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Introduction: In reverse shoulder arthroplasty (RSA) new designs enable greater amounts of lateralization to prevent instability and scapular notching and increase range of motion, however, excessive lateralization leads to stress upon the acromion that can result in scapular spine fatigue fractures. Aim of this study was to gender- and size-specifically assess the influence of glenosphere size and different humeral designs on lateralization, distalization, and bony impingement-free range of motion (ROM) in patients undergoing RSA. Methods: Computed tomography scans from 30 osteoarthritic patients (f:15, m:15) and 20 cuff tear arthropathy patients (f:10, m:10) were used to virtually simulate RSA implantation. The efficacy of an inlay Grammont-type system vs. an onlay lateralizing system combined with different glenosphere sizes (36 mm vs. 42 mm) in achieving ROM, lateralization, and distalization was evaluated. Moreover, gender and patient's constitution were correlated to humeral size by radiologically measuring the best-fit circle of the humeral head. Results: A different amount of relative lateralization was achieved in both genders using large glenospheres and onlay designs. Latter yielded a higher ROM in all planes for men and women with a 42 mm glenosphere; with the 36 mm glenosphere, an increased ROM was observed only in men. The 155° inlay design led to joint medialization only in men, whereas all designs led to lateralization in women. When adjusting the absolute amount of lateralization to humerus' size (or patient's height), regardless of implant type, women received greater relative lateralization using 36 mm glenosphere (inlay: 1%; onlay 12%) than men with 42 mm glenosphere (inlay: -3%; onlay: 8%). Conclusion: The relative lateralization achieved using onlay design is much higher in women than men. Small glenospheres yield greater relative lateralization in women compared to large glenospheres in men. Humeral lateralization using onlay designs should be used cautiously in women, as they lead to great relative lateralization increasing stress onto the acromion. Level of evidence: Basic Science Study, Computer Modeling. [ABSTRACT FROM AUTHOR]

Clear aligner therapy (CAT) has become a popular orthodontic treatment option for adolescent and adult patients for its aesthetic, patient's comfort, and convenient features. It involves a programmed and simulated virtual planning, tracking, and quantifying of tooth movement to target positions. Over the years, the therapeutic scope of CAT has increased dramatically to include a wider range of malocclusions with the aid of orthodontic auxiliaries as adjunctive biomechanics. This narrative review aims at summarizing and evaluating current practices, efficacy and predictability of sequential distalization protocol for maxillary molars in class II treatment using CAT. A systematic search for this review included electronic literature databases of MEDLINE via Pubmed, Web of Science, ProQuest and Embase to include all available published articles including systematic reviews, books, cases reports, and narrative literature reviews. Most published studies are retrospective examining small sample size. Current literature should be interpreted carefully as studies differ in their outcome measurement process and timing. Although reports show 2-3 mm of molar distalization is possible, a distinguish between bodily movement and molar tip back should be made. There is a discrepancy between computer-assisted predicted outcome and actual clinical outcome reported in literature. Molar distalization using CAT is possible. However, randomised trials with large sample size are necessary to draw more definitive conclusion about its efficacy and predictability. Due to the discrepancy between computer-assisted predicted outcome and actual clinical outcome, case refinement and possible altered treatment duration should be discussed with the patient in the planning stage. Since the process of molar distalization using CAT involves undesirable reaction force, it is essential to reinforce anchorage with suitable auxiliaries like composite attachments, class II/III elastics, and TADs. [ABSTRACT FROM AUTHOR]

Radiographic evaluation of the implant configuration after reverse shoulder arthroplasty (RSA) is time-consuming and subject to interobserver disagreement. The final configuration is a combination of implant features and surgical execution. Artificial intelligence (AI) algorithms have been shown to perform accurate and efficient analysis of images. The purpose of this study was to develop an AI algorithm to automatically measure glenosphere inclination, humeral component inclination, and the lateralization and distalization shoulder angles (DSAs) on postoperative anteroposterior radiographs after RSA. The Digital Imaging and Communications in Medicine files corresponding to postoperative anteroposterior radiographs obtained after implantation of 143 RSAs were retrieved and used in this study. Four angles were analyzed: (1) glenoid inclination angle (GIA, between the central fixation feature of the glenoid and the floor of the supraspinatus fossa), (2) humeral alignment angle (HAA, between the long axis of the humeral shaft and a perpendicular to the metallic bearing of the prosthesis), (3) DSA, and (4) lateralization shoulder angle (LSA). A UNet segmentation model was trained to segment bony and implant elements using manually segmented training (n = 89) and validation (n = 22) images. Then, an image-processing–based pipeline was developed to measure all 4 angles using AI-segmented images. Measures performed by 3 physician observers and the AI algorithm were then completed in 32 additional images. The agreements among human observers and between observers and the AI algorithm were evaluated using intraclass correlation coefficients (ICCs) and absolute differences in degree. The ICCs (95% confidence interval) for manual measurements of LSA, DSA, GIA, and HAA were 0.79 (0.55, 0.90), 0.90 (0.80, 0.95), 0.96 (0.93, 0.98), and 0.99 (0.97, 0.99), respectively. The AI algorithm measured the 32 images in the test set in less than 2 minutes. The agreement between observers and the AI algorithm was lowest when measuring the LSA for observer 2, with an ICC of 0.77 (0.52, 0.89), and an absolute difference in degrees (median [interquartile range]) of 5 (4). Better agreements were found between the AI measurements and the average manual measurements: absolute differences in degree for LSA, DSA, GIA, and HAA were 3 (5), 2 (3), 2 (2), and 2 (1), respectively; ICCs for LSA, DSA, GIA, and HAA were 0.89 (0.79, 0.95), 0.96 (0.93, 0.98), 0.85 (0.68, 0.93), and 0.98 (0.95, 0.99), respectively. The AI algorithm developed in this study can automatically measure the GIA, HAA, LSA, and DSA on postoperative anteroposterior radiographs obtained after implantation on RSA. [ABSTRACT FROM AUTHOR]

Lateralization Shoulder Angle (LSA) and Distalization Shoulder Angle (DSA) have been proposed to estimate the appropriateness of reverse shoulder arthroplasty (RSA) positioning. The purpose of this study was to evaluate the predictive value of DSA and LSA over clinical outcomes in a group of patients treated by the same surgeon with the same clinical and radiographic follow-up. A retrospective analysis of a consecutive series of RSAs performed between 2017 and 2021 was carried out. Inclusion criteria were primary RSA as a treatment for Cuff Tear Arthropathy, Massive Irreparable rotator cuff tear, Osteoarthritis or Rheumatoid arthritis, a true anteroposterior radiograph of the affected shoulder in neutral rotation at final follow-up, a minimum follow-up of 12 months, radiograph used to measure the angles, and clinical evaluation with the same follow-up. Outcome measures were shoulder range of motion (ROM), visual analog scale (VAS) for pain and Constant-Murley score (CS). A total of 83 patients were included in the study. Patients achieved on average, 130 ± 14.14° of flexion, 97.5 ± 17.67° of abduction, 62.5 ± 3.53° and 72.5 ± 10.60° of external rotation, respectively, at 0° and 90° of abduction, and 5.13° of internal rotation. The mean VAS and CS were, respectively, 2.5 ± 3.5 mm and 69 ± 2.82 points at last follow-up. The mean DSA and LSA were 45 ± 2.72 and 92.99 ± 9.17, respectively. Neither the linear nor the quadratic regression fit for DSA or LSA revealed relevant associations with any of individual ROM measures, except for the quadratic fit correlating LSA and forward flexion (beta = 0.029, P =.027). Linear fit showed a low reverse, but significant, association between DSA and VAS (beta = −0.56, P =.036) and an association of LSA with both CS (beta = −0.344, P =.009) and VAS (beta = 0.091, P =.01). Quadratic models showed higher R squared for all associations, but correlation was significant only between VAS and LSA (beta = 0.006, P =.011) We present the first evaluation of the predictive value of both DSA and LSA in a group of patients treated by the same surgeon with the same clinical and radiographic follow-up. DSA and LSA play only a marginal to no role in the prediction of RSA postoperative ROM and might have a role in predicting VAS and CS. [ABSTRACT FROM AUTHOR]

