Quantitative approach for the prediction of tooth movement during orthodontic treatment

The orthodontic treatment is aimed to displace and/or rotate the teeth to obtain the functionally correct occlusion and the best aesthetics and consists in applying forces and/or couples to tooth crowns. The applied loads are generated by the elastic recovery of metallic wires linked to the tooth crowns by brackets. These loads generate a stress state into the periodontal ligament and hence, in the alveolar bone, causing the bone remodeling responsible for the tooth movement. The orthodontic appliance is usually designed on the basis of the clinical experience of the orthodontist. In this work, a quantitative approach for the prediction of the tooth movement is presented that has been developed as a first step to build up a computer tool to aid the orthodontist in designing the orthodontic appliance. The model calculates the tooth movement through time with respect to a fixed Cartesian frame located in the middle of the dental arch. The user interface panel has been designed to allow the orthodontist to manage the standard geometrical references and parameters usually adopted to design the treatment. Simulations of specific cases are reported for which the parameters of the model are selected in order to reproduce forecasts of tooth movement matching data published in experimental works.     

Simulation of the superelastic response of SMA orthodontic wires.

Shape-memory alloys have properties that make them well suited to a variety of applications. One application for which their unique combination of properties (large elastic range, low modulus of elasticity, ability to deliver nearly constant forces over a wide range of deformations) seems ideally suited is for orthodontic retraction appliances where these properties are very desirable. The mechanical response of shape-memory alloys is modeled by a simple constitutive model that captures the essential superelastic behavior of the shape-memory wires. An initial value approach that iteratively converges to the appropriate boundary conditions is utilized to deliver numerical solutions. Qualitative agreement is shown with previous experimental works. The possible benefits of using such wires in an orthodontic retraction appliance are then investigated.     

Quantitative Approach for the Prediction of Tooth Movement During Orthodontic Treatment

The orthodontic treatment is aimed to displace and/or rotate the teeth to obtain the functionally correct occlusion and the best aesthetics and consists in applying forces and/or couples to tooth crowns. The applied loads are generated by the elastic recovery of metallic wires linked to the tooth crowns by brackets. These loads generate a stress state into the periodontal ligament and hence, in the alveolar bone, causing the bone remodeling responsible for the tooth movement. The orthodontic appliance is usually designed on the basis of the clinical experience of the orthodontist. In this work, a quantitative approach for the prediction of the tooth movement is presented that has been developed as a first step to build up a computer tool to aid the orthodontist in designing the orthodontic appliance. The model calculates the tooth movement through time with respect to a fixed Cartesian frame located in the middle of the dental arch. The user interface panel has been designed to allow the orthodontist to manage the standard geometrical references and parameters usually adopted to design the treatment. Simulations of specific cases are reported for which the parameters of the model are selected in order to reproduce forecasts of tooth movement matching data published in experimental works.     

氟对正畸儿童牙面菌斑变形链球菌的影响

目的:观察和探讨2%氟化钠对正畸患者牙面菌斑内细菌总数及变形链球菌数的影响.方法:选择34例正畸儿童,分为两组,试验组涂布2%氟化钠;对照组不做处理.分别于戴用矫治器前,戴入后1月采集上颌牙唇颊面菌斑,测定菌斑中细菌总数及变形链球菌数.结果:对照组戴用后1月,细菌总数及变形链球菌数较戴用前明显增加(P＜0.01).对照组与试验组戴用后1月相比,试验组细菌总数及变形链球菌数明显少于对照组(P＜0.05).结论:戴用固定矫治器后,牙面菌斑内细菌总数及变形链球菌数较戴用前增加,应用2%氟化钠可明显抑制正畸患者口腔内变形链球菌数,减少龋坏发生.     

