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Introduction: Despite the serious health implications associated with obstructive sleep apnoea, the condition remains under-diagnosed. This study aims to evaluate the awareness of the condition amongst the Australian community. Methods: A total of 2016 respondents recruited from a web-based panel completed an online questionnaire which assessed awareness and experience of obstructive sleep apnoea and sleep-disordered breathing. The association between the level of awareness and various socio-demographic variables was analysed using uni- and multivariate analyses. Results: The results of the questionnaire indicated that 50% and 70% of participants were unaware of adult and paediatric obstructive sleep apnoea. Socio-demographic variables including age, annual household income and education level significantly influenced a participant’s level of awareness. Approximately 8.3% of the participants had previously been diagnosed with obstructive sleep apnoea. However, 65% of participants exhibiting symptoms of daytime sleepiness had not sought health care. Paediatric sleep apnoea had been previously diagnosed in 7.1% of children residing in participant’s households but 49% of children with regular snoring had not been medically evaluated. Conclusion: A deficiency exists in the awareness of sleep apnoea amongst the Australian general public. This is reflected in the discrepancy between the number of participants exhibiting potential symptoms and those who sought medical advice.

Transient inflammatory surface resorption, referred to as orthodontic induced inflammatory root resorption (OIIRR), is an iatrogenic consequence of orthodontic tooth movement. Systemic fluoride has been associated with a reduction of OIIRR. This study aimed to investigate the effects of water fluoridation levels on OIIRR in a clinically applicable human orthodontic model.Twenty-eight patients who required bilateral maxillary first premolar extraction as part of orthodontic treatment were selected from 2 cities with high and low water fluoridation of ≥2 ppm and ≤0.05 ppm, respectively. Patients were separated into high fluoride (HF) and low fluoride (LF) groups on the basis of water fluoridation levels. Bilateral maxillary first premolar teeth were subjected to 150 g of buccal tipping forces for 12 weeks with reactivation every 4 weeks. Teeth were extracted at the end of 12 weeks. Root resorption crater volume was determined using microcomputed tomography and 3-dimensional reconstruction.HF group showed significantly less mean root resorption volume on the palatal root surface when compared with the LF group (P = 0.025). This difference was specifically displayed at palatal apical regions (P = 0.041). When root resorption volumes from the zones of orthodontic pressure (buccal cervical, palatal apical) were combined, the mean difference between HF and LF groups was statistically significant (P = 0.045).Findings of the present study indicated a positive correlation between water fluoridation and the reduction of OIIRR, especially at the zones of orthodontic pressure, using a clinically relevant human orthodontic model.

Objective To compare the skeletal, dentoalveolar and buccal bone thickness of tooth–bone-borne (Hybrid-H) and tooth-borne (TB) maxillary expanders used for rapid maxillary expansion (RME) in early and late adolescents and for surgically-assisted RME (SARME) in young adults. Materials and methods: This two-centre clinical study included initial and 6 months post-retention CBCT records of 60 patients (27 males, 33 females; mean age 15.7 ± 3.75 years). The cohort was divided into two groups according to the expander type (H or TB) and subdivided into a further three groups determined by cervical vertebrae maturation stages: early adolescents (EA), late adolescents (LA), and young adults (A). EA and LA patients underwent RME and young adults received a SARME. Results: The hybrid-designed appliance increased the internal skeletal maxillary width and nasal width more than the TB-designed appliance anteriorly in EA and posteriorly in SARME young adults. The TB expanders tipped and expanded the first premolars more than the Hybrid SARME expanders in young adults and caused a greater reduction in buccal alveolar bone thickness at the level of the first premolars and molars at the three growth stages. Conclusion The hybrid expanders, with relatively greater skeletal and nasal widening potential and fewer dentoalveolar side effects, were a favourable alternative to tooth-borne expanders for RME in the early and late adolescents, and for SARME in young adults.

The University of Sydney’s Discipline of Orthodontics has been actively pursuing research in the areas of root resorption, sleep apnea, magnets in orthodontics, implants, acceleration of orthodontic tooth movement (OTM), and remote monitoring (RM). Our research has shed light on many specific factors that influence orthodontically induced inflammatory root resorption (OIIRR). We also explored the effects of some of the most discussed acceleration interventions on OTM and OIIRR, such as vibration, micro-osteoperforations, piezocision, low-level laser therapy, light emitting diode, light amplification by stimulated emission of radiation, and pharmacological substances. Further, we have researched into maximizing orthopedic treatment outcomes of maxillary deficient children with use of intraoral force application with utilization of miniscrew-assisted rapid palatal expander. We are currently trialing use of RM to facilitate orthodontic services in the public dental clinics.

INTRODUCTION This split-mouth trial aimed to examine the effects of light-emitting diode (LED)-mediated photobiomodulation compared with no photobiomodulation on maxillary canine distalization. METHODS Twenty participants (10 males and 10 females; aged 11-20 years) requiring bilateral extraction of maxillary first premolars were included from the Sydney Dental Hospital waiting list. After premolar extractions, leveling, and alignment, canines were retracted on 0.020-in stainless steel wires with coil springs delivering 150 g of force to each side. Each patient's right side was randomly assigned to experimental or control using www.randomisation.com, and allocation concealment was performed with sequentially numbered, opaque, sealed envelopes. The experimental side received 850 nm wavelength, 60 mW/cm2 power, continuous LED with OrthoPulse device (Biolux Research Ltd, Vancouver, British Columbia, Canada) for 5 min/d. For the control side, the device was blocked with opaque black film. Patients were reviewed at 4-week intervals for force reactivation and intraoral scanning over 12 weeks. The primary outcome was the amount of tooth movement, and secondary outcomes were anchorage loss and canine rotation, all measured digitally. Blinding for study participants and the treating clinician was not possible; however, blinding was done for the measurements by deidentifying the digital scans. Linear mixed models were implemented for the data analysis. RESULTS Nineteen participants concluded the study. Data analysis showed that the treatment × time interaction was not significant, suggesting no difference in space closure (unstandardized regression coefficient [b], 0.12; 95% confidence interval [CI], -0.05 to 0.29; P = 0.17), canine rotation (b, 0.21; 95% CI, -0.82 to 1.25; P = 0.69), and anchorage loss (b, -0.01, 95% CI, -0.28 to 0.26, P = 0.94). No harms were noted. CONCLUSIONS Daily 5-minute application of LED did not result in clinically meaningful differences during extraction space closure compared with no LED application. REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616000652471). PROTOCOL The protocol was not published before trial commencement. FUNDING This research was funded by the Australian Society of Orthodontists Foundation for Research and Education.

