Andrea Wichelhaus

Objectives: Knowledge of tooth axes is important in orthodontics; however, using just one method for evaluation, e.g., orthopantomograms for tip, is not highly reliable. This study aimed to investigate tooth axes in skeletal class I/II/III using two- and three-dimensional evaluations. Methods: In this retrospective study, lateral cephalometric radiographs, orthopantomograms and digitized models of 107 adolescent patients (Ø 13.5 years; n = 36/33/38 with cI/cII/cIII) prior to orthodontic treatment were analyzed digitally regarding tip and torque of teeth. Statistical analysis was performed using SPSS (p ≤ 0.05), G*power and a multiple testing tool (Bonferroni–Holm/Hochberg). Results: Dental compensation of skeletal cII/cIII was significant acc. to Bonferroni–Holm/Hochberg for the following variables: overjet compensation in cII was seen by more retroinclined upper incisors in cII by −5.9°/−5.3° and by −8.8°/−6.6° (U1-SN/U1-PP) vs. cI/cIII (effect size f = 0.489/0.446, power 0.996/0.988). In cIII, the lower incisors were more retroinclined by −8.5°/−10.9° (L1-MP) vs. cI/cII (f = 0.576, power 1.000) and by −8.5°/−8.9° and −6.0°/−7.0° (three-dimensional analysis: L1/L2) vs. cI/cII (f = 0.522/0.527, power 0.999). Compensation of distal occlusion was found by mesial tipping of L3 by 3.5° in cII (f = 0.242, power 0.591) vs. cIII. CIII showed transversal compensation by buccal tipping of the U5 by 5.9°/4.6° vs. cII/I (f = 0.355, power 0.910) and lingual tipping of L3 by −6.4° vs. cII and −3.8° vs. cI (f = 0.446, power 0.988) and L4 by −4.0°/−2.6° vs. cII/I (f = 0.326, power 0.846). Conclusions: Decompensation, e.g., uprighting of distal tipped canines, and further protrusion of incisors might not be desired in orthodontic treatment of adolescents.

Background: Correct inclination of the incisors is crucial for function and occlusion. The aim of this retrospective cephalometric study was to investigate the effect of orthodontic treatment with passive self-ligating (SL) brackets on the incisor inclination compared to untreated controls. Methods: This study evaluated an orthodontic treatment group (n = 30, Ø13.4 years, ANB Ø2.3°) before (T1) and after (T2) orthodontic therapy with passive SL-brackets (MBT prescription, 0.022″ slot) by one experienced orthodontist. The control group was matched according to age and sex (n = 30, Ø13.3 years, ANB Ø2.5°). The incisor inclination was evaluated digitally using cephalometric lateral radiographs. Results: The cephalometric evaluation showed a significant incisor proclination during orthodontic treatment with SL brackets. The upper incisors proclined by +3.8° (U1–PP) and +3.7° (U1–SN) and the lower incisors proclined by +4.4° (L1–MP). The control group presented a reclination of the upper incisors by −1.4° (U1–PP) and −0.6° (U1–SN) and the lower incisors by −0.4° (L1–MP). The clinically relevant protrusion effect during orthodontic treatment with SL brackets summed up to +5.2° (U1–PP), and +4.3° (U1–SN) for the upper incisors (+2.0°/year, +1.6°/year) as well as +4.8° (L1–MP) for the lower incisors (+1.6°/year) compared to controls. Sex-specific differences were found. Males showed a greater proclination of the upper incisors by +5.3° (U1–PP) and +5.9° (U1–SN) compared to females in the treatment group. Conclusions: Orthodontic treatment with SL brackets results in protrusion of the upper and lower incisors by +5° compared to controls. These findings must be considered in orthodontic treatment planning according to initial diagnostics.

In recent years, there has been a growing number of adult orthodontic patients with periodontal disease. The progression of periodontal disease is well-linked to oxidative stress (OS). Nevertheless, the impact of OS on orthodontic tooth movement (OTM) is not fully clarified. Therefore, we applied an OS in vitro-model utilizing H₂O₂ to study its effect on tension-induced mechanotransduction in human osteoblasts (hOBs). Experimental parameters were established based on cell viability and proliferation. Apoptosis detection was based on caspase-3/7 activity. Gene expression related to bone-remodeling (RUNX2, P2RX7, TNFRSF11B/OPG), inflammation (CXCL8/IL8, IL6, PTRGS2/COX2), autophagy (MAP1LC3A/LC3, BECN1), and apoptosis (CASP3, CASP8) was analyzed by RT-qPCR. IL6 and PGE2 secretion were determined by ELISA. Tension increased the expression of PTRGS2/COX2 in all groups, especially after stimulation with higher H₂O₂ concentration. This corresponds also to the measured PGE2 concentrations. CXCL8/IL8 was upregulated in all groups. Cells subjected to tension alone showed a general upregulation of osteogenic differentiation-related genes; however, pre-stimulation with OS did not induce significant changes especially towards downregulation. MAP1LC3A/LC3, BECN1 and CASP8 were generally upregulated in cells without OS pre-stimulation. Our results suggest that OS might have considerable impacts on cellular behavior during OTM.