Computational studies of shape memory alloy behavior in biomedical applications

BACKGROUND: Nowadays, shape memory alloys (SMAs) and in particular Ni-Ti alloys are commonly used in bioengineering applications as they join important qualities as resistance to corrosion, biocompatibility, fatigue resistance, MR compatibility, kink resistance with two unique thermo-mechanical behaviors: the shape memory effect and the pseudoelastic effect. They allow Ni-Ti devices to undergo large mechanically induced deformations and then to recover the original shape by thermal loading or simply by mechanical unloading. METHOD OF APPROACH: A numerical model is developed to catch the most significant SMA macroscopic thermo-mechanical properties and is implemented into a commercial finite element code to simulate the behavior of biomedical devices. RESULTS: The comparison between experimental and numerical response of an intravascular coronary stent allows to verify the model suitability to describe pseudo-elasticity. The numerical study of a spinal vertebrae spacer where the effects of different geometries and material characteristic temperatures are investigated, allows to verify the model suitability to describe shape memory effect. CONCLUSION: the results presented show the importance of computational studies in designing and optimizing new biomedical devices.     

The Effect of Stress on Salivary Metal Ion Content in Orthodontic Patients

Psychological stress can alter the environment in favor of corrosion of orthodontic alloys by changing the properties of saliva. This study aimed to assess the effect of stress induction on salivary nickel and chromium content in fixed orthodontic patients. Thirty patients were enrolled in this experiment. Saliva sample collection was performed at four time points: T1, before insertion of orthodontic appliances; T2, 3 months after the initiation of orthodontic treatment, before induction of stress; T3, 15 min following the induction of stress by Trier Social Stress Test; and T4, 30 min following the induction of stress. Ion content was measured by atomic absorption spectrophotometry. The obtained data were analyzed by repeated measures analysis of variance (ANOVA) and post hoc Bonferroni test. The mean amount of salivary nickel increased from 11.9?±?5.1 μg/L at T1 to 14.1?±?5.3 μg/L at T4. This increase was found significant only at T4 comparing to T1. The average salivary chromium content changed from 4.1?±?2.3 μg/L at T1 to 5.1?±?3.3 μg/L at T4. None of the differences were significant for chromium. In conclusion, induction of stress in this study led to a significant increase in nickel release from orthodontic appliances into saliva. The salivary chromium content however was not significantly altered, yet gradually increased.     

Lead Exposure: A Contributing Cause of the Current Breast Cancer Epidemic in Nigerian Women

The paper discusses various approaches used to investigate biocompatibility by the analysis of metals release by the materials of which orthodontic appliances are made. Analysis of various biomarkers of exposure: saliva, serum, mucosa cells, or urine is used in in vivo tests. In this work, the techniques, results, and conclusions of original papers were compared by the implementation of the concept of a systematic review. The aim of the present work was to report the state-of-the-art in the research on methods used to assess exposure to trace metals from orthodontic appliances. The PubMed search identified 35 studies, among which nine met the selection criteria. The general conclusion in the studies was that metal ions were released mostly in the initial stage of the treatment. However, the majority of studies included 1–2 months long period and did not reflect long-term changes nor the impact of the complete treatment, the duration of which is several years, on the whole organism and the overall accumulation of metals from orthodontic appliances. In studies which evaluated nickel concentrations in blood and urine, long-term metal release was detected and significant differences were found. It leads to the conclusion that nickel ions are released from orthodontic appliances in measurable amounts to human organism.     

Prevalence of putative periodontopathogens in subgingival dental plaques from gingivitis lesions in Korean orthodontic patients

The objective of this study was to detect and compare the presence of periodontopathogens in the subgingival plaques of gingivitis lesions in adults who wore fixed orthodontic appliances, as opposed to adults who did not wear any orthodontic appliances. Thirty-six individuals participated in this study. Nineteen of these subjects did not wear any orthodontic appliances, and these subjects comprised the control group. The other 17 individuals had been wearing fixed orthodontic appliances for at least 3 months each. After a periodontal examination, we collected subgingival plaque samples from the gingivitis lesions of each patient. Using PCR based on 16S rDNA, we detected the presence of 6 putative periodontopathogenic species, Treponema denticola, Porphyromonas gingivalis, Tannerella forsythia (formerly Bacteroides forsythus), Prevotella nigrescens, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. With regard to the presence of individual periodontopathogens, we found that T. forsythia, T. denticola, and P. nigrescens were significantly more common in the samples obtained from the orthodontic patients than in the samples obtained from the non-orthodontic patient controls. Our results indicate that the local changes associated with the wearing of fixed orthodontic appliances may affect the prevalence of periodontopathogens in subgingival dental plaques.     