Virtual Reality (VR), Augmented Reality (AR) and Artificial Intelligence (AI) are modern days technological phenomenon that are equipped with powerful ability to revolutionize education and research. The present insight not only outlines the caveats of traditional teaching, but explores the current and potential applications of VR, AR, and AI in the field of orthodontic teaching and research. The digital technology world immersed in artificial intelligence not only enhances the ability of both student and educator in assimilating and imparting knowledge, respectively, but also, helps to create a symbiotic relationship with each other. Also, emphasis is laid on understanding and implementing the interaction of strategic framework, professionalism and patient care delivery in the era of AI, VR, and AR in order to support dynamic engagements in a pedagogical, ethically-appropriate, community-centred, culturally-sensitive and economically-feasible teaching and research milieu

Summary Objective To assess three rapid maxillary expansion (RME) appliances in nasal ventilation. Trial design Three-arm parallel randomized clinical trial. Methods Sixty-six growing subjects (10–16 years old) needing RME as part of their orthodontic treatment were randomly allocated (1:1:1 ratio) to three groups of 22 patients receiving Hyrax (H), Hybrid-Hyrax (HH), or Keles keyless expander (K). The primary outcome of nasal ventilation (pressure and velocity) and secondary outcomes (skeletal, dental, soft tissue, and nasal obstruction changes) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone-beam computed tomography (CBCT) data by applying computational fluid dynamics (CFD) method. Differences across groups were assessed with crude and adjusted for baseline values and confounders (gender, age, skeletal maturation, expansion amount, mucosal/adenoid hypertrophy, nasal septum deviation) regression models with alpha = 5%. Results Fifty-four patients were analysed (19H, 21HH, 14K). RME reduced both nasal pressure (H: −45.8%, HH: −75.5%, K: −63.2%) and velocity (H: −30%, HH: −58.5%, K: −35%) accompanied with nasal obstruction resolution (H: 26%, HH: 62%, K: 50%). Regressions accounting for baseline severity indicated HH expander performing better in terms of post-expansion maximum velocity (P = 0.03) and nasal obstruction resolution (P = 0.04), which was robust to confounders. Mucosal/adenoid hypertrophy and nasal septum deviation changes were variable, minimal, and similar across groups. The HH resulted in significantly greater increase in the nasal cross-sectional area (62.3%), anterior (14.6%), and posterior (10.5%) nasal widths. Nasal obstruction resolution was more probable among younger (P = 0.04), skeletally immature (P = 0.03), and male patients (P = 0.02) without pre-treatment mucosal hypertrophy (P = 0.04), while HH was associated with marginal greater probability for obstruction resolution. Conclusions RME resulted in improvement of nasal skeletal parameters and simulated ventilation with the former being in favour of the HH and the latter not showing significant differences among the three appliances. Limitation Attrition in the K group due to blocked activation rods possibly leading to limited sample to identify any existing group differences. Harms Replacement of blocked Keles expanders for finalizing treatment. Protocol The protocol was not published before the trial commencement. Registration Australian and New Zealand Clinical Trial Registry; ACTRN12617001136392.

Objectives: To (1) survey Australian orthodontists about their involvement with a government-funded scheme for patients with clefts, the Medicare Cleft Lip and Cleft Palate Scheme (MCLCPS) and (2) investigate their attitude toward treating patients with clefts and their training in this respect. Design: A 13-question online survey was distributed to members of the Australian Society of Orthodontists. The survey gathered information regarding respondent demographics, the number of MCLCPS-eligible patients seen in the past 12 months and usual billing practices. Results: A total of 96 complete responses were obtained. About 70% of respondents had treated MCLCPS-eligible patients in the past 12 months and 55% saw between 2 and 5 patients during this time. The likelihood of treating patients with clefts increased by a factor of 4.8 (95% CI: 1.2-18.9) if practicing outside of a capital city and 1.5 times for each decade increase in orthodontist’s age (95% CI: 1.0-2.2). The MCLCPS was utilized by 81% of orthodontists with 26% of these respondents accepting rebate only. Most orthodontists felt their university training could have better prepared them to treat patients with clefts. A minority of orthodontists felt that a rebate increase would make them more likely to treat these patients. Conclusions: Australian orthodontists who treat patients with clefts tend to be older and work outside of capital cities. The decision to treat these patients tends to not be financially motived. Specialty orthodontic training programs could improve the preparedness of their graduates to treat patients with clefts.

