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This study aimed to evaluate the effectiveness, pain, and satisfaction levels of patients treated with different thicknesses of clear aligners among class I maxillary mild crowding cases. Twenty-eight subjects were randomly divided into two groups. Group 1 were treated with 0.5 mm-thick aligners and group 2 were treated with 0.75 mm-thick aligners. Maxillary models were printed using a 3-dimensional printer and aligners were produced using a vacuum thermoforming machine. The amount of orthodontic tooth movement was evaluated by comparing pre- and post-treatment digital models and lateral cephalograms taken at the beginning and end of the treatment. Pain and satisfaction levels were measured before aligner insertion, at the 4th hour, 2nd day, 1st week, 1st month and at the end of the treatment. Increases in maxillary intercanine, interpremolar, and intermolar widths, and dental arch perimeter were significantly higher in group 2 ( p  < 0.05). The pain levels peaked at T1 and decreased gradually in both groups; group 2 demonstrated greater pain levels. Group 1 reported significantly greater satisfaction levels ( p  < 0.05). Aligner thickness is a key determinant of the extent of orthodontic tooth movement. Treatment with a 0.5 mm-thick aligner provides enhanced comfort for patients, but a 0.75 mm-thick aligner yields more efficient treatment results. Trial registration: The trial was registered on https://ClinicalTrials.gov retrospectively with the registration number of NCT06504498, on 16/07/2024.

Objective To evaluate external apical root resorption (EARR) and periodontal indices during en‐masse retraction of maxillary anterior teeth stimulated with low‐intensity electrical currents. Trial Design A two‐arm randomized controlled trial. Methods Young adult patients who visited the Department of Orthodontics at Damascus University between November 2023 and March 2024 and met predefined inclusion criteria were randomly allocated into two groups using block randomization. The study included 34 patients, with 17 assigned to the electrically stimulated en‐masse retraction (ESER) group and 17 to the conventional en‐masse retraction (CER) group. The force for the en‐masse retraction technique in both groups was 250 g per side. The force was applied through bilateral closed‐coil nickel‐titanium springs anchored to an orthodontic mini‐screw on each side. In the ESER group, each upper anterior tooth was subjected to a continuous electrical stimulation of 15–20 µA for 5 h daily, utilizing an intraoral removable electrical stimulation device. EARR was assessed using digital panoramic radiographs. Four periodontal indices were also used to assess periodontal status. Blinding was confined to data analysis. Results Thirty‐four patients (26 females and 8 males) were analyzed with a mean age of 21.12 ± 2.41 years. At the end of the en‐masse retraction phase, no significant difference in EARR was observed between the two groups (p > 0.05). The observed root resorption in the ESER and CER ranged between 0.27 and 0.64 and 0.32 and 0.71 mm, respectively. Also, insignificant differences were found in all periodontal indices studied at all measurement points between the two groups (p > 0.05). Conclusions Low‐intensity electrical stimulation had no significant effect on root resorption during the en‐masse retraction of the six upper anterior teeth. Both groups exhibited comparable slight root resorption without any significant difference between them. Additionally, low‐intensity electrical stimulation did not affect the periodontal status during en‐masse retraction. Trail Registration Clinical Trials database (NCT06873490).

Objectives To clinically compare the effects of broader archwires to standard archwires, using conventional brackets in both cases, on the transverse and incisor changes in maxillary and mandibular arches during leveling and alignment. Materials and methods Fifty-two patients presenting with crowding were allocated into two groups; one group received the broad Damon archwires while the other received standard 3M OrthoForm III Ovoid archwires. All participants were treated with conventional brackets using similar archwire sequences (0.014, 0.018, 0.016 × 0.022/0.016 × 0.025, 0.019 × 0.025 NiTi/CuNiTi archwires). Digital casts were obtained from alginate impressions before treatment (T0) and six weeks after inserting 0.019 × 0.025 NiTi archwires (T1). Pretreatment (T0) and post-alignment (T1) lateral cephalograms were obtained for each patient. The primary outcomes were the changes in the transverse arch dimensions and incisor inclination. The secondary outcomes were the horizontal and vertical linear changes in incisor position. Results Complete data were collected for 47 patients. There was a significant increase in arch width during treatment within each group, except for upper inter-molar width in 3M group ( P  = 0.071). Damon wire induced a statistically significant increase in maxillary inter-second premolar width ( P  = 0.042), and mandibular inter-first premolar ( P  = 0.043), inter-second premolar ( P  = 0.008) and inter-molar widths ( P  = 0.033) compared to 3M group. The increase in incisor proclination and the linear change in incisor position were significant within each group, with less mandibular incisor proclination ( P  = 0.004) and horizontal advancement ( P  = 0.038) in the Damon group. Conclusions Damon archwires created a comparatively greater increase in the maxillary inter-second premolar width and the mandibular inter-first premolar, inter-second premolar, and inter-molar widths, and less proclination and horizontal advancement in mandibular incisors. The study provides invaluable evidence that using broad archwires with self-ligating brackets is the reason behind any greater expansion observed in this system rather than the unique mechanical and biological features exerted by the self-ligating system. Clinical relevance Our results suggest that Damon archwire might be a better alternative compared to the narrower standard archwires that are usually used with conventional brackets, especially in the mandibular arch, in cases where mild to moderate crowding is planned to be resolved with a non-extraction approach. However, as arch expansion in the absence of posterior crossbites raises the question of long-term stability, the reported advantage of the use of wide wires should be interpreted with caution and should be considered in the retention phase, bearing in mind that achieving a good post-treatment occlusion is important for enhancing post-treatment stability.

