Disentangling the effects of CAD/CAM customized appliances and piezocision in orthodontic treatment: New evidence.
Ontology highlight
ABSTRACT: Objectives
To discern the effects of computer-aided design (CAD)/computer-aided manufactured (CAM) customized appliances and piezocision on orthodontic treatment (OT).Materials and methods
The study combined findings from two previously published randomized controlled trials: (1) standard OT vs piezocision-assisted standard OT, and (2) CAD/CAM OT vs piezocision-assisted CAD/CAM OT. Piezocision is a minimally invasive corticotomy surgical procedure used to accelerate orthodontic treatment and CAD/CAM refers to CAD/CAM customized brackets and archwires. The outcomes were the overall treatment time, and the durations of the alignment phase and fine-tuning phase. Clinical and radiological features also were evaluated.Results
The combined study included 48 patients with similar baseline characteristics. Compared to the standard treatment, CAD/CAM technology alone significantly decreased the overall median OT time from 543 to 394 days (P < .001) and from 543 to 254 days (P < .0001) when combined with piezocision. Although piezocision significantly reduced the duration of the alignment phase in the mandible and maxilla, CAD/CAM technology considerably shortened the fine-tuning phase. All periodontal and radiographic parameters remained stable from the start to the end of treatment in all groups.Conclusions
CAD/CAM technology combined with piezocision accelerates the entire OT process, during the alignment phase for piezocision and during the fine-tuning phase for CAD/CAM, with a global reduction of the overall treatment time of more than 50%.
SUBMITTER: Charavet C
PROVIDER: S-EPMC8549547 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:ObjectiveNowadays, CAD/CAM technologies enrich orthodontics in several ways. While they are commonly used for diagnoses and treatment planning, they can also be applied to create individualized bracket systems. The purpose of this prospective quasi-randomized study was to evaluate the clinical efficiency of a customized bracket system and its comparison with directly bonded conventional self-ligating bracket treatment.Materials and methodsAltogether 38 patients were separated into two groups, treated either with direct bonded self-ligating brackets (Damon, Ormco, USA) or with indirect bonded customized CAD/CAM brackets (Insignia™, Ormco, USA). Overall treatment time, number of treatment appointments, number of lost or repositioned brackets, number of arch wires and wire bends, Little Irregularity Index, cephalometric analyses and ABO scores were compared. Superimpositions of the virtual set-ups and the treatment results of the CAD/CAM group were performed to evaluate the clinical realization of the treatment planning.ResultsNo differences between both treatment groups were found concerning overall treatment time, number of appointments and number of archwire bends. Bonding failures occurred more often using the CAD/CAM system. Indirectly bonded brackets did not have to be repositioned as often as directly bonded brackets. Treatment results with both systems were similar concerning their effects on the reduction of ABO scores. The number of used archwires was higher in the CAD/CAM group. Treatment with both systems led to further proclination of the incisors. Proclination in the lower jaw was greater than proclination in the upper jaw, and there was a statistically significant difference between the two treatment systems. Comparing the treatment results with the virtual set-ups, mesial positions were met best, followed by vertical positions. Transversal positions showed the greatest discrepancies. Concerning angles, values of angulation showed greatest accordance to the virtual set-up, while values of inclinations showed greatest discrepancies.ConclusionIn comparison with a direct bonded self-ligating bracket system the use of indirect bonded customized CAD/CAM brackets showed only minor influence on treatment efficiency and treatment outcomes. Transversal expansion, deep bite correction, expression of torque and anchorage loss remain challenges in the treatment with straight-wire appliances. Trial registration DRKS, DRKS00024350. Registered 15 February 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024350 .