STUDY OBJECTIVES: To evaluate facial 3-dimensional (3D) stereophotogrammetry’s effectiveness as a screening tool for pediatric obstructive sleep apnea (OSA) when used by dental specialists. METHODS: One hundred forty-four participants aged 2–17 years, including children fully diagnosed with pediatric OSA through nocturnal polysomnography or at high-risk or low-risk of pediatric OSA, participated in this study. 3D stereophotogrammetry, Craniofacial Index, and Pediatric Sleep Questionnaire were obtained from all participants. Ten dental specialists with interest in pediatric sleep breathing disorders classified OSA severity twice, once based only on 3D stereophotogrammetry and then based on 3D stereophotogrammetry, Craniofacial Index, and Pediatric Sleep Questionnaire. Intrarater and interrater reliability and diagnostic accuracy of pediatric OSA classification were calculated. A cluster analysis was performed to identify potential homogeneous pediatric OSA groups based on their craniofacial features classified through the Craniofacial Index . RESULTS: Intrarater and interrater agreement suggested a poor reproducibility when only 3D facial stereophotogrammetry was used and when all tools were assessed simultaneously. Sensitivity and specificity varied among clinicians, indicating a low screening ability for both 3D facial stereophotogrammetry, ranging from 0.36–0.90 and 0.10–0.70 and all tools ranging from 0.53–1.0 and 0.01–0.49, respectively. A high arched palate and reversed or increased overjet contributed to explaining how participating dental clinicians classified pediatric OSA. CONCLUSIONS: 3D stereophotogrammetry-based facial analysis does not seem predictive for pediatric OSA screening, alone or combined with the Pediatric Sleep Questionnaire and Craniofacial Index when used by dental specialists interested in sleep-disordered breathing. Some craniofacial traits, more specifically significant sagittal overjet discrepancies and an arched palate, seem to influence participating dental specialists’ classification. CITATION: Fernandes Fagundes NC, Carlyle T, Dalci O, et al. Use of facial stereophotogrammetry as a screening tool for pediatric obstructive sleep apnea by dental specialists. J Clin Sleep Med. 2022;18(1):57–66.

The past decade (2009-19) has seen orthodontics incorporate many new infusions into its fold. This scoping review analyzes published orthodontic literaure in five different domains:(1) Recent advancements in orthodontic 3D applications including 3D printing, diagnosis and management. (2) Recent advancements in orthodontic biomaterials, nanotechnology, biomimetics, battery-driven devices. (3) Recent advancements in orthodontic patient education, orthodontic training, and orthodontics practice management. (4) Recent advancements in orthodontic E-health protocols, tele-orthodontics, teleconsultations etc. and (5) Recent advancements in orthodontic marketing and social media influences. A total of 1245 records were searched,of which 65 potentially relevant articles were retrieved in full. 42 studies met the selection criteria following screening and were included in the scoping review. The review found studies pertaining to morphological features or surface characteristics with respect to 3D applications (3D printing, diagnosis and management)as the most represented outcome assessment (49%).Orthodontic Marketing & Influence of Social Media (27%) and Biomaterials,Nano-Technology,Biomimetics and battery Driven devices have also been considerably reported (20%) in the past decade. More scientific data needs to be gathered in the field of Patient education, E-health, tele-orthodontics, and protection of patient confidentiality. The authors present COS (Core Outcome Sets)that could be a road map for evaluating currently employed developments as well as testing new ones in future.

Fluoride has a major role in strengthening the structure of enamel against acids. Despite differences between caries and root resorption processes, both events inherently involve acidic dissolution of dental tissues. The aim of the present study was to investigate the effects of water fluoridation levels on the surface roughness of root cementum and resorption craters. The findings provided more insight into the influence of fluoride on the surfaces of intact cementum surface and resorption craters.Twenty-eight orthodontic patients were recruited from two cities in Turkey, with high (≥ 2 ppm) and low (≤ 0.05 ppm) water fluoridation. These patients needed bilateral maxillary first premolar extraction as part of their orthodontic treatment and were allocated into two study groups (n = 14 in each group) based on water fluoridation exposure level: the high-fluoride group (HF) and low-fluoride group (LF). 150 g of buccal tipping forces was applied to all maxillary first premolar teeth for 12 weeks with a beta-titanium spring which was reactivated every 4 weeks. All maxillary premolars were removed at the end of the experiment for surface roughness assessment using three-dimensional confocal microscopy and the associated software. The buccal root surface and the largest buccal resorption crater were investigated.Resorption craters were significantly rougher in LF group compared to HF group (p = 0.002). Craters were rougher than the intact root surfaces (p = 0.000). Cervical and apical regions were significantly rougher than the middle region (p = 0.000 and p = 0.024, respectively).Higher water fluoridation level of ≥ 2 ppm resulted in significantly smoother root resorption craters than low water fluoridation level of ≤ 0.05 ppm when the teeth were subjected to 150 g of buccal tipping force. Fluoride seems to have a protective role at the interface of root resorption, and further mineral or histological studies may shed light on the exact protective process against root resorption.

Summary Aim To compare root resorption (RR) after rapid maxillary expansion (RME) and slow maxillary expansion (SME) through micro-computed tomography (micro-CT). Subjects and methods Twenty-six subjects who required maxillary expansion and bilateral upper first premolar extraction were randomly assigned to RME (n = 13, mean age: 13.25 ± 0.88 years) or SME (n = 13, mean age: 13.53±1.28 years) group. A hyrax-type acrylic bonded expansion appliance was used. The Hyrax screw was activated ¼ turn twice a day for 20 days in the RME group and ¼ turn every second day for 80 days in the SME group. One randomly selected upper first premolar was extracted in each patient after active expansion. The appliance was left in situ for a 24-week retention period then the contralateral upper first premolar was extracted. Extracted teeth were scanned with micro-CT and the volume of the resorption craters was analysed with a specialized software. Transversal skeletal and dental widths were measured on posteroanterior radiographs taken before and after expansion and retention periods. Results The resorption craters were concentrated mostly on the buccal surface and middle level in all samples. The total RR in the RME group was less post-expansion (P ≤ 0.05) and more post-retention (P > 0.05) than the SME group. During retention, there was a significant decrease in the total RR in the SME group (P > 0.05) and an increase in the RME group. Both RME and SME groups displayed a similar increase in skeletal transverse dimensions, but inter-molar width increased significantly more in the SME group during the whole experimental period. Conclusion RME does not have an advantage over SME in terms of skeletal expansion and the amount of RR when a retention period of six months is followed.

