Orthodontics has witnessed not only an exponential rise in demand from adult patients but accompanying this, the emergence of alternate aesthetic treatment options to the more traditional fixed labial appliance. The concept of using clear aligners as a means of achieving tooth movement has increased in popularity among both patients and clinicians alike. However, the question over best research evidence as to their clinical effectiveness to treat a range of malocclusion traits remains elusive and controversial among the profession.In an attempt to offer the profession some clear guidance, The Angle Society of Europe reviewed and discussed the current published evidence (2005-2018) on their clinical use, during the annual meeting in January 2020, to help formulate a consensus viewpoint on the clinical applications.

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BACKGROUND: White spot lesions (WSLs) occur as a side effect in over 25 % of patients who undergo orthodontic treatment, causing aesthetic problems and a risk of deeper enamel and dentine lesions. Dutch orthodontists show substantial variation in their application of WSL preventive measures, which include little incorporation of evidence from the literature. We recently developed an evidence-based clinical practice guideline (CPG) on this topic, which was further converted into a computerized clinical decision support system (CDSS) to facilitate its incorporation into clinical practice. The present study aimed to assess the effectiveness of this CPG-based CDSS, with regard to actually preventing WSL development during orthodontic treatment with fixed appliances compared to usual preventive measures. Our study also aimed to evaluate the effects of implementing the CPG-based CDSS into routine clinical practice using a multifaceted strategy.
METHODS: We designed a hybrid effectiveness-implementation study assessing both clinical effectiveness of the CPG and its implementation into routine practice. A total of 840 patients nested in 14 orthodontic practices will be randomly assigned as clusters to the intervention or the control arm. Patients recruited by the orthodontist in the intervention group will be treated following the CPG, while the usual preventative measures will be followed in the control arm. The primary outcome measure is the proportion of patients with newly formed or enlarged WSLs after 6-9 months of treatment with fixed appliances, and at the end of treatment, using the CPG for WSL prevention compared with usual preventive measures. An additional aim is to obtain some preliminary outcomes regarding the implementation process.
CONCLUSIONS: This study investigates the effectiveness of a newly developed guideline to improve oral health during orthodontic treatment, while simultaneously illuminating potential difficulties in adopting a guideline in general orthodontic practice. The innovative features of this study include the risk-based CDSS that discriminates between patients\' oral health statuses with regard to preventive measure utilization in general orthodontic practices. Most studies focusing on WSL prevention apply the preventive intervention to each patient in an experimental setting, resulting in overtreatment and a disconnect from the real-world conditions in which the intervention is to be applied. Additionally, one of the overreaching goals of this initiative is to create a gold standard for WSL prevention during orthodontic treatment, against which future studies can compare new promising preventive measures and the readiness of clinicians to change and adopt new treatments. By doing so, we want to help bridge the gap between science and orthodontic clinical practice and improve the quality of oral health care.
BACKGROUND: This trial is registered with the Dutch Trial Registry of the Dutch Cochrane Center under number NTR5012 , registration date 2 March 2015.

BACKGROUND: Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring.
METHODS: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations.
CONCLUSIONS: 1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) 2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) 3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) 4. We suggest that qualified dentists provide oversight—rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) 5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) 6. We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits—as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE).
CONCLUSIONS: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations.

Invisalign is an increasingly popular technique for aligning teeth and correcting malocclusions orthodontically. This article analyzes the current professional literature published on Invisalign and the benefits and risks of using the technique for both patients and doctors. The steady increase in the number of cases treated with Invisalign and where the technique is going in the future is investigated. Ten guidelines for Invisalign treatment and patient selection are given, along with case examples.

OBJECTIVE: To analyze morphological variations of retrieved orthodontic miniscrews and to evaluate the mechanical properties that may adversely affect relocation of miniscrews.
METHODS: Retrieved miniscrews were classified with scanning electron microscopy according to the degree of morphological deformation of the tip. To evaluate the differences in mechanical characteristics during reinsertion, changes in insertion torque, insertion time and differences in successful insertion load were compared between unused controls and retrieved miniscrews. In addition, surface composition analysis of retrieved miniscrews was performed using energy-dispersive x-ray spectroscopy.
RESULTS: Significant tip deformation was evident in the majority (>84.5%) of retrieved miniscrews. Initial conditions such as insertion site or duration of insertion were not associated with the presence of tip deformation. Insertion load for successful bone penetration increased in proportion to the degree of tip deformation; however, serial changes in insertion torque were similar to those of the controls. Deposited debris such as carbon, calcium, and phosphorus was noted on the retrieved miniscrews.
CONCLUSIONS: Miniscrews retrieved after primary insertion exhibited decreased cutting ability due to deformation of the tip structure, as well as surface contamination.

