Application of Bioengineering to Clinical Orthodontics

A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Biomedical Engineering and Biomaterials".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 15650

Special Issue Editor

Division of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
Interests: orthodontic tooth movement; bone biology; periodontal tissue remodeling

Special Issue Information

Dear Colleagues,

The World Health Organization (WHO) considers malocclusion one of the most important oral health problems. It is not only young patients who have orthodontic treatment needs, but also quite a few of adults. During orthodontic treatment, alveolar bone and periodontal tissues undergo remodeling under mechanical force loading. With the recent technology development, remarkable breakthroughs have been achieved in the fields of dental tissue engineering, introducing exciting changes to the field of orthodontics. On the other hand, research on the mechanism of orthodontic tooth movement is also providing input to other dental fields and fields beyond dentistry that involve bone biology.  

This Special Issue aims to publish high-quality original research work, case reports, as well as reviews on the range of bioengineering methods and their applications in orthodontics and bone remodeling. Topics of interest include but are not limited to:

  • Application of bioengineering models for tooth movement;
  • Biomolecular and cellular mechanisms in orthodontics;
  • Computational approaches in tooth movement;
  • Orthodontic biomechanics.

Dr. Yanqi Yang
Guest Editor

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Keywords

  • tooth movement
  • biomechanics
  • orthodontics
  • tissue engineering
  • bone biology
  • mechanical loading

Published Papers (11 papers)

