Abstract: Abstract Background The purpose was to determine the predictability of tooth movements through clear aligner among premolar extraction patients and to explore the effects of various factors on tooth movements. Methods A total of 31 extraction patients (10 males and 20 females; age 14–44) receiving clear aligner treatment (Invisalign) were enrolled in this study. The actual post-treatment models and pre-treatment models were superimposed using the palatal area as a reference and registered with virtual post-treatment models. A paired t test was used to compare the differences between actual and designed tooth movements of maxillary first molars, canines, and central incisors. A multivariate linear mixed model was performed to examine the influence of variables on actual tooth movements. Results Compared to the designed tooth movements, the following undesirable tooth movements occurred: mesial movement (2.2 mm), mesial tipping (5.4°), and intrusion (0.45 mm) of first molars; distal tipping (11.0°), lingual tipping (4.4°), and distal rotation of canines (4.9°); lingual tipping (10.6°) and extrusion (1.5 mm) of incisors. Age, crowding, mini-implant, overbite, and attachments have differential effects on actual tooth movements. Moreover, vertical rectangular attachments on canines are beneficial in achieving more predictable canine and incisor tooth movements over optimized attachments. Lingual tipping and extrusion of incisors were significantly influenced by the interaction effects between incisor power ridge and different canine attachments ( p < 0.05). Conclusions Incisors, canines, and first molars are subject to unwanted tooth movements with clear aligners among premolar extraction patients. Age, crowding, mini-implant, overbite, and attachments influence actual tooth movements. Moreover, vertical rectangular attachments on canines are beneficial in achieving more predictable incisor tooth movements over optimized canine attachments.

Abstract: The article describes the orthodontically treated case of a 25-year-old patient with skeletal and dental class III malocclusion, anterior crossbite, which caused functional and aesthetic problems, occlusal trauma, and incisor wear. Treatment with transparent aligners was proposed to meet the patient’s needs, using the sequential distalization protocol. While sequential distalization is well documented for class II malocclusion treatment in maxillary arch teeth, further investigations are necessary for class III malocclusions. In fact, lower teeth movements are more complex due to mandibular bone density and the presence of the third molars, which are often extracted to perform distalization. In addition, the use of intermaxillary elastics helps control the proclination of the anterior teeth as a reaction to distalizing forces. At the end of the treatment, the patient reached molar and canine class I and positive overjet and overbite. The inclination of lower incisors and the interincisal angle have improved, resulting in aesthetic and functional enhancement.

Abstract: OBJECTIVES To evaluate treatment effects in Class II patients using infrazygomatic crest (IZC) miniscrews (MS). MATERIALS AND METHODS A prospective sample of 25 adolescents (14 females and 11 males; mean age: 13.6 ± 1.5 years) who underwent maxillary dentition distalization treatment with IZC MSs were recruited. Lateral cephalograms and digital models at the beginning of treatment (T1) and after Class II molar correction (T2) were obtained. To compare cephalometric and digital model changes, paired t-test and Wilcoxon test were used. A significance level of 5% was used. RESULTS All patients achieved Class II molar correction over a mean period of 7.7 ± 2.5 months. The IZC MS therapy provided 4 mm of distalization; there was 1.2 mm of intrusion of the first molar with 11.2° distal tipping. The maxillary incisors were retracted 4.7 mm and tipped lingually 13.4°. Overjet and overbite showed a reduction of 3.6 mm and 2.4 mm, respectively. The occlusal plane rotated clockwise 2.8°. The upper lip was retracted by 1 mm and the nasolabial angle increased 5.1°. There was an increase in the interpremolar and intermolar distances. CONCLUSIONS Total arch distalization of the maxillary dentition using IZC MS was effective in the treatment of Class II malocclusions.

