Comparison of external apical root resorption in maxillary anterior teeth following en-masse versus two-step retraction: a 3D volumetric CBCT-based randomized controlled trial
This study aimed to quantify and compare EARR in maxillary anterior teeth following en-masse versus two-step retraction using 3D cone-beam computed tomography (CBCT), finding no statistically significant differences between techniques.
Orthodontically induced external root resorption (OIERR) is a recognized adverse effect of orthodontic treatment. Limited literature exists that reported on volumetric root changes in anterior open bite patients treated with clear aligners. This study aimed to evaluate three-dimensional volumetric changes in anterior teeth roots using cone-beam computed tomography (CBCT) in open-bite patients treated with clear aligners. Fifty CBCT scans [pre-treatment (T1) and post-treatment (T2)] obtained from 25 adult patients (11 males,14 females; mean age: 32.67 ± 10.67 years) with anterior open bite (1–4 mm) treated using clear aligners were retrospectively analyzed. Semi-automated segmentation of the twelve anterior teeth was performed using Blue Sky Plan software, followed by three-dimensional superimposition in 3-matic software. A reference line at the cementoenamel junction was used to trim the crown, and root volumes were measured at both time points. Percentage changes in root volume between pre-treatment and post-treatment were calculated. The level of significance was set at p ≤ 0.05. Skeletal and dental parameters were assessed before and after treatment. The reproducibility of the measurements was assessed using the intraclass correlation coefficient (ICC). Both intra-examiner and inter-examiner reliability were excellent (ICC: 0.90–0.94 and 0.92–0.96, respectively; p < 0.001). All anterior teeth demonstrated significant reduction in root volume. Maxillary canines showed the greatest percentage decrease (− 6.33 ± 2.58%), followed by the central (− 5.91 ± 4.93%) and lateral incisors (− 5.50 ± 3.24%). Mandibular canines again showed the largest reduction (− 6.75 ± 2.33%), followed by lateral (− 5.58 ± 3.20%) and central incisors (− 4.86 ± 2.54%). Males exhibited significantly greater root volume reduction across all anterior teeth (p < 0.05), while no significant correlation was found with age. Patients with anterior open bite who were treated with clear aligners showed mild root volume reduction in all anterior teeth with canines being most affected. This reduction is generally considered to be clinically insignificant. Male patients showed greater volumetric reduction, whereas age and magnitude of incisor movement were not significantly correlated with root volume changes.
Dina Elfouly, Esraa A Elnadoury, Tarek El-Bialy· BMC Oral Health· 0 citations
To describe changes in maxillofacial morphology observed during bone-anchored maxillary protraction (BAMP) treatment in children with cleft lip and palate (CLP). This prospective, single-arm observational study included 20 consecutively treated patients with CLP (60% male; mean age at baseline (T1), 11.7 ± 1.0 years) who underwent BAMP therapy as part of a treatment protocol. Lateral cephalograms were obtained at baseline (T1) and at the end of maxillary protraction (T2; mean age, 15.3 ± 1.6 years). Protraction was considered complete when a positive overjet with adequate incisor overlap had been achieved and judged stable by the treating orthodontist, or when no further sagittal improvement was observed over two consecutive annual reviews, after which the miniplates were removed. Skeletal and dental changes were assessed using cephalometric measurements. Method error was evaluated using intraclass correlation coefficients. Statistical analyses included paired comparisons and exploratory univariable regression analyses. Significant increases were observed in the SNPg angle, midfacial length, mandibular length, and maxillomandibular difference, accompanied by a significant reduction in the SN/GoMe angle. The SNA angle increased by 1.3° from T1 to T2; however, this change did not reach statistical significance (95% CI: -0.17 to 2.66). Exploratory univariable analyses suggested that baseline age and observation time were associated with selected skeletal changes; these analyses were hypothesis-generating only. BAMP therapy was not associated with a statistically significant change in maxillary sagittal position (SNA), and overall skeletal changes were modest; clinicians should therefore maintain realistic expectations regarding the extent of skeletal correction achievable. Because the primary outcome (SNA) was not statistically significant, these findings are hypothesis-generating; whether BAMP can stabilise maxillary position during growth in milder discrepancies, and thereby reduce the likelihood of later orthognathic surgery, requires confirmation in controlled studies. Because the study had no control group, the observed T1-T2 changes cannot be separated from normal growth, and no causal effect of BAMP can be inferred.