Summary Objective To assess upper airway volume changes after rapid maxillary expansion (RME) with three different expanders. Trial design Three-arm parallel randomized clinical trial. Methods Sixty-six patients, 10–16 years old, in permanent dentition, with maxillary transverse deficiency were recruited and assigned with block randomization (1:1:1 ratio) and allocation concealment to three groups of 22 patients each (Hyrax, Hybrid-Hyrax, and Keles keyless expander). The primary outcome (overall upper airway volume change) and secondary outcomes (volume changes in the nasal cavity, nasopharynx, oropharynx, and hypopharynx) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone beam computed tomography. Differences across groups were assessed with crude or adjusted for confounders (gender, age, growth stage, skeletal pattern, baseline airway volume, and amount of expansion) linear regression models. Results Fifty-one patients were analysed (19, 19, and 13 in the Hyrax, Hybrid-Hyrax, and Keles groups). Maxillary expansion resulted in considerable increases in total airway volume in the Hybrid-Hyrax group (+5902.1 mm3) and less in the Hyrax group (+2537.9 mm3) or the Keles group (+3001.4 mm3). However, treatment-induced changes for the primary and all secondary outcomes were of small magnitude and no significant difference was seen among the three expanderes in the total airway volume in either crude or adjusted analyses (P > 0.05 in all instances). Finally, among pre-peak patients (CVM 1–3), the Hybrid-Hyrax expander was associated with significantly greater increases in total airway volume compared to the Hyrax expander (P = 0.02). Conclusions RME resulted in relatively small increases in total upper airway volume and its separate compartments, with mostly no statistically significant differences across the Hyrax, Hybrid-Hyrax, and Keles groups. Limitations Significantly greater attrition was found in the Keles group due to appliance failure. The current trial might possibly be under-powered to detect differences between groups, if such exist. Harms Keles expanders blocked during activations and required substitution for completion of treatment. Protocol The protocol was not published before trial commencement. Registration Australian and New Zealand Clinical Trial Registry (ACTRN12617001136392).

INTRODUCTION This study aimed to retrospectively evaluate the dentoskeletal effects of clear aligners (Invisalign) vs miniplate-supported posterior intrusion (MSPI) and identify factors associated with posttreatment overbite in adults with anterior open bite. METHODS Twenty-nine patients treated with Invisalign and 24 with MSPI combined with full-fixed orthodontic appliances were included from 5 orthodontic practices. Pretreatment and posttreatment lateral cephalometric measurements were included as outcomes. Comparisons across groups and identification of final overbite predictors were assessed with regression modeling and machine learning techniques. RESULTS MSPI induced significantly greater maxillary molar intrusion (1.5 mm; 95% confidence interval [CI], 0.83-2.17; P

Article Title and Bibliographic Information Effect of conventional combined orthodontic-surgical treatment on oral health−related quality of life: A systematic review and meta-analysis. Yi J, Lu W, Xiao J, Li X, Li Y, Zhao Z. Am J Orthod Dentofacial Orthop 2019; 156:29-43. Source of Funding Government National Natural Science Foundation of China (grant 81801018 ) and Orthodontic National Key Clinical Specialty Program of China , West China Hospital of Stomatology , Sichuan University . Type of Study/Design Systematic review with meta-analysis.

This study evaluated the trends in orthodontic practitioner choice over the past 15 years and explored the lay public's understanding of different orthodontic practitioner options in the U.S., specifically, orthodontists compared with general dentists.A survey was distributed to a representative sample of laypersons in the U.S. The response rate was 90.2%, and 727 completed responses were analyzed.A 28.2% shift away from orthodontists toward general dentists over the last 15 years was significant (P 0.001). The 2 most frequently endorsed ways respondents found their orthodontic practitioners were a recommendation from another dentist (54.2%) and their family's general dentist who offered orthodontic treatment in-house (22.9%). Respondents' knowledge of orthodontists was limited; 85.0% believed that dentists who perform orthodontic treatment are also orthodontic specialists. Only 17.1% of respondents disagreed with the statement that "a dentist who advertises orthodontic treatment is an orthodontic specialist." In addition, 89.7% were not aware that a dentist could not be called an orthodontist without separate training from an accredited residency program. Finally, 64.2% of respondents did not know that an orthodontist must complete more education than a general dentist.Over the past 15 years, the percentage of orthodontic patients treated by general dentists has increased significantly. The public's ability to differentiate between different types of orthodontic practitioners is poor, showing substantial confusion about orthodontists' qualifications. Most respondents believed that orthodontists are best suited for their orthodontic treatment, but they rely heavily on their general dentists for orthodontic practitioner decisions.

Introduction This split-mouth trial aimed to investigate the effect of low-level laser therapy (LLLT) on the amount of maxillary canine distalization when applied every 4 weeks over 12 weeks. Methods Twenty-two adolescents and young adults (15 female, 7 male; aged 13-25 years; n = 22) requiring bilateral maxillary first premolar extractions were recruited. After extractions and leveling-alignment, canines were retracted using closed-coil nickel-titanium springs delivering 150 g of force. LLLT was applied to 8 intraoral points on the buccal and palatal sides around the canine root for 10 seconds per point, on day 0, 28, and 56 with the control side receiving sham application. Alginate impressions were taken every 4 weeks on day 0, 28, 56, and 84. The amount of tooth movement, anchorage loss, and canine rotation were measured digitally. Randomization was generated using www.randomisation.com and allocation concealment through sequentially numbered, opaque, sealed envelopes. Participants, operator, and statistic assessor were blinded. Linear regression modeling accounting for clustering within each patient was used to identify differences between LLLT and control sides. Results Twenty-one patients completed the study. The total amount of tooth movement was similar in the LLLT (2.55 ± 0.73 mm) and control group (2.30 ± 0.86 mm), whereas 0.25 mm (95% confidence interval, –0.21, 0.71 mm) of difference was insignificant (P = 0.27). No significant differences were found for anchorage loss (P = 0.22) or canine rotation (P = 0.25). No harms were reported. Conclusions Application of LLLT every 4 weeks did not result in differences in the amount of tooth movement, anchorage loss, and canine rotation during extraction space closure.