Large deformation analysis of orthodontic appliances

The deformations of orthodontic appliances used for space closure are large so that any mathematical analysis will require a nonlinear approach. Existing incremental finite element and finite difference numerical methods suffer from excessive computational effort when analyzing these problems. An accurate segmental technique is proposed to handle these difficulties in an extremely efficient fashion. The segmental technique starts by assuming that an orthodontic appliance is composed of a number of smaller segments, the ends of which undergo small relative rotation. With an appropriate choice of local coordinate system the equilibrium equations for each segment are linearized and solved in a straightforward manner. The segments are then assembled using geometric and force compatibility relations similar to the transfer matrix method. Consequently, the original nonlinear boundary value problem is solved as a sequence of linear initial value problems which converge to the required boundary conditions. As only one segment need be considered at a time, the computations can be performed accurately and efficiently on a PC type computer. Although an iterative solution is used to match the boundary conditions, the time required to solve a given problem ranges from a few seconds to a couple of minutes depending on the initial geometric complexity. The accuracy of the segmental technique is verified by comparison with an exact solution for an initially curved cantilever beam with an end load. In addition, comparisons are made with existing experimental and numerical results as well as with a new set of experimental data. In all cases the segmental technique is in excellent agreement with the results of these other studies.     

Screening of fluoride analysis as a biochemical parameter in the orthodontic treatment using fixed appliances

Saliva is a critical and useful biological fluid necessary for good health and for the appropriate execution of mouth activities. Orthodontic biomaterials have a complex relationship with many components, including the oral environment. Treatment with fixed orthodontic appliances may causes dental caries. As a result, it is necessary to comprehend how orthodontic therapy and various fluoride regimens affect the chances of developing dental cavities as well as individual risk factors. Usage of fluoride will tend to reduce the caries in the patients diagnosed with the fixed orthodontic treatment. The aim of this study was to screen the biochemical parameter of the fluoride levels in the patients undergone and completed the treatment of orthodontic fixed appliances. In this study, 35 patients have been visited on day 1 as well as day 35 and categorized as T₀ and T₁ groups. Saliva samples were collected and fluoride levels were measured between T₀ and T₁ groups. Using the fluoride kit with the spectrophotometer, fluoride levels were measured. The results confirmed similar fluoride levels between T₀ (26.11 ± 4.86) and T₁ (27.71 ± 4.40) groups. There was no significant association observed in this study (p = 0.56). Fluoride might have no role in the patients undergoing orthodontic treatment.     

Comparative assessment of the cell-surface antigens and gene expression profiles of the gingival tissue biomarkers in subjects with fixed functional and removable functional orthodontic appliances

BackgroundThis study aimed to examine the cellular components of the gingiva during orthodontic treatment with fixed and removable appliances. The cellular and molecular cues of pathologies of the gingival tissue associated with the use of different orthodontic appliances could be studied.Materials and methodsTissue samples of gingiva were received from healthy patients undergoing gingivectomy for aesthetic purpose and from patients with fixed and removable functional orthodontic appliances undergoing gingivectomy for gingival overgrowth. The collected samples were stored in a sterile container with phosphate-buffered saline and to carry out further processes it was transported to the laboratory.ResultsCells positive for ECAD and NCAD were found to be increased in fixed appliances where as CD90 and CD105 positive cells showed no significant difference in all the three groups. CD24 and CD146 positive cells were increased significantly in removable and fixed than normal whereas CD133 positive cells were decreased in removable and fixed than normal. CD44 positive cells showed no noticeable change in all three groups. The gene expression levels of KRT5, SOX2, NANOG, and CXCL5 were found to be significantly increased in removable and fixed appliance groups. However, KRT8, CXCL10, and TIMP1 were increased only in fixed appliance group but CXCL10 showed decreased expression in removable appliance group. KRT6A, MYC, and MMP9 were decreased in fixed appliance group whereas MYC and MMP9 were increased in removable appliance group. KRT6A, KRT8, and TIMP1 showed no significant difference in removable appliance group.ConclusionThis study demonstrated essential roles of various genes, showing their contribution in regulating cell proliferation and migration in both the removable and fixed functional appliances.     