Background Piezocision is a minimally invasive surgical method aiming to accelerate tooth movement. However, its effect was found to be transient, appertaining to the regional acceleratory phenomenon (RAP). Hence, the aim of the study was to evaluate the effect of single and multiple piezocisions on the rate of orthodontic tooth movement (OTM). Moreover, the impact of both protocols on canine tipping and orthodontically induced inflammatory root resorption (OIIRR) has been assessed. Methods Thirty indicated patients for the therapeutic extraction of maxillary first premolars were enlisted in this split-mouth study, and they were randomly split into two equal groups, each including 15 subjects. In the Single Application Group (SAG), one side of the maxillary arch arbitrarily received a single piezocision before the onset of canine retraction, whereas in the Multiple Application Group (MAG), piezocisions were randomly performed on one side, three times on a monthly basis, over the 12-week study period. The contralateral sides of both groups served as the controls. Canine retraction was carried out bilaterally using nickel-titanium closed-coil springs, delivering 150 g of force, and the rate of tooth movement, as well as canine tipping were evaluated on a monthly basis, over a 3-month period. Cone-bean computed tomography scans were also conducted pre- and post- canine retraction, and OIIRR was assessed using Malmgren Index. Results The reported outcomes revealed a significant increase in the amount of canine retraction, canine tipping, as well as root resorption scores on the experimental sides in both groups SAG and MAG post-retraction ( p  < 0.001). However, upon comparing the experimental sides in both groups, non-significant differences have been observed between them regarding all the assessed outcomes ( p  > 0.05). Conclusions Single and multiple piezocisions effectively accelerate OTM in comparison to conventional orthodontic treatment, with relative outcomes reported by both intervention frequencies. Accordingly, single piezocision is recommended as an adjunct to OTM. Furthermore, significant tooth tipping as well as a significantly higher root resorption risk accompanies both single and multiple piezocision applications in conjunction with OTM. Name of the Registry Clinicaltrials.gov Trial Registration Number NCT05782088 Date of Registration 23/03/2023 “Retrospectively registered”. URL https://clinicaltrials.gov/ct2/show/NCT05782088

Background The bowing effect observed during premolar extractions presents a challenge in clear aligner therapy. This study aims to investigate the accuracy of maxillary tooth movement in first premolar extraction cases using the in-house clear aligner (IHCA), comparing the palatal power arm (PA) and non-power arm (control / C). Methods Eighteen adults requiring maxillary first premolars extraction using IHCA were recruited. Using a randomized controlled trial with a split-mouth design, each patient received treatment for both PA and C. Data at the 24th IHCA comprising virtual-power arm (VPa), virtual-control (VC), actual-power arm (APa) and actual-control (AC) were measured by superimposition with pretreatment digital model, using 3D GOM Inspect software. Six types of tooth movement were assessed. Paired t-test or Wilcoxon signed-rank test was used to compare the differences between groups. Root mean square error (RMSE) as predictability was computed. Results For the maxillary canine, there was no significant difference between the PA and C groups for all types of tooth movement except rotation. Specifically, the PA exhibited a significantly less difference in distal-in rotation compared to the control group (APa-VPa -3.54°/AC-VC -11.57°). Similarly, the RMSE of PA demonstrated better accuracy in rotation than the control (PA 7.85°/control 15.98°). In terms of anchorage, the RMSE of PA indicated greater deviation than the control in the second premolar mesial-in rotation and crown-tipping. Regarding the first molar, the RMSE of PA was mostly similar to that of the control. Conclusion IHCA can effectively retract maxillary canines in cases involving premolar extraction. However, although palatal power arms improve the accuracy of canine rotation, no notable benefits are seen for other types of tooth movement or for anchorage control. Trial registration Current Controlled Trials ISRCTN14020146 of the International Standard Randomized Controlled Trial. The date of registration was 16/11/2022. The trial was retrospectively registered.