| S-EPMC8645527 | biostudies-literature
Project description:Measuring the dimensions of personalized devices can provide relevant information for the production of future such devices used in various medical specialties. Difficulties with standardizing such measurement and obtaining high accuracy, alongside cost-intensive measuring methodologies, has dampened interest in this practice. This study presents a methodology for automatized measurements of personalized medical appliances of variable shape, in this case an orthodontic appliance known as Tübingen Palatal Plate (TPP). Parameters such as length, width and angle could help to standardize and improve its future use. A semi-automatic and custom-made program, based on Rhinoceros 7 and Grasshopper, was developed to measure the device (via an extraoral scanner digital file). The program has a user interface that allows the import of the desired part, where the user is able to select the necessary landmarks. From there, the program is able to process the digital file, calculate the necessary dimensions automatically and directly export all measurements into a document for further processing. In this way, a solution for reducing the time for measuring multiple dimensions and parts while reducing human error can be achieved.
| S-EPMC9774752 | biostudies-literature
Project description:Based on three-dimensional scanning and computer-aided design and computer-aided manufacturing (CAD/CAM) techniques, customized bracket systems are increasingly used. However, data remain limited regarding customized bracket design, characteristics, and stability. This study was undertaken to evaluate the design, bond strength, and residual adhesives of four different CAD/CAM customized brackets that were attached to human tooth specimens by indirect bonding. Thirty extracted human upper premolars were divided into five groups: Group 1, preadjusted self-ligating labial metal bracket; Group 2, lingual self-ligating metal injection molding customized bracket; Group 3, gold-casted lingual customized bracket; Group 4, labial self-ligating milled customized bracket; Group 5, labial customized resin base bracket. Except in Group 1, premolar specimens were scanned via model scanner, and the images were sent to each manufacturing company to fabricate customized brackets and transfer trays/jigs. Debonding force (DF; N) was measured by Instron universal testing machine and shear bond strength (SBS; MPa) was calculated via dividing DF by bonding area. Adhesive remnants were analyzed via stereo microscopic images. Group 2 (196.90±82.75 N) exhibited significantly higher DF than Group 1 (62.77±12.65 N); other groups exhibited similar DFs, compared with Group 1. No customized bracket groups exhibited significant differences in SBS, relative to Group 1 (6.73±1.36 MPa). However, SBS in Group 5 (11.46±7.22 MPa) was significantly higher than in Group 3 (3.58±2.14 MPa). Group 3 had significantly lower ARI scores than other groups (P<0.05). Customized brackets exhibited large deviations in DF and SBS; all customized bracket systems exhibited DF that was equivalent or superior to that of preadjusted brackets, even when placed by indirect bonding.
| S-EPMC6133347 | biostudies-literature
Project description:Orthodontic tooth movement (OTM) occurs through proteolytic remodelling within the periodontium following the application of external force to the tooth. This study describes the first characterization of the salivary peptidome and protease profile during the alignment stage of fixed appliance orthodontic treatment. Unstimulated whole mouth saliva from 16 orthodontic patients (10 males, 6 females, mean (SD) age 15.2 (1.6) years) was collected prior to fixed appliance placement (T1), 1-h (T2), 1-week (T3) following fixed appliance placement and on completion of mandibular arch alignment (T4). Salivary peptides were extracted using filtration followed by mass spectrometry to identify amino acid sequences. Protease prediction was carried out in silico using Proteasix and validated with gelatin zymography and enzyme-linked immunosorbent assay. A total of 2852 naturally-occurring peptides were detected, originating from 436 different proteins. Both collagen and statherin-derived peptide levels were increased at T2. Proteasix predicted 73 proteases potentially involved in generating these peptides, including metalloproteinases, calpains and cathepsins. Changes in predicted activity of proteases over time were also observed, with most metalloproteinases showing increased predicted activity at T2-T3. Increased gelatinolytic activity and MMP8/MMP9 levels were detected at T3. Collectively, multiple protein targets and changes in protease-predicted activity during OTM have been identified.