Introduction The purpose of this 2-arm-parallel split-mouth trial was to investigate the effect of low-level laser therapy (LLLT) on the repair of orthodontically induced inflammatory root resorption (OIIRR). Methods Twenty patients were included in this study, with 1 side randomly assigned to receive LLLT, and the other side served as a sham. Eligibility criteria included need for bilateral maxillary first premolar extractions as part of fixed appliance treatment. OIIRR was generated by applying 150 g of buccal tipping force on the maxillary first premolars for 4 weeks. After the active force was removed, the teeth were retained for 6 weeks. LLLT commenced with weekly laser applications using a continuous beam 660-nm, 75-mW aluminum-gallium-indium-phosphorus laser with 1/e2 spot size of 0.260 cm2, power density of 0.245 W/cm2, and fluence of 3.6 J/cm2. Contact application was used at 8 points buccally and palatally above the mucosa over each tooth root for 15 seconds with a total treatment time of 2 minutes. After 6 weeks, the maxillary first premolars were extracted and scanned with microcomputed tomography for primary outcome OIIRR calculations. Subgroup analysis included assessment per root surface, per vertical third, and sites of heaviest compressive forces (buccal-cervical and palato-apical). Randomization was generated using www.randomization.com , and allocation was concealed in sequentially numbered, opaque, sealed envelopes. Blinding was used for treatment and outcome assessments. Two-tailed paired t tests were used to determine whether there were any statistically significant differences in total crater volumes of the laser vs the sham treated teeth. Results Total crater volumes were 0.746 mm3 for the laser treated teeth and 0.779 mm3 for the sham. There was a mean difference of 0.033 ± 0.39 mm3 (95% CI, −0.21 to 0.148 mm3) greater resorption crater volume in the sham group compared with the laser group; this was not statistically significant (P = 0.705). No harm was observed. Conclusions: No significant difference was found between LLLT and sham control groups in OIIRR repair.

Background The use of low-level laser therapy is growing in the field of dentistry especially in orthodontics to speed up tooth movement and in implantology to aid osseointegration. In these dental applications, the laser energy needs to penetrate through the periodontium to the target site to stimulate photobiomodulation. The percentage of energy loss when laser is transmitted through the periodontium has not been previously studied. With the use of an 808-nanometer diode laser, the aim was to investigate the percentage loss of laser energy when transmitted through the periodontium to the extraction socket. Methods The percentage energy loss of an 808-nm diode laser through the periodontium was measured in 27 tooth sockets by using a specifically designed photodiode ammeter. Results For each millimeter of increased bone thickness there was 6.81% reduction in laser energy (95% confidence interval, 5.02% to 8.60%). The gingival thickness had no statistically significant effect on energy penetration. Conclusion Energy penetration depends markedly on bone thickness and is independent of gingival thickness. Practical Implications To the best of the authors’ knowledge, this study is one of the first to investigate laser penetration through the periodontium. Evidence from this study showed that laser energy penetration through the periodontium is markedly affected by bone thickness but less so by gingival thickness. Clinicians need to be aware of the biological factors that could affect laser energy penetration to the target site and adjust their laser dosages accordingly. These findings may guide dental practitioners in selecting the appropriate laser dosage parameters for low-level laser therapy.

Introduction Studies have demonstrated the potential efficacy of micro-osteoperforations in accelerating tooth movement by amplifying the expression of inflammatory markers. The aim of this investigation was to examine the effects of micro-osteoperforations on orthodontic root resorption with microcomputed tomography. Methods This prospective controlled clinical trial involved 20 subjects requiring extraction of the maxillary first premolars as part of their orthodontic treatment. A buccal tipping force of 150 g was applied to both premolars. Using the Propel appliance (Propel Orthodontics, San Jose, Calif), micro-osteoperforations were applied at a depth of 5 mm on the mesial and distal aspects in the midroot region of the experimental side of the first premolar root; the contralateral side served as the control. After 28 days, both premolars were extracted. The teeth were scanned under microcomputed tomography, and the volumes of root resorption craters were calculated and compared. Results Premolars treated with micro-osteoperforation exhibited significantly greater average total amounts of root resorption than did the control teeth (0.576 vs 0.406 mm3). The total average volumetric root loss of premolars treated with micro-osteoperforation was 42% greater than that of the control teeth. Conclusions This 28-day trial showed that micro-osteoperforations resulted in greater orthodontic root resorption. However, these results should be verified in patients who are undergoing full-length orthodontic treatment.

Introduction The aim of this study was to evaluate the short- and long-term effects of hybrid-Hyrax, Alt-RAMEC and applied, miniscrew reinforced, heavy intermaxillary elastics on a modified lingual arch in growing skeletal Class III patients. Methods Fifteen subjects (seven male, eight female) were included, with an average age of 12.52 ± 0.94 years, of cervical vertebrae maturation (CVM) stage CS2-CS4 and skeletal Class III malocclusions due to a retrognathic maxilla. Nine weeks of Alt-RAMEC were followed by eight to nine weeks of maxillary protraction with heavy 400 gm Class III elastics worn 24 h/day. Treatment was finalised with orthodontic fixed appliances. Cone beam computed tomographic (CBCT) scans were taken initially (T1), at the end of maxillary protraction (T2) and four years after active orthopaedic treatment (T3). Cephalometric measurements were performed on reconstructed lateral cephalograms and the differences between time intervals were calculated using an analysis of variance (ANOVA). Results A positive overjet was achieved in all but one subject. From T1 to T2, A point advanced 3.12 ± 3.42 mm and from T2 to T3 advanced a further 2.21 ± 3.49 mm. Significant initial increases in SNA of 1.05° ± 1.10° (p = 0.004), ANB of 2.71° ± 1.01° (p = 0.00), Wits of 4.49 ± 2.21 mm (p = 0.00) and overjet of 4.90 ± 1.66 mm (p = 0.00) were accomplished and maintained without significant changes in the vertical dimension. Upper and lower incisor inclinations were not affected by the protraction protocol but significantly increased (U1-PP: 8.39° ± 5.59°) between T2 and T3. SNB decreased initially by 1.67° ± 1.34° (p = 0.00) but relapsed due to residual mandibular growth and a counterclockwise rotation of the mandibular plane. Conclusion The hybrid-Hyrax Alt-RAMEC combined with miniscrew reinforced heavy Class III elastics resulted in a favourable and stable Class III correction.