Introduction This randomized clinical trial compared arch dimensional changes, dentoskeletal changes, and the rate of overbite correction in deep bite adults treated with fixed appliances and either maxillary incisor bite turbos (IBT) or canine bite turbos (CBT). Materials and methods Forty-six deep bite subjects treated with fixed appliances were randomized into IBT (n = 23) and CBT (n = 23) groups. Changes in intercanine width (ICW), arch height (AH), and Little’s Irregularity Index (LII) were analyzed from before treatment (T 0 ) to 3 months after aligning with 0.012” NiTi archwires in both arches (T 1 ). Cephalometric changes between T 0 and the visit when normal overbite was achieved (T 2 ) were assessed. Within-group and between-group comparisons were analyzed at a significance level of 0.05. Results In both groups, mandibular ICW, and maxillary and mandibular AH significantly increased while maxillary and mandibular LII decreased. Maxillary and mandibular incisor proclination and molar extrusion were observed. The IBT group showed significantly greater changes in mandibular ICW, maxillary and mandibular AH, and mandibular incisor proclination than the CBT group. However, the overbite correction rate and the LII reduction were not significantly different between the groups. Conclusions The IBT and CBT produced similar effects on arch dimensions and dentoskeletal changes. However, the IBT group demonstrated greater arch dimensional changes. Clinical relevance Clinicians may consider IBT if flaring incisors is desired. Alternatively, CBT is better for cases with limited incisor proclination and where minimizing arch dimension change is needed, such as in narrow ridge situations. Clinical trial registration The trial was registered at Thai Clinical Trial Registry on https://www.thaiclinicaltrials.org , under the identifier TCTR20230811013.

Introduction This study aims to determine if intraoral 850 nm LED irradiation could reduce the duration of lower anterior crowding alignment. Methods In a parallel-designed, randomized controlled clinical trial 60 patients with 2 to 6 mm of lower incisor crowding who need non-extraction treatment, were randomly assigned to the intervention and control groups by block randomization (36 females, 24 males, mean age: 19.93 ± 3.05). MBT brackets (0.022 × 0.28-inch) were bonded for both groups and the NiTi wires in sequences were put in place until correction of crowding. The intra-oral LED device with a wavelength of 850 nm and power density of 70 mW/cm 2 was used for 5 min per day in the intervention group. The control group did not receive any light. The primary outcome was the duration of crowding correction. The patient's pain according the modified McGill pain questionnaire was the secondary outcome. The Cox regression model was used to compare groups. Mann–Whitney test was used for pain analysis. Results The crowding at baseline was the same between the two groups ( P  > 0.05). Duration of treatment in the intervention group was 104.7 days (95% CI: 95.6 -113.8) and significantly shorter than 161.9 days (95% CI: 151.5 -171.2) in the control group. The control group experienced a significantly higher pain score of 6.8 (95% CI: 6.1–7.5) immediately after archwire placement than the intervention group 5.4 (95% CI: 4.6–6.3). Conclusions Intra-oral LED 850 nm significantly decreased the relieving time of lower incisor crowding by up to 36% and reduced pain experience.

Background Low-intensity electrical stimulation (LIES) is one of the recent physical techniques employed to accelerate orthodontic tooth movement and reduce treatment time. Objective This trial aimed to assess the effectiveness of the LIES technique in shortening the en-masse retraction time and evaluate skeletal, dental, or soft tissue changes on lateral cephalograms. Methods Young adult patients with a Class II division I malocclusion who visited the Department of Orthodontics at the University of Damascus Faculty of dentistry, between October 2022 and February 2023 and met specific inclusion criteria were included in this two parallel arms randomized controlled trial (RCT). The patients were randomly distributed into: the LIES group and the traditional en-masse retraction (TRAD) group. Computer-generated random numbers were used for the patient assignment. Blinding was performed only during data extraction and analysis. Mini-screws were used for anchorage during the en-masse retraction, and a force of 250 g was applied bilaterally with Nickel-Titanium springs. In the LIES group, each upper anterior tooth received a 15–20 µA electrical stimulation for five uninterrupted hours daily using an intraoral removable electrical stimulation device. The assessed outcomes were the required time for completing the en-masse retraction phase and the skeletal, dental, and soft tissue changes using lateral cephalograms at specific time points (T0: baseline; T1: before en-masse retraction; T2: end of en-masse retraction). Results Out of 127 patients were examined, 36 adult patients were enrolled and entered data analysis with a mean age of 20.91 ± 2.24 years. The en-masse retraction phase in the LIES group took a significantly shorter time than that in the TRAD group by a mean of 2.69 months ( P  < 0.001). Insignificant differences were observed between the two groups in almost all measured variables. In addition, a slight anterior rotation of the mandible was observed in both groups. A greater horizontal retraction of the apices of the upper incisors was seen in the LIES group compared to the TRAD group ( P  = 0.005). Conclusions The LIES shortened the required time for the en-masse retraction of the upper anterior teeth by approximately 30% compared to the traditional method. No significant differences between the two groups were observed in skeletal and soft tissue variables. However, a greater bodily movement of the upper incisors was noted in the LIES group. Registration This trial was retrospectively registered in the Clinical Trials database (ID: NCT06639204) and it was first posted on 15/10/2024.