Real time polymerase chain reaction analysis in the patients treated with fixed appliances after the orthodontic treatment: A follow-up study

This study aimed to compare the changes in the salivary cariogenic bacteria levels using qPCR and oral hygiene status after orthodontic treatment with fixed appliances during the retention phase concerning the patient and treatment variables. In this study, saliva samples were collected from 35 patients before debonding (T₀) and after five weeks of debonding on retention (T₁). The saliva samples were collected to extract the genomic DNA, and using specific probes and primers using real-time polymerase chain reaction was performed to analyze the changes in S. mutants, S. sobrinus, L. Casei after orthodontic treatment with fixed appliances. Additionally, OHI levels were also measured. The current study confirms the statistical association between T0 and T1 groups of S. mutants (p = 0.028) and S. sobrinus (p = 0.049). However, a lack of association was observed with L. Casei (p > 0.05). The number of bacteria was decreased from the T₀ group and increased in the T₁ group in Streptococcus mutants (S. mutants) and Streptococcus Sobrinus (S. sobrinus) while in Lactobacillus Casei (L. Casei) it was vice versa between T₀ and T₁ groups. The Oral Hygiene Levels (OHI) levels were also found to be statistically associated (p = 0.003). This study concludes that comparing the salivary cariogenic bacterial levels at T₀ (before debonding of fixed orthodontic appliances), with T1 (Five weeks after the debonding), and despite better oral hygiene, there was increase in salivary S mutants and S sobrinus levels. The current study suggested that orthodontic patients need careful hygienic procedures during the retention period. Future studies are recommended with additional follow-up and a large sample size.     

复方茶多酚含漱液对正畸儿童牙面菌斑中致龋菌的影响

目的观察复方茶多酚含漱液对正畸儿童牙面菌斑中细菌总数和变形链球菌数的影响,以及牙菌斑内原位pH的改变。方法选择42例戴用固定矫治器的正畸儿童,随机分为2组,试验组用复方茶多酚含漱液漱口,对照组用蒸馏水漱口。分别于戴用矫治器前,戴入后1月采集上下颌牙唇颊面菌斑,测定菌斑中细菌总数及变形链球菌数,同时测定牙菌斑原位pH。结果对照组戴用后1月,细菌总数及变形链球菌数较戴用前明显增加(P0.01),牙菌斑原位pH较戴用前降低(P0.01)。试验组与对照组戴用后1个月相比,试验组细菌总数及变形链球菌数明显少于对照组(P0.01),牙菌斑原位pH高于对照组(P0.01)。结论戴用固定矫治器后,牙面菌斑内细菌总数及变形链球菌数较戴用前增加,牙菌斑原位pH较戴用前降低,应用茶多酚含漱液可明显抑制正畸儿童口腔内变形链球菌数,减少龋坏发生。     

A Computational Fluid Dynamic Analysis of Peri-Bracket Salivary Flow Influencing the Microbial and Periodontal Parameters

