2024 NESO Cup Poster Competition

PROCEEDINGS

Comparing Slot Dimensions of in-House 3D-printed Brackets Against Injection-Molded Controls

John A. Baker
State University of New York at Buffalo, Buffalo, NY

Objectives: The objective of this study is to determine if VarseoSmile Crown Plus (VSC, BEGO GmbH & Co. KG, Bremen, Germany) is a suitable material for in-house fabrication of 3D-printed orthodontic brackets by comparing dimensional accuracies of 3D-printed brackets against stainless-steel injection-molded metal and polycrystalline alumina alternatives.

Methods: Five 0.022”-slot maxillary right canine twin brackets with 0° torque were 3D-printed with a FormLabs 3B+ resin 3D-printer (FormLabs, Springville, MA) using VSC. Brackets were 3D-printed in 50μm layers, cured, and sandblasted using 80μm glass beads at 1.5 bar. Slot dimensions of the 3D-printed brackets were analyzed via measuring light microscopy and compared with similar dimensions from metal and ceramic controls (Victory Series and Clarity Advanced respectively, 3M, St. Paul, MN). One-way ANOVA was performed to determine the statistical differences between bracket slot dimensions of the 3D-printed brackets vs controls.

Main Results: Slot measurements showed excellent consistency in the quality and precision of 3D-printed brackets (Σ=0.0003”), however lacked accuracy in achieving the desired size of 0.022”, potentially due to polymerization shrinkage during production. To address this, a scaler was implemented in production, which resulted in desired slot height without significantly impacting width (p=0.332). Resultant 3D-printed bracket dimensions are within the acceptable margin of error of injection-molded controls. The mean slot width of the 3D-printed brackets was 0.0225”: not significantly different than metal or ceramic controls (0.0219”, p=0.155; 0.224”, p=0.799, respectively)..

Conclusions: Orthodontic brackets can be 3D-printed using VSC with reliable accuracy within tolerances of commercially-available injection-molded alternatives.

Treatment Outcomes with LightForceTM 3D-Printed Custom Brackets and Clear Aligners

Hamiduddin A; Warunek S; Aszkler R; Al-Jewair T
Department of Orthodontics, School of Dental Medicine, University at Buffalo

Objectives: This retrospective comparative study assessed treatment quality, duration and accuracy using a customized 3D-printed bracket system LightForceTM (LF) and clear aligners (CA).

Methods and materials: The study was conducted on patients presenting for comprehensive orthodontic treatment. 70 subjects were included (37 LF and 33 CA). Pre- and post-treatment records were collected from a single private practice. 3-D printed models were evaluated using the ABO Cast-Radiograph Evaluation (C-R Eval) criteria to assess treatment quality. Treatment duration was evaluated in months. Treatment accuracy was evaluated by comparing the predicted (TP) and the achieved (T1) arch width changes at the canine, first premolar and first molar between the groups.

Normality was checked by Shapiro-Wilks tests or QQ-plots. Individual CR, widths and duration were analyzed using Mann-Whitney U test and linear mixed model regression depending on data normality. Multiple testing adjustments were made using the Benjamini-Hochberg method to control false discovery rate. All significance tests used a 0.05 alpha level

Results & Statistics: No significant differences were observed between the two groups in terms of ABO C-R Eval total score (P=0.503). Treatment duration was not statistically significant between the two groups (P=0.138). There was significant difference between LF and CA groups in TP-T1 of the maxillary inter-canine width (P= 0.013).

Conclusions: Treatment with CA did not demonstrate significantly greater quality compared to LF nor did treatment duration show significant differences between LF and CA. Additionally, CA demonstrated accuracy in archwidth prediction, whereas LF showed accuracy in predicting maxillary inter-canine width, lower inter-molar and inter-premolar widths.

Surgeon Perceptions on Cleft Repair Feasibility Following Nasoalveolar Molding Therapy

Jeremiah Y. Kim, DMD1, Katalina Gerasopoulou Pappa, DMD, ML1, Mairaj K. Ahmed, DDS, MS1 ,2, Peter J. Taub, MD2

1Division of Orthodontics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
2Division of Plastic and Reconstructive Surgery, Departments of Dental/Oral Maxillofacial Surgery, Otolaryngology and Surgery, Icahn School of Medicine at Mount Sinai, New York, New York

Despite the efficacy of Nasoalveolar molding (NAM) treatment in redirecting soft tissue formation and improving esthetic outcomes of primary cleft repair, NAM is not universally adopted as a presurgical modality to treat patient with cleft lip and/or cleft palate (CL+/-P). This study aims to provide additional evidence that NAM treatment in CL+/-P patients can lead to improved surgical outcomes and the reduction of secondary revision surgery.

A questionnaire containing 12 patient profiles (6 pre-NAM and 6 post-NAM), each with 9 questions, was distributed to surgeons through various surgeon organization listservs. A 5-point Likert scale was used to evaluate nasal, columellar, and lip deformities with regards to severity of deformity, quality of expected surgical outcome, and likelihood of revision surgery. Descriptive statistics was used to summarize surgeon ratings for patient profiles. Differences between pre-NAM and post-NAM profiles were examined using independent samples t-tests and
generalized estimating equation (GEE) models to account for possibility of within surgeon’s clustering.