OBJECTIVE: To survey retention protocols and need for practical retention guidelines among orthodontists in Norway and to compare the results with similar studies in other countries.
METHODS: A questionnaire was mailed to all members of the Norwegian Association of Orthodontists. It included questions about their background and their current retention protocol, as well as their perceived need for common retention guidelines.
RESULTS: The response rate was 77.7% (69.3% males and 30.7% females). The most common maxillary retainer was a combination of a fixed and removable retainer, followed by a clear thermoplastic retainer. In the mandible, a fixed retainer bonded to all anterior teeth was most common (66.4%). Retention in the maxilla lasted 2 to 3 years (34.7%) or 3 to 5 years (23.8%). In the mandible, 41.5% of the orthodontists left the retainer in place for >5 years. When retention lasted more than 3 years, 70% of the orthodontists left the responsibility for retainer checkups to the patients or the general practitioners. The main reason for choosing a certain retention protocol was clinical experience (57.4%). Only 3.5% of the orthodontists based their protocols on information from the literature. Half?of the orthodontists, significantly women, expressed a need for common retention guidelines.
CONCLUSIONS: In Norway, bonded retainers alone were reported to be most commonly used in the mandible, while bonded retainers used in combination with a removable retainer appear to be the most commonly used appliances in the maxilla. This is similar to the most frequently used retainers in other countries, but there are disparities in duration and follow-up protocols. Most female orthodontists desire common retention guidelines.

BACKGROUND: Our objective was to analyze patterns of tooth movement and changes of arch dimension by superimposing 3-dimensional (3D) virtual models.
METHODS: The sample consisted of 24 Korean adults with Class I malocclusion and minimal crowding, treated by first premolar extractions, sliding mechanics (0.022-in MBT brackets [3M Unitek, Monrovia, Calif] with 0.019 × 0.025-in stainless steel wire) and moderate anchorage. The 3D virtual maxillary casts at pretreatment and posttreatment were superimposed with the best-fit method. Linear and angular variables were measured with 3Txer program (Orapix, Seoul, Korea). Wilcoxon signed rank and Mann-Whitney tests were used for statistical analysis.
RESULTS: There was no significant difference in the individual tooth movement between the right and left sides (P > 0.05). For the movement of each tooth, the maxillary central incisors (U1), lateral incisors (U2), and canines (U3) were significantly inclined lingually, extruded, and moved posteriorly and laterally. The maxillary second premolar (U5), first molar (U6), and second molar (U7) had significant mesial inward rotation, anterior movement, and contracted toward the midsagittal plane. The ratio of anteroposterior movement between the maxillary anterior and posterior teeth was 5:1. The amounts of contraction in U5, U6, and U7 were 1.4, 1.3, and 1.2 mm, respectively. When the amount of change between the adjacent teeth were compared, the linguoversion in U1 was significantly greater than that of U2. U3 and U5 showed significant opposite movements in all variables. There were differences only in angulation and vertical displacement between U6 and U7.
CONCLUSIONS: Superimposition of 3D virtual models could be a guideline for precise virtual treatment planning.

The obstructive sleep apnea syndrome (OSAS) is characterized by repetitive upper airway obstructions during sleep. This sleep-related breathing disorder is associated with excessive daytime sleepiness and increased cardiovascular risk. Recently, the national multidisciplinary guidelines for the diagnosis and treatment of OSAS in adults have been thoroughly revised. In the guidelines an important place has been created for mandibular repositioning appliances. With these devices, which resemble activators, a widening of the upper airways is produced during sleep by advancing the mandible. According to the guidelines therapy with repositioning appliances should be considered a first-line treatment for patients with mild to moderate OSAS.

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