Invisible Orthodontics: Current Concepts and Solutions in Lingual Orthodontics

Objectives: The purpose of this study was to develop a procedure for quantifying the buccal alveolar bone thickness surrounding each tooth prior to orthodontic treatment in 3D, using CBCT.
Methods: This retrospective cross-sectional study was carried out on 18 Singaporean Chinese patients. A total of 18 CBCT scans met the inclusion criteria, resulting in a sample size of 85 teeth, using two kinds of CBCT scanners. All CBCT data were stored in DICOM format. Buccal Alveolar bone thickness was measured after defining the boundaries of each individual tooth and surrounding alveolar bone using Kruskal-Wallis, Mann-Whitney U-test, and linear regression for statistical analysis.
Results: There was statistical significant difference in buccal bone thickness between incisor versus premolar, incisor versus molar, canine versus premolar, Canine and premolar versus molar. However, the difference between incisors and canines and between central and lateral incisors was not significant. There was also no statistical significant difference in the buccal bone thickness between maxillary and mandibular incisors, between maxillary and mandibular central incisors, and between maxillary and mandibular lateral incisors, neither between maxillary and mandibular canines.
Conclusions: The thickness of buccal bone is lowest in the incisor and canine reigns with no statistically significant difference between canines and incisors. The thickness of the alveolar bone in premolar region is significantly greater than incisor and canine regions but lesser than molar region. No statistically significant differences were found regarding buccal bone thickness between maxillary and mandibular incisors and canines.

/pdf/quantitative-three-dimensional-assessment-of-buccal-alveolar-5amta7peae.pdf

Quantitative three-dimensional assessment of buccal alveolar bone thickness with dental cone-beam computed tomography

Aim To analyze the movement of anterior teeth by changing the height of the power-arm and changing the force application points during whole maxillary dentition distalization with the aid of micro-implants in lingual orthodontics to set a biomechanical reference for effective clinical use of lingual orthodontic appliance. Methods A three-dimensional finite element model of the maxillary teeth with lingual appliance and the associated support tissue was established. Maxillary dentition with the force of 200g was distalized using implant as anchorage, then the movement of anterior teeth was analyzed by changing the length of power-arm (1mm, 3mm, 6mm, 9mm) and by changing the force location from lingual side to buccal side. Results During whole maxillary dentition distalization with aid of the implants in lingual orthodontics: when the height of power arm was 1mm, the anterior teeth rotated clockwise, with the increasing of the height of power-arm, the anterior teeth rotated counterclockwise gradually. When the height of power-arm was 9mm, all anterior teeth rotated counterclockwise. Central incisor and lateral incisor rotated counterclockwise and canine rotated clockwise when the buccal side force was applied. Conclusion With the increase of the height of the power-arm, the movement pattern of the upper anterior teeth is different. The canine is more sensitive to the height of the power-arm than the central incisor and the lateral incisor. When the height of the power-arm reaches 9mm, the upper anterior teeth are displayed as crown tipping buccally movement. Compare with lingual side force, the buccal side force do better in preventing the loss of anterior tooth torque. If the upper anterior teeth are up-right or lingually tipped before treatment, it is preferable to use longer power-arm or buccal side traction force. If the anterior teeth are already tipped buccally, then short power-arm or lingual side force is advised.

A Three-Dimensional Finite Element Analysis: Maxillary Dentition Distalization with the Aid of Microimplant in Lingual Orthodontics.

INTRODUCTION
The presented study investigates differences in the biomechanics of straight and mushroom fixed lingual appliances when implementing coil springs and stops for anterior arch expansion.


MATERIALS AND METHODS
An in vitro orthodontic simulator was used to measure three-dimensional forces and moments on each tooth of a simulated maxillary arch. Mushroom and straight archwire forms of 0.016" NiTi round archwire were considered, using 0.010"x0.030" NiTi open coils and 0.016"-0.018" archwire stops (n=44 per group). Teeth in the anterior dental arch were moved from a neutral to crowded position to replicate anterior crowding of central and lateral incisors. Forces and moments of interest for lateral incisors and first premolars were compared using repeated measures mixed multivariate analysis of variance (α=0.05).


RESULTS
Three comparisons between straight vs. mushroom archwires and two comparisons of coil springs vs. stops were not statistically significant. Overall, it was found that use of a straight lingual archwire produced larger differences in forces and moments between using stops and coil springs than when using a mushroom archwire. Using stops produced larger forces and moments for both types of archwires as compared to using coil springs. The largest expansion forces were produced using straight archwires with stops, exceeding 3.0 N of force. Straight archwires with coil springs produced the lowest expansion forces on lateral incisors, just exceeding 1.5 N.


