In orthodontic treatment of patients during the mixed dentition period, arch expansion and opening deep overbite are one of the objectives to achieve proper alignment of the teeth and correction of sagittal and vertical discrepancies. However, the expected outcomes of most therapeutic regimens are not clear, making it impossible to standardize early treatment effects. Therefore, this study was designed to evaluate the impact of the Invisalign® First System on the dental arch circumference and incisor inclination in patients during the mixed dentition period. A total of 21 children during the mixed dentition period (10 females and 11 males, with an average age of 8.76 years) were included in this study. The patients received non-extraction treatment through Invisalign® First System clear aligners, and no other auxiliary devices were used except Invisalign® accessories. Subsequently, the cooperation degree of patients during treatment and the oral measurement parameters at the beginning (T1) and the end (T2) of treatment were collected. All patients showed moderate/good cooperation degree during treatment. Besides, horizontal width of the maxillary first molar increased significantly; the designed arch expansion was 4.1 mm (±1.4 mm), while the actual arch expansion was 3.0 mm (±1.7 mm). Furthermore, the torque expression rate of upper anterior teeth reached 56.53%. Invisalign® First System clear aligners can effectively correct the teeth of patients during the mixed dentition period, widen the circumference of dental arch, and control the torque of incisors.

BACKGROUND: The intrusion of maxillary anterior teeth is often required and there are various intrusion modes with mini-implants in clear aligner treatment. The objective of this study was to evaluate the effectiveness of maxillary anterior teeth intrusion with different intrusion modes, aiming to provide references for precise and safe intrusion movements in clinical practice.
METHODS: Cone-beam computed tomography and intraoral optical scanning data of a patient were collected. Finite element models of the maxilla, maxillary dentition, periodontal ligaments (PDLs), clear aligner (CA), attachments, and mini-implants were established. Different intrusion modes of the maxillary anterior teeth were simulated by changing the mini-implant site (between central incisors, between central and lateral incisor, between lateral incisor and canine), loading site (between central incisors, on central incisor, between central and lateral incisor, between lateral incisor and canine), and loading mode (labial loading and labiolingual loading). Ten conditions were generated and intrusive forces of 100 g were applied totally. Then displacement tendency of the maxillary anterior teeth and CA, and stress of the PDLs were analyzed.
RESULTS: For the central incisor under condition L14 and for the canine under conditions L11, L13, L23, and L33, the intrusion amount was negative. Under other conditions, the intrusion amount was positive. The labiolingual angulation of maxillary anterior teeth exhibited positive changes under all conditions, with greater changes under linguoincisal loading. The mesiodistal angulation of canine exhibited positive changes under labial loading, while negative changes under linguoincisal loading except for condition L14.
CONCLUSIONS: The intrusion amount, labiolingual and mesiodistal angulations of the maxillary anterior teeth were affected by the mini-implant site, loading site, and loading mode. Labial and linguoincisal loading may have opposite effects on the intrusion amount of maxillary anterior teeth and the mesiodistal angulation of canine. The labiolingual angulation of the maxillary incisors would increase under all intrusion modes, with greater increases under linguoincisal loading.

This study aims to refine clinical designs within clear aligner therapy, exploring the appropriate ratio of anterior tooth retraction to intrusion under maximum anchorage. Using a three-dimensional finite element model and evaluating 19 load scenarios with first premolar extraction, the research identifies the optimal force angle for anterior tooth retraction as 45 to 55°. For clinical planning, it is recommended to design a retraction of 0.19 mm combined with an intrusion of 0.16 mm to achieve anterior tooth retraction. This investigation is crucial for enhancing understanding of biomechanical principles in clear aligner orthodontics, offering significant insights for effective treatments.

BACKGROUND: Prefabricated myofunctional appliance can guide tooth eruption, improve dentition alignment, correct myofunctional disorders and harmful oral habits. However, its application to skeletal discrepancy may result in unsatisfactory tooth inclination. This study aimed to construct a novel appliance with overjet design to avoid this side effect and investigated its shape and mechanical changes under occlusion using three-dimensional finite element method.
METHODS: We established three samples of prefabricated myofunctional appliances. The first one was edge to edge without overjet, and the outer shield of both jaws were flattened. The second one was 3 mm overjet with stepped the outer shield. The last one was 3 mm overjet, and the outer shield of both jaws were flatted, which meant the front wall of lower jaw was strengthened with bumper, termed as lower bumper. A complete dentition model was applied to the study. 150 N occlusal force was applied to each type of appliance and the deformation displacement and the changes in stress was recorded.
RESULTS: The deformation was significant in the incisors regions, especially in the vertical and lateral dimensions. The maximum displacements of 3 mm overjet with step shield group were 7.08 mm (vertical), 3.99 mm (lateral), and 2.90 mm (sagittal), while it decreased to 3.92 mm(vertical), 1.94 mm (lateral), and 1.55 mm (sagittal) in overjet with bumper group. Moreover, the upper molar regions exhibited higher vertical and sagittal displacement in 3 mm overjet with step shield group, which were 3.03 mm (vertical) and 1.99 mm (sagittal), and the bumper design could decrease the maximum displacement to 1.72 mm (vertical) and 0.72 mm (sagittal). In addition, the Von Mises stress of appliances was analyzed, and results indicated that 3 mm overjet with step shield generated higher stress than other groups, with the maximum Von Mises stress was 0.9387 MP, which were 0.5858 and 0.5657 MP in edge to edge group and 3 mm overjet with lower bumper group, respectively.
CONCLUSIONS: The prefabricated myofunctional appliances may cause deformation during occlusion. Compared to step shield group, the application of lower bumper exhibited better resistance to occlusal force.