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Research

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12 pages, 6255 KiB  
Article
Finite Element Analysis of Fixed Orthodontic Retainers
by Sebastian Hetzler, Stefan Rues, Andreas Zenthöfer, Peter Rammelsberg, Christopher J. Lux and Christoph J. Roser
Bioengineering 2024, 11(4), 394; https://doi.org/10.3390/bioengineering11040394 - 18 Apr 2024
Viewed by 805
Abstract
The efficacy of retainers is a pivotal concern in orthodontic care. This study examined the biomechanical behaviour of retainers, particularly the influence of retainer stiffness and tooth resilience on force transmission and stress distribution. To do this, a finite element model was created [...] Read more.
The efficacy of retainers is a pivotal concern in orthodontic care. This study examined the biomechanical behaviour of retainers, particularly the influence of retainer stiffness and tooth resilience on force transmission and stress distribution. To do this, a finite element model was created of the lower jaw from the left to the right canine with a retainer attached on the oral side. Three levels of tooth resilience and variable retainer bending stiffness (influenced by retainer type, retainer diameter, and retainer material) were simulated. Applying axial or oblique (45° tilt) loads on a central incisor, the force transmission increased from 2% to 65% with increasing tooth resilience and retainer stiffness. Additionally, a smaller retainer diameter reduced the uniformity of the stress distribution in the bonding interfaces, causing concentrated stress peaks within a small field of the bonding area. An increase in retainer stiffness and in tooth resilience as well as a more oblique load direction all lead to higher overall stress in the adhesive bonding area associated with a higher risk of retainer bonding failure. Therefore, it might be recommended to avoid the use of retainers that are excessively stiff, especially in cases with high tooth resilience. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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16 pages, 11275 KiB  
Article
Biomechanical Simulation of Orthodontic En-Bloc Retraction Comparing Compound Technique and Sliding Mechanics Using a HOSEA Robotic Device
by Hisham Sabbagh, Ellen Haas, Uwe Baumert, Corinna Lesley Seidel, Linus Hötzel and Andrea Wichelhaus
Bioengineering 2024, 11(2), 153; https://doi.org/10.3390/bioengineering11020153 - 2 Feb 2024
Cited by 1 | Viewed by 891
Abstract
En-bloc retraction is a common procedure in orthodontic therapy. The application of palatal root torque moments is required to control incisor inclination during retraction, yet studies comparing forces and moments with respect to different mechanics are lacking. This study aimed to investigate the [...] Read more.
En-bloc retraction is a common procedure in orthodontic therapy. The application of palatal root torque moments is required to control incisor inclination during retraction, yet studies comparing forces and moments with respect to different mechanics are lacking. This study aimed to investigate the forces and moments during orthodontic en-bloc retraction using a robotic biomechanical simulation system, comparing two distinct approaches: (I) compound technique [stainless steel (SS) combined with nickel-titanium (NiTi)] using industrially pretorqued retraction-torque-archwires (RTA) in combination with NiTi closed coil springs; (II) conventional sliding mechanics using SS archwires with manually applied anterior twist bends in combination with elastic chains. Two dimensions (0.017” × 0.025” and 0.018” × 0.025”) and ten archwires per group were investigated using 0.022” slot self-ligating brackets. Kruskal–Wallis tests with a significance level of α = 0.05 were conducted. The biomechanical simulation showed that en-bloc retraction was characterized by a series of tipping and uprighting movements, differing significantly regarding the examined mechanics. Collateral forces and moments occurred in all groups. Notably, RTA exhibited fewer extrusive forces. The most bodily movement was achieved with the compound technique and the 0.018” × 0.025” RTA. Sliding mechanics exhibited maximum palatal root torque moments of more than 20 Nmm, exceeding recommended values. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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14 pages, 9009 KiB  
Article
Effect of Different Anchorage Reinforcement Methods on Long-Term Maxillary Whole Arch Distalization with Clear Aligner: A 4D Finite Element Study with Staging Simulation
by Bochun Mao, Yajing Tian, Yujia Xiao, Jiayi Liu, Dawei Liu, Yanheng Zhou and Jing Li
Bioengineering 2024, 11(1), 3; https://doi.org/10.3390/bioengineering11010003 - 20 Dec 2023
Cited by 1 | Viewed by 1217
Abstract
The objective of this study was to examine how various anchorage methods impact long-term maxillary whole arch distalization using clear aligners (CAs) through an automated staging simulation. Three different anchorage reinforcement methods, namely, Class II elastics, buccal temporary anchorage device (TAD), and palatal [...] Read more.
The objective of this study was to examine how various anchorage methods impact long-term maxillary whole arch distalization using clear aligners (CAs) through an automated staging simulation. Three different anchorage reinforcement methods, namely, Class II elastics, buccal temporary anchorage device (TAD), and palatal TAD, were designed. Orthodontic tooth movement induced by orthodontic forces was simulated using an iterative computation method. Additionally, the automatic adjustment of the CA was simulated through the application of the thermal expansion method. The results indicated that the palatal TAD group had the largest retraction of incisors, followed by the buccal TAD group and the Class II elastic group, while the least was in the control group. The largest distal displacements and efficiency of molar distalization for the first and the second molars were noticed in the palatal TAD group. Arch width increased at the molar and premolar levels in all groups. The FEM results suggested palatal TAD had the best performance considering anterior teeth anchorage maintenance, both sagittally and vertically. However, attention should be paid to the possible increasement of arch width. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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18 pages, 8736 KiB  
Article
Investigation of Forces and Moments during Orthodontic Tooth Intrusion Using Robot Orthodontic Measurement and Simulation System (ROSS)
by Corinna L. Seidel, Julian Lipp, Benedikt Dotzer, Mila Janjic Rankovic, Matthias Mertmann, Andrea Wichelhaus and Hisham Sabbagh
Bioengineering 2023, 10(12), 1356; https://doi.org/10.3390/bioengineering10121356 - 25 Nov 2023
Viewed by 872
Abstract
The Robot Orthodontic Measurement and Simulation System (ROSS) is a novel biomechanical, dynamic, self-regulating setup for the simulation of tooth movement. The intrusion of the front teeth with forces greater than 0.5 N poses a risk for orthodontic-induced inflammatory root resorption (OIIRR). The [...] Read more.