A total of 151 surgeons started the survey, with 65 (43.0%) completing all 12 profiles. There were 904 profiles completed, with 780 complete profiles among the 65 fully completed questionnaires. There was statistically significant difference between pre-NAM and post-NAM ratings for all outcomes. Post-NAM patients demonstrated significantly lower severity, higher expected quality of surgical outcome, and less likelihood of requiring revision surgery for their nasal, columellar, and lip deformities.

Further evidence of NAM therapy efficacy may spur greater NAM treatment adoption, and aid in improved surgical outcomes and decrease patients’ need for revision surgeries..

Idiopathic Mandibular Asymmetry in a Growing Patient

David L. Kornmehl DMD, Christopher Sohn DMD, Jairo A. Bastidas DMD, and Mairaj K. Ahmed DDS, MS

Montefiore Medical Center/Albert Einstein College of Medicine

Diagnosis: 12-year-old male presented to consult with a chief complaint of a facial asymmetry and concerns with facial esthetics. No congenital disorder or trauma observed or reported. Patient’s chin deviated 8mm to the left. Ear morphology appeared normal. Patient had permanent dentition with class I molar and canine on the right side and class II molar canine on the left side. The lower dental midline was 7mm to left of upper dental midline. Moderate crowding of maxillary and mandibular arches. Overjet was 6mm and overbite was 90%. Occlusal cant present. Patient diagnosed with idiopathic mandibular asymmetry as no syndromic, traumatic, or pathologic issues were present.

Treatment objectives and alternatives: Treatment of mandibular asymmetry was indicated for facial and psychosocial improvement. Surgical and non-extraction comprehensive orthodontic treatment was recommended with goals of harmonizing the vertical, transverse, and anteroposterior planes for patient’s facial, skeletal, and dental malposition. Alternative options of monitoring patient’s growth pattern and commencing comprehensive orthodontic treatment once growth ceased was discussed. Patient and parent elected for early treatment intervention with understanding that unfavorable growth may continue requiring future treatment.

Treatment results: Ideal facial esthetics and function were achieved at conclusion of treatment. Patient was put on recall for close follow-up to monitor growth and development.

Conclusions: Distraction osteogenesis can be used to improve facial balance, especially at an early age. By intervening in adolescence, an improvement in function and appearance can be achieved.

Treatment change among skeletal Class II with 3 different vertical divergencies: Frankfort-Mandibular Incisor Angle (FMIA) and soft-tissue profile

Yuna Park1, He-Kyong Kang1

1Department of Orthodontics & Dentofacial Orthopedics, New York University, New York, NY

Objectives: This study was designed to examine the correlation between FMIA and soft-tissue profile changes in skeletal Class II white adults with three different vertical skeletal patterns pre and post-orthodontic treatment.

Methods: 83 sets of pre- and post-treatment cephalometric images of skeletal Class II white adults (17 males, 66 females with a mean age of 28.6 ± 20.4 years pretreatment and 31.2 ± 19.8 years
post-treatment) in 3 different divergencies (21 hypodivergent, 24 normodivergent, and 40 hyperdivergent) were analyzed by 1 rater, after undergoing intra-rater reliability test. SNA, SNB,
ANB, Frankfort Mandibular Angle (FMA), Incisor Mandibular Plane Angle (IMPA), FMIA, and Z-angle were evaluated.  

Results: Data collection and analysis is currently ongoing. Anticipated date to finish all data collection is August 15, 2024 and statistical analysis will be completed by September 14, 2024. Analysis of variance (ANOVA) will be performed to compare the pre- and post-treatment measurements by vertical skeletal patterns. Post-hoc tests will be conducted to verify statistical significance among the 3 different divergent groups.

Conclusion: To be finalized and updated upon completion of the data collection and analysis.

Diagnostic Accuracy of Ultrasound in Detecting White Spot Lesions

Toothman Sulkowski T, Makowka S, Warunek S, Al-Jewair T

State University of New York at Buffalo, Buffalo, NY

Objectives: The aim of this in-vitro study was to assess the feasibility of using ultrasound (US) imaging to detect the depth of white spot lesions (WSLs) by comparing measured mean depths to those obtained by micro-computed tomography (micro-CT).

Methods: A total of 100 bovine teeth void of cracks and enamel defects were collected, disinfected, and embedded in acrylic blocks. Preliminary experiments on three samples were performed to determine the method for generating WSLs and to determine the US settings. Artificial WSLs were then created on all samples using a pH-cycling process. The depth of the WSL was subsequently measured using a linear array US system and a micro-CT (which was used as the gold standard). Shim stock samples of known thickness were also mounted in resin and measured with both machines to calibrate them.

Results: The preliminary results showed that shim stock sample 1, known to have a thickness of 25.4 μm, measured 40 μm with micro-CT and 53 μm with US. The second shim stock sample, with a known thickness of 254 μm, measured 260 μm and 400 μm with micro-CT and US, respectively. Measurements for the WSL samples were as follows: sample 1 measured 271 μm and 282 μm with micro-CT and US, respectively; sample 2 measured 185 μm and 237 μm; and sample 3 measured 191 μm and 204 μm.

Conclusions: While this study is still ongoing, preliminary findings suggest that US may be comparable to micro-CT in assessing the depth of WSLs.