OBJECTIVE: The biomechanics in achieving molar distalization may differ between fixed appliances and clear aligners in the control of tooth movement. The objective of this study was to compare the treatment effects between clear aligners (CA) and fixed appliances (FA) in patients treated with miniscrew-assisted molar distalization.
METHODS: The sample consisted of 46 subjects with mild-to-moderate crowding. A total of 22 patients treated with clear aligners (age, 25.66 ± 6.11 years old) and 24 patients treated with fixed appliances (age, 24.04 ± 4.95 years old) for miniscrew-assisted molar distalization were included in this study. The dental and skeletal changes were evaluated by the pre- and post-treatment lateral cephalograms.
RESULTS: Significant changes were found with the vertical variables SN-OP angle (2.24 ± 3.22°, P < .05) and SN-MP angle (0.73 ± 1.15°, P < .05) for the FA group when compared with the CA group (SN-OP angle 0.41 ± 2.26° and SN-MP angle -0.21 ± 1.38°, P > .05). Both treatment groups achieved a 2-3 mm. molar distalization with significant intrusion of the upper molars. The CA group showed significantly less distal tipping of molars (U6^PP angle -2.29 ± 3.29° and L6^MP angle -2.92 ± 2.49°, P < .05) compared to the FA group (-5.24 ± 4.28° and -5.53 ± 5.03°, P < .05). In addition, significant retraction and lingual inclination of the upper and lower incisors were found in both groups.
CONCLUSIONS: The changes of tooth position were evaluated by 2D lateral cephalograms, not 3D measurements.
CONCLUSIONS: Compared to fixed appliances, clear aligners seemed to have better control of vertical dimension and distal tipping of molars in patients treated with miniscrew-assisted molar distalization.

BACKGROUND: This study aimed to evaluate the effects of varying auxiliaries on tooth movement and stress distribution when maxillary central incisors were torqued 1° with a clear aligner through finite element analysis.
METHODS: Three-dimensional finite element models, including maxillary alveolar bone, periodontal ligament, dentition, and clear aligner, were constructed. According to the auxiliaries designed on the maxillary central incisor, 5 models were created: (1) without auxiliaries (control model), (2) with the power ridge, (3) with the semi-ellipsoid attachment, (4) with the horizontal rectangular attachment, and (5) with the horizontal cylinder attachment. The tooth movement and periodontal ligament stress distribution after a palatal root torque of 1° were analyzed for each of the 5 models.
RESULTS: With 1° torque predicted, the maxillary central incisor without auxiliaries showed a tendency of labial tipping, mesial tipping, and intrusion. The rotation center moved occlusally in the power ridge model. The labiolingual inclination variation increased in the semi-ellipsoid attachment model but decreased in the power ridge model. The maxillary central incisor is twisted in the distal direction in the power ridge model. The maxillary central incisor of the horizontal rectangular attachment and the horizontal cylinder attachment model behaved similarly to the control model. Periodontal stresses were concentrated in the cervical and apical areas. The maximum von Mises stresses were 11.6, 12.4, 3.81, 1.14, and 11.0 kPa in the 5 models. The semi-ellipsoid attachment model exhibited a more uniform stress distribution than the other models.
CONCLUSIONS: Semi-ellipsoid attachment performed better efficacy on labiolingual inclination, and power ridge performed better efficacy on root control. However, a distal twist of maxillary incisors could be generated by the power ridge.

