• The korean journal of orthodontics
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• v.51 no.6
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• pp.375-386
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• 2021

Objective: To evaluate the accuracy of a one-piece bracket jig system fabricated using computer-aided design and manufacturing (CAD/CAM) by employing three-dimensional (3D) digital superimposition. Methods: This in vitro study included 226 anterior teeth selected from 20 patients undergoing orthodontic treatment. Bracket position errors from each of the 40 arches were analyzed quantitatively via 3D digital superimposition (best-fit algorithm) of the virtual bracket and actual bracket after indirect bonding, after accounting for possible variables that may affect accuracy, such as crowding and presence of the resin base. Results: The device could transfer the bracket accurately to the desired position of the patient's dentition within a clinically acceptable range of ± 0.05 mm and 2.0° for linear and angular measurements, respectively. The average linear measurements ranged from 0.029 to 0.101 mm. Among the angular measurements, rotation values showed the least deviation and ranged from 0.396° to 0.623°. Directional bias was pronounced in the vertical direction, and many brackets were bonded toward the occlusal surface. However, no statistical difference was found for the three angular measurement values (torque, angulation, and rotation) in any of the groups classified according to crowding. When the teeth were moderately crowded, the mesio-distal, bucco-lingual, and rotation measurement values were affected by the presence of the resin base. Conclusions: The characteristics of the CAD/CAM one-piece jig system were demonstrated according to the influencing factors, and the transfer accuracy was verified to be within a clinically acceptable level for the indirect bracket bonding of anterior teeth.

• The korean journal of orthodontics
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• v.51 no.6
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• pp.407-418
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• 2021

Objective: To investigate differences in the heritability of skeletodental characteristics between twin pairs with skeletal Class I and Class II malocclusions. Methods: Forty Korean adult twin pairs were divided into Class I (C-I) group (0° ≤ angle between point A, nasion, and point B [ANB]) ≤ 4°; mean age, 40.7 years) and Class II (C-II) group (ANB > 4°; mean age, 43.0 years). Each group comprised 14 monozygotic and 6 dizygotic twin pairs. Thirty-three cephalometric variables were measured using lateral cephalograms and were categorized as the anteroposterior, vertical, dental, mandible, and cranial base characteristics. The ACE model was used to calculate heritability (A > 0.7, high heritability). Thereafter, principal component analysis (PCA) was performed. Results: Twin pairs in C-I group exhibited high heritability values in the facial anteroposterior characteristics, inclination of the maxillary and mandibular incisors, mandibular body length, and cranial base angles. Twin pairs in C-II group showed high heritability values in vertical facial height, ramus height, effective mandibular length, and cranial base length. PCA extracted eight components with 88.3% in the C-I group and seven components with 91.0% cumulative explanation in the C-II group. Conclusions: Differences in the heritability of skeletodental characteristics between twin pairs with skeletal Class I and II malocclusions might provide valuable information for growth prediction and treatment planning.

• The korean journal of orthodontics
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• v.51 no.6
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• pp.419-427
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• 2021

Objective: The purpose of this study was to evaluate the esthetic preference for various Korean silhouette profiles. Methods: The Korean average male and female profiles were modified by changing the lower facial height and anteroposterior lip position to produce nine types of profiles. In order to test intrarater reliability, the average profile was copied once more to be included for evaluation. A questionnaire containing 10 profiles for each sex, each of which had to be rated for preference on a numerical rating scale from 0 to 10, was administered to 30 adult orthodontic patients, 30 dental students, 30 orthodontists, and 30 dentists excluding orthodontists. The data were statistically analyzed using the intraclass correlation coefficient (ICC), independent t-test, and one-way ANOVA. Results: The ICC of overall intrarater reliability was 0.629. For several profiles, significantly higher scores were given to male profiles than to female profiles (p < 0.05). However, no significant differences were found in the scores for all profiles among the four rater groups. Among the short profiles, a significantly higher score was given to the retruded profile, and among the vertically average and long profiles, a significantly higher score was given to the horizontally average profile (p < 0.001). Among all the profiles, significantly lower scores were given to the protruded profile (p < 0.001). Conclusions: This study revealed good overall intrarater reliability, with several types of male profiles being esthetically preferred over female profiles. Moreover, while retruded and horizontally average profiles were generally preferred, protruded profiles were not.

• The korean journal of orthodontics
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• v.51 no.4
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• pp.250-259
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• 2021