A. Brudnicki, Marcin Olek, Zbigniew Surowiec et al.· Scientific Reports· 0 citations
OBJECTIVES
This randomized clinical study aimed to assess implant placement accuracy and radiographic outcomes of computer-guided versus freehand ridge split and expansion with simultaneously inserted implants in patients with horizontally deficient maxillary anterior ridges over a 2-year follow-up period.
METHODS
Twenty-two volunteers were randomly allocated (1:1) to either a computer-guided or a freehand group. The primary outcome was implant placement accuracy. Secondary outcomes included postoperative complications, marginal bone loss, horizontal ridge width changes, and peri-implant defect resolution. All parameters were evaluated radiographically at baseline, immediately after surgery, and at 3, 6, 12, and 24 months.
RESULTS
The computer-guided group demonstrated lower angular deviation versus the freehand group (1.45 ± 0.43° vs. 10.02 ± 3.24°; p < 0.001) and entry point deviation (0.54 ± 0.19 mm vs. 2.16 ± 0.31 mm; p < 0.001). Depth deviation showed a non-significant difference. Three, six, and twelve months after surgery, the freehand group exhibited higher marginal bone loss (1.02 ± 0.13, 1.57 ± 0.13, 1.58 ± 0.13, and 1.73 ± 0.17 mm, respectively) than the computer-guided group (0.27 ± 0.13, 0.35 ± 0.13, 0.36 ± 0.13, and 0.39 ± 0.15 mm, p < 0.001). The computer-guided approach also was associated with minimal ridge collapse and enhanced peri-implant defect fill.
CONCLUSIONS
The present preliminary findings suggest that computer-guided ridge split and expansion were associated with improved implant placement accuracy and peri-implant hard tissue preservation compared with the conventional freehand approach over 2 years. Both techniques achieved successful implant outcomes without major complications. However, these observations should be interpreted cautiously as preliminary evidence requiring external validation, given the limited sample size, single-operator design, and mid-term follow-up duration. Multicenter studies with larger cohorts and longer follow-up are required before confirming definitive clinical superiority.
CLINICAL SIGNIFICANCE
The present preliminary findings suggest that integrating the digital workflow into ridge split and expansion may enhance surgical precision and peri-implant hard tissue stability in narrow maxillary ridges. Nevertheless, the potential advantages of the guided approach require confirmation through larger, well-designed clinical trials before recommending widespread, routine clinical implementation.
CLINICAL TRIAL REGISTRATION
The study was prospectively registered in the ClinicalTrials.gov registry (Identifier: NCT06135506) on 11/11/2023 under the title "Artificial Intelligence/Computer Guided Ridge Splitting for Treating Horizontal Ridge Defects."
CLINICALTRIALS
gov PRS: Record Summary NCT06135506.
Asmaa Allam, N. Hatata, Walid S. Salem et al.· E -journal of dentistry· 0 citations
This study aimed to clarify the involvement of the root formation stage and apical foramen diameter (AFD) of adjacent teeth in the occurrence of external root resorption (ERR) associated with impacted maxillary canines (IMCs), and to identify novel risk indicators for more accurate clinical prediction. Forty patients with IMCs (58 canines) who underwent cone-beam computed tomography (CBCT) between May 2017 and October 2022 were retrospectively analyzed. The developmental status was assessed using the root formation stage and AFD of the central incisor (U1), lateral incisor (U2), and first premolar (U4). Additionally, spatial factors, including inter-root distance and the 3D position of the IMC, were evaluated in relation to ERR. ERR was detected in 72.5% of patients, affecting 37.1% of all examined adjacent teeth. Among the affected teeth, U2 showed the highest incidence (65.3%), followed by U1 (28.6%) and U4 (6.1%). In exploratory tooth-level comparisons, AFD was smaller in the ERR group for U1 and U4. In the supplementary affected-side-level mixed-effects analysis, no statistically significant independent association was demonstrated between maximum AFD and side-level ERR occurrence. Developmental indicators, including AFD, may provide clinically relevant information when assessing ERR associated with IMCs. These indicators should be interpreted as potential modifying factors in conjunction with established spatial relationships rather than as independent predictive markers.