Introduction Anchorage is crucial in controlling tooth movement during orthodontic treatment. Different designs have been introduced to increase the stability of miniscrews. A new miniscrew, The Sydney Mini Screw (SMS), with a hollow chamber and lateral port holes, has been developed to allow the diffusion of an injectable bone graft substitute (iBGS) into cancellous bone. The aim of this study was to analyse the optimum iBGS application with ideal chemo-mechanical properties to be used in conjunction with the novel SMS. Method A composite calcium sulphate and calcium phosphate bone graft substitute was examined. The effects of powder particle size, and the powder-to-liquid ratio on the injectability of the iBGS through the SMS were investigated. The viscosity, injectability, and mechanical properties of the new composite mixtures were assessed using rheology and universal compression measurements. Results The results showed that the optimised injectable formulation of the bone cement was acquired with the concentration of 2.5 g/ml. This concentration was readily injectable through the SMS, and its setting time was within 2–3 minutes, which is favourable for clinicians. In addition, the resulting structure fractured at 80 kPa compression stress. Conclusion The result of this study identified the specific particle size and powder-to-liquid ratio of the iBGS that can be used in conjunction with the new SMS to enhance the primary stability of orthodontic miniscrew applications.

Background With minimal manufacturer information, a variety of ‘generic’ orthodontic brackets are available online from overseas distributors. The present study investigated the metal composition of generic orthodontic brackets compared with two well-known ‘proprietary’ brands. Materials and methods Ranging in price from AU$2.99 to $65, five sets of different generic brackets were obtained directly from China via eBay (G1, G2…G5). Proprietary brackets were obtained from American Orthodontics (P1) and Rocky Mountain Orthodontics (P2). The 11, 12, 13 and 14 brackets from each set were liquefied in an acid solution and subjected to trace element analysis using inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectroscopy (ICP-OES) with respect to nickel, chromium, iron, copper, molybdenum, manganese, cadmium, mercury, arsenic and lead. Statistical analysis investigated the compositional consistency within and between each brand. Results The composition of P1 and P2 agreed with the manufacturer’s data. The generic groups typically had low molybdenum and higher copper content and approximated either 17-4 or AISI304 stainless steels or a combination of both. No relationship between brand and consistency of manufacture could be identified. The cheapest bracket contained lead. Conclusions Generic and proprietary brackets showed differences in their metal composition that may have biocompatibility implications.

Background The use of Twin Block therapy is a well-accepted functional treatment option for the correction of a Class II malocclusion. In addition to skeletal and dental changes, its use may also promote changes in airway structure and dimension, including the size of the posterior airway space (PAS). This may be of importance in reducing the risk of developing obstructive sleep apnoea syndrome (OSAS). Materials and methods Sixteen (16) subjects (eight females and eight males) underwent treatment of a Class II division 1 malocclusion via the use of a Sydney Bonded Twin Block (SBTB) appliance followed by full fixed orthodontic therapy (FFOA). Pretreatment (T1), post-twin block (T2) and post-fixed appliance (T3) lateral cephalograms were taken and skeletal and soft tissue landmarks were hand traced. A pairwise comparison was used to assess whether there were any significant differences in the cephalometric variables between each phase of treatment (T1, T2, T3). Results The skeletal variables SNB and ANB revealed a significant change between T1-T2 (p < 0.01). The sagittal size of the nasopharynx (RPAS) also recorded a significant change between T1-T3 (p < 0.05). There was no significant change in the PAS at any stage of treatment. There was an average reduction in the ANB angle of 2° (p < 0.01) between T1-T3. Conclusions There was no significant change in the size of the PAS following SBTB treatment. However, an increase in RPAS was recorded following SBTB treatment which continued to improve during FFOA therapy.

Objectives The purpose of this study was to qualitatively and quantitatively analyse the effect of glucosamine sulfate and chondroitin sulfate supplements on condylar remodelling in conjunction with bite-jumping functional appliance therapy in rats. Materials and methods The study involved 140 three-week-old, female rats which were divided into a control group (CG), a supplementation group (SG), a functional appliance (bite-jumping) group (FG) and a bite-jumping appliance and supplement recipient group (FSG). The animals were sacrificed at Day 0, Day 7 and at Day 21 after appliance placement, as well as seven days following appliance removal. The condylar head from each animal was blindly scanned using micro-computed tomography (μCT). Qualitative evaluation and volumetric measurements of the condyles, including total condylar volume (TCoV), posterior condylar volume (PCoV), total cartilage volume (TCaV) and posterior cartilage volume (PCaV), were undertaken using VGStudioMax software. Results One hundred and thirty-five rats were analysed, some of which responded to the intervention with a protruded bite (Class III response) while others responded with a retruded bite (Class II response). The TCoV and PCoV of the CG decreased during the experimental period. The functional appliance alone and the combination of the functional appliance with the supplement had a significant effect on TCoV and PCoV over the intervention period (p < 0.01), peaking at Day 7. There was no statistically significant difference in TCaV between animals that experienced Class II and Class III bite responses at Days 21 and 28 (p > 0.05). However, at Day 21, the PCaV increased significantly in those animals which displayed a Class II bite response (p < 0.05). The shape of the condyles in FG and FSG varied significantly from that of the condyles in CG and SG. Conclusion Supplement therapy was found to enhance the normal biological response to functional appliance therapy in a rat model, particularly after the functional appliance was removed. Further research using an immuno-histochemical analysis of a modified bite-jumping appliance and improved food delivery is recommended.

Article Title and Bibliographic Information Macey R, Thiruvenkatachari B, O'Brien K, Batista KBSL. Do malocclusion and orthodontic treatment impact oral health? A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2020;157(6):738–744.e10. doi: 10.1016/j.ajodo.2020.01.015 . Source of Funding Government: Public Health England or the National Health Service. Type of Study/Design Systematic review with meta-analysis of data.