| S-EPMC9837200 | biostudies-literature
Project description:BackgroundThe aims of this study were to evaluate the efficacy of alveolar corticotomy (AC) and piezocision (PZ) in accelerating maxillary canine retraction, and their effects on multiple bone remodeling expression in gingival crevicular fluid (GCF). A split-mouth, randomized controlled clinical trial was performed at the Department of Orthodontics of Pontifical Catholic University of Minas Gerais, Brazil. Eligibility criteria included orthodontic need for first maxillary premolars extractions, followed by canine retraction. Fifty-one adult patients were recruited and randomly assigned to 3 groups (allocation ratio 1:1:1). Random allocation of surgical or control interventions to each side of the maxillary arch was also conducted: G1 - AC × Control, G2 - PZ × Control, and G3 - AC × PZ. Both the definition of the group and the decision of the experimental or control sides were randomized by the software. Intraoral digital scans were performed before, 7 and 14 days after the beginning of canine retraction, and subsequently, at every 14 days until a maximum period of 6 months. GCF samples were collected before, and 1, 2, 4, 8, and 12 weeks. The primary outcome consisted in the cumulative distal movement of the canines and was measured by digital model superimposition. The secondary outcome consisted in GCF bone remodeling samples that were quantified in a multiplex immunoassay. The measurements examinator was properly blinded.ResultsForty-seven patients, 19 males and 28 females, were analyzed (mean age 20.72, SD = 6.66, range 15 to 38). Statistically significant differences in canine distal movement between AC and control in G1 were not observed (p > 0.05). In G2, PZ showed lower cumulative incisal and cervical measurements than control from the 2nd to the 24th week (p < 0.05). In G3, PZ showed a lower cumulative incisal and cervical measurements than AC from the16th to the 24th week (p < 0.05). In all groups, differences on biomarkers expression occurred at specific timepoints (p < 0.05), but a distinct pattern was not observed.ConclusionsAC and PZ were not effective to accelerate maxillary canine retraction and did not induce a distinct pattern of biomarker expression.Trial registrationNCT03089996 . Registered 24 March 2017 - Registered.
| S-EPMC8487930 | biostudies-literature
Project description:ObjectivesThe aim was to evaluate the role of resorbable membranes applied over customized titanium meshes related to soft tissue healing and bone regeneration after vertical/horizontal bone augmentation.Materials and methodsThirty patients with partial edentulism of the maxilla/mandible, with vertical/horizontal reabsorption of the alveolar bone, and needing implant-supported restorations, were randomly divided into two groups: Group A was treated using only custom-made meshes (Mesh-) and Group B using custom-made meshes with cross-linked collagen membranes (Mesh+). Data collection included surgical/technical and healing complications, "pseudo-periosteum" thickness, bone density, planned bone volume (PBV), regenerated bone volume (RBV), regeneration rate (RR), vertical bone gain (VBG), and implant survival in regenerated areas. Statistical analysis was performed between the two study groups using a significance level of α = .05.ResultsRegarding the healing complications, the noninferiority analysis proved to be inconclusive, despite the better results of group Mesh+ (13%) compared to group Mesh- (33%): estimated value -1.13 CI-95% from -0.44 to 0.17. Superiority approach confirmed the absence of significant differences (p = .39). RBV was 803.27 mm3 and 843.13 mm3 , respectively, and higher RR was observed in group Mesh+ (82.3%) compared to Mesh- (74.3%), although this value did not reach a statistical significance (p = .44). All 30 patients completed the study, receiving 71 implants; 68 out of them were clinically stable and in function.ConclusionThe results showed that customized meshes alone do not appear to be inferior to customized meshes covered by cross-linked collagen membranes in terms of healing complication rates and regeneration rates, although superior results were observed in group Mesh+compared to group Mesh- for all variables.