CONCLUSIONS
The findings of this study have elucidated significant differences in the biomechanics of transverse arch expansion using straight or mushroom fixed lingual appliances with coil springs or stops.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/ocr.12640

The in vitro biomechanics of anterior arch expansion using fixed lingual appliances with coil springs or archwire stops.

/pdf/orthodontic-simulation-of-forces-and-moments-using-space-3hsiepyxp1.pdf

Orthodontic Simulation of Forces and Moments Using Space Generation Mechanics with a Lingual Bracket System

Background The aim of present study was to investigate the difference of torque control during intrusive force on upper central incisors with normal, under and high torque in lingual and labial orthodontic systems through 3D finite element analysis. Material and methods Six 3D models of an upper right central incisor with different torque were designed in Solid Works 2006. Software ANSYS Version 16.0 was used to evaluate intrusive force on upper central incisor model . An intrusive force of 0.15 N was applied to the bracket slot in different torque models and the displacements along a path of nodes in the upper central incisor was assessed. Results On application of Intrusive force on under torqued upper central incisor in Labial system produce labial crown movement but in Lingual system caused lingual movement in the apical and incisal parts. The same intrusive force in normal-torqued central incisor led to a palatal movement in apical and labial displacement of incisal edge in Lingual system and a palatal displacement in apical area and a labial movement in the incisal edge in Labial systemin. In overtorqued upper central incisor, the labial crown displacement in Labial system is more than Lingual system. Conclusions In labial and lingual system on application of the same forces in upper central incisor with different inclinations showed different responses. The magnitudes of torque Loss during intrusive loads in incisors with normal, under and over-torque were higher in Labial system than Lingual orthodontic appliances. Key words:FEM, lingual orthodontics, intrusion, torque control, labial bracket systems.

/pdf/torque-control-during-intrusion-on-upper-central-incisor-in-3x6we39k9r.pdf

Torque Control During Intrusion on Upper Central Incisor in Labial and Lingual bracket System - A 3D Finite Element Study.

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Mini-Implants. The orthodontics of the future

To evaluate the torque expression of right permanent maxillary central incisor with varying bracket positions and to compare the torque expression of the same tooth with different crown-root angulations. Finite Element Models of Maxillary Central Incisor were used for simulation of torque expression with various crown-root angles. Three FEM models of a Maxillary Central Incisor with different crown-root angles (170˚,175˚,180˚, and 165°) were constructed with varying bracket heights and subjected to a 30° labial root torque and the resultant torque expressions were evaluated. The model with the maximum variation in crown-root angle (165˚) showed the maximum torque expression at 6mm and minimum at 3mm bracket height while the model with a minimum variation in crown-root angle (180°) showed the minimum torque expression both and 3mm and 6mm bracket height. With increase in the crown-root angles of a tooth, the torque expression away from the incisal edge increases.

Evaluation of torque expression with varied bracket positions and varying crown-root angles of maxillary central incisor – A 3 dimensional finite element study

To evaluate and compare the resultant stress on the root and PDL of a Maxillary Central Incisor with various crown-root angles. Settings and Sample Population: Finite Element Models of Maxillary Central Incisor were used for simulation of stress on the root and PDL. Three FEM models of a Maxillary Central Incisor with different crown-root angles (170˚, 175˚ and 180˚) were constructed and subjected to a force of 2N respectively. The resultant stress generated in the periodontal ligament and root surface were recorded and compared between the models.: The model with the maximum change in crown-root angle (180˚) showed the maximum stress in both PDL and root surface. The stress recorded on the root surface was more on the cervical 2/3rd in the palatal region of the tooth as compared to the labial region. Maximum stress in the PDL was seen only in the cervical 3rd of the third model. With increase in the crown-root angles of a tooth, the stress in the PDL and on the root surface increases.

Effect of various crown-root angles on the resultant stress on the root and periodontal ligament of a maxillary central incisor-A three dimensional finite element study

A wide range of clinical procedures have been introduced and practiced to correct mesially inclined mandibular molars which is a common situation among young adults, occurring usually due to inadequate space in the arch for its eruption. There are two major treatment options available for the correction of impacted / partially impacted molars and this depends on several factors. The objective was to treat a 15-year-old male patient having a lower right partially impacted 2nd molar using skeletal anchorage system. The lower right 3 molar was surgically excised, and the partially impacted 2 molar was uprighted using an orthodontic miniscrew which was placed between lower right 1 and 2 premolars on the mesial side. The use of skeletal anchorage system has an excellent advantage over conventional methods since there is prevention of unwanted movement of anchor teeth leading to successful correction without any delay in the treatment duration.

Orthodontic miniscrew supported correction of partially impacted mandibular 2nd molar- A case report

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