BACKGROUND: This was a cross-sectional study of high school students aged 13 to 15 years within the Buffalo City Metropolitan Municipality. A total of 391 participants were examined using the Index of Orthodontic Treatment need. Data was analysed using descriptive methods primarily. Pearson’s chi-square test was used to test associations between variables (subjective need, objective need, sex). METHODS: Sampling was performed using a multi-stage cluster sampling procedure. A self-administered questionnaire and clinical examination were used to collect data. The orthodontic treatment need was measured using the Index of Orthodontic Treatment Need. Objective and subjective need for orthodontic treatment was measured using the Dental Health Component and Aesthetic Component of the Index of Orthodontic Treatment Need, respectively. The data was analysed using descriptive methods primarily. The associations between subjective orthodontic treatment need and sex, objective orthodontic treatment need and sex, and subjective and objective orthodontic treatment need were determined using a Pearson’s chi-square test. The level of significance was set at 5% and all results were deemed statistically significant at p < 0.05. RESULTS: A total of 391 participants were examined, of which 66.8% (n = 261) were female and 33.3% (n = 130) were male. A definite subjective need of 13.3% (n = 52) and a definite objective need of 36.8% (n = 144) were observed in this study. Sex was associated with both subjective and objective orthodontic treatment need (p < 0.05). An association between subjective and objective orthodontic treatment need was also observed (p < 0.001). CONCLUSION: The findings of this study identified an objective and subjective orthodontic need in this sample, which can assist in the development of a public orthodontic service plan. The prevalence of malocclusions in need of orthodontic treatment can be used to determine the resources required for such a service. Additionally, this data can be used as baseline data from which other research projects may be planned.
The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on people's daily lives, resulting in lifestyle changes, social distancing, isolation, as well as economic consequences. An evaluation of the effects of COVID-19 on oral health is necessary. The aim of the study was to evaluate the effects of fixed orthodontic treatment on periodontal health and quality of life in adult patients. Due to the COVID-19 pandemic, the study methodology was based on a questionnaire consisting of 20 items addressed to patients undergoing orthodontic treatment. The questions concerned the frequency and duration of toothbrushing, brushing techniques as well as the use of auxiliary means of oral hygiene, with the objective of drawing conclusions regarding the oral health of this patient population. Additionally, 5 items adapted from the Oral Health Impact Profile-5 (OHIP-5) were included, asking subjects how frequently they had experienced specific problems during orthodontic treatment. The oral health of adult patients undergoing orthodontic treatment was influenced by the technique, frequency and means of toothbrushing. During fixed orthodontic treatment, pathological changes in periodontal tissues were often observed (23.6-56.4%), along with other conditions influencing patients' quality of life (10.2-81.3%). Early diagnosis of periodontal conditions during orthodontic treatment is essential for treatment success. Orthodontists should instruct patients on appropriate oral hygiene practices and on detecting changes in periodontal status, as well as should recommend periodontal consultation when needed. Orthodontic treatment in adult patients, through esthetic and functional improvement, should lead to an improvement in psychosocial wellbeing and an increase in quality of life.
