• The korean journal of orthodontics
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• v.52 no.5
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• pp.345-353
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• 2022

Objective: To investigate airway volumes using cone-beam computed tomography (CBCT) by skeletal patterns, sex, and cervical vertebral maturation (CVM) stages in Korean adolescents. Methods: The sample consisted of pretreatment CBCT and cephalograms of 95 adolescents (aged 12-19) obtained out of 1,611 patients examined for orthodontic treatment from 2018 to 2020 in Kyungpook National University Dental Hospital. The samples were classified into two sex groups; three skeletal pattern groups, four chronological age groups and four CVM stages. Nasopharyngeal volumes (NPV), oropharyngeal volumes (OPV), total pharyngeal airway volume (TAV) and minimum cross-sectional area (MCA) measurements were taken from the CBCT. Multiple linear regression analyses to find out which one of the independent variables are good predictors for airway variables. Significant factors were analyzed by two-way multivariate analysis of variance (MANOVA) then multiple comparisons were analyzed using a t-test, and Fisher least significant difference. Results: Age, sex, CVM, and Sella-Nasion-B point have significant influence on airway variable. Males and females showed similar patterns of change in chronological age groups 1-3; however, males had larger NPV, OPV, and MCA at CVM in group 4. According to CVM stages, males had larger OPV, TAV, and MCA at CVM stage 6 (p-value: 0.019, 0.021, 0.015, respectively) and no sex differences at CVM stages 3, 4, and 5. Conclusions: Skeletal patterns have an effect on airway volume. Sex differences were found in CVM 6.

• The korean journal of orthodontics
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• v.53 no.1
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• pp.35-44
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• 2023

Objective: Surgically assisted maxillary protraction is an alternative protocol in severe Class III cases or after the adolescent growth spurt involving increased maxillary advancement. Correction of the maxillary deficiency has been suggested to improve pharyngeal airway dimensions. Therefore, this retrospective study aimed to analyze the airway changes cephalometrically following surgically assisted maxillary protraction with skeletal anchorage and Class III elastics. Methods: The study population consisted of 15 Class III patients treated with surgically assisted maxillary protraction combined with skeletal anchorage and Class III elastics (mean age: 12.9 ± 1.2 years). Growth changes were initially assessed for a mean of 5.5 ± 1.6 months prior to treatment. Airway and skeletal changes in the control (T0), pre-protraction (T1), post-protraction (T2), and follow-up (T3) periods were monitored and compared using lateral cephalometric radiographs. Statistical significance was set at p < 0.05. Results: The skeletal or airway parameters showed no statistically significant changes during the control period. Sella to nasion angle, N perpendicular to A, Point A to Point B angle, and Frankfort plane to mandibular plane angle increased significantly during the maxillary protraction period (p < 0.05), but no significant changes were observed in airway parameters (p > 0.05). No statistically significant changes were observed in the airway parameters in the follow-up period either. However, Sella to Gonion distance increased significantly (p < 0.05) during the follow-up period. Conclusions: No significant changes in pharyngeal airway parameters were found during the control, maxillary protraction, and follow-up periods. Moreover, the significant increases in the skeletal parameters during maxillary protraction were maintained in the long-term.

• Journal of Korean Dental Science
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• v.16 no.1
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• pp.23-34
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• 2023

Purpose: This study aims to investigate the force delivery profile of thermoformed aligners (TFA) compared with direct-printed aligners (DPA) and to explore the effect of different activation amounts on forces and moments of respective groups. A secondary objective is to observe the amount of stress relaxation that occurs over the 7~14 days when aligners are maintained in a simulated intraoral environment. Materials and Methods: An in vitro setup was created to quantify forces and moments. It consisted of a three dimensional-printed base plate and segmented maxillary teeth, placed in a semi-enclosed chamber to maintain a temperature of 37℃. Ninety clear aligners were divided into nine groups of ten aligners each based on material types (Zendura, ATMOS, TC-85) and activation amounts. Aligners were created with 0.00, 0.25- and 0.50-mm activations for lingual bodily movement of the upper left central incisor and kept on models in the "stressed" position in a 37℃ water bath. Three force components acting on the upper left lateral incisor, upper left central incisor, and upper right central incisor were measured for each time point, beginning from the initial baseline measurement, 8 hours, 16 hours, 24 hours, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, and lastly, 14 days. Result: TC-85 aligners in every activation group showed less force on teeth than Zendura and ATMOS. Significant force levels from 0.0 mm activation were present and stayed consistent over the course of 14 days. Comparisons made for baseline measurements to 7-days and 14-days showed statistically significant change from the baseline force level. Conclusion: TC-85 aligners demonstrated lower, more consistent forces with fewer side effects. Aligners can generate forces even when no activation is programmed. No major decreases in force levels over time were observed; the intra-oral clinical simulated environment and length of observation time could contribute to this.