Fixed vestibular appliances decrease the “self-cleansing” action of saliva and promote aggregation of dental plaque by disturbing the salivary flow field on tooth surfaces, leading to a higher prevalence of enamel demineralization and periodontal diseases. In the current study, we investigated the salivary dynamic characteristics of plaque retention and periodontal status around appliances during orthodontic treatment. By reconstructing lower central incisors and orthodontic appliances, we simulated saliva flow on the tooth surface and then characterized and quantified the salivary flow pattern surrounding the bracket and archwire. In parallel, we tested the total peri-bracket bacterial counts and periodontal status to assess interrelations. Our results demonstrate that orthodontic appliances disturb the salivary flow field on tooth surfaces and can lead to a decrease in salivary velocity and an increase in bacterial numbers. Local vortexes forming in the areas gingival to the bracket, together with the narrow space limitation, contributed to the periodontal inflammatory response. This study confirms that changes in salivary flow are an obvious predisposing factor for bacterial accumulation, and advances the ability to replicate, in vitro, the salivary characteristics of plaque retention and periodontal status around appliances during orthodontic treatment.     

Finite element modeling of superelastic nickel–titanium orthodontic wires

Thanks to its good corrosion resistance and biocompatibility, superelastic Ni–Ti wire alloys have been successfully used in orthodontic treatment. Therefore, it is important to quantify and evaluate the level of orthodontic force applied to the bracket and teeth in order to achieve tooth movement. In this study, three dimensional finite element models with a Gibbs-potential-based-formulation and thermodynamic principles were used. The aim was to evaluate the influence of possible intraoral temperature differences on the forces exerted by NiTi orthodontic arch wires with different cross sectional shapes and sizes. The prediction made by this phenomenological model, for superelastic tensile and bending tests, shows good agreement with the experimental data. A bending test is simulated to study the force variation of an orthodontic NiTi arch wire when it loaded up to the deflection of 3 mm, for this task one half of the arch wire and the 3 adjacent brackets were modeled. The results showed that the stress required for the martensite transformation increases with the increase of cross-sectional dimensions and temperature. Associated with this increase in stress, the plateau of this transformation becomes steeper. In addition, the area of the mechanical hysteresis, measured as the difference between the forces of the upper and lower plateau, increases.     

The Effect of Fixed Orthodontic Appliances and Fluoride Mouthwash on the Oral Microbiome of Adolescents – A Randomized Controlled Clinical Trial

While the aesthetic effect of orthodontic treatment is clear, the knowledge on how it influences the oral microbiota and the consequential effects on oral health are limited. In this randomized controlled clinical trial we investigated the changes introduced in the oral ecosystem, during and after orthodontic treatment with fixed appliances in combination with or without a fluoride mouthwash, of 10–16.8 year old individuals (N = 91). We followed several clinical parameters in time, in combination with microbiome changes using next-generation sequencing of the bacterial 16S rRNA gene. During the course of our study, the oral microbial community displayed remarkable resilience towards the disturbances it was presented with. The effects of the fluoride mouthwash on the microbial composition were trivial. More pronounced microbial changes were related to gingival health status, orthodontic treatment and time. Periodontal pathogens (e.g. Selenomonas and Porphyromonas) were highest in abundance during the orthodontic treatment, while the health associated Streptococcus, Rothia and Haemophilus gained abundance towards the end and after the orthodontic treatment. Only minor compositional changes remained in the oral microbiome after the end of treatment. We conclude that, provided proper oral hygiene is maintained, changes in the oral microbiome composition resulting from orthodontic treatment are minimal and do not negatively affect oral health.     

Exposure of Cleft Lip and Palate Patients to Toxic Elements Released during Orthodontic Treatment in the Study of Non-Invasive Matrices

The Objective

The aim of the study was evaluation of metal ions (nickel and chromium) released from orthodontic appliances in cleft lip and palate patients and the usefulness of non-invasive matrices (saliva and hair).