Saliva is a valuable, noninvasive diagnostic fluid that mirrors the body's health, especially during physiological changes such as orthodontic tooth movement. The application of orthodontic force triggers an inflammatory response in the periodontal ligament, leading to the release of biomarkers like Vascular Endothelial Growth Factor (VEGF) and Transforming Growth Factor Beta 1 (TGF-β1), both crucial for bone remodeling and tissue repair. However, there are limited data on how salivary levels of these biomarkers change during different stages of fixed orthodontic treatment with NiTi archwires. The aim of the study was to determine the salivary levels of VEGF and TGF-β1 during each stage of the fixed orthodontic treatment using NiTi wires. This prospective observational study involved 11 patients requiring fixed orthodontic treatment with premolar extraction. Saliva samples were collected at four different time intervals: T0, Pretreatment; T1, 1 month after placement of 0.014/0.016 Round NiTi; T2, 1 month after placement of 0.017 × 0.025 Rectangular NiTi; and T3, 1 month after placement of 0.019 × 0.025 Rectangular NiTi. VEGF and TGF-β levels were analyzed using a high-sensitivity enzyme-linked immunosorbent assay (ELISA). The data were analyzed using repeated measures ANOVA. The mean VEGF concentration was 260.00 ± 188.42 pg/mL at T0, 144.32 ± 175.81 pg/Ml at T1, 228.95 ± 142.05 pg/Ml at T2, and 309.11 ± 285.43 pg/mL at T3. Although fluctuations in VEGF levels were observed over time, the difference was not statistically significant (F = 1.679, P = 0.215). The mean TGF-β1 concentration was 111.64 ± 58.99 pg/mL at T0, 99.29 ± 18.01 pg/mL at T1, 115.00 ± 87.90 pg/Ml at T2, and 92.93 ± 54.07 pg/mL at T3. Despite these variations across the time points, the difference was not statistically significant (F = 0.353, P = 0.659). Though the VEGF and TGF-β1 levels in saliva showed significant clinical changes, they did not show statistically significant variation across the different stages of orthodontic treatment. However, the findings of this study indicate that saliva can be used as an alternative to gingival crevicular fluid (GCF) for estimating the levels of TGF-β1, which addresses a significant gap in the literature. Future research with larger sample sizes and more diverse populations is required to fully establish the reliability and generalizability of salivary VEGF and TGF-β1 monitoring in orthodontic practice.
This study aimed to evaluate the effect of external force applied from mini-screws to the aligner during space closure in extraction cases, and to determine the optimal loading conditions to prevent lingual crown tipping of the incisor and mesial tipping of the molar using the finite element (FE) method. A three-dimensional FE model of the maxillary dentition with extraction of first premolars was constructed, and three different loading conditions were designed. The aligner was activated for 0.25 mm of incisor retraction without using mini-screws, with application of 0, 100, 200, or 300 cN of distal force through mini-screws placed in the posterior region, or with application of 0, 100, 200, 300, or 400 cN of intrusive force through mini-screws placed in the anterior region, in addition to the application of 300 cN of distal force. As the magnitude of distal force increased, the degree of mesial tipping of the first molar gradually decreased, becoming almost zero with nearly 300 cN of distal force. As the magnitude of intrusive force increased in addition to the application of 300 cN of distal force, the degree of lingual crown tipping of the central incisor gradually decreased, becoming almost zero with nearly 400 cN of intrusive force. Application of 300 cN of distal force to the aligner from mini-screws placed in the posterior region could completely prevent mesial tipping of the molar and anchorage loss during anterior retraction. Application of 400 cN of intrusive force from mini-screws placed in the anterior region could prevent lingual crown tipping of the incisor, thus providing better torque control for the incisors.
