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The association of overjet size and traumatic dental injuries-A systematic review and meta-analysis.Dental Traumatology : Official... Oct 2019Traumatic dental injuries are one of the most prevalent diseases globally, impacting people of different ages and socio-economic statuses. As disease prevention is... (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIMS
Traumatic dental injuries are one of the most prevalent diseases globally, impacting people of different ages and socio-economic statuses. As disease prevention is preferable to management, understanding when an individual's overjet is prone to dental trauma helps identify at-risk patients, so to institute preventive strategies. The aim of this study was to identify the different overjet sizes that present an increased risk for developing dental trauma across different ages and dentition stages.
METHODS
The title and protocol were registered and published a priori with the Joanna Briggs Institute (JBI) and PROSPERO (CRD42017060907) and followed the JBI methodology of systematic reviews of association (etiology). A three-step search strategy was performed, including electronic searches of gray literature and four databases. Studies of healthy human participants of any age and in any dental dentition stage were considered for inclusion. Only high methodological quality studies with low risk of bias were included. Where possible, meta-analyses were performed using the random-effects model, supplemented with the fixed-effects model in situations where statistical heterogeneity was ≤50%, assessed using the I statistic.
RESULTS
The study identified 3718 articles, 41 were included. An increased overjet was significantly associated with higher odds of developing trauma in all dentition stages and age groups. Children 0-6 years with an overjet ≥3mm have an odds of 3.37 (95%CI, 1.36-8.38, P = 0.009) for trauma. Children in the mixed and secondary dentition with an overjet >5mm have an odds of 2.43 (95%CI, 1.34-4.42, P = 0.004). Twelve-year-old children with an overjet >5mm have an odds of 1.81 (95%CI, 1.44-2.27, P < 0.0001).
CONCLUSIONS
The results confirm the association between increased overjet and dental trauma. A child in the primary dentition could be considered as having an overjet at risk for trauma when it is ≥3mm. In the early secondary dentition, the threshold for trauma is an overjet ≥5mm.
Topics: Child; Dentition, Permanent; Humans; Malocclusion, Angle Class II; Overbite; Tooth Injuries; Tooth, Deciduous
PubMed: 31062510
DOI: 10.1111/edt.12481 -
European Journal of Orthodontics Feb 2017Oral habits are common etiological factors for anterior open bites (AOBs) in growing children and adolescents. The objective of this review was to provide a literature... (Review)
Review
BACKGROUND/OBJECTIVES
Oral habits are common etiological factors for anterior open bites (AOBs) in growing children and adolescents. The objective of this review was to provide a literature synthesis evaluating the effectiveness of open bite correction in growing individuals with the use of habit-interception appliances.
SEARCH METHODS
Electronic searches were conducted on PubMed, Embase, Cochrane Library, Web of Sciences, Scopus, Google Scholar, Scielo, and Lilacs databases. Trials registries were consulted for ongoing trials, and a partial grey literature search was also conducted.
SELECTION CRITERIA
The selection criteria included controlled clinical trials enrolling growing subjects who underwent habit-interception orthodontic treatment to correct dental and/or skeletal AOB.
DATA COLLECTION ANALYSIS
Data was grouped and analysed descriptively. A meta-analysis was only possible regarding crib therapy effectiveness. Qualitative appraisal was performed according to Cochrane Risk of Bias tool for randomized clinical trials (RCTs) and the MINORS tool for non-randomized clinical trials (nRCTs).
RESULTS
Two RCTs and nine nRCTs were identified. Most of them presented relevant limitations. Crib therapy demonstrated to be effective (+3.1mm overbite correction). However, most of the dental effects are seemingly lost with time; and the skeletal effects are still controversial. Other habit-interception appliances, such as spurs, were not sufficiently investigated.
CONCLUSIONS
Crib therapy appears to be effective on a short time basis. As for other habit-interception appliances, insufficient evidence could not provide reliable conclusions.
Topics: Adolescent; Bias; Child; Habits; Humans; Open Bite; Overbite
PubMed: 26846264
DOI: 10.1093/ejo/cjw005 -
Turkish Journal of Orthodontics Mar 2017The present systemic review was conducted with the main purpose to evaluate the quantitative effects of orthognathic surgeries, extraction versus non-extraction... (Review)
Review
OBJECTIVE
The present systemic review was conducted with the main purpose to evaluate the quantitative effects of orthognathic surgeries, extraction versus non-extraction treatment, and the type of malocclusion in the stability of anterior open-bite (AOB) correction over the long-term.