The Robot Orthodontic Measurement and Simulation System (ROSS) is a novel biomechanical, dynamic, self-regulating setup for the simulation of tooth movement. The intrusion of the front teeth with forces greater than 0.5 N poses a risk for orthodontic-induced inflammatory root resorption (OIIRR). The aim was to investigate forces and moments during simulated tooth intrusion using ROSS. Five specimens of sixteen unmodified NiTi archwires and seven NiTi archwires with intrusion steps from different manufacturers (Forestadent, Ormco, Dentsply Sirona) with a 0.012″/0.014″/0.016″ wire dimension were tested. Overall, a higher wire dimension correlated with greater intrusive forces Fz (0.012″: 0.561–0.690 N; 0.014″: 0.996–1.321 N; 0.016″: 1.44–2.254 N) and protruding moments Mx (0.012″: −2.65 to −3.922 Nmm; 0.014″: −4.753 to −7.384 Nmm; 0.016″: −5.556 to −11.466 Nmm) during the simulated intrusion of a 1.6 mm-extruded upper incisor. However, the ‘intrusion efficiency’ parameter was greater for smaller wire dimensions. Modification with intrusion steps led to an overcompensation of the intrusion distance; however, it led to a severe increase in Fz and Mx, e.g., the Sentalloy 0.016″ medium (Dentsply Sirona) exerted 2.891 N and −19.437 Nmm. To reduce the risk for OIIRR, 0.014″ NiTi archwires can be applied for initial aligning (without vertical challenges), and intrusion steps for the vertical levelling of extruded teeth should be bent in the initial archwire, i.e., 0.012″ NiTi. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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11 pages, 1497 KiB  
Article
Force-Controlled Biomechanical Simulation of Orthodontic Tooth Movement with Torque Archwires Using HOSEA (Hexapod for Orthodontic Simulation, Evaluation and Analysis)
by Ellen Haas, Andreas Schmid, Thomas Stocker, Andrea Wichelhaus and Hisham Sabbagh
Bioengineering 2023, 10(9), 1055; https://doi.org/10.3390/bioengineering10091055 - 7 Sep 2023
Cited by 3 | Viewed by 1307
Abstract
This study aimed to investigate the dynamic behavior of different torque archwires for fixed orthodontic treatment using an automated, force-controlled biomechanical simulation system. A novel biomechanical simulation system (HOSEA) was used to simulate dynamic tooth movements and measure torque expression of four different [...] Read more.
This study aimed to investigate the dynamic behavior of different torque archwires for fixed orthodontic treatment using an automated, force-controlled biomechanical simulation system. A novel biomechanical simulation system (HOSEA) was used to simulate dynamic tooth movements and measure torque expression of four different archwire groups: 0.017″ x 0.025″ torque segmented archwires (TSA) with 30° torque bending, 0.018″ x 0.025″ TSA with 45° torque bending, 0.017″ x 0.025″ stainless steel (SS) archwires with 30° torque bending and 0.018″ x 0.025″ SS with 30° torque bending (n = 10/group) used with 0.022″ self-ligating brackets. The Kruskal–Wallis test was used for statistical analysis (p < 0.050). The 0.018″ x 0.025″ SS archwires produced the highest initial rotational torque moment (My) of −9.835 Nmm. The reduction in rotational moment per degree (My/Ry) was significantly lower for TSA compared to SS archwires (p < 0.001). TSA 0.018″ x 0.025″ was the only group in which all archwires induced a min. 10° rotation in the simulation. Collateral forces and moments, especially Fx, Fz and Mx, occurred during torque application. The measured forces and moments were within a suitable range for the application of palatal root torque to incisors for the 0.018″ x 0.025″ archwires. The 0.018″ x 0.025″ TSA reliably achieved at least 10° incisal rotation without reactivation. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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15 pages, 4310 KiB  
Article
Deep Learning Models for Automatic Upper Airway Segmentation and Minimum Cross-Sectional Area Localisation in Two-Dimensional Images
by Guang Chu, Rongzhao Zhang, Yingqing He, Chun Hown Ng, Min Gu, Yiu Yan Leung, Hong He and Yanqi Yang
Bioengineering 2023, 10(8), 915; https://doi.org/10.3390/bioengineering10080915 - 2 Aug 2023
Viewed by 1371
Abstract
Objective: To develop and validate convolutional neural network algorithms for automatic upper airway segmentation and minimum cross-sectional area (CSAmin) localisation in two-dimensional (2D) radiographic airway images. Materials and Methods: Two hundred and one 2D airway images acquired using cone-beam computed tomography (CBCT) scanning [...] Read more.
Objective: To develop and validate convolutional neural network algorithms for automatic upper airway segmentation and minimum cross-sectional area (CSAmin) localisation in two-dimensional (2D) radiographic airway images. Materials and Methods: Two hundred and one 2D airway images acquired using cone-beam computed tomography (CBCT) scanning were randomly assigned to a test group (n = 161) to train artificial intelligence (AI) models and a validation group (n = 40) to evaluate the accuracy of AI processing. Four AI models, UNet18, UNet36, DeepLab50 and DeepLab101, were trained to automatically segment the upper airway 2D images in the test group. Precision, recall, Intersection over Union, the dice similarity coefficient and size difference were used to evaluate the performance of the AI-driven segmentation models. The CSAmin height in each image was manually determined using three-dimensional CBCT data. The nonlinear mathematical morphology technique was used to calculate the CSAmin level. Height errors were assessed to evaluate the CSAmin localisation accuracy in the validation group. The time consumed for airway segmentation and CSAmin localisation was compared between manual and AI processing methods. Results: The precision of all four segmentation models exceeded 90.0%. No significant differences were found in the accuracy of any AI models. The consistency of CSAmin localisation in specific segments between manual and AI processing was 0.944. AI processing was much more efficient than manual processing in terms of airway segmentation and CSAmin localisation. Conclusions: We successfully developed and validated a fully automatic AI-driven system for upper airway segmentation and CSAmin localisation using 2D radiographic airway images. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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12 pages, 1772 KiB  
Article
A Proposal for the Classification of Temporomandibular Joint Disc Deformity in Hemifacial Microsomia
by Xiaochen Xue, Zhixu Liu, Hongpu Wei and Xudong Wang
Bioengineering 2023, 10(5), 595; https://doi.org/10.3390/bioengineering10050595 - 16 May 2023
Cited by 1 | Viewed by 1183
Abstract
Hemifacial microsomia (HFM) is the second most common congenital craniofacial disease and has a wide spectrum of symptoms. The classic diagnostic criterion for hemifacial microsomia is the OMENS system, which was later refined to the OMENS+ system to include more anomalies. We analyzed [...] Read more.
Hemifacial microsomia (HFM) is the second most common congenital craniofacial disease and has a wide spectrum of symptoms. The classic diagnostic criterion for hemifacial microsomia is the OMENS system, which was later refined to the OMENS+ system to include more anomalies. We analyzed the data of 103 HFM patients with magnetic resonance imaging (MRI) for temporomandibular joint (TMJ) discs. The TMJ disc classification was defined into four types: D0 for normal disc size and shape; D1 for disc malformation with adequate length to cover the (reconstructed) condyle; D2 for disc malformation with inadequate length to cover the (reconstructed) condyle; and D3 for no obvious presence of a disc. Additionally, this disc classification was positively correlated with the mandible classification (correlation coefficient: 0.614, p < 0.01), ear classification (correlation coefficient: 0.242, p < 0.05), soft tissue classification (correlation coefficient: 0.291, p < 0.01), and facial cleft classification (correlation coefficient: 0.320, p < 0.01). In this study, an OMENS+D diagnostic criterion is proposed, confirming the conjecture that the development of the mandibular ramus, ear, soft tissue, and TMJ disc, as homologous and adjacent tissues, is affected to a similar degree in HFM patients. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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Review