• The korean journal of orthodontics
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• v.53 no.5
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• pp.317-327
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• 2023

Objective: This study aimed to evaluate the association between low tongue position (LTP) and the volume and dimensions of the nasopharyngeal, retropalatal, retroglossal, and hypopharyngeal segments of the upper airway. Methods: A total of 194 subjects, including 91 males and 103 females were divided into a resting tongue position (RTP) group and a LTP group according to their tongue position. Subjects in the LTP group were divided into four subgroups (Q1, Q2, Q3, and Q4) according to the intraoral space volume. The 3D slicer software was used to measure the volume and minimum and average cross-sectional areas of each group. Airway differences between the RTP and LTP groups were analyzed to explore the association between tongue position and the upper airway. Results: No significant differences were found in the airway dimensions between the RTP and LTP groups. For both retropalatal and retroglossal segments, the volume and average cross-sectional area were significantly greater in the patients with extremely low tongue position. Regression analysis showed that the retroglossal airway dimensions were positively correlated with the intraoral space volume and negatively correlated with A point-nasion-B point and palatal plane to mandibular plane. Males generally had larger retroglossal and hypopharyngeal airways than females. Conclusions: Tongue position did not significantly influence upper airway volume or dimensions, except in the extremely LTP subgroup.

• The korean journal of orthodontics
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• v.53 no.5
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• pp.328-335
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• 2023

Objective: The aim of this study was to determine whether an association between study quality, other study characteristics, and Altmetric Attention Scores (AASs) existed in orthodontic studies. Methods: The Scopus database was searched to identify orthodontic studies published between January 1, 2017, and December 31, 2019. Articles that satisfied the eligibility criteria were included in this study. Study characteristics, including study quality were extracted and entered into a pre-pilot data collection sheet. Descriptive statistics were calculated. On an exploratory basis, random forest and gradient boosting machine learning algorithms were used to examine the influence of article characteristics on AAS. Results: In total, 586 studies with an AAS were analyzed. Overall, the mean AAS of the samples was 5. Twitter was the most popular social media platform for publicizing studies, accounting for 53.7%. In terms of study quality, only 19.1% of the studies were rated as having a high level of quality, with 41.8% of the studies deemed moderate quality. The type of social media platform, number of citations, impact factor, and study type were among the most influential characteristics of AAS in both models. In contrast, study quality was one of the least influential characteristics on the AAS. Conclusions: Social media platforms contributed the most to the AAS for orthodontic studies, whereas study quality had little impact on the AAS.

• The korean journal of orthodontics
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• v.53 no.5
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• pp.298-306
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• 2023

Objective: Pain following the insertion of separators and archwires varies with age, sex, race, ethnicity, threshold, and health status. This study aimed to evaluate the characteristics of pain in orthodontic patients after the insertion of elastomeric separators, its effects on daily life, and its association with age and sex in a population not previously studied in this regard. Methods: A cross-sectional study of 130 patients undergoing orthodontic treatment included collecting data on demographics, pain experienced following the placement of separators, time of onset, duration, characteristics, change in dietary pattern or chewing side, intake of analgesics, and severity of pain on the Wong Baker's scale. The results are reported as counts and percentages. Associations between sex and age were evaluated using Pearson's chi-square test. Results: Among the 130 patients, 56.2% were 9-20 years old, 63.8% experienced pain following the insertion of separators, 22.9% had their first episode of pain at 4 hours, 56.6% experienced intermittent pain, and 37.3% experienced discomfort; 18.1% males and 81.9% females experienced pain following the insertion of separators. Pearson's chi-square test showed a significant association between pain and sex (P = 0.04). Most patients (37.3%) reported "hurts little more" for pain intensity on Wong Baker's scale and 21.7% reported all four quadrants as sites of pain. Conclusions: The pain experienced after separator insertion was associated with sex and age. Females experienced more pain than males and patients between the age range of 21 and 36 years suffered more pain during mastication than between 9 and 20 years old.

• The korean journal of orthodontics
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• v.53 no.2
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• pp.106-115
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• 2023

Objective: To evaluate the null hypothesis that there is no difference in a set of clinical predictors of potentially impacted canines between low-risk patients with and without displaced canines. Methods: The normal canine position group consisted of 30 patients with 60 normally erupting canines ranked in sector I (age, 9.30 ± 0.94 years). The displaced canine group comprised 30 patients with 41 potentially impacted canines ranked in sectors II to IV (age, 9.46 ± 0.78 years). Maxillary lateral incisor crown angulation, inclination, rotation, width, height, and shape, as well as palatal depth, arch length, width, and perimeter composed a set of clinical predictors, which were evaluated on digital dental casts. Statistical analyses consisted of group comparisons and variable correlations (p < 0.05). Results: There was a significant association between sex and mesially displaced canines. Unilateral canine displacement was more prevalent than bilateral displacement. The crown of the maxillary lateral incisors was significantly angulated more mesially and rotated mesiolabially in low-risk patients with displaced canines, who also had a shallower palate and shorter anterior dental arch length. Lateral incisor crown angulation and rotation, as well as palatal depth and arch length, were significantly correlated with the canine displacement severity. Conclusions: The null hypothesis was rejected. Maxillary lateral incisor angulation inconsistent with the "ugly duckling" stage as well as a shallow palate and short arch length are clinical predictors that can significantly contribute to the early screening of ectopic canines in low-risk patients.