Orthodontists frequently use elastomeric chains for space closure and incisor retraction, though these chains are prone to force degradation and permanent deformation over time. Initially introduced in the early 20th century, elastic power chains became more widely adopted in orthodontic practice in the 1960s due to industrial advancements. There are three main types of elastomeric chains: closed (continuous), open (short), and long (broad), available in various colors such as clear and black. Elastomeric chains generate forces for several orthodontic applications, including traction of impacted teeth, space closure, midline correction, retraction of canines and incisors post-extraction, tooth leveling and alignment, mesial displacement in posterior regions, and space closure. However, therapeutic control challenges arise as the force exerted by these chains diminishes over time, with studies indicating a reduction of 50%-75% in the first 24 hours, followed by continued exponential decay. This study aimed to analyze the rate of force decay in closed and open power chains, both black and transparent, from four orthodontic manufacturers (American Orthodontics®, Ortho Technology®, Ormco®, and Orthometric®). Additionally, we sought to determine any significant differences among brands and colors that could influence the elastics' clinical effectiveness. A total of 48 power chain samples were tested for force decay by using a universal orthodontic force gauge. The chains, stretched to 90 mm (twice their original length), were measured at 0 hours, 24 hours, 1 week, 2 weeks, 3 weeks, 4 weeks, and 5 weeks. The samples were stored in artificial saliva within a laboratory water bath at a constant 37°C to simulate the oral environment. Tukey's honestly significant difference (HSD) test was applied to assess differences between brands, colors, types (closed or open), and time intervals. The study revealed significant differences in force decay among the various orthodontic power chains over the 5-week evaluation period. American Orthodontics® demonstrated the highest reduction in force, with a decay of 73.42% by week 5, while Ormco® exhibited the least decay at 48.17%. The black power chains of American Orthodontics® and Ortho Technology® showed superior initial force retention compared to their clear power chains counterparts, although all tested materials experienced substantial force decay. Closed power chains consistently retained higher forces than open ones across all brands, highlighting their potential advantage in clinical applications requiring optimal force delivery. The significant differences in decay patterns suggest that clinicians should consider using Ormco® and Orthometric® for prolonged applications due to its relative stability, while the black power chains of American Orthodontics® and Ortho Technology® may be more suitable for cases requiring immediate, high forces. Additionally, the consistent superiority of closed power chains in force retention emphasizes their potential advantages in optimizing tooth movement, reinforcing the need for orthodontists to align material choices with specific clinical objectives. This study highlights the significant variability in force decay among different orthodontic power chains, emphasizing the necessity for careful material selection based on both initial strength and long-term performance. The findings advocate for tailored approaches to enhance treatment efficacy and patient outcomes in orthodontic care.
White spot lesions (WSLs) are the most common lesions in orthodontic treatment. Preventing WSLs during and after orthodontic treatment is a major challenge in modern dentistry. Introducing nanotechnology-based materials with antimicrobial, anticariogenic, and remineralizing potential is the emerging trend to prevent WSL. This systematic review was conducted to find the effectiveness of nanoparticle-based oral rinses in preventing WSL in orthodontic treatments. The systematic review included human trials published in English between January 2010 and September 2024. The search strategy involved exploring electronic databases such as PubMed Central, SCOPUS, Web of Science, and Cochrane. The reviewers individually assessed the risk of bias in the included studies using the recommended assessment of the risk of bias approach in the included studies. One study that met the inclusion criteria was included in this systematic review. The overall incidence of WSLs per tooth after six months was 9.52% for the nanosilver (NS) mouthwash, compared to 24.4% for both the fluoride and chlorhexidine (CHX) mouthwashes. The right maxillary lateral incisor had the highest incidence (38.09%). Gingival margins of maxillary teeth had a higher incidence of WSLs compared to mandibular teeth, as the formation of biofilm is high in maxillary teeth. Nanosilver mouthwash reduces the incidence of WSLs by over 80% compared to chlorhexidine and fluoride mouthwash in fixed orthodontic treatment. Furthermore, better-conducted trials with various nanoparticle-based mouthwashes are necessary for their clinical use in orthodontic patients.
The advent of machine and deep learning has raised the possibility of increased efficiency and indeed improved accuracy in relation to the interpretation of clinical images. Moreover, the use of deep learning has become imbedded within orthodontics with attempts to utilise this approach in informing treatment planning. The aim of this study was to develop and test an AI-based tool capable of measuring tooth width and dental crowding. Sets of pre and post treatment plaster study models were acquired of 245 patients who had treatment completed in a specialist orthodontic practice by a single orthodontist. These models were scanned to create stereolithography (STL) files. These files were used to train an AI tool capable of calculating the mesio-distal widths of each of the teeth in the arches. To test the validity of this model, direct comparison was made between the AI tool and human raters. A sample of twelve sets of pre-treatment study models were known as the "test data". The test data was analysed by a group of five orthodontic clinicians at two separate time intervals 6 weeks apart. Statistical analysis confirmed a high level of agreement between human raters and also in relation to the novel AI-based tool. Inter-rater reliability among the human raters was high with Intraclass correlation coefficients (ICCs) ranging from 0.911 to 0.946 between the intervals. Manual measurements also demonstrated a high level of agreement with the AI tool (ICC= 0.956; Mean absolute difference= 0.4 mm). The novel AI-based tool demonstrated reliability in calculating mesiodistal widths of teeth in an untreated arch. This tool will be further developed to incorporate other parameters such as arch levelling, to provide a means to calculate the overall space requirement within the dental arches.
