A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Objectives: The purpose of this study was to evaluate clinical outcomes based on the American Board of Orthodontics Objective Grading System (ABO-OGS) in a 30-month postgraduate orthodontic residency and to determine what factors affected these treatment outcomes. Methods: Consecutively debonded cases from July 1, 2010 to June 30, 2011 treated by residents in the Orthodontics Department at Nova Southeastern University were graded using the ABO-OGS. The age and sex of the patient, the treatment time, the missed appointments and the number of providers were documented. Discrepancy indices were calculated for each patient. These variables were assessed and their associations with the obtained treatment outcome scores were evaluated. Results: The average OGS score of the debonded cases was 33.87. There was no significant correlation between total OGS score and the demographic or explanatory variables. There were significant correlations found between the discrepancy index (DI) and the treatment time, the number of providers, but not the OGS. Significant correlations were also identified between treatment time and the number of failed appointments and the number of providers. Extraction cases were shown to have a significantly longer treatment time. Out of the eight objective measurements of the OGS, occlusal contacts, marginal ridges, buccolingual inclination and alignment/rotations scored the highest points in our evaluation with an average of 7.81, 6.37, 5.04, and 5.01 respectively. Conclusions: This study indicated the Nova Southeastern University Orthodontic Department average OGS score is about 6 points higher than the ABO clinical exam passing score. The initial complexity of a case was not a pre-determined factor for the final treatment results. This study identified several aspects of treatment outcomes that need improvement including, occlusal contacts, marginal ridges, correcting buccolingual inclination and improving the alignment.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Introduction: One of the challenges in orthodontics is obtaining desired tooth movement. A recent development in orthodontics offers patients more comfort by minimizing pain, and shortening the treatment time. Low level laser therapy (LLLT) emerged as a technology that may accelerate the velocity of tooth movement and shorten the orthodontic treatment period. LLLT (630-1000nm) has been shown to modulate various biological processes including wound healing and bone remodeling. Bone remodeling is one of the biological processes that ensue during tooth movement. Bone remodeling is a continuous process characterized by bone deposition at sites of tension and bone resorption on the pressure sites. At cellular level bone remodeling is regulated by receptor activator of NF-κB (RANK) and receptor activator of NF-κB ligand (RANKL) and Osteoprotegrin (OPG). RANK and RANKL promotes osteoclastic differentiation and promotes bone resorption. OPG is a soluble decoy receptor that competes with RANK for binding to RANKL and inhibits the osteoclastic activity. The goal of the research is to understand the regulatory effects of LLLT on bone metabolism at the cellular level. Furthermore, the purpose of this study is to evaluate the critical parameters of low level lasers on the early stage of ostegenic regulation of human osteoblast cells. In this study, CRL-1427 cells derived from human osteosarcoma which have an osteoblast phenotype were used as cell model. Methods: Human osteoblast cells CRL1427(ATCC, Manassas, VA) were cultured in minimum essential medium supplemented with 10% fetal bovine serum and 1% antibiotics and incubated in at 37°C with 5% CO2. The monolayer of cells after reaching 70-80% confluency were irradiated with a single dose of Galium Aluminum Arsenide (Ga-Al-As) laser, with a wave length of 830nm and output power of 85mW with 0.6, 1.5, 1.8 Joules/cm2 energy exposure regimes. The mRNA expressions of Alkaline phosphatase (ALP), Osteoprotegerin (OPG), RANKL and RANK were compared after seven days by quantitative real time PCR. Results: We observed that treatment of CRL 1427 cells with LLLT (1.5, 1.8 Joules/cm2) irradiation significantly increased the expression of ALP, OPG, RANKL and RANK mRNAs compared to the control group (P≤0.05). There was no significant difference between the control group and mRNA expression of ALP, OPG, RANK, or RANKL at 0.6J/cm2of irradiation. Conclusion: LLLT irradiation can directly influence the expression of genes associated with bone metabolism and potentially represents a mechanism that facilitates rapid bone remodeling.