Background Hormonal and enzymatic factors may render certain individuals more susceptible to orthodontically induced inflammatory root resorption (OIIRR). The objectives of this study are (1) to identify biochemical key markers in blood and saliva that may be correlated to the trend of extensive OIIRR and (2) to utilise these markers to predict a susceptible patient-receiving orthodontic treatment. Methods Nine patients (mean age 23 + 2.9 years) who had moderate to severe OIIRR that assessed via orthopantomograms and met the inclusion criteria were classified as the root resorption group (RRG). Blood chemistry was evaluated using the collection of fasting blood and unstimulated saliva samples. Multiplex enzyme-linked immunosorbent assay (ELISA) arrays were used to screen blood and saliva samples for human cytokines, chemokines and several key enzymes that may play a role in root resorption following orthodontic force application. Biochemical findings from 16 matching subjects were used as the control (CG) for comparative measurements. Results Patients with moderate to severe OIIRR showed a significant increase in salivary cytokines including interleukin (IL) 7, IL-10, IL-12p70 and interferon-gamma (IFN-γ) level as well as a significant decrease in IL-4 level. Osteocalcin and procollagen type I N-terminal peptide (P1NP) appeared to be the only blood factors that showed a significant difference, more in the CG than the RRG. Conclusions Saliva might be a more valuable way of measuring changes in cytokine expression than blood secondary to orthodontic treatment. Although the increased expression of pro-inflammatory and anti-inflammatory cytokines may be determinants in the development of moderate to severe OIIRR, cytokine expression may be affected by several potential inflammations in another part of the body. Future research could investigate the cause/effect relationship of different cytokines, in a larger group of patients and at different time intervals, using digital subtraction radiography techniques and microfluidic biosensors.

Since its induction in 1997, the Invisalign® appliance has vastly evolved through the years. Having used this appliance since inception to its current form, we have learnt much through trial and error and accumulated much experience. The product had advanced substantially since the days of only treating simple Class I malocclusions. It is now possible to treat multiple extraction cases, skeletal asymmetries, as well as, surgical and non-surgical camouflage cases. This article summarises the experiences of two specialist orthodontists who had spent time to perfect the system through understanding the biology of tooth movement, and also utilising smart biomechanics to bypass the inadequacies and further enhance the patient and clinician׳s experience in using the appliance.

Objectives To assess the potential effects of casein phosphopeptides (CPPs) on orthodontically induced iatrogenic root resorption (OIIRR) and orthodontic teeth movement. Materials and methods Forty Wistar rats (aged 11 weeks) were randomly divided into experimental group (EG; n = 20) that received a diet supplemented with CPP and control group (CG; n = 20) devoid of diet supplement. A 150 g force was applied using nickel titanium (NiTi) coil that was bonded on maxillary incisors and extended unilaterally to a maxillary first molar. At Day 28, animals in both groups were euthanized. Volumetric assessment of root resorption craters and linear measurement of maxillary first molars movement were blindly examined using a micro-computed tomography scan. Results Nine rats were excluded from the experiment due to loss during general anesthesia or appliances' failure. Intra-operator reproducibility was high in both volumetric and linear measurements, 92.8 per cent and 98.5-97.6 per cent, respectively. The results reveal that dietary CPP has statistically insignificant effect on the overall OIIRR and orthodontic movement. Conclusions CPP seems to have statistically insignificant effect on the volume of OIIRR and orthodontic movement in rats. A long-term study with larger sample size using a different concentration of CPP is required to clarify the dentoalveolar effect of CPP.

Background Orthodontically-induced inflammatory root resorption (OIIRR) is an unwelcome side effect of orthodontic treatment. Mechanical vibration has been suggested as a preventative measure but evidence is limited. The aim of this study was to investigate whether whole body mechanical vibration has a positive influence on OIIRR. Material and methods Thirty-six 10-week-old Wistar rats were divided into three groups, which received either 30 Hz vibration, 60 Hz vibration or no vibration to serve as a control group. A heavy mesial force of 100 g was applied to the left maxillary first molar using nickel-titanium closed-coil springs. The right maxillary first molar served as an internal control. The vibration groups received 30 Hz or 60 Hz of whole body vibration for 10 minutes per day for 14 days. A volumetric analysis of the extent of root resorption on the mesial-buccal root of the first maxillary molar was examined using micro-computed tomography. Results When compared with the control group, the animals that received 30 Hz (p = 0.21) and 60 Hz (p = 0.16) of mechanical vibration did not show a statistically significant reduction in OIIRR. The results did not show a statistically significant difference in the extent of OIIRR between 30 Hz and 60 Hz vibration groups (p = 0.78). Conclusion Mechanical vibration at 30 Hz and 60 Hz, when applied in an experimental model of whole body vibration, showed no significant effect on either physiological root resorption or OIIRR in rat molars loaded by a heavy orthodontic force.

Almuzian, Mohammed/0000-0002-1696-6649 WOS: 000468066900001 PubMed: 31084610 BackgroundBiomarkers can aid in detecting and preventing clinical disease through the recognition of change in biological samples. The objective of this case-control study was to further the knowledge on the use of big toenail and hair samples as biomarkers for fluoride exposure.MethodsA total of 48 participants from an endemic (IC) and a non-endemic (SC) fluorosis region were included. Big toenail and hair samples were collected from each participant and the fluoride concentration was determined. The results of 42 participants were reported: 21 participants (11 males and 10 females, mean age 15.66+2.61years) from IC and 21 participants (11 males and 10 females, mean age 15.06+0.79years) from SC.ResultsThe mean fluoride concentration of big toenail (2.340.26mg/kg) and hair (0.24 +/- 0.04mg/kg) in the endemic region was significantly higher than the mean fluoride concentration of big toenail (0.98 +/- 0.08mg/kg) and hair (0.14 +/- 0.02mg/kg) in the non-endemic region (p