To assess the diagnostic accuracy of artificial intelligence-based models in the determination of tooth extraction in orthodontic treatment planning. A comprehensive literature search was conducted in multiple databases (PubMed, LILACS, Web of Science, Scopus, EBSCO, and Google Scholar) up to June, 2024. Studies that met the inclusion criteria based on the PIRD (Participants, Index test, Reference test, Diagnostic) framework were selected. The risk of bias of included studies was assessed using the QUADAS-2 tool, and their methodological quality was evaluated as well using a standardized checklist. Out of 361 retrieved records, eleven studies were included in this review. Nine of these studies achieved a score of over 50% on the AI quality checklist, indicating acceptable methodological quality. However, a comprehensive assessment using the QUADAS-2 tool revealed that all studies had some level of risk of bias, particularly in patient selection, the conduct of AI-based predictions, and the reference standard used. Neural networks and classifier models demonstrated the high level of accuracy ranging from 82% to 94% in determining the optimal tooth extraction protocol. However, to ensure reliable predictions, artificial intelligence-based models should be rigorously trained, incorporating a comprehensive range of factors.
The objective of this study was to compare the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) with the Dental Aesthetic Index (DAI) in evaluating orthodontic treatment needs among adolescents. In addition, it sought to assess the concordance between adolescents' self-perception of the Aesthetic Component of the IOTN (AC-IOTN) with the evaluations made by orthodontic professionals. A two-stage stratified cluster sampling method was used to select 248 high school students aged 11-14. Clinical examinations were conducted by specialist orthodontists. DAI, AC-IOTN, and DHC-IOTN were measured based on the students' occlusal morphology. Students also made self-assessments using the AC-IOTN. In terms of DHC-IOTN, 9.7% of students had severe cases that definitely needed treatment. The DAI assessment identified 5.2% with severe malocclusion and 4% with handicapping malocclusion. Using the AC-IOTN, the students assessed 4.8% of cases as severe, compared with 8.5% according to orthodontists. A comparative analysis of the results of the modified DAI and the DHC-IOTN, using Chi-squared test demonstrated highly significant differences between the two indices. The study highlights the need for improved orthodontic assessment methods, preventive care, and enhanced dental education to improve students' oral health behaviors.
An ideal orthodontic adhesive should provide a bond strong enough to withstand the forces of orthodontic treatment and mastication without dislodging, while also being safe enough to prevent surface damage debonding. Shear bond strength (SBS) is a critical factor that determines the quality of bonding in orthodontics. Nanoparticle-enhanced adhesives have been reported to offer additional benefits such as antimicrobial properties and remineralization effects, making them worth investigating for their shear bond characteristics. Aim: This in vitro study aimed to evaluate and compare the SBS and Adhesive Remnant Index (ARI) scores of orthodontic adhesives containing copper-substituted hydroxyapatite (Cu-HA) nanoparticles with a conventional orthodontic adhesive. Twenty-eight extracted human premolar teeth were randomly divided into two groups of 14. In Group 1, orthodontic brackets were bonded using Enlight adhesive mixed with Cu-HA nanoparticles, while Group 2 used conventional Enlight adhesive. SBS was measured using a Universal Testing Machine, and the debonded samples were evaluated for ARI scores under scanning electron microscopy (SEM). Statistical analyses were performed using independent t-tests for SBS comparison and Mann-Whitney U tests for ARI score differences. A P value < 0.05 was considered statistically significant. The group using Enlight adhesive with Cu nanoparticles exhibited a significantly higher mean SBS (9.03 ± 6.17 MPa) compared to the conventional adhesive group (5.51 ± 2.099 MPa, P = 0.003). The median ARI score for the Cu-HA nanoparticle group was 3, while the conventional group had a median ARI score of 2 (P = 0.022). Both SBS and ARI scores were significantly higher in the Cu-HA nanoparticle group. Copper-substituted hydroxyapatite nanoparticles enhance bond strength and adhesive retention, making them a promising alternative to conventional adhesives in orthodontics. The findings indicate that adhesives containing Cu-HA nanoparticles, especially when combined with the Enlight adhesive, offer superior bond strength and adhesive retention compared to conventional adhesives. This could lead to improved clinical outcomes in orthodontic bonding, potentially reducing bracket failure rates and enhancing treatment efficiency.