Objective: The aim of this study was to compare the differences in mandibular posterior anatomic limit (MPAL) distances stratified by vertical patterns in patients with skeletal Class III malocclusion by using cone-beam computed tomography (CBCT). Methods: CBCT images of 48 patients with skeletal Class III malocclusion (mean age, 22.8 ± 3.1 years) categorized according to the vertical patterns (hypodivergent, normodivergent, and hyperdivergent; n = 16 per group) were analyzed. While parallel to the posterior occlusal line, the shortest linear distances from the distal root of the mandibular second molar to the inner cortex of the mandibular body were measured at depths of 4, 6, and 8 mm from the cementoenamel junction. MPAL distances were compared between the three groups, and their correlations were analyzed. Results: The mean ages, sex distribution, asymmetry, and crowding in the three groups showed no significant differences. MPAL distance was significantly longer in male (3.8 ± 2.6 mm) than in female (1.8 ± 1.2 mm) at the 8-mm root level. At all root levels, MPAL distances were significantly different in the hypodivergent and hyperdivergent groups (p < 0.001) and between the normodivergent and hyperdivergent groups (p < 0.01). MPAL distances were the shortest in the hyperdivergent group. The mandibular plane angle highly correlated with MPAL distances at all root levels (p < 0.01). Conclusions: MPAL distances were the shortest in patients with hyperdivergent patterns and showed a decreasing tendency as the mandibular plane angle increased. MPAL distances were significantly shorter (~3.16 mm) at the 8-mm root level.

• The korean journal of orthodontics
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• v.51 no.4
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• pp.260-269
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• 2021

Objective: To identify the most favorable sites that optimize the initial stability and survival rate of orthodontic mini-implants, this study measured hard and soft tissue thicknesses in the median and paramedian regions of the palate using cone-beam computed tomography (CBCT) and determined possible sex- and age-related differences in these thicknesses. Methods: The study sample comprised CBCT images of 189 healthy subjects. The sample was divided into four groups according to age. A grid area was set for the measurement of hard and soft tissue thicknesses in the palate. Vertical lines were marked at intervals of 0, 1.5, and 3.0 mm lateral to the midpalatal suture, while horizontal lines were marked at 2-mm intervals up to 24 mm from the posterior margin of the incisive foramen. Measurements were made at 65 points of intersection between the horizontal and vertical lines. Results: The palatal hard tissue thickness decreased from the anterior to the posterior region, with a decrease in the medial-to-lateral direction in the middle and posterior regions. While the soft tissue was rather thick around the lateral aspects of the palatal arch, it formed a constant layer that was only 1-2-mm thick throughout the palate. Statistically significant differences were observed according to sex and age. Conclusions: The anterolateral palate as well as the midpalatal suture seem to be the most favorable sites for insertion of orthodontic mini-implants. The thickness of the palate differed by age and sex; these differences should be considered while planning the placement of orthodontic mini-implants.

• The korean journal of orthodontics
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• v.51 no.4
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• pp.270-281
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• 2021

Objective: The aim of this in vitro study was to evaluate the changes in friction between orthodontic brackets and archwires coated with aluminum oxide (Al₂O₃), titanium nitride (TiN), or chromium nitride (CrN). In addition, the resistance of the coatings to intraoral conditions was evaluated. Methods: Stainless steel canine brackets, 0.016-inch round nickel-titanium archwires, and 0.019 × 0.025-inch stainless steel archwires were coated with Al₂O₃, TiN, and CrN using radio frequency magnetron sputtering. The coated materials were examined using scanning electron microscopy, an X-ray diffractometer, atomic force microscopy, and surface profilometry. In addition, the samples were subjected to thermal cycling and in vitro brushing tests, and the effects of the simulated intraoral conditions on the coating structure were evaluated. Results: Coating of the metal bracket as well as nickel-titanium archwire with Al₂O₃ reduced the coefficients of friction (CoFs) for the bracket-archwire combination (p < 0.01). When the bracket and stainless steel archwire were coated with Al₂O₃ and TiN, the CoFs were significantly lower (0.207 and 0.372, respectively) than that recorded when this bracket-archwire combination was left uncoated (0.552; p < 0.01). The friction, thermal, and brushing tests did not deteriorate the overall quality of the Al₂O₃ coatings; however, some small areas of peeling were evident for the TiN coatings, whereas comparatively larger areas of peeling were observed for the CrN coatings. Conclusions: Our findings suggest that the CoFs for metal bracket-archwire combinations used in orthodontic treatment can be decreased by coating with Al₂O₃ and TiN thin films.

• The korean journal of orthodontics
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• v.49 no.6
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• pp.349-359
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• 2019

Objective: The aim of this study was to analyze three-dimensional (3D) changes in maxillary dentition in Class II malocclusion treatment using arch wire with continuous tip-back bends or compensating curve, together with intermaxillary elastics by superimposing 3D virtual models. Methods: The subjects were 20 patients (2 men and 18 women; mean age 20 years 7 months ${\pm}$ 3 years 9 months) with Class II malocclusion treated using $0.016{\times}0.022-inch$ multiloop edgewise arch wire with continuous tip-back bends or titanium molybdenum alloy ideal arch wire with compensating curve, together with intermaxillary elastics. Linear and angular measurements were performed to investigate maxillary teeth displacement by superimposing pre- and post-treatment 3D virtual models using Rapidform 2006 and analyzing the results using paired t-tests. Results: There were posterior displacement of maxillary teeth (p < 0.01) with distal crown tipping of canine, second premolar and first molar (p < 0.05), expansion of maxillary arch (p < 0.05) with buccoversion of second premolar and first molar (p < 0.01), and distal-in rotation of first molar (p < 0.01). Reduced angular difference between anterior and posterior occlusal planes (p < 0.001), with extrusion of anterior teeth (p < 0.05) and intrusion of second premolar and first molar (p < 0.001) was observed. Conclusions: Class II treatment using an arch wire with continuous tip-back bends or a compensating curve, together with intermaxillary elastics, could retract and expand maxillary dentition, and reduce occlusal curvature. These results will help clinicians in understanding the mechanism of this Class II treatment.

