups I and II than in the control group (P < 0.001), with no statistically significant difference between Groups I and II regarding vertical bone loss (P = 0.477 and 0.108, respectively); percent of changes were 8.68 ± 2.69 and 8.61 ± 2.14 respectively. The greatest reduction in alveolar bone width was observed at 1 mm: 17.81 ± 3.97 (Group I), 19 ± 2.77 (Group II), and 41.79 ± 10.3 (Group III); overall P < 0.001. Histologically, Group I had the highest area% of lamellar bone and no residual inflammation, followed by Group II, which showed more inflammation; Group III had the lowest area% of lamellar bone. Intervention techniques were clinically and radiographically proven effective in ARP, however, CS + Xenografts histological results showed more lamellar bone and less residual inflammations.

In this report, we describe a successful orthodontic treatment through the maxillary sinus and show the utility of cone-beam computed tomography (CBCT) for this procedure. A 20-year-old man with Class I molar relationships and crowding of the maxillary and mandibular anterior teeth came to us to improve his malocclusion. Maxillary molar distalization was necessary to reduce the crowding of the teeth. This was achieved by the use of temporary anchorage devices (TADs) and the uprighting of the mandibular molars. However, several roots of the maxillary molars protruded into the maxillary sinus. The maxillary sinus is a known barrier to orthodontic tooth movement, leading to root resorption and/or tipping movement. We aimed to distalize the maxillary molars through the maxillary sinus by bodily movement. The findings were three-dimensionally confirmed by using the superimposition of CBCT obtained before and after the treatment.

Palatally impacted canines are usually challenging to treat in terms of both biomechanics and possible side effects. Different therapeutic approaches have been reported with or without the use of temporary anchorage devices, including the canine-first approach. Two groups of patients with palatally impacted canines were compared, observing their canine movement measured on consecutive CBCTs after three months of treatment. In the control group, impacted canines were treated with direct anchorage on miniscrews, and in the test group with indirect anchorage using a miniscrew-supported transpalatal arch. The primary outcome was the canine movement speed; the secondary outcome was the change in the root length of adjacent teeth. The median monthly apex speed was 1.05 mm in the control group (IR [0.74, 1.64]) and 0.72 mm in the test group (IR [0.27, 1.30]). The median monthly cusp displacement was 1.89 mm in the control group (IR [1.04, 2.84]) and 1.08 mm in the test group (IR [0.81, 1.91]). Approximately 50% of teeth adjacent to an impacted canine underwent a negative root length change of less than 1 mm in the majority of cases, but no significant differences were found in root length changes between groups. No statistically significant differences in the reported speeds were found, and no miniscrew failures were observed in either group.

Objectives Surgical correction of skeletal maxillary retroposition is often associated with changes in the morphology of the nose. Unwanted alar flaring of the nose is observed in many cases. The aim of the present study was therefore to investigate the influence of surgical advancement of the maxilla on changes in the soft-tissue morphology of the nose. Having a coefficient that allows prediction of change in the nasal width in Caucasian patients after surgery would be helpful for treatment planning. Materials and methods All 33 patients included in this retrospective study were of Caucasian descent and had skeletal Class III with maxillary retrognathia. They were all treated with maxillary advancement using a combination of orthodontic and maxillofacial surgery methods. Two cone-beam computed tomography (CBCT) datasets were available for all of the study's participants (16 female, 17 male; age 24.3 ± 10.4 years): the first CBCT imaging was obtained before the planned procedure (T0) and the second 14.1 ± 6.4 months postoperatively (T1). Morphological changes were recorded three-dimensionally using computer-aided methods (Mimics (Materialise NV, Leuven/Belgium), Geomagic (Geomagics, Morrisville/USA)). Statistical analysis was carried out using SPSS 21 for Mac. Results The mean sagittal advancement of the maxilla was 5.58 mm. The width of the nose at the alar base (Alb) changed by a mean of + 2.59 mm (±1.26 mm) and at the ala (Al) by a mean of + 3.17 mm (±1.32 mm). Both of these changes were statistically highly significant ( P  = 0.000). The increase in the width of the nose corresponded to approximately half of the maxillary advancement distance in over 80 % of the patients. The nasolabial angle declined by an average of −6.65° (±7.71°). Conclusions Maxillary advancement correlates with a distinct morphological change in nasal width. This should be taken into account in the treatment approach and in the information provided to patients.