The design of reverse shoulder arthroplasty (RSA) implants has evolved significantly over the past 50 years. Today there are many options available that differ in design of the glenoid and humeral components, fixation methods, sizes, and modularity. With respect to the humeral component, the literature has generally focused on the differences between inlay and onlay designs and the potential impact on outcomes. However, inlay and onlay design represents only one factor of many. It is our hypothesis that separating onlay and inlay designs into 2 distinct entities is an oversimplification as there can be a wide overlap of the 2 designs, depending on surgical technique and the implant selected. As such, the differences between inlay and onlay designs should be measured in absolute terms—meaning combined distalization and lateralization. By reviewing the many factors that can contribute to the glenosphere–humerus relationship, the role of inlay and onlay humeral designs as an important distinguishing feature is shown to be limited. Preliminary studies suggest that the amount of distalization and lateralization of the construct may be the most accurate method of describing the differences in the constructs. Inlay and onlay humeral component design represents only one factor of many that may impact outcomes. A more accurate method of defining specific design and technique factors in RSA is the degree of lateralization and distalization. [ABSTRACT FROM AUTHOR]

Abstract Introduction In reverse shoulder arthroplasty (RSA) new designs enable greater amounts of lateralization to prevent instability and scapular notching and increase range of motion, however, excessive lateralization leads to stress upon the acromion that can result in scapular spine fatigue fractures. Aim of this study was to gender- and size-specifically assess the influence of glenosphere size and different humeral designs on lateralization, distalization, and bony impingement-free range of motion (ROM) in patients undergoing RSA. Methods Computed tomography scans from 30 osteoarthritic patients (f:15, m:15) and 20 cuff tear arthropathy patients (f:10, m:10) were used to virtually simulate RSA implantation. The efficacy of an inlay Grammont-type system vs. an onlay lateralizing system combined with different glenosphere sizes (36 mm vs. 42 mm) in achieving ROM, lateralization, and distalization was evaluated. Moreover, gender and patient’s constitution were correlated to humeral size by radiologically measuring the best-fit circle of the humeral head. Results A different amount of relative lateralization was achieved in both genders using large glenospheres and onlay designs. Latter yielded a higher ROM in all planes for men and women with a 42 mm glenosphere; with the 36 mm glenosphere, an increased ROM was observed only in men. The 155° inlay design led to joint medialization only in men, whereas all designs led to lateralization in women. When adjusting the absolute amount of lateralization to humerus’ size (or patient’s height), regardless of implant type, women received greater relative lateralization using 36 mm glenosphere (inlay: 1%; onlay 12%) than men with 42 mm glenosphere (inlay: -3%; onlay: 8%). Conclusion The relative lateralization achieved using onlay design is much higher in women than men. Small glenospheres yield greater relative lateralization in women compared to large glenospheres in men. Humeral lateralization using onlay designs should be used cautiously in women, as they lead to great relative lateralization increasing stress onto the acromion. Level of evidence Basic Science Study, Computer Modeling.

Background: The lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are used to reproducibly measure lateralization and distalization after reverse shoulder arthroplasty (RSA). However, LSA and DSA may not offer a precise measurement of humeral lateralization and distalization and this relationship has not been explored. The aim of this study was to evaluate the validity of these measurements and to propose new measurement methods to estimate implant lateralization and distalization. Methods: 3D models were constructed from computed tomography (CT) scans of 30 patients using a software platform. For each patient 24 different RSA modifications were created, resulting in 720 different RSA configurations. For each configuration LSA and DSA angles as well as lateralization and distalization distances were measured. Moreover, for each configuration two new measurements were done: the lateralization index (LI) and distalization index (DI). Correlations of the lateralization and distalization parameters were evaluated between measurements. Results: Weak correlations were founded between LSA and lateralization (r = 0.36, p < 0.01), whereas moderate correlations were observed between LI and lateralization (r = 0.72, p < 0.01). No significant correlations were found between DSA and distalization (r = 0.17, p = 0.113). In contrast, moderate correlations were identified between DI and distalization (r = 0.69, p < 0.01). Conclusion: LI and DI are more reliable methods to estimate implant lateralization and distalization compared to angular radiographic measurements. However, the prognostic significance in predicting clinical outcomes after RSA remains unknown. [ABSTRACT FROM AUTHOR]

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• All Cases treated with our infra-zygomatic gear distalizer appliance resulted in successful distalization of the maxillary first molar, reaching Class I molar relationship. • A significant amount of distalization (4.03 ± 0.62) occurred after an average duration of 6.4 months. • The rate at which maxillary first molar distalization occurred was an average of 0.61 ± 0.18 mm per month. • The maxillary first molars showed a significant intrusion of 1.37 ± 0.83 mm. • No changes in the three-dimensional position of the maxillary anterior segment had occurred throughout the trial. It is now possible to predictably distalize maxillary first molars in nongrowing patients with the infra-zygomatic gear distalizer and to improve malocclusions without having to extract the premolars and regardless of the patient's compliance. The purpose of this study was to investigate the amount and rate of distal movement of the maxillary first molars using our proposed appliance after extraction of maxillary second molars. Ten nongrowing female patients successfully treated with our proposed appliance were the subjects of this study. The amount, rate, and type of distalization, were analyzed through upper jaw cone beam computed tomography (pre- and post-treatment) and scanned casts taken on a monthly interval. The average amount of distalization of the maxillary first molars was 4.03 mm at the crown level and 2.88 mm at the root level. The rate of distalization had an average of 0.61 mm per month with a maximum of 0.79 mm in the first month because of the regional acceleratory phenomena after extracting the maxillary second molar. The maxillary first molars were distalized in a significant manner and all patients reached a Class I relation within an average duration of 6.4 months. The proposed appliance proved to be a viable noncompliance modality to distalize maxillary first molars correcting maxillary Class II malocclusions characterized by maxillary protrusion or maxillary incisor crowding. [ABSTRACT FROM AUTHOR]

To explore the mandibular retromolar space length (MRSL), initial root‐inner cortex contact percentage (IRCCP), and the various factors that influence mandibular molar distalization. Searches were undertaken in PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and grey literature (Google Scholar and OpenGrey) for eligible cross‐sectional observational studies measuring the MRSL and IRCCP in healthy adult patients. The risk of bias and evidence quality were evaluated using the Joanna Briggs Institute's checklist and GRADE framework. Thirteen studies involving 1169 patients were included for qualitative synthesis. Seven of these studies were eligible for quantitative analysis. Meta‐analysis showed that the mean MRSL at the subfurcation‐6 mm plane in Asian normodivergent cases was 3.78 mm (95% confidence interval [CI]: 2.81–4.35; I2 = 79.7%) for skeletal Class‐I malocclusions, 3.02 mm (95% CI: 2.10–3.94; I2 = 62.5%) for Class‐II, and 4.43 mm (95% CI: 3.14–5.73; I2 = 75.1%) for Class‐III. The mean MRSL at the sub‐cementoenamel junction (CEJ)‐10 mm plane for Asian, Class‐I, normodivergent cases was 3.28 mm (95% CI: 2.44–4.12; I2 = 68.9%). The mean IRCCP for Asian, Class‐I, normodivergent cases was 27.2% (95% CI: 0.22–0.32; I2 = 0%). In Asian normodivergent cases, MRSL ranges from 3.28 to 4.43 mm with a 27.2% IRCCP for Class‐I. Cone‐beam computed tomography imaging is recommended for measuring the MRSL in the apex region particularly before molar distalization. Factors influencing MRSL and IRCCP include different races, skeletal patterns, facial types, and third‐molar status. [ABSTRACT FROM AUTHOR]