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21 pages, 371 KiB  
Review
Effects of Plasma Treatment on the Strength of Bonding to Ceramic Surfaces in Orthodontics—A Comprehensive Review
by Elizabeth Gershater, Olivia Griswold, Brooke E. Talsania, Yu Zhang, Chun-Hsi Chung, Zhong Zheng and Chenshuang Li
Bioengineering 2023, 10(11), 1323; https://doi.org/10.3390/bioengineering10111323 - 16 Nov 2023
Viewed by 984
Abstract
Over the past several decades, orthodontic treatment has been increasingly sought out by adults, many of whom have undergone restorative dental procedures that cover enamel. Because the characteristics of restorative materials differ from those of enamel, typical bonding techniques do not yield excellent [...] Read more.
Over the past several decades, orthodontic treatment has been increasingly sought out by adults, many of whom have undergone restorative dental procedures that cover enamel. Because the characteristics of restorative materials differ from those of enamel, typical bonding techniques do not yield excellent restoration–bracket bonding strengths. Plasma treatment is an emerging surface treatment that could potentially improve bonding properties. The purpose of this paper is to evaluate currently available studies assessing the effect of plasma treatment on the shear bond strength (SBS) and failure mode of resin cement/composite on the surface of ceramic materials. PubMed and Google Scholar databases were searched for relevant studies, which were categorized by restorative material and plasma treatment types that were evaluated. It was determined that cold atmospheric plasma (CAP) treatment using helium and H2O gas was effective at raising the SBS of feldspathic porcelain to a bonding agent, while CAP treatment using helium gas might also be a potential treatment method for zirconia and other types of ceramics. More importantly, CAP treatment using helium has the potential for being carried out chairside due to its non-toxicity, low temperature, and short treatment time. However, because all the studies were conducted in vitro and not tested in an orthodontic setting, further research must be conducted to ascertain the effectiveness of specific plasma treatments in comparison to current orthodontic bonding treatments in vivo. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
15 pages, 665 KiB  
Review
Ageing and Inflammation: What Happens in Periodontium?
by Luying Zhu, Zhongyuan Tang, Renjie Hu, Min Gu and Yanqi Yang
Bioengineering 2023, 10(11), 1274; https://doi.org/10.3390/bioengineering10111274 - 2 Nov 2023
Cited by 1 | Viewed by 3486
Abstract
Periodontitis is a chronic inflammatory disease with a high incidence and severity in the elderly population, making it a significant public health concern. Ageing is a primary risk factor for the development of periodontitis, exacerbating alveolar bone loss and leading to tooth loss [...] Read more.
Periodontitis is a chronic inflammatory disease with a high incidence and severity in the elderly population, making it a significant public health concern. Ageing is a primary risk factor for the development of periodontitis, exacerbating alveolar bone loss and leading to tooth loss in the geriatric population. Despite extensive research, the precise molecular mechanisms underlying the relationship between ageing and periodontitis remain elusive. Understanding the intricate mechanisms that connect ageing and inflammation may help reveal new therapeutic targets and provide valuable options to tackle the challenges encountered by the rapidly expanding global ageing population. In this review, we highlight the latest scientific breakthroughs in the pathways by which inflammaging mediates the decline in periodontal function and triggers the onset of periodontitis. We also provide a comprehensive overview of the latest findings and discuss potential avenues for future research in this critical area of investigation. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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Other