METHODS
The systematic search for studies was conducted through MEDLINE, CINAHL, EMBASE, Scopus, PsychINFO, various key journals, and review articles; November 30, 2016, was the last date for the search. The Quality Assessment Tool for Quantitative Studies was used to grade the methodological quality of the studies.
RESULTS
The present review included 14 studies. Stability of the corrected AOB ranged from 61.9% to 100%. The studies with orthognathic surgeries showed a stability of 70-100%. The studies without orthognathic surgeries showed the stability of 61.9-96.7%. All of the studies were retrospective. The mean change in AOB before (T1) and after treatment (T2-T1) was 0.1 mm to 6.93 mm and the mean change in overbite from T2 to T3 (T3-T2) was -0.06 mm to 2.5 mm.
CONCLUSION
Studies with orthognathic surgeries presented with high amount of long-term stability in corrected AOB. No significant difference was noticed in relation to the type of malocclusion and extraction or non-extraction cases.
PubMed: 30112488
DOI: 10.5152/TurkJOrthod.2017.010 -
Journal of Orofacial Orthopedics =... Jul 2020To systematically search the scientific literature concerning the influence of playing a wind instrument on tooth position and/or facial morphology. (Meta-Analysis)
Meta-Analysis
PURPOSE
To systematically search the scientific literature concerning the influence of playing a wind instrument on tooth position and/or facial morphology.
METHODS
The PubMed, EMBASE and Cochrane databases were searched up to September 2019. Orthodontic journals were hand searched and grey literature was sought via Google Scholar. Observational studies and (randomized) controlled clinical trials that assessed tooth position and/or facial morphology by profile cephalograms, dental casts or clinical examination were included. The potential risk of bias was assessed. Data from wind instrument players and controls were extracted. Descriptive analysis and meta-analysis were performed.
RESULTS
In total, 10 eligible studies with a cross-sectional (n = 7) or longitudinal design (n = 3) and an estimated low to serious risk of bias were included. Sample sizes ranged from 36 to 170 participants, varying from children to professional musicians. Descriptive analysis indicated that adults playing a single-reed instrument may have a larger overjet than controls. Playing a brass instrument might be associated with an increase in maxillary and mandibular intermolar width among children. Longitudinal data showed less increase in anterior facial height among brass and single-reed players between the age of 6 and 15. Children playing a wind instrument showed thicker lips than controls. Meta-analysis revealed that after a follow-up of 6 months to 3 years, children playing brass instruments had a significant reduction in overjet as compared to controls. The magnitude of the effect was of questionable clinical relevance and the generalizability was limited.
CONCLUSIONS
Playing a wind instrument can influence tooth position and facial morphology in both children and adults. Aspects that stand out are overjet, arch width, facial divergence/convergence and lip thickness. However, evidence was sparse and the strength of the premise emerging from this review was graded to be "very low".
Topics: Adult; Child; Cross-Sectional Studies; Face; Humans; Music; Overbite; Tooth
PubMed: 32556368
DOI: 10.1007/s00056-020-00223-9 -
Journal of Orthodontics Jun 2022To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living...
AIM
To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion.
METHODS
A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme.
RESULTS
The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias.
CONCLUSION
This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.
Topics: Adult; Dental Occlusion; Humans; Malocclusion; Overbite; Quality of Life; Risk Factors; Tooth Injuries
PubMed: 34488471
DOI: 10.1177/14653125211042891 -
Journal of Dentistry May 2015To determine whether interceptive orthodontics prior to the age of 11 years is more effective than later treatment in the short- and long-term. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To determine whether interceptive orthodontics prior to the age of 11 years is more effective than later treatment in the short- and long-term.
DATA AND SOURCES
Multiple electronic databases were searched, authors were contacted as required and reference lists of included studies were screened.
STUDY SELECTION
Randomised and quasi-randomised controlled trials were included, comparing children under the age of 11 years requiring interceptive orthodontic correction for a range of occlusal problems, to an untreated or positive control group. Data extraction and quality assessment were performed independently and in duplicate.