Abstract: Preface. Acknowledgements. Introduction. Chapter 1. Orthodontic Diagnosis and Treatment Planning. Normal and Ideal Occlusion. Normal Occlusion in the Primary Dentition. Angle Classification of Malocclusion. Angle Class I Malocclusion. Class I Malocclusions in the Primary and Mixed Dentitions. Angle Class II Division 1 Malocclusion. Angle Class II Division 2 Malocclusion. Class II Malocclusions in the Primary and Mixed Dentitions. End-to-End Occlusions. Angle Class III Malocclusion. Class III Malocclusions in Primary and Mixed Dentitions. Super Class I Malocclusion. Super Class II and Super Class III Malocclusions. Subdivision Malocclusions. Class II Subdivision Malocclusions. Class III Subdivision Malocclusions. Class II-III Subdivision Malocclusion. Incisor Compensations in Class II and Class III Malocclusions. Iowa Notation System for Angle Classification. Rules for Assigning Angle Classification. Rating the Severity of a Malocclusion. Orthodontic Records. Clinical Examination. Summary of Findings, Problem List, and Diagnosis. Consultation with Patient and/or Parent. Chapter 2. Dental Impressions and Study Cast Trimming. Study Casts. Digital Casts. Alginate Impressions. Mandibular Impression. Record of Centric Occlusion. Pouring of Plaster Study Casts. Study Cast Trimming. Chapter 3. Dental Cast Analysis in Adults. Tooth Size-Arch Length Analysis. The Measurement of Tooth Size and Arch Length. Factors Influencing a Tooth Size-Arch Length Analysis. Curve of Spee. Incisor Inclination and Anteroposterior Position. Second and Third Molar Evaluation. Comparison of TSALD and the Irregularity Index. Arch Width Measurements. Diagnostic Setup. Bolton Analysis. Overbite and Overjet Measurements. Mandibular Crowding. Tooth Widths in Normal Occlusion. Chapter 4. Dental Cast Analysis in the Mixed Dentition. Tooth Size-Arch Length Analysis. Prediction of the Widths of Nonerupted Canines and Premolars. Revised Hixon-Oldfather Prediction Method. Iowa Prediction Method for Both Arches. Standard Error of Estimate. Radiograph Image Problems. Proportional Equation Prediction Method. Tanaka and Johnston Prediction Method. Measurement of Arch Lengths on Casts. Measurement Instruments and Guidelines. Factors that Influence a Mixed-Dentition Arch Length Analysis. Interpretation of a Mixed-Dentition Arch Length Analysis. Chapter 5. Radiographic Analysis. Periapical Survey. Panoramic Radiograph. Occlusal Radiographs. Cone Beam Radiographs. Lateral Cephalometric Radiographs. Anatomic Landmarks. Cephalometric Landmarks. Cephalometric Point Locations. Cephalometric Angles and Distances. Cephalometric Norms and Treatment Goals. Lateral Cephalometric Tracing. Posteroanterior Cephalometric Radiograph. Analog versus Digital Radiography. Chapter 6. Lingual and Palatal Arches. Incisor Liability and Leeway Space. Passive Lower Lingual Holding Arch. Prevalence of Incisor Crowding. Premature Loss of a Primary Molar. Asymmetric Loss of a Primary Canine. Nance Holding Arch. Trans-palatal Arch. Insertion of a Passive Lingual or Palatal Arch. Fixed-Removable Lingual and Palatal Arches. Undesirable Side Effects of Passive and Active Lingual and Palatal Arches. Laboratory Prescription and Construction of a Lower Loop Lingual Arch. Chapter 7. Management of Anterior Crossbites. Prevalence of Anterior Crossbite Malocclusions. Angle Classification. Centric Relation to Centric Occlusion Functional Shift on Closure. Overbite. Adequate Arch Length. Inclination of Maxillary Incisor Roots. Rotation of Tooth in Crossbite. Number of Teeth in Crossbite. Alignment of Lower Anterior Teeth. Treatment of Anterior Crossbites with Removable Appliances. Treatment of Anterior Crossbites with Fixed Appliances. Construction of a Removable Maxillary Appliance to Close