BACKGROUND: Contemporary orthodontic practice faces challenges related to treatment complications, often linked to deficiencies in multidisciplinary clinical competency. A clear understanding of the coordination across the stomatognathic system is essential, yet no standardized instrument exists to assess core skills. This study aimed to develop and validate a comprehensive assessment tool and evaluate current competency levels and associated factors among Chinese orthodontists across dental, periodontal, temporomandibular joint (TMJ), and myofunctional domains. METHODS: A cross-sectional survey was conducted across multiple regions of China from January to June 2025 among 434 practicing orthodontists. A three-component assessment instrument was developed through systematic expert review: Subjective Competency Scale (SCS), Clinical Practice Behavior Scale (CPBS), and Objective Knowledge Test for Orthodontists (OKTO). Psychometric properties were evaluated through exploratory factor analysis, reliability testing, and validity assessment. Competency variations across four domains were analyzed using Friedman tests, and demographic predictors were identified through stepwise multiple regression. RESULTS: The instrument demonstrated satisfactory reliability (SCS: Cronbach’s α = 0.897) and validity. Significant competency disparities existed across domains (all p < 0.001). Orthodontists showed highest competencies in dental areas (SCS: 4.45 ± 0.77; practice compliance: 78.00%) but substantial deficits in TMJ (SCS: 3.33 ± 1.17; practice compliance: 56.45%) and myofunctional domains. Objective knowledge patterns revealed adequate TMJ knowledge (82.58%) but poor myofunctional understanding (68.26%). Educational attainment emerged as the strongest predictor (β = 0.262, p < 0.001), followed by age (β = 0.201) and continuing education participation (β = 0.127). CONCLUSIONS: This study represents an initial attempt to develop and validate a multidimensional competency assessment framework for orthodontists, with the aim of offering a structured approach to evaluating interdisciplinary clinical competencies. TMJ and myofunctional domain-specific deficiencies, which were found to be associated with educational attainment, may serve as potential risk factors affecting treatment stability and complication prevention within the Chinese clinical context. This instrument, with preliminary validation evidence based on a Chinese sample, offers a tentative framework for systematic competency evaluation that requires further validation across diverse contexts.
Misaligned teeth can result in a wide range of physical, psychological, and functional impairments influencing both oral and systemic health. This calls for the need for an early orthodontic intervention, which is crucial to prevent these consequences and improve both functions and cosmetic appearance. The objectives of the current article are to identify the role of orthodontic treatment in maintaining psychological well-being and social health, to ascertain the potential challenges in delivering orthodontic treatment, and propose specific recommendations to overcome identified challenges. Orthodontic treatment plays a defining role in improving the psychological well-being of the person, by augmenting self-confidence as they are more comfortable about their appearance. In conclusion, orthodontic treatment is quite effective in improving the psychological and social well-being of people with misaligned teeth. The need of the hour is to identify the existing challenges and provide effective treatment to aid in improving the quality of life of the affected person.