RESULTS
Twenty-two studies were potentially eligible for meta-analysis, the majority related to growth modification. Other outcomes considered included correction of unilateral posterior crossbite, anterior openbite, extractions and ectopic maxillary canines. Meta-analysis was possible for 11 comparisons. For Class II correction in the short-term, meta-analyses demonstrated a statistically significant reduction in ANB (-1.4 degrees, 95 CI: -2.17, -0.64) and overjet (-5.81mm, 95 CI: -6.37, -5.25) with both functional appliances and headgear versus control. In the long-term, however, statistical significance was not found for the same outcomes. Treatment duration was prolonged with both functional appliances (6.85 months, 95 CI: 3.24, 10.45) and headgear (12.47 months, 95 CI: 8.67, 16.26) compared to adolescent treatments. Meta-analyses were not possible for comparisons of other interceptive treatments due to heterogeneity and methodological limitations.
CONCLUSIONS
The results suggest a lack of evidence to prove that early treatment carries additional benefit over and above that achieved with treatment commencing later; however, this does not necessarily imply that early treatment is ineffective. Further high quality trials are required to assess the effectiveness of early treatment compared to later intervention.
CLINICAL SIGNIFICANCE
Interceptive orthodontics is variously recommended for a range of malocclusions both of skeletal and dental aetiology. The merits of interceptive treatment, however, are often disputed. Further high quality trials are required to assess the effectiveness of early treatment compared to later intervention.
Topics: Age Factors; Child; Humans; Malocclusion; Orthodontics; Orthodontics, Corrective; Orthodontics, Interceptive; Overbite; Treatment Outcome
PubMed: 25684602
DOI: 10.1016/j.jdent.2015.02.003 -
The Journal of Evidence-based Dental... Sep 2020To compare removable and fixed orthodontic devices in the correction of non-skeletal anterior crossbite in children and adolescents in the mixed dentition.
OBJECTIVE
To compare removable and fixed orthodontic devices in the correction of non-skeletal anterior crossbite in children and adolescents in the mixed dentition.
MATERIALS AND METHODS
Electronic searches were conducted in the following databases: PubMed, Web of Science, Scopus, Medline Ovid, Lilacs, US Clinical Trials, and Proquest. A hand search of the reference lists of the included articles and a Google Scholar search were also conducted. References were evaluated by 2 review authors. Articles that met the eligibility criteria were included. Data extraction, methodological quality assessment (Cochrane tool), and strength of the evidence evaluation (GRADE) were also carried out.
RESULTS
Seven articles were included. The results showed that removable and fixed devices were equally efficacious for overjet correction. Removable and fixed devices can also present inconveniences regarding pain and discomfort levels, the accomplishment of everyday activities (leisure and school), and the performance of functions, such as chewing and speech. However, treatment time and costs were significantly lower in orthodontic therapy with fixed appliances. Sequence generation, allocation concealment, and complete outcome data were not a concern. Blinding of participants or personnel was not reported in any article, and blinding of the assessor was a concern in 2 articles. Selective reporting was a concern in 2 articles. The certainty of the evidence for overjet correction was very low.
CONCLUSION
Removable and fixed orthodontic devices are efficacious for overjet correction in non-skeletal anterior crossbite. However, treatment time and costs are lower for cases treated with fixed devices.
Topics: Adolescent; Child; Dentition, Mixed; Humans; Malocclusion; Overbite
PubMed: 32921377
DOI: 10.1016/j.jebdp.2020.101423 -
International Journal of Oral and... May 2024The purpose of this study was to investigate the scientific evidence on the short- and long-term effects of orthodontic correction of anterior open bite (AOB) using... (Meta-Analysis)
Meta-Analysis Review
The purpose of this study was to investigate the scientific evidence on the short- and long-term effects of orthodontic correction of anterior open bite (AOB) using skeletal anchorage (SA). Clinical studies on the use of SA for AOB in patients with permanent dentition, or at least 12 years of age, were searched. Short- and long-term (≥2 years) outcomes were collected. Mean differences were calculated from pooled data. Twenty-four eligible articles with a total of 362 subjects were selected for inclusion in the meta-analysis. There was a significant increase in overbite (3.88 mm, P < 0.001) and maxillary molar intrusion (-2.15 mm, P < 0.001). The mandible showed counterclockwise rotation with anterosuperior chin movement (all P < 0.001). Long term, the decrease in overbite was 19.9% and decrease in molar intrusion was 22.9%. The decrease in the mandibular projection was 14.6% for ANB (A-point-nasion-B-point angle) and 46.2% for mandibular anteroposterior position. The overall risk of bias in the included studies was rated as moderate to high, and publication bias existed for several key variables. SA for maxillary molar intrusion effectively improved dental and skeletal outcomes, but there was a long-term decrease in overbite and maxillary molar position. The variable data quality, heterogeneity, and publication bias in investigated outcomes are limitations in interpreting the findings.
