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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.

To investigate the effectiveness of AcceleDent Aura vibrating device on the rate of canine retraction. Thirty-two patients requiring extraction of upper first premolars and canine retraction were randomly allocated with a 1:1 ratio into either no-appliance group or the AcceleDent Aura appliance group. Canine retraction was done applying 150gm of retraction force using NiTi coil springs on 16 × 22 stainless steel archwires. The duration of the study was 4 months. Models were collected and digitized directly after extraction of upper first premolars and at monthly intervals during canine retraction for recording the monthly as well as the total distance moved by the canine. Digitized models were superimposed on the initial model and data were statistically analyzed. Anchorage loss, rotation, tipping, torque and root condition were evaluated using cone beam computed tomography imaging. Pain was evaluated by visual analog scale. No patients were dropped-out during this study. There was no statistically significant difference between both groups regarding the total distance travelled by the canine ( P  = 0.436), as well as the rate of canine retraction per month ( P  = 0.17). Root condition was the same for the two groups. Regarding the pain level, there was no statistically significant difference between the two groups at day 0 ( P  = 0.721), after 24 h ( P  = 0.882), after 72 h ( P  = 0.378) and after 7 days ( P  = 0.964). AcceleDent Aura was not able to accelerate orthodontic tooth movement. Pain level couldn’t be reduced by vibrational force with an AcceleDent device during orthodontic treatment. Root condition was not affected by the vibrational forces.

Background To evaluate the effectiveness of two minimally invasive surgical procedures in the acceleration of canine retraction: piezocision and laser-assisted flapless corticotomy (LAFC). Methods Trial design: A single-centre randomized controlled trial with a compound design (two-arm parallel-group design and a split-mouth design for each arm). Participants: 36 Class II division I patients (12 males, 24 females; age range: 15 to 27 years) requiring first upper premolars extraction followed by canine retraction. Interventions: piezocision group (PG; n  = 18) and laser-assisted flapless corticotomy group (LG; n  = 18). A split-mouth design was applied for each group where the flapless surgical intervention was randomly allocated to one side and the other side served as a control side. Outcomes: the rate of canine retraction (primary outcome), anchorage loss and canine rotation, which were assessed at 1, 2, 3 and 4 months following the onset of canine retraction. Also the duration of canine retraction was recorded. Random sequence: Computer-generated random numbers. Allocation concealment: sequentially numbered, opaque, sealed envelopes. Blinding: Single blinded (outcomes’ assessor). Results Seventeen patients in each group were enrolled in the statistical analysis. The rate of canine retraction was significantly greater in the experimental side than in the control side in both groups by two-fold in the first month and 1.5-fold in the second month ( p  < 0.001). Also the overall canine retraction duration was significantly reduced in the experimental side as compared with control side in both groups about 25% ( p  ≤ 0.001). There were no significant differences between the experimental and the control sides regarding loss of anchorage and upper canine rotation in both groups ( p  > 0.05). There were no significant differences between the two flapless techniques regarding the studied variables during all evaluation times ( p  > 0.05). Conclusions Piezocision and laser-assisted flapless corticotomy appeared to be effective treatment methods for accelerating canine retraction without any significant untoward effect on anchorage or canine rotation during rapid retraction. Trials registration ClinicalTrials.gov (Identifier: NCT02606331 ).

The purpose of the present study was to investigate the effect of vibration on orthodontic tooth movement and safety assessment based on our previous basic research in animal experiments. A double-blind prospective randomized controlled trial using split-mouth design was conducted in patients with malocclusion. The left and right sides of maxillary arch were randomly assigned to vibration (TM + V) and non-vibration (TM) groups. After leveling, vibrations (5.2 ± 0.5 g-forces (gf), 102.2 ± 2.6 Hertz (Hz)) were supplementary applied to the canine retracted with 100 gf in TM + V group for 3 min at the monthly visit under double-blind fashion, and the canine on the other side without vibration was used as TM group. The amount of tooth movement was measured blindly using a constructed three-dimensional dentition model. The amount of canine movement per visit was 0.89 ± 0.55 mm in TM group (n = 23) and 1.21 ± 0.60 mm in TM + V group (n = 23), respectively. There was no significant difference of pain and discomfort, and root resorption between the two groups. This study indicates that static orthodontic force with supplementary vibration significantly accelerated tooth movement in canine retraction and reduced the number of visits without causing side effects.