Introduction: When skeletal transverse discrepancies exist between the maxilla and mandible, they commonly manifest in dental malocclusion. If left uncorrected, the malocclusion can lead to periodontal issues, tooth fractures, tooth loss, or other significant dental problems. Utilization of microimplants in palatal expansion aims to correct transverse discrepancies between the maxilla and mandible by separating the palatal suture in a parallel manner aimed at maximizing skeletal changes and minimizing dental side effects. Overlying soft tissue changes can be affected by the induced skeletal changes. The purpose of this study is to evaluate skeletal expansion and the overlying soft tissue change that occurs using MARPEs (microimplant assisted rapid palatal expanders) at the end of orthodontic treatment in skeletally mature (Cervical Vertebral Maturation (CMV) ≥ 5) patients using cone-beam computed tomography (CBCT) imaging and to evaluate soft tissue changes that occur at the time of orthodontic treatment completion using CBCT imaging. Materials and Methods: CBCT scans from 19 patients who were treated using microimplant assisted rapid palatal expanders were traced and evaluated at three time points: Before orthodontic treatment (T1), post MARPE expansion with MARPE in place (T2), and after orthodontic treatment with MARPE removed. Fourteen hard tissue landmarks and six soft tissue landmarks in the midface and nasal cavity regions were traced by three judges at each time point. The traced landmark points were averaged among all three judges and comparisons were made between the three time points to see the amount of expansion that occurred at various anatomical 2 regions. Intraclass correlation coefficient (ICC) was used to evaluate inter-judge reliability for all measurements. A repeated measures ANOVA test was used for statistical comparison across all three time points and a Tukey post hoc test was used for comparison between time points. Significance was set to .05 and ICC was set to >.70. Results: Expansion with microimplant assisted rapid palatal expanders can affect the hard tissue of the midface region as well as the overlying soft tissue. Increases in skeletal width from the ANS down to the maxillary alveolar bone were statistically significant in both the short term (T1-T2) and long term (T1-T3). The nasal cavity width at inferior turbinate area increased significantly after expansion (T2) and remained increased at treatment completion (T3) and the increased soft tissue width of the alar base that presented after expansion therapy remained increased at treatment completion. Conclusion: Maxillary expansion with microimplant assisted expanders resulted in skeletal changes throughout the maxilla and led to a significant long-term increase in nasal cavity width. The soft tissue changes associated with MARPE treatment show that a widening of the base of the nose may be expected after expansion and can remain at treatment completion.

Introduction: Orthodontic and orthopedic expansion is necessary to create space to resolve crowding due to arch deficiency or tooth size discrepancy. The Invisalign First clear aligner appliance as a modality for early interceptive orthodontic treatment has become incorporated into orthodontic practices in very recent years. The present study aims to investigate the magnitude of expansion of the Invisalign First clear aligner appliance compared to a Schwartz removable expander in patients with mixed dentition. Additionally, the study aims to compare the efficacy and predictability of Invisalign First clear aligners in this population. Materials & Methods: In this retrospective study, a sample was collected from a single orthodontist practitioner. The sample consisted of 34 patients, 16 patients treated with Invisalign First clear aligners only (Group1) and 19 patients treated with a Schwartz removable appliance and Invisalign First clear aligners (Group 2). Intraoral scans of four timepoints, initial (T1), post-expansion for Group 2 only (T1Exp), first refinement (T2), and final (T3), and planned Clincheck goal (P) model from Clincheck software were imported to Align Technology’s digital measure program (Quantify©). Arch widths and molar inclinations were measured at each timepoint and the changes between timepoints were calculated. Predictability of arch expansion was calculated as T13 (change between initial and final) divided by the Planned dimension multiplied by one hundred. A two sample t-test was used to assess differences in the changes in arch widths and predictability of expansion between two groups. Results: There were statistically significant differences found in the magnitude of expansion and predictability of arch expansion between two groups. Group 2 showed a greater amount of expansion and predictability. Group 1 showed about 50-60% of the planned expansion at the end of treatment. In regards to magnitude of expansion when comparing the two groups, the efficacy predictability of transverse dimensional changes were significantly greater in the Group 2 compared to Group 1, 83% vs 56% (p = 0.001), respectively. The changes in inclination were similar in both groups, with no statistically significant differences.Conclusions: There is a significantly greater amount of expansion and greater predictability with the Schwartz removable appliance compared to the Invisalign First clear aligner appliance in the mixed dentition. The predictability of Invisalign First was 56% and indicates a significant overcorrection of arch expansion is required at the virtual treatment planning stage in Clincheck in order to obtain the arch expansion that was planned