To investigate the disease burden of caries in primary teeth across global, 21 regions, and 204 countries and territories from 1990 to 2021. Data on caries in primary teeth from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) 2021 Study. The global incidence, prevalence of caries in primary teeth associated disability-adjusted life years (DALYs) were analyzed. The burden of the disease and temporal trends were quantified by calculating the age-standardized rate (ASR) and estimated annual percentage changes (EAPCs). To evaluate the distributional disparities in the burden of caries in primary teeth, the slope index of inequality (SII) was used. Additionally, a frontier analysis was performed to pinpoint areas for improvement and examine disparities between countries according to their levels of development. From 1990 to 2021, the ASR of incidence, prevalence, and DALYs declined globally. In 2021, Eastern Europe had the highest ASR for the incidence and DALYs of caries in primary teeth, with Romania being the country bearing the greatest disease burden. The burden of caries in primary teeth was negatively associated with sociodemographic index (SDI) across the 21 GBD regions. The SII of each indicator decreased from 1990 to 2021. Many countries, regardless of their level of development, have considerable potential to reduce the burden of caries in primary teeth. The global burden of caries in primary teeth is in a state of alleviation. However, health inequalities in caries in primary teeth related to SDI have continued for over 30 years. The high burden of caries in primary teeth is concentrated in low- and middle-income countries. Active and effective prevention and strong management strategies are needed in specific regions to reduce the burden of caries in primary teeth and achieve equity in health outcomes.
Assessment of total root volume, root length, labial bone height, and amount of intrusion for three different intrusive mechanics; orthodontic miniscrews, utility arch, and the nitinol reverse curve archwire (RCA). Twenty-one deep bite orthodontic patients (male and female, age range 12-16 years old), were involved in the current study. According to the method of intrusion for lower incisors, the patients were randomly subdivided into three groups; Group (A): patients received an intrusive force delivered by elastics from two mini-screws between mandibular lateral incisor and mandibular canine. Group (B): patients received an intrusive force delivered by intrusive utility arch. Group (C): patients received an intrusive force delivered by RCA. Cone beam computed tomography (CBCT) was taken just before and after completion of intrusion of the lower anterior segment. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 18; Bonferroni's post hoc test was used for pair-wise comparisons when the ANOVA test is significant. The significance level was set at P ≤ 0.05. A statistically significant difference in root length reduction was found among the three groups. Post hoc analysis revealed no significant difference between group A and group B with mean difference (-0.97 mm, -0.93 mm). However, root length reduction in group A and group B was significantly greater than that of group C, which showed the least mean difference (-0.81 mm) in root length reduction. The nitinol RCA produce adverse effects as a root resorption and reduction of labial bone height during intrusion of the lower anterior segment more than that produced by the orthodontic miniscrews with elastics and utility arch as intrusive mechanics.
OBJECTIVES: To develop and evaluate the reliability and validity of the Orthodontic Health Literacy (OrthoHL) Scale, designed to measure orthodontic health literacy. MATERIALS AND METHODS: The scale was developed following a four-phase process that included item development, factor analysis, reliability assessment, and validity assessment. Data were collected in Wuhan, China, from three participant groups (total n = 974; n = 412, 512, and 50) in 2024. Item development phase utilised the Delphi method, achieving expert consensus from 13 specialists across orthodontics, general dentistry, nursing and public health and human factor engineering/ergonomics. Reliability assessment was conducted through internal consistency and test-retest methods, and validity assessment used exploratory factor analysis and confirmatory factor analysis. RESULTS: The 19-item OrthoHL Scale demonstrated strong psychometric properties, including acceptable test-retest reliability, internal consistency, and content, convergent, discriminant, and criterion-related validity. Additionally, the OrthoHL Scale had four dimensions of orthodontic health literacy, namely orthodontic knowledge, information access, information evaluation and specialist selection. The four dimensions were positively correlated with proactive orthodontic behaviours. CONCLUSION: The OrthoHL Scale is a reliable and valid tool for evaluating the orthodontic health literacy and facilitates dental health studies that take orthodontic health literacy into account.