The aim of this study is to investigate the biomechanics for orthodontic tooth movement (OTM) subjected to concurrent single-tooth vibration (50Hz) with conventional orthodontic force application, via a clinical study and computational simulation. Thirteen patients were recruited in the clinical study, which involved distal retraction of maxillary canines with 1.5N (150g) force for 12weeks. In a split mouth study, vibration and non-vibration sides were randomly assigned to each subject. Vibration of 50Hz, of approximately 0.2N (20g) of magnitude, was applied on the buccal surface of maxillary canine for the vibration group. A mode-based steady-state dynamic finite element analysis (FEA) was conducted based on an anatomically detailed model, complying with the clinical protocol. Both the amounts of space closure and canine distalization of the vibration group were significantly higher than those of the control group, as measured intra-orally or on models (p<0.05). Therefore it is indicated that a 50Hz and 20g single-tooth vibration can accelerate maxillary canine retraction. The volume-average hydrostatic stress (VHS) in the periodontal ligament (PDL) was computationally calculated to be higher with vibration compared with the control group for maxillary teeth and for both linguo-buccal and mesial-distal directions. An increase in vibratory frequency further amplified the PDL response before reaching a local natural frequency. An amplification of PDL response was also shown to be induced by vibration based on computational simulation. The vibration-enhanced OTM can be described by mild, vigorous and diminishing zones among which the mild zone is considered to be clinically beneficial.

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

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.

This clinical trial compared the time to complete the levelling and alignment stage with flapless piezocision procedure in the treatment of severe maxillary malocclusion with premolar extraction cases. Two-arm parallel group randomized controlled trial was performed at the Orthodontics Unit of Universiti Sains Malaysia, Malaysia. Sixteen patients with severe anterior maxillary crowding (Little’s irregularity index: 7–9 mm) and required bilateral first premolars extraction was recruited. The participants were randomly assigned to a study group according to a simple randomization method using a sealed envelope mentioned about the group name. Both groups were treated with fixed orthodontic appliance using the 0.022-in. slot of McLaughlin Bennett Trevisi prescription brackets. The piezocision group received flapless piezocision corticotomy about 4–5 mm in length and 3 mm depth on the labial mucogingiva between the roots of six anterior teeth. The number of days since treatment started, Little’s irregularity index, gingival recession, pocket depth, pulp vitality, patient perception of the pain and satisfaction level were recorded before the treatment, at about 1 month and 2 months post-treatment, and at the completion of the levelling and alignment stage. The overall time to complete levelling and alignment stage was significantly shorter in the piezocision group than the control group (mean difference = 31.5 days, 95% CI 6.5, 56.5; p = 0.018). Greater reduction in Little’s irregularity index and faster alignment rate in the first 2 months  were found in the piezocision group compared to the control group (p < 0.05). No changes in the gingival recession, pocket depth, and pulp vitality in both groups were observed. Patients who received piezocision surgery experienced no or mild pain and were satisfied with the treatment. Flapless piezocision corticotomy is an effective adjunct that shortens treatment time during levelling and alignment stage without any adverse effects on the teeth and surrounding tissues. It is also painless, acceptable and satisfactory to the patients. Trial registration: ACTRN12621001350819.

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.

This prospective randomized clinical trial aimed to evaluate the effect of low-level laser therapy on tooth movement during Class II intermaxillary elastics treatment. Forty-two patients with Class II malocclusion were included, and their maxillary quadrants were allocated into two groups: treatment with an active diode laser and a placebo group. In each group, the time taken to obtain Class I occlusion after 6 months, rate of movement, total displacement of the maxillary canine to Class I occlusion and pain were recorded. The time to reach Class I occlusion in the active laser group (2.46 ± 2.1 months) was not significantly different from that in the placebo group (2.48 ± 2.0 months) ( p  = 0.938). Interestingly, the total distance of movement on the active laser side (2.27 ± 1.5 mm) was significantly greater than that on the placebo side (1.64 ± 1.3 mm) ( p  = 0.009). The pain levels on days 1, 2 and 3 were not significantly different between the laser and placebo sections. The rate of distance change toward Class I occlusion in the laser group (1.1 ± 0.7 mm/month) was significantly higher than that in the placebo group (0.74 ± 0.6 mm/month) ( p  = 0.037). Low-level laser therapy (970 nm) did not reduce the time needed to obtain Class I occlusion, but a significant acceleration in tooth movement was observed in the irradiated group. Trial registration: NCT02181439. Registered 04 July 2014— https://www.clinicaltrials.gov/ct2/results?term=cinelaser .