Oxidative stress (OS) is a common feature of many inflammatory diseases, oral pathologies, and aging processes. The impact of OS on periodontal ligament cells (PDLCs) in relation to oral pathologies, including periodontal diseases, has been investigated in different studies. However, its impact on orthodontic tooth movement (OTM) remains poorly understood. This study used an in vitro model with human PDLCs previously exposed to H₂O₂ to investigate the effects of OS under a static compressive force which simulated the conditions of OTM. Human PDLCs were treated with varying concentrations of H₂O₂ to identify sub-lethal doses that affected viability minimally. To mimic compromised conditions resembling OTM under OS, the cells were pretreated with the selected H₂O₂ concentrations for 24 h. Using an in vitro loading model, a static compressive force (2 g/cm²) was applied for an additional 24 h. The cell viability, proliferation, and cytotoxicity were evaluated using live/dead and resazurin assays. Apoptosis induction was assessed based on caspase-3/7 activity. The gene expression related to bone remodeling (RUNX2, TNFRSF11B/OPG, BGLAP), inflammation (IL6, CXCL8/IL8, PTGS2/COX2), apoptosis (CASP3, CASP8), and autophagy (MAP1LC3A/LC3, BECN1) was analyzed using RT-qPCR. This study suggests an altering effect of previous OS exposure on static-compression-related mechanosensing. Further research is needed to fully elucidate these mechanisms.

The periodontal ligament (PDL) is crucial for maintaining the integrity and functionality of tooth-supporting structures. Mechanical forces applied to the tooth during orthodontic tooth movement generate pore pressure gradients, leading to interstitial fluid movement within the PDL. The generated fluid shear stress (FSS) stimulates the remodeling of PDL and alveolar bone. Herein, we present the construction of a parallel fluid-flow apparatus to determine the effect of FSS on PDL cells. The chamber was designed and optimized using computer-aided and computational fluid dynamics software. The chamber was formed by PDMS using a negative molding technique. hPDLCs from two donors were seeded on microscopic slides and exposed to FSS of 6 dyn/cm² for 1 h. The effect of FSS on gene and protein expression was determined using RT-qPCR and Western blot. FSS upregulated genes responsible for mechanosensing (FOS), tissue formation (RUNX2, VEGFA), and inflammation (PTGS2/COX2, CXCL8/IL8, IL6) in both donors, with donor 2 showing higher gene upregulation. Protein expression of PTGS2/COX2 was higher in donor 2 but not in donor 1. RUNX2 protein was not expressed in either donor after FSS. In summary, FSS is crucial in regulating gene expression linked to PDL remodeling and inflammation, with donor variability potentially affecting outcomes.

(1) Background: After more than a decade since their first description, Inadvertent Tooth Movements (ITMs) remain an adverse effect of orthodontic retainers without a clear etiology. To further investigate the link between ITMs and the mechanical properties of different retainers, the response upon vertical loading was compared in three retainer types (two stainless steel and one nickel–titanium). The influence of different reference teeth was also considered. (2) Methods: Three retainers (R1, R2, R3) were tested in a newly developed biomechanical analysis system (FRANS). They were bonded to 3D-printed models of the lower anterior jaw and vertically displaced up to 0.3 mm. Developing forces and moments were recorded at the center of force. (3) Results: The vertical displacement caused vertical forces (Fz) and labiolingual moments (My) to arise. These were highest in the lateral incisors (up to 2.35 ± 0.59 N and 9.27 ± 5.86 Nmm for R1; 1.69 ± 1.06 N and 7.42 ± 2.65 Nmm for R2; 3.28 ± 1.73 N and 15.91 ± 9.71 Nmm for R3) for all analyzed retainers and with the R3 retainer for all analyzed reference teeth, while the lowest Fz and My values were recorded with the R1 retainer. (4) Conclusions: Displacements of 0.2 mm and larger provided forces and moments which could be sufficient to cause unwanted torque movements, such as ITMs, in all analyzed retainers. Clinicians must be mindful of these risks and perform post-treatment checkups on patients with retainers of all materials.