The most common extra-alveolar sites for miniscrew placement are the infrazygomatic crest region (IZC) and mandibular buccal shelf region (MBS). The aim of the study is to determine the amount of distalization achieved with IZC and MBS mini screws, and if it has any correlation with the growth pattern. Pre-treatment scan (T1) and post-distalization (T3) scans of 30 patients were taken in whom en masse distalization with either IZC or MBS mini screws or both was achieved. T1 and T2 scans were then superimposed on OrthoAnalyzer software using landmark reference points on maxilla and mandible and assessed for the amount of distalization. The following statistical tests were conducted: Kappa statistics to assess the intra-observer reliability, Descriptive statistics for the amount of distalization by both IZC and buccal shelf mini screws, and its correlation with varying growth patterns and gender. The mean distalization achieved with IZC anchorage was 3.491 ± 0.471 mm and the mean distalization achieved with buccal shelf mini screw anchorage was 4.412 ± 0.904 mm. A weak negative correlation between growth pattern and amount of distalization was observed (r=-0.379; p=0.007). The present study suggests that both infrazygomatic and buccal shelf anchorage for arch distalization in borderline surgical class II and III cases are effective modalities. It also suggests that the skeletal facial pattern may favorably influence the amount of distalization in hypodivergent facial type, especially with MBS anchorage. [ABSTRACT FROM AUTHOR]

Glenoid-sided lateralization in reverse shoulder arthroplasty (RSA) decreases bony impingement and improves rotational range of motion, but has been theorized to increase the risk of acromial or scapular spine fractures (ASFs). The purpose of this study was to assess if glenoid-sided lateralization even up to 8 mm increases the risk for stress fracture following RSA with a 135° inlay humeral component. A retrospective review was performed from a multicenter prospectively collected database on patients who underwent primary RSA from 2015 to 2021. All RSAs were performed with a 135° inlay humeral component. Varying amounts of glenoid lateralization were used from 0 to 8 mm. Preoperative radiographs were reviewed for the presence of acromial thinning, acromiohumeral distance (AHD), and inclination. Postoperative implant position (distalization, lateralization, and inclination) as well as the presence of ASF was evaluated on minimum 1-year postoperative radiographs. Regression analyses were performed on component and clinical variables to assess for factors predictive of ASF. Acromial or scapular spine fractures were identified in 26 of 470 shoulders (5.5%). Glenoid-sided lateralization was not associated with ASF risk (P =.890). Furthermore, the incidence of fracture did not vary based on glenoid-sided lateralization (0-2 mm, 7.4%; 4 mm, 5.6%; 6 mm, 4.4%; 8 mm, 6.0%; P >.05 for all comparisons). RSA on the dominant extremity was predictive of fracture (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.20-5.75; P =.037), but there was no relationship between patient age, sex, preoperative acromial thinning, or diagnosis and risk of fracture. Although there was no difference in mean postoperative AHD between groups (P =.443), the pre- to postoperative delta AHD was higher in the stress fracture group (2.0 ± 0.7 cm vs. 1.7 ± 0.7 cm; P =.015). For every centimeter increase in delta AHD, there was a 121% increased risk for fracture (OR 2.21, 95% CI 1.33-3.68; P =.012). Additionally, for every 1-mm increase in inferior glenosphere overhang, there was a 19% increase in fracture risk (P =.025). Up to 8 mm of glenoid-sided metallic lateralization does not appear to increase the risk of ASF when combined with a 135° inlay humeral implant. Humeral distalization increases the risk of ASF, particularly when there is a larger change between pre- and postoperative AHD or higher inferior glenosphere overhang. In cases of pronounced preoperative superior humeral migration, it may be a consideration to avoid excessive postoperative distalization, but minimizing bony impingement via glenoid-sided lateralization appears to be safe. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) effectively treats severe obesity, but some patients may require revisional surgery like limb lengthening (LL) for postoperative weight gain. This study aims to compare 30-day serious complications and mortality rates between LL and primary RYGB, given limited safety data on LL. Patients who underwent LL and RYGB were identified from the 2020 and 2021 MBSAQIP databases, the only years in which LL data were available. Baseline characteristics and 30-day rates of serious complications and mortality were analyzed. A total of 86,990 patients underwent RYGB and 455 underwent LL. Patients undergoing RYGB were younger (44.4 versus 49.8 yr, P <.001), had a higher body mass index (BMI) (45.5 versus 41.8 kg/m2, P <.001) and higher rates of comorbidities including diabetes (30.0 versus 13.6%, P <.001). RYGB and LL had similar operative duration (125.3 versus 123.2 min, P =.5). There were no statistical differences between cohorts for length of stay (LOS) (1.6 RYGB versus 1.6 LL d, P =.6). After LL, there were higher 30-day rates of reoperation (3.3 versus 1.9%, P =.03) and deep surgical site infections (1.3 versus.5%, P =.03) compared to RYGB. There were no differences in overall serious complications (5.1 LL versus 5.0% RYGB, P = 1.0) and mortality (.2 LL versus.1% RYGB, P =.5). Multivariable logistic regression adjustment found that previous venous thromboembolism was associated with serious complications after LL. When compared to primary RYGB, LL has a favorable safety profile with similar 30-day rates of serious complications and mortality. [ABSTRACT FROM AUTHOR]

Purpose: Joint line (JL) position change in total knee arthroplasty (TKA) may alter knee biomechanics and impact function. The purpose of this study was to compare the change in JL position between robotic-assisted TKA (RA-TKA) and conventional TKA (C-TKA). Methods: A retrospective, radiographic analysis was conducted of patients who underwent RA-TKA and C-TKA to compare JL position change. JL position was measured in consecutive RA-TKAs and C-TKAs performed by four fellowship-trained arthroplasty surgeons. Statistical analysis was done utilizing t-tests and Mann Whitney U tests, with statistical significance being defined as a p value < 0.05. Results: Six hundred total RA-TKAs and 400 total C-TKAs were included in the analysis. There were no significant differences in patient baseline characteristics such as body mass index, range of motion, and tibiofemoral coronal alignment. RA-TKAs were associated with an average of 0.04 (2.2) mm JL position change, and C-TKAs were associated with an average 0.5 (3.2) mm JL position change (p = 0.030). There were inter-surgeon differences when comparing the change in JL position for RA-TKAs and C-TKAs between the four participating surgeons. Conclusion: RA-TKA leads to better preservation of the JL position than C-TKA, and this seems to be dependent on the arthroplasty surgeon's preferences and techniques during TKA. Whether this statistically significant difference is clinically relevant needs to be further investigated. [ABSTRACT FROM AUTHOR]