• The korean journal of orthodontics
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• v.53 no.2
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• pp.116-124
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• 2023

Objective: The absence of a guideline to refer to developing malocclusions appropriately, may be a contributing factor to the inadequacy of timely interceptive orthodontics provision. This study aimed to develop and validate a new orthodontic grading and referral index to be used by dental frontliners to prioritize the orthodontic referral of developing malocclusion in children based on its severity. Methods: A cross-sectional study involving clinical assessment with 413 schoolchildren aged between 8.1 and 11.9 years was conducted in 2018. All the presenting malocclusion was listed and graded based on a few dental guidelines to produce the draft index. The validity and reliability of the draft index were tested using twenty study models. Face and content validation was carried out using the content validation index and Modified Kappa Statistics. Results: Fourteen dental and occlusal anomalies were identified as components of malocclusion and three grades of referral (monitor, standard, urgent) were included in the final index. The scale-level content validity index average value of 0.86 and 0.87 was obtained for content and face validation, respectively. There was moderate to excellent agreement in the Modified Kappa Statistics for both validations. Excellent inter- and intra-assessor agreement was obtained. The new index displayed valid and reliable scores. Conclusions: The Index for Interceptive Orthodontics Referral was developed and validated for the dental frontliners to identify and prioritize the developing malocclusion in children based on its severity and refer for orthodontic consultation to increase the possibility for interceptive orthodontics.

• The korean journal of orthodontics
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• v.53 no.2
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• pp.89-98
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• 2023

Objective: This study aimed to compare the mechanical and thermal properties in the anterior and posterior segments of new and retrieved specimens of a commercially available multizone superelastic nickel-titanium (NiTi) archwire. Methods: The following groups of 0.016 × 0.022-inch Bioforce NiTi archwires were compared: a) anterior and b) posterior segments of new specimens and c) anterior and d) posterior segments of retrieved specimens. Six specimens were evaluated in each group, by three-point bending and bend and free recovery tests. Bending moduli (Eb) were calculated. Furthermore, the new specimens were evaluated with scanning electron microscopy/energy-dispersive X-ray spectrometry. A multiple linear regression model with a random intercept at the wire level was applied for data analysis. Results: The forces in the posterior segments or new specimens were higher than those recorded in the anterior segments or retrieved specimens, respectively. Accordingly, Eb also varied. Higher austenite start and austenite finish (Af) temperatures were recorded in the anterior segments. No statistically significant differences were found for these temperatures between retrieved and new wires. The mean elemental composition was (weight percentage): Ni, 52.6 ± 0.5; Ti, 47.4 ± 0.5. Conclusions: The existence of multiple force zones was confirmed in new and retrieved Bioforce archwires. The retrieved archwires demonstrated lower forces during the initial stages of deactivation in three-point bending tests, compared with new specimens. The Af temperature of these archwires may lie higher than the regular intraoral temperature. Even at 2 mm deflections, the forces recorded from these archwires may lie beyond biologically safe limits.

• The korean journal of orthodontics
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• v.53 no.3
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• pp.185-193
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• 2023

Objective: The growth and development of the mandible strongly depend on modeling changes occurring at its ramus. Here, we investigated covariance patterns between the morphology of the ramus and the rest of the face. Methods: Lateral cephalograms of 159 adults (55 males and 104 females) with no history of orthodontic treatment were collected. Geometric morphometrics with sliding semi-landmarks was used. The covariance between the ramus and face was investigated using a two-block partial least squares analysis (PLS). Sexual dimorphism and allometry were also assessed. Results: Differences in the divergence of the face and anteroposterior relationship of the jaws accounted for 24.1% and 21.6% of shape variation in the sample, respectively. Shape variation was greater in the sagittal plane for males than for females (30.7% vs. 17.4%), whereas variation in the vertical plane was similar for both sexes (23.7% for males and 25.4% for females). Size-related allometric differences between the sexes accounted for the shape variation to a maximum of 6% regarding the face. Regarding the covariation between the shapes of the ramus and the rest of the face, wider and shorter rami were associated with a decreased lower anterior facial height as well as a prognathic mandible and maxilla (PLS 1, 45.5% of the covariance). Additionally, a more posteriorly inclined ramus in the lower region was correlated with a Class II pattern and flat mandibular plane. Conclusions: The width, height, and inclination of the ramus were correlated with facial shape changes in the vertical and sagittal planes.