a Diastema and Correct a Lateral Incisor in Crossbite. Chapter 8. Management of Posterior Crossbites. Definition of Posterior Crossbite. Prevalence of Posterior Crossbite Malocclusions. Angle Classification. Intermolar Width Measurements. Age of Patient. Buccolingual Inclination of the Posterior Teeth. Etiology of Bilateral and Unilateral Posterior Crossbites. Vertical Dimension. Treatment of Posterior Crossbites. Correction of Posterior Crossbites with Removable Appliances. Correction of Posterior Crossbites with Fixed Expander Appliances. Chapter 9. Management of Incisor Diastemas. Prevalence of Maxillary Diastemas. Etiologic Factors to Consider. Size of Teeth and Bolton Analysis. Arch Size. Maxillary Labial Frenum. Rotated Incisors. Thumb Sucking Habit. Angle Classification. Management with Appliances. Treatment of a Diastema with a Removable Loop Spring Appliance. Treatment of a Diastema with a Finger Spring Removable Appliance. Treatment of a Diastema with Fixed Appliances. Chapter 10. Molar Uprighting and Space Gaining. Introduction. Ectopic Eruption of Permanent First Molars. Uprighting Molars in the Mixed Dentition. Ectopic Eruption of Upper First Molars. Ectopic Eruption and Tipping of Lower First Molars. Mesial Tipping of Permanent Molars after Loss of a First Molar. Prevention of Molar Tipping after Loss of a First Molar. Impaction of Second Molars. Loss of Both First and Second Molars. T-Loop Uprighting Spring and Edgewise Fixed Appliance. Forces Generated by the T-Loop Uprighting Spring. Patient Treated with a T-Loop Uprighting Spring. Helical Uprighting Spring. Forces Generated by the Helical Uprighting Spring. Patient Treated with a Helical Uprighting Spring. Other Appliances Used to Upright Molars. Repositioning of Teeth Prior to Prosthetic Restoration. Chapter 11. Orthodontic Examination and Decision Making for the Family Dentist. Introduction. Orthodontic Screening. Guidelines for Decision Making. Differentiate Class I Problems Suitable for Limited Orthodontic Treatment from More Complex Class I Problems. Pretreatment Records. Patient 1. Patient 2. Patient 3. Patient 4. Patient 5. Patient 6. Patient 7. Patient 8. Patient 9. Treatment Records. Patient 1. Patient 2. Patient 3. Patient 4. Patient 5. Patient 6. Patient 7. Patient 8. Patient 9. Chapter 12. How Orthodontic Appliances Move Teeth. Introduction. Biomechanics. Newton's First Law. Newton's Second Law. The Keys to Understanding the Delivery of Orthodontic Forces. General Displacements of Rigid Bodies. The Limitations of Illustrating Three-Dimensional Tooth Movements in Two-Dimensional Figures. Translation of a Tooth in the Edgewise Fixed Appliance. How a Tooth Is Translated in the Edgewise Fixed Appliance. Rotation of a Tooth in the Edgewise Fixed Appliance. Newton's Third Law. Chapter 13. The Edgewise Fixed Appliance. Introduction. The Edgewise Appliance. Arch Wires. Bands. Separators. Fitting a Band. Cementing a Band. Band Cements. Removal of Bands. Bonding of Brackets. Anatomic Considerations. The Straight Wire Appliance. Bracket and Molar Tube Placement. Direct and Indirect Bonding. Removal of Brackets from Teeth. Arch Form. Chapter 14. Retention Appliances. Introduction. Invisible Retainers. Essex Retainers. Basic Retainer Design. Wire-Bending Skills. Maxillary Labial Bow Bending. Ball Clasp. C-Clasp. Adams Clasp. Resta Clasp. Mandibular Labial Bow. Acrylicing Retainers. Acrylic Finishing and Polishing. Chapter 15. Orthodontic Materials. Introduction. Orthodontic Wires. Stainless Steel Wires. Sensitization. Cold Working. Recovery Heat Treatment. Annealing. Cobalt-Chromium-Nickel Wires. Beta-Titanium Wires. Nickel-Titanium Wires. Physical Properties of Orthodontic Wires. Electric Welding. Flame Soldering. Electric Soldering. Index.