In Australia and Sweden, orthodontic treatments may be performed by either a general dental practitioner (GDP) or a specialist orthodontist. Evidence suggests that the public may easily confuse a GDP who provides orthodontic treatment with a specialist orthodontist. We conducted a survey of people in Australia and Sweden to assess their understanding of the differences between a specialist orthodontist and a GDP who provides orthodontic treatments.The sample comprised 2006 Australian adults and 1010 Swedish adults who completed an online questionnaire. The survey examined the respondents' understanding of the difference between a GDP and a specialist orthodontist. Demographic data and the respondents' preference concerning future practitioner type were also collected.Although most of the responses between the countries were different with statistical significance (P 0.001), many similarities in the responses were observed. More than 90% of the respondents in both countries did not know the difference between a GDP who provides orthodontic treatment and a specialist orthodontist. Almost 75% believed that a specialist orthodontist was the most qualified practitioner to perform orthodontic treatment. Fewer than 10% of the respondents preferred to see a GDP for orthodontic treatment over a specialist. These people tended to be male, have less education, and be younger. Cost was identified as an important factor in choosing an orthodontic practitioner, particularly in the Australian sample.The clear majority of both Australian and Swedish respondents were unable to identify the difference between a specialist orthodontic and a GDP who provides orthodontic treatments.

Aim: The primary aim of this study was to assess the differences in the upper airway morphology between responders and non-responders to mandibular advancement splint (MAS) treatment in obstructive sleep apnoea (OSA) management. The secondary aim was to assess the correlation between the minimum cross-sectional area of the upper airway and the anatomical structures (i.e. mandibular external length, maxillary length, soft palate length, area of the tongue, maxillomandibular enclosure size, and anatomical balance ratio) surrounding the upper airway. The third aim was to assess the differences in the overall skeletal configuration between responders and non-responders to MAS treatment.Methods: Data from 64 patients (23 females and 41 males) diagnosed with OSA by polysomnography (PSG) at baseline and provided with an adjustable MAS were analysed. All patients had NewTom3G cone beam computed tomography (CBCT) scans, performed in the supine position, at baseline. After acclimatization to MAS, follow-up PSG tests were performed to assess the apnoea–hypopnea index (AHI) with the MAS in situ. Responders were defined by a post-treatment AHI less than 10/hour and at least 50 per cent reduction in AHI, and non-responders by a post-treatment AHI at least 10/hour or less than 50 per cent reduction in AHI. Several upper airway and anatomical variables surrounding the upper airway based on CBCT images were measured to determine the differences between responders and non-responders to MAS.Results: There were 36 responders (AHI = 24.8 ± 11.9 at baseline) and 28 non-responders (AHI = 31.2 ± 20.3 at baseline) to MAS. There were no significant differences in the upper airway morphology between responders and non-responders (P = 0.17–0.93) or in the anatomical structure surrounding the upper airway (P = 0.24–0.58).Conclusion: Within the limitations of this study, it can be concluded that there are no significant differences in upper airway morphology and in anatomical structures surrounding the upper airway between responders and non-responders to MAS treatment. These findings suggest that the craniofacial anatomical structures analyzed in this study cannot explain the response to MAS treatment.

Purpose Surgically assisted rapid maxillary expansion (SARME) is required in non-growing patients when maturity or resistance precludes desired sutural separation by noninvasive techniques. The aim of this review was to determine what volumetric changes occur in the upper airway spaces after SARME in adults. Materials and Methods A systematic review was performed with data assessed for suitability of meta-analysis. The primary outcome measurement of volumetric changes in an upper airway space was sought in non-growing patients undergoing SARME. Electronic database searches were performed for published literature in Medline (by Ovid), Pre-Medline, Old Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) spanning all available years to August 1, 2015. Unpublished literature was searched electronically through ClinicalTrials.gov and the National Research Register. Additional hand searching of reference lists of relevant articles, grey searching, and expert correspondence was conducted for any additional studies. Two authors independently screened search results, extracted data, and assessed the risk of bias of included studies. Results Twenty-one studies were located by initial screening; 10 were excluded after full-text review, leaving 11 studies eligible that met all inclusion criteria for this systematic review. In total, 204 treated patients (mean age, 18 to 31 yr) were included in the qualitative synthesis. Ten studies evaluated nasal cavity volume, 2 evaluated palatal volume, and 1 evaluated oropharyngeal volume. Appliances used included tooth-borne hyrax and transpalatal distractor devices. Conclusions SARME was found to produce substantial short-term volume increases in the nasal cavity in non-growing patients that were maintained for at least 63 months. Evidence weakly suggested no effect on oropharyngeal volume. However, most studies were evaluated as having a high risk of bias. The effect of such volume changes on respiratory function still needs to be determined; thus, SARME cannot be recommended for respiratory purposes.

Objectives: To establish the effectiveness of Alternate Rapid Maxillary Expansion and Constriction combined with Protraction Facial Mask (Alt-RAMEC/PFM) approach in treating Class III growing patients compared with PFM combined with conventional Rapid Maxillary Expansion (RME/PFM). Search sources: Unrestricted search in five electronic databases and manual searching were undertaken up to February 2018. Data selection: Randomised clinical trials (RCTs) evaluating the effectiveness of Alt-RAMEC/PFM were selected. Data extraction: Screening of references, data extraction and assessment of bias risk were evaluated independently by two reviewers. Results: Five RCTs comparing the Alt-RAMEC/PFM with RME/PFM met the inclusion criteria. Small but statistically significant mean differences favouring Alt-RAMEC/PFM protocol as measured by SNA angle (1.16°; 95% CI 0.65 to 1.66), SNB angle (0.67°; 95% CI 0.32 to 1.02) and ANB angle (0.66°; 95% CI 0.08 to 1.25) were noted. Alt-RAMEC/PFM exhibited a more favourable overjet correction when compared to RME/PFM, however, differences in other dental changes were insignificant. Conclusion: There is limited evidence with high risk of bias that Alt-RAMEC/PFM can result in a statistically significant increase in maxillary protraction compared with RME/PFM in Chinese subjects over the short-term. High-quality long-term RCTs with inclusion of patient-reported outcomes are required.