Background: Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patellofemoral instability and pain. TTO with distalization (TTO-D) is indicated for patients with patellofemoral instability, patellar malalignment, and patella alta. The current literature demonstrates several complications that may be associated with TTO, with reportedly higher rates of complications associated with TTO-D. Purpose: To analyze and compare complication rates after TTO without distalization (TTO-ND) and TTO-D and assess risk factors associated with complications. Study Design: Cohort study; Level of evidence, 3. Methods: All skeletally mature patients who underwent TTO with or without distalization by a single surgeon between September 2014 and May 2023 with a minimum of 6 months of clinical follow-up were retrospectively reviewed. Patient factors, surgical indications, perioperative data, and complications were collected via a retrospective review of electronic medical records. Concomitant procedures were categorized as intra-articular, extra-articular, and osteotomies. Results: A total of 251 TTOs (117 TTO-D, 134 TTO-ND) were included in the study group. Postoperative complications were observed in 15 operations (6%), with arthrofibrosis as the most common complication (10 operations [4%]). TTO-D and TTO-ND had similar rates of complication (5% vs 7%; P =.793). Clinical nonunion was observed in 3 operations (3%) in the TTO-D cohort and 1 operation (1%) in the TTO-ND cohort. In the TTO-D cohort, concomitant intra-articular procedures were significantly associated with an increased likelihood of complications in a univariate model. In the TTO-ND cohort, an increased tourniquet time was significantly associated with an increased likelihood of complications in a univariate model. For all TTOs as well as the TTO-D and TTO-ND cohorts, there were no significant associations between patient or surgical variables in a multivariate model. Conclusion: TTO with and without distalization is a safe procedure with low rates of complication. TTO-D was not associated with a higher rate of complications compared with TTO-ND. There was no association between complications and surgical variables for TTO procedures. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of first premolar extraction versus distalization on the vertical position and mesiodistal angulation of maxillary third molars (MxM3) in adolescent class II patients. Methods: The panoramic x-rays (OPGs) of 200 adolescent class II patients with developing MxM3s were screened. The chosen sample consisted of 2 groups: Group 1 (Distalization) comprising 48 MxM3s, and Group 2 (Extraction) comprising 50 MxM3s. The pre- and post-treatment OPGs were traced to detect the mesiodistal angulation changes of the second molars (MxM2) and MxM3s. Results: The angulation and vertical position of the MxM3s at T0 & T1 were also evaluated using Archer’s classification. The distalization group presented a non-significant decrease in the mean angulation of MxM2 and MxM3 (-2.4o & -4.5o uprighting respectively). In the extraction group, both MxM2 and MxM3 presented a highly significant decrease in the mean angulation (-10.5o & -11o uprighting respectively). The angulation and vertical position change of MxM3 significantly improved in the extraction group when compared to the distalization group (P <.001). Conclusion: Significant uprighting and occlusal positioning of the maxillary third molars occurred in the premolar extraction treatment group when compared to the distalization treatment group. The results of the current study highlight the importance of recognizing maxillary third molars during orthodontic treatment planning of Class II malocclusion cases. [ABSTRACT FROM AUTHOR]

This article discusses a study on the effects of clear aligner treatment and differential sequence distalization of maxillary posterior teeth on anchorage loss in the upper incisors. The study found that both groups experienced significant movement of the posterior teeth and displacement of the upper incisors, but more anchorage loss was observed in the anterior region in the group treated with 33% sequential distalization. Another study evaluated the effects of maxillary molar distalization treatment using clear aligners and found that a distalization movement of 2-3 mm using clear aligners was effective, but the amount of anterior anchorage loss varied depending on the sequence protocol. The study compared dental angular and linear measurements, as well as soft tissue measurements, between two groups and found significant differences in various measurements. However, further research is needed to interpret these findings. Additionally, the document provides a list of references for a study on maxillary molar distalization in adult patients using aligners, including studies on different methods and appliances used for molar distalization and their effectiveness and outcomes. [Extracted from the article]

ABSTRACT Objective: To assess the effectiveness of a customized distalizer with Variety SP® screws anchored on palatal miniscrews for upper molar distalization. Methods: Seventeen patients aged between 12.5 and 24 years underwent distalization with a customized distalizer. Lateral cephalogram and cast analysis were performed before and after distalization. Linear and angular parameters of the upper first molar, first premolar, and central incisor were assessed. Results: Distalization with the force passing near the center of resistance (CRes) of the upper first molars resulted in distal movement, with minimal distal tipping (2.8±0.45°, p0.05) and 2.65±1.1° (p

Abstract Trial design Parallel. Objective To compare skeletally anchored Carriere Motion appliance (CMA) for distalization of the maxillary buccal segment vs. Essix anchored CMA. Methods Thirty-two class II malocclusion patients were randomly allocated into two equal groups. One group was treated with infrazygomatic (IZC) miniscrew- anchored CMA (IZCG) and the other group treated with Essix retainer- anchored CMA (EXG). Two lateral cephalograms and two digital models for upper and lower arches were taken for each patient: immediately before intervention and after distalization had been completed. Results Distalization period was not significantly different between the two groups. In contrast to EXG, IZCG showed insignificant difference in ANB, lower incisor proclination, and mesial movement of the lower first molar. There was significant rotation with distal movement of maxillary canine and first molar in both groups. Conclusion IZC anchored CMA could eliminate the side effects of class II elastics regarding lower incisor proclination, mesial movement lower molars with a more significant amount of distalization of the maxillary buccal segment but with significant molar rotation. Trial registration The ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT05499221) on 12/08/2022.

To clarify the mechanics of tooth movement produced by a unique distalizer, Class II Carriere Motion appliance (CMA), in which the maxillary canine is connected to the maxillary first molar with a stiff bar, long-term tooth movement was simulated by the finite element method (FEM). The FEM models of the maxillary canine, premolars, and first molar were made based on a dental study model. The periodontal ligament (PDL) was constructed on the root and assumed to be a nonlinear elastic material. The teeth and the alveolar bone were assumed to be rigid bodies. The tooth moved by accumulating the initial movement produced by the elastic deformation of the PDL. When retraction force was applied to the canine from the mandibular dentition, the canine tipped or rotated clockwise and extruded due to the vertical component of the retraction force. The molar and premolars also tipped and moved distally, but hardly extruded because the vertical force did not act on them. As a result of these tooth movements, the canine protruded from the dentition. An interproximal space was created between the canine and the lateral incisor. These movement patterns were similar to those in other clinical studies using the CMA. [ABSTRACT FROM AUTHOR]

• Anterior open bite has been successfully corrected without extraction. • A palatal appliance efficiently distalized and intruded the maxillary posterior teeth. • After a 5-year postretention, her occlusion and facial esthetics were maintained. This case report describes successful orthodontic retreatment for vertical control with nonextraction orthodontic therapy. A 31-year-old woman complained of anterior open bite and crowding. She had slightly protrusive lips but wanted to correct her malocclusion without extraction. Two palatal temporary skeletal anchorage devices were used for the distalization of the maxillary arch along with posterior intrusion. Mandibular distalization was performed with Class III elastics. The duration of active treatment was 22 months. The plain and efficient mechanics used contributed to the effective distalization of both arches, the intrusion of the maxillary posterior teeth, and favorable profile changes. The results were still stable at the five-year follow-up period. [ABSTRACT FROM AUTHOR]