Abstract: Background: Mandibular advancement devices for obstructive sleep apnea treatment are becoming increasingly popular among patients who do not prefer CPAP devices or surgery. Our study aims to evaluate the literature regarding potential dental and skeletal side effects caused by mandibular advancement appliances used for adult OSA treatment. Methods: Electronic databases were searched for published and unpublished literature along with the reference lists of the eligible studies. Randomized clinical trials and non-randomized trials assessing dental and skeletal changes by comparing cephalometric radiographs were selected. Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate. Fourteen articles were finally selected (two randomized clinical trials and 12 non-randomized trials). Results: The results suggest that mandibular advancement devices used for OSA treatment increase the lower incisor proclination by 1.54 ± 0.16°, decrease overjet by 0.89 ± 0.04 mm and overbite by 0.68 ± 0.04 mm, rotate the mandible downward and forward, and increase the SNA angle by to 0.06 ± 0.03°. The meta-analysis revealed high statistical heterogeneity. Conclusions: The MADs affect the lower incisor proclination, overjet, overbite, the rotation of the mandible and the SNA angle. More randomized clinical trials providing high-quality evidence are needed to support those findings.

Abstract: Purpose We aimed to explore the relationship between temporomandibular disorders (TMDs) and craniofacial morphology in orthodontic patients. Methods Altogether, 262 orthodontic patients were included and divided into two groups according to their Fonseca Anamnestic Index (FAI) scores: a no-TMD group (control group, FAI < 20) and a TMD group (FAI ≥ 20). Cephalometric parameters including cranial, maxillary, mandibular, and dental parameters were traced on cephalograms. Craniofacial morphology was compared between TMD and control groups, followed by subgroup analyses based on TMD severity, gender, age, and temporomandibular joint (TMJ) symptoms. Results The prevalence of TMDs was 52.7% among included patients (138/262). The mean age of TMD patients was higher than that of the control group. No significant difference in gender distribution between the groups was observed. The most commonly reported FAI items were misaligned teeth, neck pain, and emotional tension. The Frankfort-mandibular plane angle (FMA) was larger in the TMD patients than in the control group, whereas no significant differences in other parameters were observed. Subgroup analysis based on TMD severity revealed that FMA and anterior facial height of moderate/severe TMD patients were significantly larger than those of mild or no-TMD patients. Among male patients, the anterior cranial base length was smaller, and the anterior facial height was larger in the TMD group. Among female patients, no significant differences in craniofacial morphology between the groups were observed. In juvenile patients, overjet and overbite were smaller in the TMD group. In adult patients, SNA, ANB, FMA, and gonial angle were larger in the TMD group. Within the TMD group, patients with TMJ pain or noises exhibited characteristic craniofacial features compared to patients without these symptoms. Conclusions Orthodontic patients with TMDs have specific craniofacial morphology, suggesting a relationship between TMDs and particular craniofacial features in orthodontic patients.