• The korean journal of orthodontics
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• v.51 no.1
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• pp.43-54
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• 2021

Objective: To investigate the cephalometric predictors of the future need for orthognathic surgery in Korean patients with unilateral cleft lip and palate (UCLP) despite long-term use of facemask with miniplate (FMMP). Methods: The sample consisted of 53 UCLP patients treated by a single orthodontist using an identical protocol. Lateral cephalograms were taken before commencement of FMMP therapy (T0; mean age, 10.45 years), after FMMP therapy (T1; mean age, 14.72 years), and at follow-up (T2; mean age, 18.68 years). Twenty-eight cephalometric variables were measured. At T2 stage, the subjects were divided into FMMP-Nonsurgery (n = 33, 62.3%) and FMMP-Surgery (n = 20, 37.7%) groups according to cephalometric criteria (point A-nasion-point B [ANB] < -3°; Wits-appraisal < -5 mm; and Harvold unit difference [HUD] > 34 mm for FMMP-Surgery group). Statistical analyses including discrimination analysis were performed. Results: In FMMP-Surgery group, the forward position of the mandible at T0 stage was maintained throughout the whole stages and Class III relationship worsened with significant growth of the mandibular body and ramus and counterclockwise rotation of the maxilla and mandible at the T1 and T2 stages. Six cephalometric variables at T0 stage including ANB, anteroposterior dysplasia indicator, Wits-appraisal, mandibular body length, HUD, and overjet were selected as effective predictors of the future need for surgical intervention to correct sagittal skeletal discrepancies. Conclusions: Despite long-term use of FMMP therapy, 37.7% of UCLP patients became candidates for orthognathic surgery. Therefore, differential diagnosis is necessary to predict the future need for orthognathic surgery at early age.

• The korean journal of orthodontics
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• v.51 no.2
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• pp.115-125
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• 2021

Objective: To evaluate the reasons influencing the preferences for a certain type of orthodontic appliance over another among prospective patients (PP) and orthodontists. Methods: A total of 49 PP and 51 orthodontists were asked about their preferences for the following appliances: clear aligners (CA), lingual metallic brackets (LMB), polycrystalline and monocrystalline ceramic brackets, and buccal metallic brackets (BMB). The participants rated the importance of 17 potential reasons that would explain their choices. The reasons that contributed most to these preferences were identified. Non-parametric tests (Fisher's exact, χ2 and Mann-Whitney tests) and multivariate analyses (regression and discriminant analysis) were used to assess the data (α = 0.05). Results: CA and BMB were the most chosen appliances by PP and orthodontists, respectively. LMB was the most rejected option among both groups of participants (p < 0.001). Rates of the importance of pain/discomfort, smile esthetics, finishing details, and feeding/speech impairment showed the highest differences between PP and orthodontists (p < 0.0005). Discriminant analyses showed that individuals who considered treatment time and smile esthetics as more important were more likely to prefer CA, while those who prioritized finishing details and cost were more likely to choose BMB (p < 0.05). Conclusions: Reasons related to comfort and quality of life during use were considered as more important by PP, while those related to the results and clinical performance of the appliances were considered as more relevant by orthodontists.

• The korean journal of orthodontics
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• v.51 no.2
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• pp.77-85
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• 2021

Objective: To evaluate the accuracy of a multi-stage convolutional neural network (CNN) model-based automated identification system for posteroanterior (PA) cephalometric landmarks. Methods: The multi-stage CNN model was implemented with a personal computer. A total of 430 PA-cephalograms synthesized from cone-beam computed tomography scans (CBCT-PA) were selected as samples. Twenty-three landmarks used for Tweemac analysis were manually identified on all CBCT-PA images by a single examiner. Intra-examiner reproducibility was confirmed by repeating the identification on 85 randomly selected images, which were subsequently set as test data, with a two-week interval before training. For initial learning stage of the multi-stage CNN model, the data from 345 of 430 CBCT-PA images were used, after which the multi-stage CNN model was tested with previous 85 images. The first manual identification on these 85 images was set as a truth ground. The mean radial error (MRE) and successful detection rate (SDR) were calculated to evaluate the errors in manual identification and artificial intelligence (AI) prediction. Results: The AI showed an average MRE of 2.23 ± 2.02 mm with an SDR of 60.88% for errors of 2 mm or lower. However, in a comparison of the repetitive task, the AI predicted landmarks at the same position, while the MRE for the repeated manual identification was 1.31 ± 0.94 mm. Conclusions: Automated identification for CBCT-synthesized PA cephalometric landmarks did not sufficiently achieve the clinically favorable error range of less than 2 mm. However, AI landmark identification on PA cephalograms showed better consistency than manual identification.