Titanium has been widely used for dental implants, and in particular, roughened titanium surfaces have provided a means for increasing bone apposition and strengthening the implant-to-bone interface. Finding a way to further increase osseointegration is important because there is a significant clinical benefit to patients if a stable anchor can be established instead of anchoring orthodontic hardware to the molars. In this study, the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on the ability of temporary anchorage devices (TADs) to osseointegrate was investigated. The temporary anchorage devices (TADs) used in this study were manufactured from commercially pure titanium and divided into 2 types of treatments: (1) sandblasted and acid-etched (i.e. the control) and (2) sandblasted and acid-etched treated with Medtronic INFUSE® Bone Graft (recombinant human bone morphogenetic protein-2 placed on an absorbable collagen sponge). The implants were placed on the cranial bones of 10 adult male Sprague-Dawley rats. The rats were euthanized by carbon dioxide asphyxiation 6 weeks following surgery for histological examination and biomechanical testing. The results from visual inspection and biomechanical testing showed that the sandblasted and acid-etched TADs treated with rhBMP-2 promoted better osseointegration than TADs that were only sandblasted and acid-etched. Specifically, surface modified TADs treated with rhBMP-2 on bottom showed an increased surface coverage by bone and an increase in the adhesion strength at the TAD-to-bone interface.

Introduction: The objective of this retrospective longitudinal study was to assess and compare the surgical changes and stability of the maxilla, mandible, and mandibular condyle, in patients who have undergone surgery first approach (SFA) followed by conventional braces or Invisalign (Inv) treatment. Methods: Thirty patients had a cone beam computed tomography (CBCT) exam taken at three timepoints: T1 (presurgery), T2 (immediately after surgery), and T3 at the completion of orthodontics treatment. After the cranial base registration, twenty-seven landmarks were located on each time point using axial, sagittal, and coronal cross-sectional views in the ITK-SNAP software. In addition, seventeen skeletal angular and linear variables were measured using the 3D Slicer software. Result: In general, both Groups had similar sugical changes (T2-T1) and stability (T3-T2). There was a statistically significant longer postsurgical orthodontic time in the Fixed Group (x̅ = five months). Skeletally, comparing T3-T2 the B point showed a statistically significant inferior position in the Fixed Group compared to the Inv Group (1.3 mm), resulting in a larger increase in mandibular plane angle in the Fixed Group (x̅ = 2.7 degrees). Conclusion: The Fixed appliances and clear aligner therapy in the surgery first approach resulted in similar skeletal changes and stability, except for the mandibular plane angle, which showed a greater increase in the Fixed Group. This result may suggest that patients with hyperdivergent skeletal pattern could benefit from aligner therapy for the postsurgical orthodontic phase.