Background: Distalization tibial tubercle osteotomy (TTO) is an effective treatment for improving patellar height in patients with patella alta associated with patellofemoral instability and cartilage lesions. The addition of a patellar tendon tenodesis has been suggested; nonetheless, concerns exist regarding possible increased patellofemoral cartilage stresses. Purpose: To evaluate pre- and postoperative patellar tendon length and alignment parameters on magnetic resonance imaging (MRI), as well as patient-reported outcome measures (PROMs) after distalization TTO without patellar tendon tenodesis. Study Design: Case series; Level of evidence, 4. Methods: Twenty skeletally mature patients who underwent distalization TTO with or without anteromedialization at our institution between December 2014 and August 2021 were included. All patients underwent pre- and postoperative MRIs of the affected knee. The Caton-Deschamps index (CDI), the axial and sagittal tibial tubercle–trochlear groove (TT-TG) distances, the distances from the tibial plateau to the patellar tendon insertion and the tibial tubercle, and the patellar tendon length were assessed. PROMs included the International Knee Documentation Committee Subjective Knee Evaluation Form, the Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale, the Kujala Anterior Knee Pain Scale, and the Veterans RAND 12-Item Health Survey mental and physical component scores. Results: The mean patient age at surgery was 27.4 years (range, 14-42 years). Radiographic parameters demonstrated improved patellar height (CDI decreased from 1.36 to 1.11; P <.001) after distalization TTO. The distance from the tibial plateau to the patellar tendon insertion significantly decreased from 20.1 mm preoperatively to 17.9 mm postoperatively (P <.020), and the patellar tendon length decreased from 53.4 mm preoperatively to 46.0 mm postoperatively (P <.001). The patellar tendon insertion was not distalized after distalization TTO, likely because of scarring of the patellar tendon proximal to the osteotomy site. Patients demonstrated significant pre- to postoperative improvements on all PROMs (P ≤.024 for all). There were 4 (20%) complications—2 cases of arthrofibrosis, 1 postoperative infection, and 1 osteotomy delayed union. Conclusion: Distalization TTO without patellar tendon tenodesis was associated with improved radiographic outcomes and PROMs. It provides an additional tool for surgical management of patellofemoral pathology with associated patella alta. [ABSTRACT FROM AUTHOR]

Trial design: Parallel. Objective: To compare skeletally anchored Carriere Motion appliance (CMA) for distalization of the maxillary buccal segment vs. Essix anchored CMA. Methods: Thirty-two class II malocclusion patients were randomly allocated into two equal groups. One group was treated with infrazygomatic (IZC) miniscrew- anchored CMA (IZCG) and the other group treated with Essix retainer- anchored CMA (EXG). Two lateral cephalograms and two digital models for upper and lower arches were taken for each patient: immediately before intervention and after distalization had been completed. Results: Distalization period was not significantly different between the two groups. In contrast to EXG, IZCG showed insignificant difference in ANB, lower incisor proclination, and mesial movement of the lower first molar. There was significant rotation with distal movement of maxillary canine and first molar in both groups. Conclusion: IZC anchored CMA could eliminate the side effects of class II elastics regarding lower incisor proclination, mesial movement lower molars with a more significant amount of distalization of the maxillary buccal segment but with significant molar rotation. Trial registration: The ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT05499221) on 12/08/2022. [ABSTRACT FROM AUTHOR]

Background: It is often stated that loose seton drainage results in distal migration of a fistula tract in perianal fistula. The aim of the present study was to assess this distalization of trans- and suprasphincteric perianal fistulas after a silicone seton has been inserted. Methods: Consecutive patients who underwent loose seton placement for the management of a transsphincteric or suprasphincteric fistula between January 2016 and December 2021 with a pre- and postoperative magnetic resonance imaging (MRI) were included in the present retrospective study. The height of the external anal sphincter (EAS) and the level of penetration of perianal fistula through the EAS or puborectal muscle (PRM) were determined on MRI. Primary outcome was migration of the fistula tract through the EAS and PRM. Results: Thirty-eight patients with perianal fistulas were included. Median height of the EAS was 28 (IQR 25–34) mm before seton placement and 27 (IQR 24–33) mm afterward. Median level of perforation was 32 (IQR 17–40) mm before seton placement and 28 (IQR 17–40) mm afterward (p = 0.37). One fistula (3%) was downgraded from mid to low transsphincteric and was laid open after 14.9 months of loose seton drainage. Conclusions: No statistically significant distalization of complex fistula tracts after loose silicone seton drainage was found. Some complex fistulas may downgrade to a less complex fistula after long-term seton drainage. However, loose silicone seton drainage should not be offered to patients as a treatment option to downgrade a complex fistula to a simple one or even have the hope to heal it. [ABSTRACT FROM AUTHOR]

In reverse shoulder arthroplasty (RSA), there are a plethora of measurements regarding implant lateralization and distalization to optimize the center of rotation. Two specific measurements known as the "lateralization shoulder angle" (LSA) and "distalization shoulder angle" (DSA) have been the recent focus of studies to assess their association with RSA and postoperative function. The aim of this study was to evaluate the prognostic clinical value of the LSA and DSA in a large cohort of patients with cuff tear arthropathy (CTA) who were treated with different RSA systems. Two local shoulder arthroplasty registries were reviewed for all RSA patients documented to have undergone a radiologic assessment and complete 2-year follow-up examination. The main inclusion criterion was primary RSA in patients with CTA. Patients with either a complete teres minor tear, os acromiale, or acromial stress fracture reported between the time of surgery and the 24-month follow-up were excluded. Five RSA implant systems with 4 neck-shaft angles (NSAs) were assessed. The Constant score, Subjective Shoulder Value, and range of motion at 2 years were correlated with both the LSA and DSA assessed on 6-month anteroposterior radiographs. Linear and parabolic univariable regressions were calculated for both shoulder angles, for each prosthesis system, and for the entire patient cohort. Between May 2006 and November 2019, there were a total of 630 CTA patients who had undergone primary RSA. Of this large cohort of patients, 270 were treated with the Promos Reverse prosthesis system (NSA, 155°); 44, Aequalis Reversed II (NSA, 155°); 62, Lima SMR Reverse (NSA, 150°); 25, Aequalis Ascend Flex (NSA, 145°); and 229, Univers Revers (NSA, 135°). The mean LSA was 78° (standard deviation [SD], 10°; range, 6°-107°), and the mean DSA was 51° (SD, 10°; range, 7°-91°). The average Constant score at 24 months' follow-up was 68.1 points (SD, 13 points; range, 13-96 points). Neither the linear nor parabolic regression calculations for the LSA or DSA revealed significant associations with any of the clinical outcomes. Different patients may achieve different clinical outcomes despite having identical LSA and DSA values. There is no association between angular radiographic measurements and 2-year functional outcomes after RSA. [ABSTRACT FROM AUTHOR]

