Clinical guidelines to integrate temporary anchorage devices for bone-borne orthodontic appliances in the digital workflow

Graf, Simon; Hansa, Ismaeel

doi:10.25259/apos_78_2019

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…Many case reports describe the application of this protocol, but studies with larger samples are needed to establish the efficiency and the applicability of these techniques in the daily practice. These studies report some complications ascribable to the misfit between the planned and the positioned miniscrews but fail to quantify them [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of the digital workflow for guided insertion of orthodontic palatal TADs: a step-by-step 3D analysis

et al. 2022

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Background The introduction in the orthodontic field of the digital workflow for guided insertion of palatal TADs and the development of the 1-visit protocol led to the reduction of chair time and the possibility of complete customization of designs and materials. Conversely, the reduction of operative steps implicates a lower tolerance of deviations between the planned and the actual position of the miniscrews, particularly when the orthodontic device is fixed on 4 palatal TADs or has a rigid structure. This study aims to analyze the influence of each step of the digital workflow on the deviation of the miniscrews’ axis of insertion in a bicortical sample. The null hypothesis is that there are no significant differences in the deviations among the operative steps. Methods 33 subjects were selected for insertion of bicortical palatal miniscrews with a 1-visit protocol. Digital files were collected at the three stages of the workflow (i.e., digital planning, laboratory prototype, post-insertion impression). A 3D software analysis was performed on a total of 64 miniscrews. After automatic shape recognition of the guiding holes of the digital plan and the scanbodies of the laboratory prototype and post-insertion impression as geometric cylinders, their three-dimensional longitudinal axis was traced and the deviation among them was calculated. Friedman test with Bonferroni correction was performed to assess the significance of the deviations among the three steps, with significance set at p < 0.05. Results The laboratory step has a significantly lower degree of deviations (2.12° ± 1.62) than both the clinical step (6.23° ± 3.75) and the total deviations (5.70° ± 3.42). No significant differences were found between miniscrews inserted on the left or the right side. Conclusions This study suggests that laboratory procedures such as surgical guide production or rapid prototyping don’t play a significant role in the degree of deviations between the planned and the positioned palatal TADs. Conversely, the clinical steps have a bigger influence and need to be carefully evaluated. Despite this difference, there is a cumulative effect of deviations that can lead to the failure of the 1-visit protocol.

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Section: Introductionmentioning

confidence: 99%

Accuracy of the digital workflow for guided insertion of orthodontic palatal TADs: a step-by-step 3D analysis

et al. 2022

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“…14 Recently, the digital planning of MARPE has offered unique advantages in terms of safety of implant placement. [15][16][17][18][19] However, treatment of patients with a thin posterior palatal bone remains challenging.…”

Section: Introductionmentioning

confidence: 99%

Digital Planning and Manufacturing of Maxillary Skeletal Expander for Patients with Thin Palatal Bone

Cantarella

Karanxha

Zanata

et al. 2021

MDER

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The miniscrew-assisted rapid palatal expansion approach has given new opportunities for the treatment of maxilla transverse deficiency by providing an alternative to the surgical approach for adult patients. However, the presence of a thin palatal bone can compromise the success of such approach. Recently, the digital planning of the miniscrew-assisted appliances has offered unique advantages in terms of safety and accuracy of the overall process. The aim of this study is to describe the digital planning and MSE fabrication with cad-cam technology using 6 mini-screws in cases with a palatal bone thickness of less than 2.5 mm.

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“…On the other hand, technology innovation has impacted orthodontics with digital workflows for planning and fabricating miniscrew-supported appliances. A digital planning process involves the utilization of the intraoral scanning file and the cone beam computed tomography (CBCT) imaging of maxillary bone for determining the miniscrew position and designing the appliance structure [6]. Additive manufacturing (AM) is used afterwards for the fabrication of the appliance [7].…”

Section: Introductionmentioning

confidence: 99%

“…Secondly, it enhances the accuracy of the planning process by allowing a better assessment of the miniscrew insertion sites on the basis of patient's CBCT. In this way, a more appropriate temporary anchorage device (TAD) insertion site in terms of bone thickness can be chosen, and any possible damage to nearby structures during miniscrew insertion can be avoided [6]. Thirdly, the AM technology allows for a complete customization of the appliance for each case [9].…”

Section: Introductionmentioning

confidence: 99%

Digital Workflow for 3D Design and Additive Manufacturing of a New Miniscrew-Supported Appliance for Orthodontic Tooth Movement

et al. 2021

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The introduction of digital workflows and their combination with miniscrew assisted appliances has opened new and enthusiastic perspectives in modern orthodontics. However, in all digital workflows currently in use for orthodontic tooth movement, the miniscrews are inserted first in the maxillary bone, often by means of a surgical guide, and then the appliance is fabricated and secured over the miniscrews with different fixation mechanisms. By doing so, some adaptation problems can be encountered while securing the appliance over the miniscrews, and the chairside time required can therefore be significant. In the present study, we introduce a digital workflow for the design and fabrication of a new appliance, customized on the individual morphology of maxillary bone by using patient Cone Beam Computed Tomography CBCT, for sagittal and vertical orthodontic tooth movement (DIVA, divergent anchors). Differently from the existing protocols, the appliance is cemented first intraorally, serving as a surgical guide for the subsequent insertion of miniscrews. In this way, the adaptation problems are avoided and the chair-side time is reduced.

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Clinical guidelines to integrate temporary anchorage devices for bone-borne orthodontic appliances in the digital workflow

Cited by 6 publications

References 19 publications

Accuracy of the digital workflow for guided insertion of orthodontic palatal TADs: a step-by-step 3D analysis

Accuracy of the digital workflow for guided insertion of orthodontic palatal TADs: a step-by-step 3D analysis

Digital Planning and Manufacturing of Maxillary Skeletal Expander for Patients with Thin Palatal Bone

Digital Workflow for 3D Design and Additive Manufacturing of a New Miniscrew-Supported Appliance for Orthodontic Tooth Movement

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