Abstract: To examine the skeletal, dental, and soft-tissue cephalometric effects of class II correction using Invisalign's mandibular advancement feature in growing patients.A retrospective cohort clinical study was performed on cases that were started between 2017 and 2019. A total of 32 patients (13 females, 19 males), with an average age of 13 years old (9.9-14.8 years) had undergone Invisalign treatment (Align Technology, Inc., San Jose, CA) wherein the mandibular advancement phase was completed were included. Photos, digital study models, and cephalograms were taken once during the patients' initial visit and again upon completing the mandibular advancement phase of treatment. The number of aligners worn and the time of treatment in months was recorded for each subject. Cephalometric analysis was performed and overjet and overbite were measured. Statistical analysis was performed using SPSS statistical software (version 25; SPSS, Chicago, Ill) and the level of significance was set at P <0.05. Descriptive statistics were performed to generate means and differences for each cephalometric measurement as well as patient data including age, treatment time, and aligner number. Differences between measurements from patients before treatment (T1) and after treatment (T2) with the mandibular advancement feature were evaluated using a paired t -test.All 32 patients had multiple jumps staged for the precision wings, i.e., incremental advancement. The average length of treatment for the MA phase was 9.2 months (7.5-13.8 months) and the average number of aligners used during this time was 37 (30-55). Statistically significant differences between T1 and T2, in favor of class II correction, were observed in the ANB angle, WITS appraisal, facial convexity, and mandibular length. The nasolabial angle, overjet, and overbite also showed statistically significant changes between T1 and T2.Invisalign aligners with the mandibular advancement feature took approximately 9 months for 1.5 mm of overjet correction. The lower incisor angulation was maintained during class II correction. The minimal skeletal changes are in favor of class II correction.

Abstract: This study aimed to investigate the malocclusion complexity and orthodontic treatment need among children with and without autism spectrum disorder (ASD) referred for orthodontic treatment by quantifying the Discrepancy Index (DI) and Index of Orthodontic Treatment Need (IOTN).Dental records of 48 ASD and 49 non-ASD consecutive patients aged between 9 and 18 years (median age 13.0 years) referred for orthodontic treatment were reviewed and compared. The Discrepancy Index (DI) was quantified to determine the malocclusion complexity, and the Index of Orthodontic Treatment Need (IOTN), including the Dental Health Component (IOTN-DHC) and Aesthetic Component (IOTN-AC), was quantified to determine the orthodontic treatment need. Statistical analysis included descriptive analysis, Pearson chi-square tests, Fisher's exact test, Mann-Whitney U tests, and several univariate and multivariate regression analyses. The statistical analysis used descriptive analysis, Pearson chi-square test, Fisher's exact test, and multivariate logistic regression.The results show that both malocclusion complexity (DI, p = 0.0010) and orthodontic treatment need (IOTN-DHC, p = 0.0025; IOTN-AC p = 0.0009) were significantly higher in children with ASD. Furthermore, children with ASD had a higher prevalence of increased overjet (p = .0016) and overbite (p = .031).Malocclusion complexity and orthodontic treatment need are statistically significantly higher among children with ASD than children without ASD, independent of age and sex.Children with autism may benefit from visits to a dental specialist (orthodontist) to prevent, to some extent, developing malocclusions from an early age.

Abstract: The aim of this article is to establish a comprehensive nation-wide prevalence of malocclusion traits on the sagittal, vertical, and transverse planes of space in Saudi Arabia.A systematic search was conducted in three databases (Medline via PubMed, Embase, and Web of Science) and complemented with a manual search of Google Scholar and the reference list of included studies. Original studies of Saudi Arabian healthy individuals at any age were included. The quality and the risk of bias of the included studies were assessed using the Joanna Briggs Institute's appraisal tool. The data about the selected malocclusion traits on the sagittal, vertical, and transverse planes of space were extracted and pooled.Out of 7163 identified titles, 11 studies were finally included. The risk of bias was high in two studies, moderate in eight studies, and low in one study. The studied age groups were from early childhood to late adulthood, with a total sample size of 19,169 participants. The majority of the studies recruited their sample from school/public sources, whereas the remaining three studies recruited their sample from dental (non-orthodontic) clinics.Within the limitations of this study, pooled prevalence of Angle's Class I molar relation in Saudi Arabia was similar to other populations but Angle's Class II and Class III molar relations were lower and higher, respectively. These differences could be attributed to population-related differences in craniofacial morphology. Teeth crowding, teeth spacing, and midline shift, along with increased overjet and overbite, were among the most common malocclusion traits occurring in Saudi Arabia.