Materials and Methods

The material studied consisted of 100 individuals, including 59 females and 41 males of 5 to 16 years of age, which were divided into 3 groups: experimental–patients with cleft lip and palate (36 individuals, the average treatment time 5.74 years); control group–patients without cleft lip and palate, during orthodontic treatment (32 individuals, the average treatment time 1.78 years) and the control group patients without cleft lip and palate, without any orthodontic appliances (32 individuals). Samples (saliva, hair) were collected and subjects underwent a survey by questionnaire. Multi-elemental analyses of the composition of non-invasive matrices was conducted in an accredited laboratory by inductively coupled plasma spectrometry technique ICP-OES. The results were reported as mean contents of particular elements (Cd, Cr, Cu, Fe, Mn, Mo, Ni, Si) in hair and in saliva.

Results

The concentration of Cr, Ni, Fe and Cu ions in saliva of cleft lip and palate patients were several times higher as compared with not treated orthodontically control groups and higher than in the group with orthodontic appliances. Among the assessed matrices, hair of cleft lip and palate patients seem to be not a meaningful biomarker.

Conclusion

It was found that orthodontic appliances used in long-term treatment of cleft lip and palate patients do not release toxic levels of Cr and Ni ions.     

Testing a computer-assisted bending machine for manufacturing orthodontic treatment elements]

The use of suitable orthodontic devices producing desired defined force systems is of importance for successful orthodontic treatment. Bending loops can be difficult and time-consuming. Computerised fabrication would enable very precise reproduction of individual loops. A bending machine has now been developed within the framework of a computer-assisted treatment concept. In this study, a prototype machine was used to fabricate U-, T- and delta loops made of stainless steel, cobalt chromium and titanium molybdenum wire. The various geometric parameters of each loop were measured to determine how precisely they had been produced. Furthermore, the force system of each loop were experimentally investigated during simulated activation in an orthodontic measurement and simulation system. The results indicate that the geometric parameters had an average error of 2.8 degrees for angles and 0.9 mm for lengths. Owing to the fabrication errors, loops of the same type produced different force systems. Overall, the new bending machine can fabricate different types of loop, but the requirements of very precise fabrication are currently not met. This fact, together with further limitations in terms of configuration, means that the machine cannot be used routinely at present. However, the machine can nevertheless be considered a good basis for further development.     

Salivary Nickel and Chromium Levels in Orthodontic Patients with and Without Periodontitis: a Preliminary Historical Cohort Study

Many periodontal patients may need orthodontic treatment. Alterations in oral environment particularly the reduction of pH in periodontal patients could affect metal ion release from orthodontic appliances. However, there is no study on metal ion release in periodontal patients. The aim of this preliminary study was to comparatively evaluate, for the first time, salivary levels of nickel and chromium in periodontal patients (versus healthy controls) under orthodontic treatment for 2 months. In this in vivo study, 40 subjects were evaluated. Patient selection and standardization of orthodontic treatment protocols were prospectively designed and performed. Two groups of n = 20 each (control: healthy orthodontic patients, cohort: orthodontic patients with periodontitis) underwent similar protocols of fixed orthodontic treatment for 2 months. After 2 months, salivary nickel and chromium concentrations of the case and cohort groups were measured using inductively coupled plasma mass spectrometry (ICP-MS). The values were compared between the two groups using t test. There were 10 men and 10 women in each group. The mean age of patients was 34.6 ± 3.6 years old. The salivary level of nickel was 338.2 ± 235.5 ng/ml and 182.8 ± 116.5 ng/ml in the cohort and control groups, respectively (P = 0.0118). The salivary level of chromium was 7.4 ± 3.15 ng/ml in the cohort and 6.35 ± 2.39 ng/ml in the control group (P = 0.2214). Salivary level of nickel might be considerably higher in periodontal patients undergoing 2 months of orthodontic treatment compared to orthodontic patients with healthy gingivae.

     

A computer program for the analysis of dental models.

This paper presents the details and logic of a Fortran computer program which carries out routine clinical analysis of dental models resulting from impressions of the teeth and related structures, which are subsequently cast in plaster of Paris. The program is primarily intended for use by the orthodontist who is engaged in research or clinical practice, and is useful in studies related to changes in the dentition as a result of orthodontic treatment.