Background Anterior open bite (AOB) malocclusion usually represents a complicated and advanced orthodontic problem. The skeletal variant of AOB used to be treated with a combined orthodontic and surgical approach, until the posterior segments’ intrusion has been validated as an alternative, effective and conservative treatment modality for such cases with comparable outcomes to the surgical approach. The objective of this two-arm parallel randomized clinical trial was to compare the effects of mini-screw supported maxillary versus bi-maxillary buccal segments’ intrusion on the amount of anterior open bite closure. Methods Twenty-two adult patients aged 17–25 years, with skeletal open bite and anterior dental separation of 3–8 mm were randomized to either the comparator (Maxillary Intrusion with Consolidation of mandibular buccal segments-MIC) or intervention (Bimaxillary buccal segments’ intrusion-BMI) groups. Miniscrew-assisted buccal segments’ intrusion was instituted using fixed appliances on rigid stainless steel archwires (19 × 25 stainless steel) via nickel-titanium coil springs in the maxilla and memory chains in the mandible. The intrusion force was 200 g per maxillary buccal segment in both groups, and it was 150 g for each mandibular posterior segment in the BMI group. Duration of intrusion was 6 months. Results Anterior open bite was significantly closed in both groups with means of 3.8 ± 0.84 (95% confidence interval [CI] 3.2–4.4) and 3.84 ± 1.47 mm (CI;2.8–4.9) for the MIC and BMI groups, respectively with no significant difference between them (p-value < 0.05). Maxillary posterior teeth experienced significant intrusion in both groups, with a mean of 2.89 ± 1.13 mm (CI;2.63–3.14) in the MIC group and 2.26 ± 1.62 mm (CI;1.89–2.62) in the BMI group. Statistically significant mandibular posterior teeth intrusion occurred in both groups with means of 0.86 ± 0.91 (CI;0.65–1.06) and 0.33 ± 0.84 mm (CI;0.14–0.52) in the BMI and MIC groups, respectively, with a statistically significant difference of 0.53 ± 0.14 (CI;0.25–0.8) mm. However, such difference was considered clinically insignificant. Conclusions Anterior open bite closure could be successfully achieved with maxillary buccal segments intrusion without the need for active intrusion of the mandibular posterior segments, as long as the latter are efficiently consolidated. Trial registration The trial was prospectively registered at clinicaltrials.gov with an identifier number of NCT04713280.

Background Low-intensity electrical stimulation (LIES) is considered a relatively recent technology that has received little attention in orthodontics as a method of acceleration. This study aimed to evaluate patient-reported outcome measures when LIES is used to accelerate the en-masse retraction of the upper anterior teeth. Materials and methods The sample consisted of 40 patients (8 males, 32 females; mean age 21.1 ± 2.3 years), with Class II division I malocclusion who required extraction of the first premolars to retract upper anterior teeth. They were randomly assigned to the LIES group ( n  = 20) and the conventional en-masse retraction group (CER; n  = 20). Patient responses regarding pain, discomfort, burning sensation, swelling, chewing difficulty, speech difficulty, and painkillers’ consumption were recorded at these nine assessment times: 24 h (T1), 3 days (T2), and 7 days (T3) after force application, then in the second month after 24 h (T4), 3 days (T5), and 7 days (T6) of force re-activation, and finally after 24 h (T7), 3 days (T8), and 7 days (T9) of force re-activation in the third month. Results The mean values of pain perception were smaller in the LIES group than those in the CER group at all assessment times with no statistically significant differences between the two groups except during the second and third months (T5, T6, T8, and T9; P  < 0.005). However, discomfort mean values were greater in the LIES group with significant differences compared to CER group during the first week of the follow-up only (T1, T2, and T3; P  < 0.005). Burning sensation levels were very mild in the LIES group, with significant differences between the two groups at T1 and T2 only ( P  < 0.001). Speech difficulty was significantly greater in the LIES group compared to CER group at all studied times ( P  < 0.001). High levels of satisfaction and acceptance were reported in both groups, without any significant difference. Conclusion Both the LIES-based acceleration of en-masse retraction of upper anterior teeth and the conventional retraction were accompanied by mild to moderate pain, discomfort, and chewing difficulty on the first day of retraction. These sensations gradually decreased and almost disappeared over a week after force application or re-activation. Trial registration ClinicalTrials.gov, ClinicalTrials.gov, NCT05920525. Registered 17 June 2023 - retrospectively registered, http://clinicaltrials.gov/study/NCT05920525?term=NCT05920525&rank=1 .