Background: It is often stated that loose seton drainage results in distal migration of a fistula tract in perianal fistula. The aim of the present study was to assess this distalization of trans- and suprasphincteric perianal fistulas after a silicone seton has been inserted. Methods: Consecutive patients who underwent loose seton placement for the management of a transsphincteric or suprasphincteric fistula between January 2016 and December 2021 with a pre- and postoperative magnetic resonance imaging (MRI) were included in the present retrospective study. The height of the external anal sphincter (EAS) and the level of penetration of perianal fistula through the EAS or puborectal muscle (PRM) were determined on MRI. Primary outcome was migration of the fistula tract through the EAS and PRM. Results: Thirty-eight patients with perianal fistulas were included. Median height of the EAS was 28 (IQR 25–34) mm before seton placement and 27 (IQR 24–33) mm afterward. Median level of perforation was 32 (IQR 17–40) mm before seton placement and 28 (IQR 17–40) mm afterward (p = 0.37). One fistula (3%) was downgraded from mid to low transsphincteric and was laid open after 14.9 months of loose seton drainage. Conclusions: No statistically significant distalization of complex fistula tracts after loose silicone seton drainage was found. Some complex fistulas may downgrade to a less complex fistula after long-term seton drainage. However, loose silicone seton drainage should not be offered to patients as a treatment option to downgrade a complex fistula to a simple one or even have the hope to heal it. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate how lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are related to clinical and kinematic outcomes after reverse total shoulder arthroplasty. Thirty-three patients were evaluated at least six months postoperatively. The Single Assessment Numeric Evaluation (SANE), Constant Murley Score (CMS), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) were used. Shoulder kinematics was evaluated with a stereophotogrammetric system. LSA and DSA inter-rater reliability was analysed through the interclass correlation coefficient (ICC). Stepwise forward linear regression analysis was conducted between LSA and DSA with clinical scales and kinematic measures, between which a correlation analysis was conducted. The inter-rater reliability for LSA (mean ICC = 0.93) and DSA (mean ICC = 0.97) results were good to excellent. Greater LSA values were associated with higher peaks of internal rotation (p = 0.012, R2 = 0.188) and range of motion (ROM) (p = 0.037, R2 = 0.133). SANE (p = 0.009), CMS (p = 0.031), and SST (0.026) were positively correlated to external rotation, while VAS (p = 0.020) was negatively related. Abduction peaks were positively related to CMS (p = 0.011) and SANE (p = 0.037), as well as abduction ROM (SANE, p = 0.031; CMS, p = 0.014). [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to assess the impact of aligner activation and power arm length and material on canine and aligner displacement, von Mises stress in the power arm, and principal stress in the periodontal ligament (PDL) during canine tooth distalization using finite element analysis (FEA). The effects of aligner activation and power arm length were primary outcomes, while the effect of the power arm material was a secondary outcome. Methods Aligner activation (0.1 mm or 0.2 mm) was applied without using a power arm in two models. The effects of aligner activation, power arm length (12, 13, or 14 mm) and power arm material (stainless steel [SS] or fiber-reinforced composite [FRC]) on canine distalization were investigated in 12 models by evaluating displacement and stress via ALTAIR OptiStruct analysis. Results Greater canine displacement was observed in all models with 0.2 mm than 0.1 mm of aligner activation. When models with the same aligner activation were compared, reduced mesiodistal tipping, increased palatal tipping, and increased extrusion of the canine cusp were observed with increasing power arm length. Moreover, the von Mises stress increased as the power arm length increased. Increasing the aligner activation and power arm length increased the maximum principal stress in the PDL. Power arms of the same length in both materials showed the same results in terms of canine displacement, clear aligner displacement, and maximum principal stress in the PDL. However, under conditions of equal length and aligner activation, the von Mises stress of the SS power arm was higher than that of the FRC power arm. Conclusion Using a power arm in canine distalization reduced mesiodistal tipping but increased palatal tipping and extrusion of the canine cusp. Aligner activation and additional force increased tooth movement and principal stress in the canine PDL. FRC power arms exhibited less von Mises stress than SS power arms.

Abstract Background This study aimed to assess the correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption during molar distalization using clear aligner therapy (CAT). Materials and methods Thirty-eight cone beam computed tomography scans (CBCTs) obtained pre- (T0) and post-treatment (T1) from 19 adult patients (36.68 ± 13.50 years), who underwent maxillary molar distalization using Invisalign® aligners (Align Technology, Inc., San José, CA, USA) with a minimum of 2 mm distalization, were evaluated in this study At least 22 h of aligner wear per day was a main inclusion criterion. Sinus proximity and changes in root lengths were measured for 61 molars (183 roots). Spearman coefficient analysis was used for assessing correlation between sinus proximity and root resorption. The level of significance was set at p ≤ 0.05. The reproducibility of measurements was assessed by intraclass correlation coefficient (ICC). Results Spearman coefficient revealed no significant correlation between sinus proximity and molar root resorption for mesiobuccal, distobuccal or palatal roots (p = 0.558, p = 0.334, p = 0.931, respectively). Conclusion There was no correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption.

ABSTRACTMany patients and guardians prefer not to have teeth extracted as part of orthodontic treatment. Modified C-Palatal Plates (MCPPs) have been developed as an effective oral appliance. The design and procedure for placing these appliances involve a sequence of steps and specialized instruments such as a miniscrew driver. By understanding the biomechanics associated with MCPP placement, molar positioning can be optimized with less distal tipping and greater distalization. In addition to recognizing the various advantages of MCPPs, the implications of MCPPs should be considered, including the following: how far back the molars need to be moved, the effects of second and third molars in adolescents, the effects in maxillary pneumatization cases, potential impact on the airway, long-term stability, and a comparison of MCPPs to headgear. The purpose of this report is to introduce MCPP as an oral appliance that uses both miniscrews and miniplates to efficiently distalize molars minimizing the need for extraction.

Background: This study aimed to assess the impact of aligner activation and power arm length and material on canine and aligner displacement, von Mises stress in the power arm, and principal stress in the periodontal ligament (PDL) during canine tooth distalization using finite element analysis (FEA). The effects of aligner activation and power arm length were primary outcomes, while the effect of the power arm material was a secondary outcome. Methods: Aligner activation (0.1 mm or 0.2 mm) was applied without using a power arm in two models. The effects of aligner activation, power arm length (12, 13, or 14 mm) and power arm material (stainless steel [SS] or fiber-reinforced composite [FRC]) on canine distalization were investigated in 12 models by evaluating displacement and stress via ALTAIR OptiStruct analysis. Results: Greater canine displacement was observed in all models with 0.2 mm than 0.1 mm of aligner activation. When models with the same aligner activation were compared, reduced mesiodistal tipping, increased palatal tipping, and increased extrusion of the canine cusp were observed with increasing power arm length. Moreover, the von Mises stress increased as the power arm length increased. Increasing the aligner activation and power arm length increased the maximum principal stress in the PDL. Power arms of the same length in both materials showed the same results in terms of canine displacement, clear aligner displacement, and maximum principal stress in the PDL. However, under conditions of equal length and aligner activation, the von Mises stress of the SS power arm was higher than that of the FRC power arm. Conclusion: Using a power arm in canine distalization reduced mesiodistal tipping but increased palatal tipping and extrusion of the canine cusp. Aligner activation and additional force increased tooth movement and principal stress in the canine PDL. FRC power arms exhibited less von Mises stress than SS power arms. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption during molar distalization using clear aligner therapy (CAT). Materials and methods: Thirty-eight cone beam computed tomography scans (CBCTs) obtained pre- (T0) and post-treatment (T1) from 19 adult patients (36.68 ± 13.50 years), who underwent maxillary molar distalization using Invisalign® aligners (Align Technology, Inc., San José, CA, USA) with a minimum of 2 mm distalization, were evaluated in this study At least 22 h of aligner wear per day was a main inclusion criterion. Sinus proximity and changes in root lengths were measured for 61 molars (183 roots). Spearman coefficient analysis was used for assessing correlation between sinus proximity and root resorption. The level of significance was set at p ≤ 0.05. The reproducibility of measurements was assessed by intraclass correlation coefficient (ICC). Results: Spearman coefficient revealed no significant correlation between sinus proximity and molar root resorption for mesiobuccal, distobuccal or palatal roots (p = 0.558, p = 0.334, p = 0.931, respectively). Conclusion: There was no correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study on the use of clear aligners for distalizing the mandibular dentition. The study used finite element analysis to compare different methods and sites for total distalization. The results showed that clear aligners primarily cause mesiodistal tipping of individual teeth, with lingual tipping and extrusion of the mandibular anterior teeth being common. The study suggests that selecting the traction site and considering the elastic modulus of the aligners are important factors in achieving desired tooth movements. However, the study had limitations in terms of modeling individual patient diversity and clinical orthodontic force. Further research is needed to address these factors. [Extracted from the article]

