OBJECTIVE:To compare pain experiences in patients treated with self-ligating (SmartClip™) and conventional (Victory™) preadjusted edgewise brackets during initial alignment.MATERIALS AND METHODS:Seventy-three patients (50 females and 23 males) between 15 and 21 years of age were randomly allocated either the SmartClip appliance or the VictoryTM Series appliance. The participants rated their overall pain experience on a 100-mm visual analogue scale (VAS) at five time points: 6 hours (T1), 24 hours (T2), 3 days (T3), 1 week (T4), and 2 weeks after bracket placement (T5). All teeth were in the permanent dentition and had mild lower incisor crowding as assessed by Little’s Irregularity Index. Moreover, participants reported any anti-inflammatory medication. An independent t-test was used to assess differences between both groups in terms of pain experience.RESULTS:Pain peaked between 24 hours and 3 days and gradually declined. No significant differences in pain scores were observed between groups at any time point (P > 0.05).CONCLUSION:There were no clinically significant differences in pain perception between the two bracket systems during initial alignment. The current evidence does not support claims that one bracket system results in lower perceived pain levels than another.

BACKGROUND AND AIM: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.MATERIALS AND METHODS: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.RESULTS: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.CONCLUSION: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.

OBJECTIVE:To retrospectively evaluate the prevalence and positional classification of maxillary and mandibular canine impactions in the Saudi population of Jeddah and Al-Madinah Al-Munawwarah using digital panoramic radiographs, posteroanterior skull views, and cone-beam computed tomography scans.METHODS:This cross-sectional retrospective study was conducted using the radiographic databases” of Jeddah Specialty Dental Center and King Fahad General Hospital. The sample included 177 radiographs from 68 males and 109 females within the age range of 14–40 years. The main extracted data were the frequency and percentage of the utilized radiograph, gender, side distribution of impaction, angulation of the impacted canine to the midsagittal plane, and vertical level of impacted canines about the neighboring adjacent tooth.RESULTS:The most commonly used radiographs were PD (70.6%), PD-CBCT (21.5%), PD-CBCT-PA (2.3%), PD-PA (1.1%), and CBCT alone (4.5%). Unilateral impaction was more common than bilateral impaction (69.5% had unilateral impaction and only 30.5% had bilateral impaction). Females had a significantly higher prevalence of impaction than males (61.6% and 38.4%, respectively). The most common angulation of the impacted canine was >30°(44.6%), followed by 16–30°(28.2%), and the least common angulation was 0–15 °(27.1%). The vertical level showed that the most common level of impaction was between the cementoenamel junction and halfway up the root of the neighboring adjacent tooth (53.1%).CONCLUSION:PD is the most commonly used method to diagnose canine impaction. Unilateral impactions are more common than bilateral impactions. Females had a higher prevalence of impaction than males.

OBJECTIVES:Deep bite correction with aligners involves anterior intrusion and posterior extrusion. During lower incisor intrusion with clear aligners (CAs), root disengagement from the alveolar bone can cause complications. Frog staging protocol applies sequential forces, targeting lateral incisors first, then central incisors. This study compares conventional and Frog staging intrusion protocols using attachments for mandibular anterior teeth to optimize clinical practice.MATERIALS AND METHODS:A 3D finite element (FE) model, including the clear aligner, periodontal ligament (PDL), and mandibular dentition, was established. Four groups were analyzed: Group 1 (Conventional intrusion with attachments), Group 2 (Conventional intrusion without attachments), Group 3 (Frog staging intrusion with attachments), and Group 4 (Frog staging intrusion without attachments). Rectangular molar attachments (4.0 × 2.0 × 0.75 mm) and vertical canine attachments (3.5 × 1.8 × 0.75 mm) provided anchorage. Incisor attachments (3.0 × 1.5 × 0.75 mm) facilitated precise force application. Stress distribution was evaluated using von Mises stress (overall stress), maximum principal stress (tensile), and minimum principal stress (compressive).RESULTS:Frog staging resulted in balanced stress distribution and reduced adverse effects compared to conventional intrusion. Attachments minimized stress and displacement, enhancing intrusion mechanics. Frog staging better controlled root displacement and stress concentration at the root apex.CONCLUSIONS:Frog staging intrusion with attachments is biomechanically superior for lower incisor intrusion, reducing complications and providing a safer approach for deep bite correction with CAs.

BACKGROUND: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.MATERIALS AND METHODS: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.RESULTS: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.CONCLUSION:Copper-substituted hydroxyapatite nanoparticles enhance bond strength and adhesive retention, making them a promising alternative to conventional adhesives in orthodontics.CLINICAL RELEVANCE: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.

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.