Throughout the course of orthodontic treatment, preventive measures are crucial to lower the risk of plaque accumulation, subsequent decalcification, and the development of white-spot lesions. This study was done to assess antibacterial efficacy of orthodontic brackets covered with nanoparticles mixture with silver-copper oxide or zincoxide. This in-vitro study includes three groups of 12 brackets each coated with coated with nanoparticles combined with silver-copper oxide hybrid or zincoxide, and an uncoated group as the control. Physical vapor deposition was used for the coating process. Using the colony-forming unit, the antibacterial efficacy was assessed against Lactobacillus acidophilus and Streptococcus mutans.The antibacterial activity of coated brackets was assessed at just after coating and four months later. The obtained data were statistically evaluated. The L.acidophilusand S. mutanscount was reduced most effectively by brackets coated with a blend of silver and copper oxide nanoparticles, followed by zinc oxide nanoparticles, and least effectively by control groups. When compared to an unprotected surface, the surface is smoothed out after being covered with nanoparticles. The strongest antibacterial activity was found in brackets coated with silver-copper oxide hybrid followed by zinc oxide nanoparticle combination and least with uncoated brackets. In order to prevent decalcification, orthodontic bracket antibacterial coating could be further evaluated in clinical settings.
This study aimed to evaluate and compare the biomechanical behavior of titanium and poly-ether-ether-ketone (PEEK) orthodontic mini-screws. The objectives were to assess their performance through four biomechanical tests: maximum insertion torque (MIT), fracture torque (FT), vertical pull-out strength (VPS), and horizontal resistance (HR). A total of 156 mini-screws (78 titanium, 78 PEEK), equally divided into 1.4 mm and 1.6 mm diameter groups, were inserted into artificial bone blocks under standardized in vitro conditions. Mechanical testing was conducted to evaluate each performance parameter. Data were analyzed using IBM statistical package for the social sciences (SPSS) software via one-way analysis of variance (ANOVA) or the Kruskal-Wallis test, depending on distribution, with a significance level of P < 0.05. The 1.6 mm PEEK group exhibited insertion torque comparable to titanium (P > 0.05), although overall PEEK screws showed lower MIT values. In FT, VPS, and HR tests, PEEK screws frequently deformed, or fractured under loading, whereas titanium screws demonstrated significantly higher mechanical performance (P < 0.001). Titanium mini-screws outperformed unreinforced PEEK screws across all mechanical tests, demonstrating superior torsional, pull-out, and lateral resistance. Additionally, larger-diameter screws (1.6 mm) showed better mechanical performance than smaller ones (1.4 mm) in both materials.
This systematic review and meta-analysis evaluated the efficacy and safety of minimally invasive surgical techniques (MIS) to accelerate orthodontic tooth movement. A comprehensive search of PubMed, Web of Science, Cochrane CENTRAL, ProQuest, ScienceDirect, and OVID, along with manual reference screening, was conducted up to January 2024. Randomized controlled trials comparing MIS methods (including micro-osteoperforation, piezocision, flapless corticotomy/corticision, interseptal bone reduction, discision, and laser-assisted flapless corticotomy) with conventional orthodontic treatment were included. Thirty trials (809 participants) met eligibility criteria. Meta-analysis demonstrated significantly faster canine movement with MIS at one month (WMD 0.42 mm; 95% CI 0.26-0.58; P < 0.00001), two months (WMD 0.55 mm; 95% CI 0.35-0.75; P < 0.00001), and three months (WMD 0.52 mm; 95% CI 0.26-0.78; P = 0.0001). Subgroup analyses indicated micro-osteoperforation significantly accelerated movement (P < 0.05), while flapless corticotomy was not effective beyond two months (P > 0.05). Overall treatment time was reduced (WMD -42.30 days; 95% CI -68.31 to -16.30; P = 0.001), while no significant difference was found for en-masse retraction (WMD 1.55; 95% CI -0.65 to 3.76; P = 0.17). Reported adverse effects were minimal, with rare unintended tooth movements. MIS appears effective in accelerating orthodontic tooth movement and reducing treatment duration, particularly early in treatment, but heterogeneity highlights the need for standardized protocols and long-term multicenter trials.