Abstract: INTRODUCTION: Protraction therapy for maxillary deficiency in the treatment of skeletal class III malocclusion involves the use of facemask. Conventionally facemask has been anchored to the maxillary dentition, which is responsible for some of the counter-productive effects of facemask therapy including backward and downward rotation of the chin, increase in the lower anterior facial height, proclination of maxillary incisors, retroclination of mandibular incisors apart from mesialization of maxillary molars with extrusion and decreased overbite. AIM: The aim of this article is to highlight the nuances of Bone-Anchored Maxillary Protraction (BAMP) including a literature review, which is comprehensive and narrative and comparing the different techniques involved such as type 1 BAMP versus type 2 BAMP and BAMP versus facemask. MATERIALS AND METHODS: A computerized search was performed in electronic databases such as PubMed, PubMed Central, Cochrane, Embase, DOAJ, and Google scholar using key words such as “bone-anchored maxillary protraction” and “BAMP.” The search was confined to articles in English published till March 2021. Forty-seven case-controlled, cross-sectional, retrospective and prospective studies, as well as systematic reviews and meta-analysis were included in this article, which were limited to human subjects. A hand search of the reference lists of the included articles was also carried out to include missed out articles. CONCLUSION: To overcome these drawbacks, BAMP was introduced, which causes both maxillary protraction, restraint of mandibular growth with minimal dentoalveolar changes. BAMP is used widely nowadays in the treatment of skeletal class III malocclusion.

Abstract: This paper is divided into Part 1, the study findings, and Part 2, a detailed explanation of orthodontic and surgical methods used in the study. In this Part 1, treatment protocols will be mentioned, but explained in Part 2.

Abstract: Summary Background Retention after orthodontic treatment is still a challenge and more evidence about post-treatment stability and patients’ perceptions of different retention strategies is needed. Objectives This trial compares removable vacuum-formed retainers (VFR) with bonded cuspid-to-cuspid retainers (CTC) after 5 years of retention. Trial design A single centre two-arm parallel-group randomized controlled trial. Methods This trial included 104 adolescent patients, randomized into two groups (computer-generated), using sequentially numbered, opaque, and sealed envelopes. All patients were treated with fixed appliances in both jaws with and without tooth extractions. Patients in the intervention group received a VFR in the mandible (n = 52), and patients in the active comparator group received a CTC (n = 52). Both groups had a VFR in the maxilla. Dental casts at debond (T1), after 6 months (T2), after 18 months (T3), and after 5 years (T4) were digitized and analysed regarding Little’s Irregularity Index (LII), overbite, overjet, arch length, and intercanine and intermolar width. The patients completed questionnaires at T1, T2, T3, and T4. Results Post-treatment changes between T1 and T4 in both jaws were overall small. In the maxilla, LII increased significantly (median difference: 0.3 mm), equally in both groups. In the mandible, LII increased significantly in the group VFR/VFR (median difference: 0.6 mm) compared to group VFR/CTC (median difference: 0.1 mm). In both groups, overjet was stable, overbite increased, and arch lengths decreased continuously. Intercanine widths and intermolar width in the mandible remained stable, but intermolar width in the maxilla decreased significantly. No differences were found between groups. Regardless of retention strategy, patients were very satisfied with the treatment outcome and their retention appliances after 5 years. Limitations It was not possible to perform blinded assessments of digital models at follow-up. Conclusions Post-treatment changes in both jaws were small. Anterior alignment in the mandible was more stable with a bonded CTC retainer compared to a removable VFR after 5 years of retention. Patients were equally satisfied with fixed and removable retention appliances. Trial registration ClinicalTrials.gov (NCT03070444).