OBJECTIVE:The goal of this study was to determine the prevalence of midline shift in relation to gender, location, and classification of malocclusion.MATERIAL AND METHODS:A total of 150 dentistry students aged 18–25 (93 females and 57 males) were picked at random from Mustansiriyah University. Dental midline shifting is evaluated by comparing the positions of the maxillary and mandibular dental midlines to the face midline, with the philtrum serving as a reference point.RESULTS:About a quarter of the total sample had dental midline shift (26%) which was more prevalent in mandibular arch. The prevalence of dental midline shift was more common in females (60,5%). In general, dental midline deviation was more common in angle’s Class I and Class II than Class III, while for the maxillary arch, it was common in angle’s Class I and Class II, Divison 1, and for the mandibular arch, it was more common in angle’s Class I and Class III. The deviation was more common to the right side in both arches.CONCLUSIONS:A quarter of the total sample had dental midline shift, most of them were females, and the deviation was more common in the mandibular arch in Class I angle’s classification.

BACKGROUND:Enamel deproteinization using 5.25% sodium hypochlorite (NaOCl) or papain before enamel etching has been proposed to increase shear bond strength (SBS) of orthodontic brackets. Yet, evidence about its efficacy remains unclear.OBJECTIVE:This systematic review assesses the effects of enamel deproteinization on SBS and the adhesive remnant index (ARI) of orthodontic brackets bonded using different adhesives.MATERIAL AND METHODS:Four databases, PubMed, Cochrane Database of Systematic Reviews, Scopus, and Web of Science™ Core Collection, and gray literature were searched with no limitations up to May 2024.SELECTION CRITERIA:Randomized studies in vitro.DATA COLLECTION AND ANALYSIS:Study selection, data extraction, and risk of bias assessment were done independently in duplicates. Random-effects meta-analysis of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by subgroup analysis, sensitivity analysis, and the Grades of Recommendations, Assessment, Development and Evaluation analysis of the evidence quality.RESULTS:A total of 19 studies (including a total of 1399 extracted premolars) were included in this systematic review. These studies compared pretreatment with enamel deproteinization and bonding with bonding only without deproteinization. Low quality of evidence indicated that enamel deproteinization using 5.25% NaOCl did not have a statistical significance change on SBS (MD = −1.17, 95% CI: −2.35 to 0.02, P = 0.05) and ARI (MD = −0.27, 95% CI: −0.55 to 0.01, P = 0.06). On the other hand, enamel deproteinization using papain significantly increased the SBS (MD = −2.78, 95% CI: −4.49 to − 1.07, P = 0.001) and did not significantly increase the ARI (MD = −0.29, 95% CI: −0.58 to 0.01, P = 0.06). The main limitations of the existing evidence pertained to risk of bias, inconsistency, and imprecision of included studies.CONCLUSION:Enamel deproteinization using 5.25% NaOCl showed no significant effects on SBS and ARI, while papain was associated with significantly higher SBS only with no significant effects on the ARI of orthodontic brackets bonded using resin composites or resin-modified glass ionomers.

The self-ligating bracket system and corticision are two methods for acceleration of orthodontic tooth movement (OTM). The current study aimed to assess the effect of a self-ligating bracket system combined with corticision on the rate of OTM. The present study was conducted on 16 female patients divided into two groups: an experimental group of eight patients treated by self-ligating bracket systems used as fixed orthodontic appliances combined with a corticision as a minimally invasive surgical technique for accelerating OTM, and a control group of eight patients treated only by self-ligating bracket systems used as fixed orthodontic appliances. The primary outcome was the percentage of change in Little's Index of Irregularity (LII). The secondary outcome was the time taken to finish the leveling and alignment stage. In a comparison of the percentage of change in LII for the upper arch between the two groups, the experimental group recorded values that were significantly greater than those recorded in the control group at all time intervals T0-T7, except for T8-T10, which were similar. Both groups recorded (100 ± 0%), with no significant difference between groups (P = 1). The combination of two methods for acceleration of OTM, a self-ligating bracket system combined with corticision, accelerates the rate of OTM more than in the case of using a self-ligating bracket system only.

Composite resins and bonding agents are indispensable in orthodontic practice, necessitating a thorough understanding of their cytotoxic effects, particularly when expired. This study aimed to evaluate the influence of expired composite and bonding materials on human gingival fibroblasts (hGFs). Both expired and nonexpired composite resins and bonding agents were tested on hGFs using direct exposure methods. Viability assays, morphological evaluations, and wound healing assays were conducted at 24 and 72 hours post exposure. Exposure to both expired and nonexpired materials led to significant reductions in hGF viability and alterations in morphology. Wound healing assays demonstrated impaired migratory abilities of hGFs following exposure to these materials. The study highlights the importance of prudent material selection, handling, and monitoring in orthodontic practice to mitigate adverse effects on gingival tissues. Proper management of expired materials is crucial for cost-effectiveness, waste reduction, and patient safety. Further research into the long-term impacts of expired materials on gingival and periodontal health is imperative to ensure clinical treatment safety and efficacy. This investigation provides valuable insights into the biocompatibility of orthodontic bonding materials and emphasizes the necessity for continued vigilance in their usage to uphold patient welfare and treatment quality.