Background: Maxillary expansion has long been used in children and adolescents for transverse discrepancies and dental crowding. With age, the mid-palatal suture becomes increasingly mature, requiring heavy, rapid force in order to achieve skeletal expansion. As an individual grows into adulthood, it has been demonstrated that a skeletally anchored expander can be used in order to achieve successful sutural separation. The side effects between these two types of expanders, including dental tipping with relative extrusion of buccal segments and clockwise mandibular rotation, have been demonstrated to have differences in their degrees of severity. However, most of the studies have evaluated the effects immediately following the expansion and not through a prolonged period in which growth may occur. The purpose of the present study was to investigate long-term skeletal differences in two types of expansion (RPE vs MARPE) on a growing population. Methods: This retrospective study included 39 adolescent subjects (mean age = 13.8 years) who had received maxillary expansion (20 RPE, 19 MARPE) with subsequent completion of orthodontic treatment. Initial and final CBCTs were used to analyze cephalometric and transversal changes between the two groups. Transverse measurements were repeated two weeks apart to test intra-observer reliability. Results: Cephalometric analysis demonstrated no significant differences in changes of FMA (p = 0.549) or MP-SN (p = 0.722) between the two groups following expansion and completion of orthodontic treatment. There were statistically significant differences in transverse changes between the two groups, with the MARPE group displaying more skeletal expansion. Conclusions: The results of the present study suggest that skeletally anchored expander - MARPE and conventional expander have similar skeletal effects in adolescents.

Introduction: The aim of this study was to determine the types and prevalence of complications following MARPE protocol at University of the Pacific and to investigate the complication of asymmetry using CBCT analysis. Methods: In the first portion of this study, 97 patients who started treatment prior to July 2020 and who had MARPE expander treatment at the University of the Pacific were included. Chart review and evaluation of progress clinical photographs were used to report the following complications: inflammation, pain, appliance malfunction, broken microscrew, and pulpitis. In the second portion of this study, 77 patients from a private practice orthodontist who started treatment prior to January 2021 were included in this study. The complication of asymmetry was measured using CBCT measurements from T1 (prior to treatment start) and T2 (immediately following MARPE expansion). The change in U6 molar angulation changes was also assessed. Results: It was determined in the first portion of this study that the most common complication was inflammation around the MARPE site, with 82% of the study population exhibiting any severity of inflammation. 3 patients exhibited severe inflammation requiring removal of MARPE. 18% reported pain in the MARPE area. 9 patients exhibited appliance malfunction, 1 patient exhibited broken microscrew, and 1 patient exhibited pulpitis. It was determined in the second portion of this study that 47% of patients exhibited asymmetry greater than 1 mm and the average asymmetry at ANS was 1.47 mm. No correlation was exhibited between amount of asymmetric expansion and the following measures: age, molar inclination, palatal thickness, posterior screw expansion and palatal vault height. 3 Conclusions: Inflammation of the MARPE is the most common complication that can result in early removal of the expander. Other complications such as asymmetry and pain are common as well.

In December 2019, the coronavirus disease 2019 (COVID-19) was first identified as an acute infectious disease in Wuhan, China and subsequently led to an ongoing pandemic. At the onset of the pandemic, dental professionals were understood to face the greatest exposure risk to SARS-Cov-2 due to aerosolization of fluids from the oral cavity and respiratory airways . As a result, dental professionals, including academic institutions and their students and residents halted much of their operations to minimize exposure risks and potentially slow the spread of infection to peers and patients alike. Currently, there is little in the literature that describes the changes that academic institutions have implemented in the face of pandemics. This study will discuss the chronology, modifications, and possible resultant outcomes of COVID-19 related events in respect to Graduate Endodontic programs in the United States.

The goal of this study was to determine if a relationship exists between pretreatment facial attractiveness and posttreatment occlusal outcome in orthodontic patients. A randomized sample of forty-seven patients (26 males, 21 females) was selected for inclusion in this study. Orthodontic evaluators rated pretreatment patient photographs (frontal smile, frontal, profile) using a 100 mm visual analog scale (VAS). Occlusal outomes were evaluated using percentage reduction in weighted Peer Assessment Rating (PAR) index scores and the American Board of Orthodontics objective grading system (ABO-OGS). Spearman correlation coefficients were calculated to assess the relationship between pretreatment VAS attractiveness ratings and posttreatment occlusal scores. There was a fair correlation between facial attractiveness and reduction in weighted PAR index scores for all patients (r=.41, p<.01) and for male patients (r=.48, p<.05). The results showed a good correlation between facial attractiveness and the ABO-OGS for females (r=-.55, p<.05).