In dentistry, moral judgment skills are a fundamental competency that helps dentists make the best decisions when faced with challenging clinical problems and ethical dilemmas. The aim was toexamine the moral sensitivity levels of fourth- and fifth-grade dentistry students and orthodontic clinicians. The study included fourth-grade (n = 116) and fifth-grade dentistry students (n = 106) as well as orthodontic clinicians, including residents and specialists (n = 117). Data were collected using a sociodemographic form and the self-administered Moral Sensitivity Questionnaire (MSQ) including six sub-dimensions: autonomy, holistic approach, conflict, orientation, providing benefit, and application. Participants were asked to rate the questionnaire on a 7-point Likert-type scale. Cronbach's alpha coefficient was used in reliability analysis. Continuous variables were presented as mean and standard deviation, and categorical variables were summarized as frequency and percentage. Intergroup differences were assessed by one-way ANOVA. Pairwise comparisons were further identified with Tukey's post-hoc test. Two-way ANOVA was performed to assess the combined effects of group and demographic variables on the total scale score. The overall reliability of the MSQ scale was 0.84. The total moral sensitivity scores for fourth-grade, fifth-grade students, and orthodontic clinicians were 92.7 ± 15.7, 92.4 ± 17.8, and 93.8 ± 14.4, respectively, revealing no statistically significant difference. Fifth-grade students scored significantly lower than orthodontic clinicians on the Holistic Approach and Conflict sub-dimensions but scored significantly higher on the Orientation sub-dimension compared to orthodontic clinicians. Undergraduate dentistry students and orthodontic clinicians exhibited moderate levels of moral sensitivity. Fifth-grade students were found to have higher moral sensitivity thanorthodontic clinicians on the holistic approach and conflict sub-dimensions, while orthodontic clinicians were found to be more sensitive on the orientation sub-dimension. These differences suggest that integrating case-based ethics training into the dental curriculum, regardless of academic year, can help students better identify ethical issues and develop strategies to address them effectively.
Background and Objectives: The impact of orthodontic appliances on oral health-related quality of life (OHRQoL) has gained increasing attention, particularly in relation to patient-centered outcomes. Clear aligners (CAs) are often perceived as more comfortable than fixed appliances (FAs), although evidence remains limited and heterogeneous. This systematic review and meta-analysis aimed to compare the effects of CAs and FAs on OHRQoL in patients with Angle class I malocclusion and to further evaluate the reliability of the findings using trial sequential analysis (TSA). Materials and Methods: This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251051003). A comprehensive search of PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL was conducted. Only randomized controlled trials comparing CAs and FAs and reporting OHRQoL outcomes (OHIP-14) were included. Random-effects meta-analyses were performed on early changes in OHRQoL. TSA was applied to control for type I and II errors and to evaluate the sufficiency of the cumulative evidence. Results: Two randomized controlled trials (n = 74) were included in the quantitative synthesis. Both treatments were associated with a transient deterioration in OHRQoL after appliance placement. Meta-analysis showed statistically significant improvements favoring CAs in psychological discomfort (p = 0.007) and psychological disability (p < 0.001), while no significant differences were observed for other domains or for overall OHRQoL. Exploratory TSA suggested an early signal in favor of psychological outcomes, with the cumulative Z-curve crossing the monitoring boundary; however, given the very small number of included trials, these findings should be regarded as preliminary and hypothesis-generating rather than confirmatory. In contrast, for most other outcomes, the required information size was not reached and results remained inconclusive. For handicap, TSA suggested that a clinically relevant difference is unlikely. Conclusions: Clear aligners may provide a modest short-term advantage over fixed appliances in psychological aspects of OHRQoL, while no consistent differences are observed in physical or overall domains, based on very limited evidence. TSA suggests a preliminary signal in psychological outcomes but highlights insufficient evidence for most other domains. These results should be interpreted with caution, and further high-quality randomized trials are needed.