Objective To evaluate the accuracy, reliability, and efficiency of voxel- and surface-based registrations for cone-beam computed tomography (CBCT) mandibular superimposition in adult orthodontic patients. Methods Pre- and post-orthodontic treatment CBCT scans of 27 adult patients were obtained. Voxel- and surface-based CBCT mandibular superimpositions were performed using the mandibular basal bone as a reference. The accuracy of the two methods was evaluated using the absolute mean distance measured. The time that was required to perform the measurements using these methods was also compared. Statistical differences were determined using paired t-tests, and inter-observer reliability was assessed by intraclass correlation coefficients (ICCs). Results The absolute mean distance on seven mandible surface areas between voxel- and surface-based registrations was similar but not significantly different. ICC values of the surface-based registration were 0.918 to 0.990, which were slightly lower than those of voxel-based registration that ranged from 0.984 to 0.996. The time required for voxel-based registration and surface-based registration was 44.6 ± 2.5 s and 252.3 ± 7.1 s, respectively. Conclusions Both methods are accurate and reliable and not significantly different from each other. However, voxel-based registration is more efficient than surface-based registration for CBCT mandibular superimposition.

Objective This study aims to develop a method for three-dimensional (3D) superimposition of the maxillary jaws and dentition using Cone Beam Computed Tomography (CBCT) and intraoral scan data, and to evaluate its accuracy and reliability. Materials and methods This study included 32 adult patients with Angle Class II malocclusion who underwent clear aligner therapy (CAT). The patients were categorized into two groups: Group 1 (TMEM: Third Molar Extraction Management group), including 16 individuals who had undergone maxillary third molar extraction prior to treatment. Group 2 (RMEM: Retained Maxillary Third Molar group), consisting of 16 patients who retained their maxillary third molars throughout the treatment period. CBCT scans and intraoral scan data were obtained at pre-treatment and post-treatment stages. Voxel-based superimposition and surface-based alignment techniques were applied to register the CBCT images before and after treatment. Subsequently, the digitized maxillary dentition model from intraoral scans was integrated with the CBCT dataset. Image alignment was performed, and its accuracy was verified. The precision and reliability of both alignment methods were systematically evaluated. Results The measurement results revealed that the average alignment accuracy of the CBCT images before and after treatment was 0.52 ± 0.03 mm (0.52 ± 0.03 mm in the TMEM group and 0.53 ± 0.03 mm in the RMEM group, the difference between the two groups was not significant, p  = 0.782, p  > 0.05), while the average alignment accuracy of the intraoral scan model integrated onto the CBCT images was 0.20 ± 0.02 mm (0.20 ± 0.01 mm in the TMEM group and 0.20 ± 0.01 mm in the RMEM group, the difference between the two groups was not significant, p  = 0.551, p  > 0.05). All registration methods demonstrated excellent inter-examiner reproducibility within each group (ICC > 0.9). Conclusion This study identified a reproducible and reliable method for 3D superimpose of the maxillary jaw and dentition before and after orthodontic treatment. This method can be used to assess changes in the position of the maxillary dentition and jaw morphology following orthodontic treatment.

The objective of this study was to evaluate intraobserver reliability and inter-observer reproducibility of a 3-dimensional (3D) assessment method for mandibular changes of growing patients after orthodontic treatment for Class III malocclusion. Methods Cone-beam computed tomography (CBCT) scans were performed before and after orthodontic treatment for 27 patients. During the scan, the patient was positioned such that his/her mandibular plane was parallel to floor. Three observers independently worked on the DICOM data, reconstructed the pre- and post-treatment 3D models in software, selected the stable anatomical structures (basal bone area from the lingual surface of the symphysis to the distal aspect of the first molars) to guide the automated superimposition process. Then, each observer registered 14 anatomical landmarks on the virtual models, for three times after suitable interval, to generate 3 sets of coordinates; the mean was taken as the coordinates for that particular landmark. The intraobserver reliability and inter-observer reproducibility of the method were analyzed. Results The ICCs was > 0.90 for 25 (92.6%) of the intraobserver assessments. The precision of the measurement method was < 0.3 mm in 24 (88.9%) cases. The interobserver reproducibility errors were < 0.3 mm in 21 of the 27 cases. Conclusions The intraobserver reliability and inter-observer reproducibility of 3D assessment of mandibular changes using the virtual models were excellent.