(1) Background: To further investigate the link between inadvertent tooth movements (ITMs) and mechanical properties of different retainers, the response upon vertical loading was compared in three different retainers (two stainless steel and one nickel-titanium). The influence of different reference teeth was also considered. (2) Methods: Three retainers (R1, R2, R3) were tested in a newly developed biomechanical analysis system (FRANS). They were bonded to 3D-printed models of the lower anterior jaw and vertically displaced up to 0.3mm. Developing forces and moments were recorded at the center of force. (3) Results: The vertical displacement caused vertical forces (Fz) and labiolingual moments (My) to arise. These were highest in the lateral incisors (up to 2.35±0.59N and 9.27±5.86Nmm for R1; 1.69±1.06N and 7.42±2.65Nmm for R2; 3.28±1.73N and 15.91±9.71Nmm for R3) for all analyzed retainers, and with the R3 retainer for all analyzed reference teeth, while the lowest Fz and My values were recorded with the R1 retainer. (4) Conclusions: Displacements of 0.2mm and larger provided forces and moments which could be sufficient to cause unwanted torque movements, such as ITMs in all analyzed retainers. Clinicians must be mindful of these risks and perform posttreatment checkups on patients with retainers of all materials.

En-bloc retraction is a common procedure in orthodontic therapy. The application of palatal root torque moments is required to control incisor inclination during retraction, yet studies comparing forces and moments with respect to different mechanics are lacking. This study aimed to investigate the forces and moments during orthodontic en-bloc retraction using a robotic biomechanical simulation system, comparing two distinct approaches: (I) compound technique [stainless steel (SS) combined with nickel-titanium (NiTi)] using industrially pretorqued retraction-torque-archwires (RTA) in combination with NiTi closed coil springs; (II) conventional sliding mechanics using SS archwires with manually applied anterior twist bends in combination with elastic chains. Two dimensions (0.017” × 0.025” and 0.018” × 0.025”) and ten archwires per group were investigated using 0.022” slot self-ligating brackets. Kruskal–Wallis tests with a significance level of α = 0.05 were conducted. The biomechanical simulation showed that en-bloc retraction was characterized by a series of tipping and uprighting movements, differing significantly regarding the examined mechanics. Collateral forces and moments occurred in all groups. Notably, RTA exhibited fewer extrusive forces. The most bodily movement was achieved with the compound technique and the 0.018” × 0.025” RTA. Sliding mechanics exhibited maximum palatal root torque moments of more than 20 Nmm, exceeding recommended values.

This study aims to examine the play between various archwires and bracket systems, exploring potential variations in angle values for specific torque and torque values for a given angle along different bracket systems. Therefore, seven brackets systems were evaluated in conjunction with different stainless steel archwires of varying dimensions (0.016″ × 0.022″, 0.018″ × 0.025″, and 0.019″ × 0.025″). Biomechanical behavior during torque development and transmission was assessed using a six-component force/torque sensor. Torque angles (5–45°) were specified with subsequent torque measurement, and the sequence was reversed by setting the torque (5–30 Nmm) and measuring the angle. A reference measurement with 0 Nmm torque served to evaluate bracket slot play. Bracket play (0 Nmm) during palatal load ranged between 20.06° and 32.50° for 0.016″ × 0.022″ wire, 12.83° and 21.11° for 0.018″ × 0.025″ wire, and 8.39° and 18.73° for 0.019″ × 0.025″ wire. The BioQuick^® bracket exhibited the highest play, while Wave SL^® and Damon^® Q brackets demonstrated the lowest play (p < 0.001). Significant differences (p < 0.001) between the brackets were observed in the torque angles required to achieve torques of 5–20 Nmm. In summary, each bracket system has a different torque transmission, which is of great clinical importance in order to achieve correct torque transmission and avoid complications such as root resorption.

The aim of this study was to investigate the load deflection characteristics of Gummetal^® wires in comparison to nickel–titanium (NiTi) wires. Four different NiTi wires and one Gummetal^® archwire were analyzed in two dimensions (0.014″ (0.36 mm) and 0.016″ × 0.022″ (0.41 mm × 0.56 mm)) and in two different orientations (edgewise and ribbonwise) using three-point bending tests at T = 37 °C. Force–displacement curves were recorded and analyzed. The Gummetal^® 0.014″ wires exhibited higher forces compared to the NiTi wires at 2.0 mm deflection. At 1.0 mm deflection, the opposite pattern was observed. For the 0.016″ × 0.022″ Gummetal^® wires, the forces were within the force interval of the NiTi wires at 2.0 mm deflection. At a deflection of 1.0 mm, no residual force was measurable for the Gummetal^® wires. All the NiTi wires investigated showed hysteresis and a superelastic plateau. However, the Gummetal^® did not form a plateau, but hysteresis was present. An easier plastic deformability compared to the NiTi wires was observed for all the tested geometries.