Abstract: Objective This study aimed to estimate the clinical effects of different types of bone-anchored maxillary protraction devices by using a network meta-analysis. Methods We searched seven databases for randomized and controlled clinical trials that compared bone-anchored maxillary protraction with tooth-anchored maxillary protraction interventions or untreated groups up to May 2021. After literature selection, data extraction, and quality assessment, we calculated the mean differences, 95% confidence intervals, and surface under the cumulative ranking scores of eleven indicators. Statistical analysis was performed using R statistical software with the GeMTC package based on the Bayesian framework. Results Six interventions and 667 patients were involved in 18 studies. In comparison with the tooth-anchored groups, the bone-anchored groups showed significantly more increases in Sella-Nasion-Subspinale (°), Subspinale-Nasion-Supramentale(°) and significantly fewer increases in mandibular plane angle and the labial proclination angle of upper incisors. In comparison with the control group, Sella-Nasion-Supramentale(°) decreased without any statistical significance in all treated groups. IMPA (angle of lower incisors and mandibular plane) decreased in groups with facemasks and increased in other groups. Conclusions Bone-anchored maxillary protraction can promote greater maxillary forward movement and correct the Class III intermaxillary relationship better, in addition to showing less clockwise rotation of mandible and labial proclination of upper incisors. However, strengthening anchorage could not inhibit mandibular growth better and the lingual inclination of lower incisors caused by the treatment is related to the use of a facemask.

Abstract: Occlusal characteristics of the primary dentition are crucial in predicting and determining permanent tooth alignment and occlusion. The aim of our study was to determine the occlusal characteristics of the primary dentition of 5-year-old children in Greece through a national pathfinder survey.A stratified cluster sample of 1222 5-year-old children was selected according to the WHO guidelines for national pathfinder surveys. Five occlusal traits were registered clinically in centric occlusion, separately for the left and right sides: sagittal relationships of the second primary molars and primary canines, overjet, overbite, crossbite, and maxillary and mandibular spacing.Most children showed a flush terminal plane of primary second molars (44.8%), a class I primary canine relationship (52.2%) and normal overjet (46.4%), but a high prevalence of Class II canine relationship (25.6%) and overjet (37.8%) were also observed. A normal overbite was found in 40% of the children and 40% had a deep overbite. Spacing was apparent in both maxilla (71.1% of children) and mandible (56.4%). The prevalence of open bite and distal step molar relationship significantly rose in children with non-nutritive sucking habits.Νon-nutritive habits were associated to altered occlusal features. No sex significant differences were found in either the sagittal relationships of second primary molars and primary canines, or overjet, overbite, crossbite and spacing.

Abstract: Skeletal Class II malocclusion is a common malocclusion that seriously affects patients' profile and occlusal function. The key to treatment is to use functional appliances guide the mandible forward. This study aimed to evaluate the clinical efficacy of traditional functional appliance Twin Block (TB) and invisible functional appliance (A6).In the retrospective cohort study, 46 patients with Class II Division 1 mandibular retrognathia (23 females, 23 males; mean age 13.66±4.25 years) from the Third Affiliated Hospital of Sun Yat-sen University were selected. They were divided into A6 group and TB group according to the type of appliance guided mandibular forward used in orthodontic treatment (n=23 each; average treatment time 9.82±3.52 months). Lateral cephalometric radiographs were taken before and at the end of each treatment, and paired t-test or paired rank-sum tests were performed when appropriate to detect any statistical significance at the level of α=0.05.The baseline characteristics of the two groups of patients were similar. Treatment with both appliances helped correct Class II malocclusion, improve the discrepancy between the maxilla and mandible, reduce the labial inclination of the maxillary anterior teeth, and relieve the deep overbite. A comparison of the treatment effects of the TB and A6 groups showed that the A6 had a better effect when moving Point A backward, and performed better in the abduction of the anterior teeth. TB group has more advantages than A6 group in moving forward point B and improving the nasolabial angle.Both the A6 and TB can significantly improve Class II malocclusion. A6 showed an obvious advantage in moving Point A backward and adducting the anterior teeth, which better corrects a skeletal Class II malocclusion.