| S-EPMC9293224 | biostudies-literature
Project description:BackgroundTreatment with fixed orthodontic appliances has been associated with significant biofilm accumulation, thus putting patients at a higher risk of oral health deterioration. The use of probiotics has been proposed to be useful in the prevention or treatment of oral pathologies such as caries and diseases of periodontal tissues. Our aim was to investigate the effects of probiotic use on inflammation of the gingival tissues and the decalcification of the enamel in patients being treated with fixed orthodontic appliances.MethodsWe searched without restrictions 8 databases and performed hand searching until September 2019. We searched for randomized controlled trials (RCTs) evaluating whether individuals with fixed orthodontic appliances benefit from probiotic treatment in terms of the inflammation of the gingivae and decalcification of the enamel. Following the selection of studies and the extraction of pertinent data, we appraised the risk of bias and the confidence in the observed effects based on established methodologies.ResultsFrom the final qualifying studies, three did not show any statistically significant effect on gingival inflammation after probiotic administration of up to 1 month. Similarly, non-significant differences were noted in another study regarding white spot lesions development (mean administration for 17 months). No adverse effects were reported and the level of evidence was considered moderate.ConclusionsSupplementation of orthodontic patients with probiotics did not affect the development of inflammation in the gingivae and decalcification in the enamel. Additional RCTs, with longer intervention and follow-up periods, and involving different combinations of probiotic strains are required.Trial registrationPROSPERO (CRD42018118008).
| S-EPMC7183645 | biostudies-literature
Project description: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.
| S-EPMC9008391 | biostudies-literature
Project description:Acid resistance of CAD/CAM resin composites. Erosion-related tooth surface loss is closely related to acid exposure, such as contact with acidic beverages or disease-related reflux. As a result, dental restorations in affected patients are also exposed to acids, which indicates that the performance and longevity of a dental restoration is impacted by the acid resistance of the individually employed restorative materials. However, unlike for ceramic materials, the acid resistance of CAD/CAM resin composites is not commonly evaluated by the manufacturers, and no standardised test methods have yet been established. Against this background, the present in vitro study aimed to examine the long-term resistance of CAD/CAM resin composites (Brilliant Crios, Cerasmart, Grandio blocs, Lava Ultimate, Shofu Block HC) against three acidic media (tonic water, acetic acid, hydrochloric acid) as well as demineralized water and to investigate potential damage mechanisms. Changes in surface roughness (Sa) were detected by confocal laser scanning microscopy (CLSM), and changes in surface hardness were measured using Vickers hardness (HV). The damage mechanisms were analysed by scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS) and micro X-ray computer tomography (µXCT). For each material, few changes in either Sa or HV were identified for at least one of the different media; for Cerasmart, the sharpest deterioration in surface properties was observed. SEM-EDS revealed leaching of barium, aluminium, and titanium from fillers in a 2 µm zone on the rough but not on the polished surface of the specimen. Within the limitations of the current study, it can be concluded that polished CAD/CAM resin composites can be recommended for clinical use in patients with erosive conditions.
| S-EPMC9220078 | biostudies-literature
Project description:Human enamel is composed mainly of apatite. This mineral of sorption properties is susceptible to chemical changes, which in turn affect its resistance to dissolution. This study aimed to investigate whether metal leakage from orthodontic appliances chemically alters the enamel surface during an in vitro simulated orthodontic treatment. Totally 107 human enamel samples were subjected to the simulation involving metal appliances and cyclic pH fluctuations over a period of 12 months in four complimentary experiments. The average concentrations and distribution of Fe, Cr, Ni, Ti and Cu within the enamel before and after the experiments were examined using ICP‒MS and LA‒ICP‒MS techniques. The samples exposed to the interaction with metal appliances exhibited a significant increase in average Fe, Cr and Ni (Kruskal-Wallis, p < 0.002) content in comparison to the control group. The outer layer, narrow fissures and points of contact with the metal components showed increased concentrations of Fe, Ti, Ni and Cr after simulated treatment, conversely to the enamel sealed with an adhesive system. It has been concluded that metal leakage from orthodontic appliances chemically alters enamel surface and microlesions during experimental in vitro simulated treatment.
| S-EPMC10914722 | biostudies-literature