Yukari Mizoguchi, Yuji Ishida, Aiko Ishizaki-Terauchi et al.· Progress in orthodontics· 0 citations
ABSTRACT Aims To evaluate whether minimally invasive non‐surgical therapy (MINST) with flapless application of enamel matrix derivative (EMD) achieves non‐inferior clinical and radiographic outcomes compared to minimally invasive surgical technique (MIST) + EMD, while improving patient‐reported outcome measures (PROMs). Materials and Methods Following CONSORT guidelines, 40 patients with mandibular Grade II furcation defects were randomised to MINST (n = 20) or MIST (n = 20) with EMD. Probing pocket depth (PPD), clinical attachment level (CAL) and cone‐beam computed tomography (CBCT) horizontal/vertical bone loss were assessed at baseline and 9 months. PROMs (visual analogue score [VAS] and Oral Health Impact Profile [OHIP‐14]) were recorded longitudinally. Results At 9 months, the mean PPD reduction was 2.20 ± 2.24 mm in the MIST group and 2.15 ± 1.76 mm in the MINST group. The adjusted mean difference was −0.22 mm (95% CI: −1.43 to 0.99 mm). The one‐sided non‐inferiority p‐value was 0.025. As the upper bound of the confidence interval remained below the prespecified non‐inferiority margin, MINST was considered non‐inferior to MIST for the primary outcome. When evaluated against the strict +1.0 mm margin, MINST achieved statistical non‐inferiority for gingival recession (p = 0.003) and vertical bone gain (p = 0.015). However, non‐inferiority could not be formally established for CAL (p = 0.067) or horizontal bone gain (p = 0.157). PROMs revealed significantly lower root hypersensitivity and improved oral‐health‐related quality of life in the MINST group at 2 weeks; however, these differences were not sustained at later timepoints. Conclusions Within the limitations of this randomised controlled trial, MINST with EMD showed clinical and radiographic outcomes generally comparable to MIST in mandibular Class II furcation defects. While non‐inferiority against a strict 1.0 mm margin was successfully established for the primary outcome (PPD) and specific secondary parameters, it could not be formally confirmed for CAL or horizontal bone gain. MINST was associated with significantly improved short‐term PROMs during the early healing phase. Trial Registration ClinicalTrials.gov identifier: NCT05541614
G. Chatzopoulos, E. Kaklamanos, Ioannis Vouros et al.· Journal of Clinical Periodon...· 0 citations
This exploratory study aimed to evaluate the expansion effects of a customized elastodontic appliance (CEA) on maxillary and mandibular arches in mixed dentition children using cone-beam computed tomography (CBCT), and to clarify whether these effects are dental, dentoalveolar, or skeletal.
This retrospective study included 31 mixed dentition children (mean age 8.3 ± 1.2 years) who underwent CEA treatment for 8.2 ± 1.3 months. Pre- and post-treatment CBCT images were used to measure width changes at three levels: cusp, alveolar bone, and apical basal bone. Paired t-tests were used for comparisons.
Significant increases were observed at cusp and alveolar levels. At the cusp level, maxillary inter-canine width increased by 2.97 mm ± 1.31 mm (95% CI: 2.49–3.45,
P
< 0.001), and mandibular inter-canine width by 2.39 mm ± 1.32 mm (95% CI: 1.91–2.87,
P
< 0.001). Maxillary second primary molar buccal cusp width increased by 1.67 mm
±
0.85 mm (95% CI: 1.36–1.98,
P
< 0.001), and mandibular counterpart by 1.26 mm
±
1.11 mm (95% CI: 0.85–1.67,
P
< 0.001). At the alveolar bone level, maxillary alveolar crest width increased by 1.39 mm ± 1.09 mm (95% CI: 0.99–1.79,
P
< 0.001), whereas mandibular alveolar crest width showed a minimal increase of 0.38 mm ± 0.75 mm (95% CI: 0.10–0.66,
P
= 0.008). No significant changes were observed in apical basal bone width in either arch.
The findings suggest that CEA may expand maxillary and mandibular arches in mixed dentition children with maxillary transverse deficiency. The maxillary expansion effect primarily involves dental movement and adaptive dentoalveolar change, without significant deep basal bone changes. In the mandible, significant dental expansion was observed at the cusp level, while the alveolar bone changes were minimal and should be interpreted cautiously. These findings provide preliminary CBCT-based evidence for the transverse expansion effects of CEA in mixed dentition children.
Not applicable. This is a retrospective, anonymous observational study without prospective intervention or a clinical trial protocol.