Abstract: OBJECTIVES To evaluate the association between malocclusion characteristics in the mixed dentition stage, breastfeeding, and past nonnutritive sucking habits in school-age children. MATERIALS AND METHODS A total of 547 school children in the mixed dentition, in the age range between 7 and 13 years, were evaluated by means of questionnaire and clinical examination. Binomial and multinomial logistic regression models were used to evaluate the associations between breastfeeding and finger and pacifier sucking habits, the malocclusion characteristics of posterior crossbite, and excessive or deficient overjet and overbite. RESULTS Individuals who had nonnutritive sucking habits had 2.16 times greater chance of having anterior open bite (odds ratio [OR] 2.16; 95% confidence interval [CI], 1.07-4.33) and 2.39 times greater chance of having posterior crossbite (OR 2.39; 95% CI, 1.56-5.49). Children who were exclusively breastfed up to at least 6 months of age had a higher frequency of normality for overjet and overbite and the lowest posterior crossbite index. However, in adjusted analysis, breastfeeding showed no association with malocclusion characteristics in the mixed dentition stage. CONCLUSIONS Breastfeeding was not associated with the presence of malocclusion in the mixed dentition, whereas past nonnutritive sucking habits were associated with the occurrence of malocclusion.

Abstract: Background: A diastema is the distance or space between two or more adjacent teeth. This abnormality can interfere with the aesthetics of a patient, and 97% of diastemas occur in the maxilla. Various treatments can be performed for diastema closure in patients, one of which is composite resin restoration. Purpose: To explain the aesthetic procedure for diastema closure. Case: A 20-year-old female patient presented with complaints of the distance between her anterior teeth (Class I Angle occlusion with normal overjet and overbite). The labial frenum associated with the diastema was normal in size and position. The patient was not amenable to invasive procedures. Case Management: Management of midline diastema closure using the direct composite technique with DSD, the putty index method and button shade technique. Conclusion: The closure of a midline diastema with direct composite using DSD, the putty index method and button shade technique provides aesthetic results with less cost and time due to the absence of laboratory procedures.

Abstract: Purpose The aim of this article is to describe the efficiency and the biomechanics of entire arch distalization with lingual appliances and mini-implant anchorage with two case reports.Material and Methods The overbite was corrected by lingual brackets and archwires with the advantage of bite plane effect. The severe overjet was eliminated by entire upper arch distalization using mini-implant anchorage.Result After 20 and 24 months of treatment, normal overbite and overjet were achieved with Class I canine and molar relationship. One-year post-retention records confirmed the stability of the treatment outcome.Conclusion Mini-implants in combination with lingual appliances may have the possibility of distalizing the whole upper arch in one phase to correct excessive overjet and deep overbite.

Abstract: Background: Our study aimed to systematically summarize the dentoskeletal effects of Herbst appliance; Forsus fatigue resistance device; and Class II elastics in adolescent Class II malocclusion. Methods: Five databases; unpublished literature; and reference lists were last searched in August 2022. Randomized clinical trials and observational studies of at least 10 Class II growing patients that assessed dentoskeletal effects through cephalometric/CBCT superimpositions were eligible. The included studies quality was assessed with the RoB 2 and ROBINS-I tools. A random-effects model meta-analysis was performed. Heterogeneity was explored with subgroup and sensitivity analyses. Results: Among nine studies (298 patients); two-to-three studies were included in each meta-analysis. Less post-treatment upper incisor retroclination (<2) and no overbite; overjet; SNA; SNB; and lower incisor inclination differences were found between Herbst/Forsus and Class II elastics. No differences in maxilla; condyle; glenoid fossa; and most mandibular changes were found between Herbst and Class II elastics; except for a greater 1.5 mm increase in mandibular length and right mandibular ramus height (1.6 mm) with Herbst. Conclusions: Herbst and Class II elastics corrected the molar relationship; but Herbst moved the lower molars more mesially. Apart from an additional mandibular length increase; no other dental and anteroposterior skeletal difference was found. Forsus was more effective in molar correction; overjet reduction; and upper incisor control than Class II elastics. Trial registration number OSF: 10.17605/OSF.IO/8TK3R.