BACKGROUND: The purpose of this study was to evaluate the therapeutic effect of modified clear Twin Block (CTB) aligner and traditional twin block (TB) appliance from skeletal, dentoalveolar and soft tissue changes in adolescents with skeletal class II malocclusion.
METHODS: A total of 80 adolescents, included in this study from two medical centres, were distributed into CTB group, TB group and control group based on the treatment they received. Lateral cephalograms at pre-treatment (T1) and post-treatment (T2) were measured by modified Pancherz\'s cephalometric analysis, and dentoskeletal and soft tissue changes were analysed by independent-sample t-test, paired-sample t-test, ANOVA test and Scheffe\'s Post Hoc test.
RESULTS: Seventy-five adolescents completed the study, including 32 in the CTB group, 32 in the TB group and 11 in the control group. Both CTB and TB treatment showed significant differences in most dentoskeletal and soft tissue measurements. Compared with the control group, improvements were observed in class II molar relationship through significant different in S Vert/Ms-S Vert/Mi in the CTB group (P < .01) and the TB group (P < .001), as well as deep overjet through significant different in S Vert/Is-S Vert/Ii in the CTB group (P < .001) and the TB group (P < .001). Besides, the CTB group also showed less protrusion of lower incisors and resulted in a more significant improvement in profile with fewer adverse effects on speaking, eating and social activities.
CONCLUSIONS: For adolescents with skeletal class II malocclusion, CTB appliance was as effective as TB on improving dentoskeletal and soft tissue measurements, featuring more reliable teeth control and patient acceptance.

To study the values of mini-implant anchorage in orthodontics for children in the mixed dentition stage, 78 children in the mixed dentition stage who had accepted orthodontic treatment in our hospital from January 2020 to January 2021 were enrolled into this study. All children were treated with straight-wire appliance. According to their anchorages, children were divided into observation group and control group based on the random number table. Children in the control group used face-bow to control the anchorages and children in the observation group used mini-implants to control the anchorages. After treatment, the upper central incisor convex distance difference, inclination angle of the upper central incisor, displacement of the molar, gingival health, masticatory function, treatment effect and adverse reaction rate of children in two groups were compared. One year after treatment, compared with children in the control group, children in the observation group had smaller the upper central incisor convex distance difference, inclination angle of the upper central incisor, displacement of the molar, small scores of plaque index (PLI), bleeding index (BI) and gingival index (GI), stronger biting force and higher masticatory efficiency, lower adverse reaction rate during treatment, better treatment effect, higher satisfaction of orthodontic treatment. And differences of all the above indexes were statistically significant (p < 0.05). Mini-implant anchorages have good stability and directive force, and have certain values in orthodontics for children in the mixed dentition stage.

BACKGROUND: The aim of this study is to conduct a comparative evaluation of different designs of clear aligners and examine the disparities between clear aligners and fixed appliances.
METHODS: 3D digital models were created, consisting of a maxillary dentition without first premolars, maxilla, periodontal ligaments, attachments, micro-implant, 3D printed lingual retractor, brackets, archwire and clear aligner. The study involved the creation of five design models for clear aligner maxillary anterior internal retraction and one design model for fixed appliance maxillary anterior internal retraction, which were subsequently subjected to finite element analysis. These design models included: (1) Model C0 Control, (2) Model C1 Posterior Micro-implant, (3) Model C2 Anterior Micro-implant, (4) Model C3 Palatal Plate, (5) Model C4 Lingual Retractor, and (6) Model F0 Fixed Appliance.
RESULTS: In the clear aligner models, a consistent pattern of tooth movement was observed. Notably, among all tested models, the modified clear aligner Model C3 exhibited the smallest differences in sagittal displacement of the crown-root of the central incisor, vertical displacement of the central incisor, sagittal displacement of the second premolar and second molar, as well as vertical displacement of posterior teeth. However, distinct variations in tooth movement trends were observed between the clear aligner models and the fixed appliance model. Furthermore, compared to the fixed appliance model, significant increases in tooth displacement were achieved with the use of clear aligner models.
CONCLUSIONS: In the clear aligner models, the movement trend of the teeth remained consistent, but there were variations in the amount of tooth displacement. Overall, the Model C3 exhibited better torque control and provided greater protection for posterior anchorage teeth compared to the other four clear aligner models. On the other hand, the fixed appliance model provides superior anterior torque control and better protection of the posterior anchorage teeth compared to clear aligner models. The clear aligner approach and the fixed appliance approach still exhibit a disparity; nevertheless, this study offers a developmental direction and establishes a theoretical foundation for future non-invasive, aesthetically pleasing, comfortable, and efficient modalities of clear aligner treatment.

Low-angle skeletal class II malocclusions are often observed with sagittal and vertical developmental abnormalities of the mandible. Two-phase orthodontic treatment of functional orthopedic therapy combined with fixed correction is one of the most common methods to treat of skeletal class II malocclusions. This case report describes the two-phase orthodontic treatment of a patient with severe low-angle skeletal class II malocclusion. A Twin Block orthodontic appliance was used to improve mandibular growth, and the adjustment of the occlusal relationship using a fixed appliance after functional therapy. After treatment, a significant improvement was observed in the patient\'s facial appearance and occlusal relationship. Additionally, a 7-year follow-up confirmed the stability of the treatment results. Although a vertical facial growth direction is difficult to control, the Twin Block orthodontic appliance in adolescents might effectively improve the difference in the sagittal growth of the mandible. Whilst the growth pattern could not be fully controlled, the treatment significantly improved the patient\'s facial profile and occlusion.