Purpose: The purpose of this study was to quantify differences in mechanical stability of a wedge-shaped distalization tibial tubercle osteotomy (TTO) with a standard technique, versus a modified technique with use of a proximal bone block and distally angled screw trajectory. Methods: Ten fresh-frozen cadaver lower extremity specimens (five matched pairs) were utilized. Within each specimen pair, one specimen was randomly assigned to undergo a standard distalization osteotomy fixed with two bicortical 4.5-mm screws oriented perpendicular to the long axis of the tibia, and the other to undergo a distalization osteotomy with modified fixation utilizing a proximal bone block and distally angled screw trajectory. Each specimen's patella and tibia were mounted on a servo-hydraulic load frame using custom fixtures (MTS Instron). The patellar tendon was dynamically loaded to 400 N at a rate of 200 N/second for 500 cycles. Following the cyclic loading, loading to failure was done at 25 mm/min. Results: The modified distalization TTO technique demonstrated significantly higher average load to failure compared to the standard distalization TTO technique (1339 N vs. 844.1 N, p < 0.001). Average maximum tibial tubercle displacement during cyclic loading was significantly smaller in the modified TTO technique group compared to the standard TTO technique (1.1 mm vs. 4.7 mm, p < 0.001). Conclusion: This study demonstrates that distalization TTO utilizing a modified technique with a proximal bone block and distally aimed screws is biomechanically superior to standard distalization TTO without proximal bone block and screw trajectory perpendicular to the long axis of the tibia. This increased stability may aid in reducing the reported higher complication rates (including loss of fixation, delayed union and nonunion) following distalization TTO, although future clinical outcome studies are warranted. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the relationship between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty (RSA) with stratification based on measurement method and implant design. This systematic review was performed using PRISMA-P guidelines. PubMed/Medline, Cochrane Trials, and Embase were queried for articles evaluating the relationship between humeral lengthening and clinical outcomes inclusive of range of motion (ROM), strength, outcome scores, and pertinent complications (acromial and scapular spine fractures, nerve injury) after RSA. The relationship between humeral lengthening and clinical outcomes was reported descriptively overall and stratified by measurement method and implant design (globally medialized vs. lateralized). A positive association was defined as increased humeral lengthening being associated with greater ROM, outcome scores, or a greater incidence of complications, whereas a negative association denoted that increased humeral lengthening was associated with poorer ROM, outcome scores, or a lower incidence of complications. Meta-analysis was performed to compare humeral lengthening between patients with and without fractures of the acromion or scapular spine. Twenty-two studies were included. Humeral lengthening was assessed as the acromiohumeral distance (AHD), the distance from the acromion to the greater tuberosity (AGT), the acromion to the deltoid tuberosity (ADT), and the acromion to the distal humerus (ADH). Of 11 studies that assessed forward elevation, a positive association with humeral lengthening was found in 6, a negative association was found in 1, and 4 studies reported no association. Of studies assessing internal rotation (n = 9), external rotation (n = 7), and abduction (n = 4), all either identified a positive or lack of association with humeral lengthening. Studies assessing outcome scores (n = 11) found either a positive (n = 5) or no (n = 6) association with humeral lengthening. Of the studies that assessed fractures of the acromion and/or scapular spine (n = 6), 2 identified a positive association with humeral lengthening, 1 identified a negative association, and 3 identified no association. The single study that assessed the incidence of nerve injury identified a positive association with humeral lengthening. Meta-analysis was possible for AGT (n = 2) and AHD (n = 2); greater humeral lengthening was found in patients with fractures for studies using the AGT (mean difference 4.5 mm, 95% CI 0.7-8.3) but not the AHD. Limited study inclusion and heterogeneity prohibited identification of trends based on method of measuring humeral lengthening and implant design. The relationship between humeral lengthening and clinical outcomes after RSA remains unclear and requires future investigation using a standardized assessment method. [ABSTRACT FROM AUTHOR]

Class II malocclusion is one of the most commonly seen malocclusions in the orthodontic practice, with a variety of treatment modalities found in the literature. Maxillary molar distalization is a one of treatment options of dental Class II patients with excessive overjet, anterior crowding, or both. However, a commonly seen side effect in the conventional distalization devices is anchor loss. Here, in this case report, we have shown the successful treatment of a Class II malocclusion patient with a new concept of modified placement of the hybrid hyrax appliance, which was used effectively for en-masse, bodily distalization of maxillary teeth, with no anchorage loss. Also, the same appliance could be used for retention after the active distalization period till the treatment completion. [ABSTRACT FROM AUTHOR]

Despite the evolution of reverse total shoulder arthroplasty (RTSA), limitations in range of motion (ROM) and strength leading to limited increases in functional scores have been reported. This study was undertaken to determine the effects of humeral tray lateralization. A retrospective clinical study was performed on 35 patients who underwent RTSA with a single implant (Aequalis Ascend Flex short stem; Tornier SAS–Wright Medical Inc., Bloomington, MN, USA) and a humeral tray offset of 1.5 mm from July 2016 to November 2020 by a single surgeon. Patients were classified into two groups: an inferiorly positioned humeral tray group resulting in humeral lateralization (the inferior group [n = 22]) and a superiorly positioned humeral tray group resulting in distalization (the superior group [n = 13]). Constant-Murley score, University of California-Los Angeles shoulder scale, Simple Shoulder Test, Activity scale, American Shoulder and Elbow Surgeons shoulder score, and pain visual analog score were evaluated. ROM for forward flexion and abduction was measured. Strengths of forward flexion, internal rotation at 90° abduction, and external rotation at side (ER) were measured. Computed tomography was performed postoperatively to measure the amount of humeral lateralization. Postoperative ER power was greater in the inferior group (32.39 N ± 12.08 N) than in the superior group (23.77 N ± 10.96 N; P =.043). Postoperative abduction ROM was also greater in the inferior group (158.18° ± 18.36° vs. 128.08° ± 34.97°; P =.011), and humeral tray center to greater tubercle distance was larger in this group (54.68 mm ± 5.31 mm vs. 50.76 mm ± 3.65 mm; P =.025). Lateralization by inferior humeral tray positioning provided better results than distalization by superior humeral tray positioning in RTSA in terms of ER strength and abduction ROM. RTSA with humeral lateralization appears to result in better functional outcomes in certain conditions. [ABSTRACT FROM AUTHOR]

Finite element (FE) analysis has emerged as the primary tool to investigate complex problems that are difficult to test clinically on living tissues, yielding valuable but not necessarily applicable information on orthodontic treatment modalities. Many studies are being published but the findings are difficult to interpret, lack in relevance, or cannot be critically appraised. In this paper, the FE modeling design and impact on the quality and outcome of research are discussed, with focus on how to narrow the gap between theory and clinical application. [ABSTRACT FROM AUTHOR]