ObjectiveThis prospective controlled study evaluated the effect of bone-anchored maxillary protraction therapy in cleft children with Class III malocclusion using CBCT-derived 3D surface models.Materials and subjectsEighteen cleft patients between 10 and 12 years old were included. Intermaxillary elastics were worn after the placement of four zygoma bone plates for 18 months. Uniquely, three age-matched untreated groups including both cleft subjects and non-cleft subjects with Class III malocclusion served as controls. Profile photos and CBCT scans for each patient were taken before (T0) and 18 months after the protraction (T1). 3D measurements were made on CBCT surface models from the treatment group using tomographic color mapping method. Cephalometric measurements were made on lateral cephalogram reconstructed from the CBCT scans and were compared with those obtained from the control groups.ResultsTwo thirds of the treatment subjects showed improved lip projection towards more convex facial profile. The most significant skeletal changes on 3D surface models were observed at the zygomatic regions (mean 1.5-mm forward, downward, and outward displacement) and at the maxillary complex (mean 1.5-mm forward displacement). Compared with the control groups, the treatment subjects showed significant increase in the SNA and ANB angles, increased Wits appraisal, a more forward movement of point A and overjet improvement (p < 0.05).ConclusionsBAMP in cleft patients gives a significant forward displacement of the zygomaxillairy complex in favor of the Class III treatment.Clinical relevanceThis treatment method shows clearly favorable outcome in cleft patients after 1.5 years of BAMP.

Objectives Surgically assisted rapid maxillary expansion (SARME) is a treatment modality to overcome maxillary constrictions. During the procedure of transverse expansion, unwanted asymmetries can occur. This retrospective study investigates the transverse expansion behavior of the maxilla utilizing a simulation-driven SARME with targeted bone weakening. Materials and methods Cone beam computer tomographies of 21 patients before (T1) and 4 months after treatment (T2) with simulation-driven SARME combined with a transpalatal distractor (TPD) and targeted bone weakening were superimposed. The movements of the left, right, and frontal segments were evaluated at the modified WALA ridge, mid root level, and at the root tip of all upper teeth. Linear and angular measurements were performed to detect dentoalveolar changes. Results Dentoalveolar changes were unavoidable, and buccal tipping of the premolars (6.1° ± 5.0°) was significant ( p < 0.05). Transverse expansion in premolar region was higher (6.13 ± 4.63mm) than that in the molar region (4.20 ± 4.64mm). Expansion of left and right segments did not differ significantly ( p > 0.05). Conclusion Simulation-driven SARME with targeted bone weakening is effective to achieve symmetrical expansion in the transverse plane. Clinical relevance Simulation-driven targeted bone weakening is a novel method for SARME to achieve symmetric expansion. Dental side effects cannot be prohibited.

This prospective controlled trial aimed to evaluate the skeletal effect of 3.5-years bone anchored maxillary protraction (BAMP) in growing cleft subjects with a Class III malocclusion. Subjects and Method: Nineteen cleft patients (11.4 ± 0.7-years) were included from whom cone beam computed tomography (CBCT) scans were taken before the start of BAMP (T0), 1.5-years after (T1) and 3.5 y after (T2). Seventeen age- and malocclusion-matched, untreated cleft subjects with cephalograms available at T0 and T2 served as the control group. Three dimensional skeletal changes were measured qualitatively and quantitatively on CBCT scans. Two dimensional measurements were made on cephalograms. Results: Significant positive effects have been observed on the zygomaticomaxillary complex. Specifically, the A-point showed a displacement of 2.7 mm ± 0.9 mm from T0 to T2 (p < 0.05). A displacement of 3.8 mm ± 1.2 mm was observed in the zygoma regions (p < 0.05). On the cephalograms significant differences at T2 were observed between the BAMP and the control subjects in Wits, gonial angle, and overjet (p < 0.05), all in favor of the treatment of Class III malocclusion. The changes taking place in the two consecutive periods (ΔT1-T0, ΔT2-T1) did not differ, indicating that not only were the positive results from the first 1.5-years maintained, but continuous orthopedic effects were also achieved in the following 2-years. Conclusions: In conclusion, findings from the present prospective study with a 3.5-years follow-up provide the first evidence to support BAMP as an effective and reliable treatment option for growing cleft subjects with mild to moderate Class III malocclusion up to 15-years old.