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17 pages, 7407 KiB  
Case Report
Biomechanical Considerations in the Orthodontic Treatment of a Patient with Stabilised Stage IV Grade C Generalised Periodontitis: A Case Report
by Fung Hou Kumoi Mineaki Howard Sum, Zhiyi Shan, Yat Him Dave Chan, Ryan Julian Dick Hei Chu, George Pelekos and Tsang Tsang She
Bioengineering 2024, 11(4), 403; https://doi.org/10.3390/bioengineering11040403 - 19 Apr 2024
Viewed by 633
Abstract
Orthodontic treatment of periodontally compromised patients presents unique challenges, including controlling periodontal inflammation, applying appropriate force, designing an effective dental anchorage, and maintaining treatment results. Deteriorated periodontal support leads to alterations in the biological responses of teeth to mechanical forces, and thus orthodontists [...] Read more.
Orthodontic treatment of periodontally compromised patients presents unique challenges, including controlling periodontal inflammation, applying appropriate force, designing an effective dental anchorage, and maintaining treatment results. Deteriorated periodontal support leads to alterations in the biological responses of teeth to mechanical forces, and thus orthodontists must take greater care when treating patients with periodontal conditions than when treating those with a good periodontal status. In this article, we report the case of a 59-year-old woman with stabilised Stage IV grade C generalised periodontitis characterised by pathological tooth migration (PTM). The assessment, planning, and treatment of this patient with orthodontic fixed appliances is described. Moreover, the anchorage planning and biomechanical considerations are detailed. Specific orthodontic appliances were employed in this case to produce force systems for achieving precise tooth movement, which included a cantilever, mini-screws, and a box loop. Careful application of those appliances resulted in satisfactory aesthetic and functional orthodontic outcomes in the patient. This case highlights the importance of multidisciplinary collaboration in the treatment of patients with severe periodontitis and the potential for tailored biomechanical approaches in orthodontic treatment to furnish good outcomes. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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12 pages, 883 KiB  
Perspective
Teeth Microcracks Research: Towards Multi-Modal Imaging
by Irma Dumbryte, Donatas Narbutis, Maria Androulidaki, Arturas Vailionis, Saulius Juodkazis and Mangirdas Malinauskas
Bioengineering 2023, 10(12), 1354; https://doi.org/10.3390/bioengineering10121354 - 25 Nov 2023
Cited by 1 | Viewed by 1391
Abstract
This perspective is an overview of the recent advances in teeth microcrack (MC) research, where there is a clear tendency towards a shift from two-dimensional (2D) to three-dimensional (3D) examination techniques, enhanced with artificial intelligence models for data processing and image acquisition. X-ray [...] Read more.
This perspective is an overview of the recent advances in teeth microcrack (MC) research, where there is a clear tendency towards a shift from two-dimensional (2D) to three-dimensional (3D) examination techniques, enhanced with artificial intelligence models for data processing and image acquisition. X-ray micro-computed tomography combined with machine learning allows 3D characterization of all spatially resolved cracks, despite the locations within the tooth in which they begin and extend, and the arrangement of MCs and their structural properties. With photoluminescence and micro-/nano-Raman spectroscopy, optical properties and chemical and elemental composition of the material can be evaluated, thus helping to assess the structural integrity of the tooth at the MC site. Approaching tooth samples having cracks from different perspectives and using complementary laboratory techniques, there is a natural progression from 3D to multi-modal imaging, where the volumetric (passive: dimensions) information of the tooth sample can be supplemented by dynamic (active: composition, interaction) image data. Revelation of tooth cracks clearly shows the need to re-assess the role of these MCs and their effect on the structural integrity and longevity of the tooth. This provides insight into the nature of cracks in natural hard materials and contributes to a better understanding of how bio-inspired structures could be designed to foresee crack propagation in biosolids. Full article
(This article belongs to the Special Issue Application of Bioengineering to Clinical Orthodontics)
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