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Background This study aimed to evaluate the levels of pain and discomfort associated with employing mini-implants as a temporary skeletal anchorage device compared to the traditional transpalatal arches (TPAs) during upper anterior teeth retraction in patients with upper dentoalveolar protrusion and to determine the level of acceptance of both techniques among patients. Methodology The study sample consisted of 38 patients (29 women and nine men) with an average age of 21.7 years. The patients were randomly and equally distributed into two groups. In the first group: upper anterior teeth were en-masse retracted using mini-implants (the TAD group), whereas, in the second group, TPAs were used during the two-step retraction of upper anterior teeth (the TPA group). Standardized questionnaires were distributed to all patients after 24 hours of mini-implant application. The questionnaire asked the patients to rate their pain perception, swelling sensation, eating difficulties, talking impairments, and cleansing difficulties on a four-point Likert scale on the third-day, one-week, two-week, and one-month follow-ups after the anchorage application. Wilcoxon matched-pairs signed-rank tests were used to evaluate intragroup changes, whereas Mann-Whitney U tests were employed to examine intergroup differences. Results Patients in the TAD group had higher pain and swelling levels than those in the TPA group, and differences were statistically significant at the first three assessment time points. The differences between the two groups were statistically insignificant regarding eating and talking difficulties, whereas differences were statistically significant for brushing difficulties. These impairments decreased to almost normal levels after one month of treatment initiation. Conclusions TPAs, when used for anchorage in the two-step retraction technique, were less problematic compared to mini-implants with en-masse retraction, where the sensation of pain or swelling around the mini-implants did not last for more than a week. The difficulties of cleaning, chewing, and speaking in the presence of mini-implants were temporary and mostly disappeared within two weeks of mini-implant application.

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BACKGROUND: Comprehensive orthodontic treatment may last for 20-24 months. Reducing the treatment time has become a common demand from both patients and orthodontists. Minimally invasive piezocision is one of the suggested approaches to accelerate the orthodontic tooth movement. OBJECTIVES: The aim of this randomized controlled clinical trial was to assess the effectiveness of the flapless piezocision procedure in accelerating the retraction of upper incisors. MATERIAL AND METHODS: A single-blinded, parallel-group randomized controlled clinical trial was conducted at the Department of Orthodontics at the University of Damascus Dental School, Syria. The study involved 42 patients (11 males, 31 females) at the age of 16-31 years (mean age: 19.15 years). The patients had class II division I malocclusion and were treated with fixed appliances using the two-step retraction technique. With an allocation ratio of 1:1, the participants were randomly assigned to either the experimental group (n = 21) or the control group (n = 21) using a computer-generated list of random numbers. Allocation was concealed due to the use of sequentially numbered, opaque, sealed envelopes. The primary outcomes were the rate of incisor retraction (RIR) and the time required for retraction. The outcome assessor was blinded. RESULTS: The data analysis included 20 patients in each group. The rate of incisor retraction significantly increased in the experimental group by 53%, with a significant shortening of the retraction time in the experimental group by 27% (p < 0.001). The rate of anchorage loss was significantly lesser in the experimental group (p < 0.001). Regarding the cephalometric assessment, incisor tipping was significantly greater in the control group than in the experimental group. Skeletal measurements showed insignificant changes following retraction between the 2 groups. CONCLUSIONS: The piezocision procedure was found to be effective in accelerating the retraction of 4 upper incisors, reducing the retraction time, preserving anchorage and enhancing root torque control during retraction.

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OBJECTIVES: To compare the time to close extraction spaces between en masse (ER) and two-step retraction (TSR). MATERIALS AND METHODS: Forty-eight patients with bimaxillary protrusion underwent treatment with extraction of four first premolars. All patients were randomly allocated to one of two groups: ER (n = 24) or TSR (n = 24). The main outcome was the time required to close spaces between ER and TSR; the closing time of spaces between females and males was a secondary outcome. The size of premolars was measured on the models and data were collected on clinical records at the following times: retraction start date (T1) and space closure completion date (T2). The total time to close the extraction spaces was calculated for each extracted premolar (T1 to T2). The Kaplan Meier method and the Log-Rank test were used to compare the groups. RESULTS: The time to close extraction spaces showed significant differences between the ER and TSR groups. While ER took between 12.1 and 13.8 months, TSR took between 24.7 and 26.8 months. The TSR group showed a significant difference between sexes; male patients took 5.5 months longer than female patients for the extraction spaces to close. CONCLUSIONS: TSR takes between 1.8 and 2.2 times longer than ER to close the extraction spaces and it took longer in males than females.

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OBJECTIVES: The purpose of this two-arm parallel trial was to compare en masse (ER) and two-step retraction (TSR) during space closure. MATERIALS AND METHODS: Forty-eight adult patients with bimaxillary protrusion who were planned for treatment with extraction of four first premolars were enrolled. All patients were randomly allocated in a 1:1 ratio to either the ER (n = 24) group or the TSR (n = 24) group. The main outcome was the amount of posterior anchorage loss in the molars and the retraction of the incisors between ER and TSR; the difference in incisor and molar inclination was a secondary outcome. Lateral cephalometric radiographs and oblique cephalometric radiographs at 45° were taken before retraction (T1) and after space closure (T2). Cephalograms were digitized and superimposed on the anatomic best fit of the maxilla and mandible by one operator who was blinded to the treatment group. RESULTS: Neither incisor nor molar crown movements showed any significant differences between the ER and TSR. There were no significant differences in the tipping of incisors and molars between the two groups. CONCLUSIONS: No significant differences existed in the amount of retraction of incisors and anchorage loss of molars between ER and TSR. Changes in incisor and molar tipping were similar, with the crowns showing more movement than the apex.

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