Distalization of the maxillary molars is among the most commonly employed nonextraction treatment strategies for angle Class II malocclusion. This approach is primarily recommended for subjects with dentoalveolar maxillary protrusion or minor skeletal abnormalities. A case of a 17-year-old Hispanic male patient with Class II skeletal base with Class II end on canines and molars, upper anterior crowding, severe overjet, and moderate overbite is hereby reported. He refused extraction; therefore, he was offered full single upper arch distalization using subzygomatic temporary anchorage devices (TADs). After 11 months of retraction, the TADs were removed and it was observed that the overjet and overbite were now within normal values and midline shift was also corrected. Satisfactory leveling and alignment, alleviation of crowding, and Class I molar and canine relationship were achieved. The aim of this case report was to describe full single arch distalization using subzygomatic TADs in a patient with Class II skeletal, molar, and canine relationships. [ABSTRACT FROM AUTHOR]

Abstract Objectives To three-dimensionally analyse the stress distribution and displacement pattern in the maxillofacial complex following intrusion and distalization of the maxillary arch using finite element analysis in skeletal class II malocclusion with prognathic maxilla and vertical maxillary excess using miniplates and mini-implants. Materials and methods Finite Element models of a skull, Y-shaped stainless steel miniplate, mini-implant and a posted arch were generated. Three force levels (1) 200 g (2) 300 g and (3) 500 g per side were applied to the assembly. The models were pre-processed and the analysis was performed using ANSYS version 18.1 software. Alterations in von mises stress, principal maximum stress, principal minimum stress and compressive stress were analysed around the sutures and surface landmarks. Results With miniplates, there was a maximum stress concentration at the zygomatic buttress with even stress distribution at the fronto-maxillary, zygomatico-temporal, zygomatico-frontal and pterygomaxillary sutures along with anatomical landmarks such as frontal process of maxilla, ANS, Point A, prosthion and maxillary process of zygoma. First molars experienced greater distalization effects with buccal flaring when miniplates were used. With mini-implants, canine and premolars also exhibited greater distalization effects. In the root apices, lateral incisors showed increased lingual root movement with mini-implants. Conclusion Miniplates provide a greater distalizing effect while mini-implants produce increased intrusive effect. The distalizing effect is greater when 500 g of force is applied using miniplates with significantly even stress distribution and displacement pattern.

Class III Malocclusion presents a complex orthodontic challenge with various treatment options, including orthodontic camouflage and orthognathic surgery. Among these, mandibular molar distalization stands as an orthodontic approach for treating Class III Malocclusion in adults. This systematic review aims to evaluate the current evidence regarding mandibular molar distalization techniques in the treatment of Class III. The search across PubMed, Scopus, Cochrane, and Web of Science databases yielded 582 articles, from which eight met the inclusion criteria. These inclusion criteria were as follows: English language, full text, studies randomized clinical trials, and retrospective studies that evaluated various methods of mandibular distalization for Class III Malocclusion in adult patients, from 2013 to May 2023. Lower molar distalization has gained attention as a non-surgical alternative with effective and efficient outcomes. However, various treatment modalities have limitations, including reliance upon malocclusion severity, diagnosis, patient cooperation, and operator experience. From the studies analyzed, it was found that techniques using skeletal anchorage with TADs, mini-plates, or ramal plates, offer stable anchorage and controlled tooth movement, they allow unilateral action in cases of asymmetry, and they are the most effective methods for achieving distal body displacement of the tooth. Despite the promising results, the relatively small number of studies calls for more high-quality research to explore the efficacy and outcomes of different mandibular molar distalization approaches. The lack of standardized protocols and guidelines for mandibular molar distalization in Class III Malocclusion is also attributed to the limited available literature. [ABSTRACT FROM AUTHOR]

One of the most frequent malocclusion encountered is class II and distalization is considered as a conservative way of treatment. Maxillary molar distalization has been used successfull since long time in orthodontics to correct class II malocclusion. This technique can be used to treat crowding, regain lost arch length, correct deep overbite and correct maxillomandibular relationship. Numbers of techniques have been developed to distalize the molars with or without the need of extraction. As a result of over retained deciduous second molars in maxilla the permanent first molars and premolars errupt in a distal position resulting in a class II molar premolar and canine relation.A 13 years old post pubertal male patient having named B_ reported to department of orthodontics and dentofacial orthopaedics with chief complaint of irregularly placed upper & lower front teeth, who was diagnosed with class II subdivision, having class I molar on left side & class II molar relation on right side and class I canine relation on both side with overjet of 3mm and overbite of 4 mm, crowding of 8mm in upper & 7mm in lower arch, Upper midline is coinciding with lower arch having straight facial profile, 115° nasolabial angle, incompetent lips. Treatment was started with .022 MBT bracket system. Initially levelling and aligning were started with .014 Niti. The modified TPA was placed to start correction from the initial levelling phase. By light coupling force from the modified TPA to the band ensures correction of rotation and correction of crossbite. Two lingual button were place at the palatal surface of the right premolars to derotate them using elastics. A nickel titanium open coil spring was placed between right lateral and first premolar to provide space for the highy placed canine to align. It was necessary to prevent the loss of anchorage, Temporary Anchorage Device were used to control the inclination of upper anteriors. For attainment of molar distalization modified TPA appliance was found to be efficient, non-invasive and non-compliant appliance where 5 mm of distalization was achieved in 3 months and occlusion was settled with class I molar and class I canine relation. [ABSTRACT FROM AUTHOR]

This literature review is issued by the American Society for Metabolic and Bariatric Surgery regarding limb lengths in Roux-en-Y gastric bypass (RYGB) and their effect on metabolic and bariatric outcomes. Limbs in RYGB consist of the alimentary and biliopancreatic limbs and the common channel. Variation of limb lengths in primary RYGB and as a revisional option for weight recurrence after RYGB are described in this review. [ABSTRACT FROM AUTHOR]

Distalization of the maxillary molars is among the most commonly employed nonextraction treatment strategies for angle Class II malocclusion. This approach is primarily recommended for subjects with dentoalveolar maxillary protrusion or minor skeletal abnormalities. A case of a 17-year-old Hispanic male patient with Class II skeletal base with Class II end on canines and molars, upper anterior crowding, severe overjet, and moderate overbite is hereby reported. He refused extraction; therefore, he was offered full single upper arch distalization using subzygomatic temporary anchorage devices (TADs). After 11 months of retraction, the TADs were removed and it was observed that the overjet and overbite were now within normal values and midline shift was also corrected. Satisfactory leveling and alignment, alleviation of crowding, and Class I molar and canine relationship were achieved. The aim of this case report was to describe full single arch distalization using subzygomatic TADs in a patient with Class II skeletal, molar, and canine relationships.

Introduction: With the advent of mini-implants, Class II correction has become routine. The study's goal was to compare the “Bone-Anchored Pendulum Appliance (BAPA)” to the “Bone-Anchored Intraoral Bodily Molar Distalizer (BAIBMD)” in terms of clinical efficacy. Materials and Procedures: Five boys and five girls were among the 10 patients in this split-mouth trial who had to have their molars distalized. On one side, BAPA Construction, and on the other, BAIBMD was piloted. A titanium mini-screw was used to secure both appliances to the bone since this was a spilled-mouth technique. The first molar bands to apply 200 g of force were used for both devices, as with all the other components that were similar for both appliances. For both sides, the nature, duration, and rate of tooth movement were compared. Using the Wilcoxon signed-rank test, descriptive statistics for several parameters were examined. Results: Distalization was accomplished on both sides with clinical success. The rate of distalization did not show any significant variation. Less time was needed for distalization with BAPA, as evidenced by the statistically substantial variances in treatment duration between the two groups. Molar tipping was noticed in BAPA, and it was statistically significant. Conclusion: While the pace of distalization was equal for both appliances, BAIBMD required more time than BAPA but resulted in a distal tooth movement that was mostly translatory in nature.