Topics: Humans; Open Bite; Overbite; Tooth Movement Techniques; Orthodontic Anchorage Procedures; Cephalometry; Malocclusion, Angle Class II
PubMed: 37949782
DOI: 10.1016/j.ijom.2023.10.031 -
Annals of Palliative Medicine Dec 2021This systematic review aimed to evaluate and compare the treatment effects of activator appliances on untreated class II skeletal malocclusion patients in terms of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review aimed to evaluate and compare the treatment effects of activator appliances on untreated class II skeletal malocclusion patients in terms of skeletal, dental, and soft tissue changes.
METHODS
We searched 11 databases from January 1966 to May 2021 for randomized and clinical controlled trials that compared the treatment effects of activator appliances on untreated Class II skeletal malocclusion patients. All data were analyzed using RevMan 5.3 software.
RESULTS
According to the inclusion/exclusion criteria, 16 articles qualified for the final analysis. Thirteen outcome indicators of teeth, bone tissue, and soft tissue were compared and analyzed: SNA°, SNB°, ANB°, SN-MP°, ANS-Me, Co-Gn, Go-Me, overjet, overbite, U1-SN°, L1-MP°, UL-E, and LL-E. Five randomized controlled trials (RCTs) evaluations were of medium quality, and 11 controlled clinical trials (CCTs) evaluations were of B grade. Bone tissue changes: compared with the untreated group, the SNA and ANB decreased, and the SNB, SN-MP, ANS-Me, Co-Gn, and Go-Me increased after activator appliance treatment, and the differences were statistically significant (P<0.001). Dental changes: compared with the untreated group, the overjet, overbite and U1-SN in the treated group decreased significantly, while the L1-MP increased significantly (P<0.0001). Soft tissue changes: compared with untreated patients, the UL-E of patients treated with an activator appliance decreased significantly (P<0.0001); however, there was no significant difference in the LL-E between the two groups (P=0.09).
DISCUSSION
Since the imprecision and high level of heterogeneity of the articles, further large-sample and high-quality clinical trials are necessary to evaluate effects of orthodontic treatment with activator appliance on patients with skeletal Class II malocclusion. In addition, this study failed to explore the long-term stability of activator treatment, so long-term studies are needed to assess the stability of its effect on the skeletal, dental, and soft tissue changes.
Topics: Activator Appliances; Humans; Malocclusion, Angle Class II; Overbite
PubMed: 35016488
DOI: 10.21037/apm-21-3205 -
European Journal of Orthodontics Dec 2016To systematically compare the efficacy of fixed and removable functional appliances in Class II malocclusion in terms of morphological and patient-centred outcomes. (Comparative Study)
Comparative Study Review
OBJECTIVES
To systematically compare the efficacy of fixed and removable functional appliances in Class II malocclusion in terms of morphological and patient-centred outcomes.
SEARCH METHODS
A comprehensive search of electronic databases without language or time restrictions was undertaken, applying a pre-specified search strategy. Supplementary electronic searching of orthodontics journals and references list of included studies was performed.
SELECTION CRITERIA
Randomized (RCTs) and controlled (CCTs) clinical trials involving children under 16 years with Class II malocclusion and overjet more than 5mm were included.
DATA COLLECTION AND ANALYSIS
A range of clinician- and patient-centred outcomes were evaluated and compared. Risk of bias assessment was carried out using the Cochrane Collaboration tool.
RESULTS
Only four clinical trials were found to meet our criteria, of which two were RCTs, comparing the Herbst and the Twin Block appliances. Two further CCTs, compared the Activator to the Forsus and the Twin Force Bite Corrector, respectively. One study was assessed to be at unclear and the remaining at high risk of bias, precluding meta-analysis. There was also significant clinical heterogeneity in terms of methodology, type of intervention and the measured outcomes. Both modalities were effective in correcting the overjet with little differences found in cephalometric changes and a shortage of data concerning patient-centred outcomes.
CONCLUSION
There is little evidence concerning the relative effectiveness of fixed and functional appliances or in relation to patient experiences and perceptions of these treatment modalities. Further well-designed clinical trials assessing the relative merits of both clinician- and patient-centred outcomes are needed.
Topics: Cephalometry; Child; Humans; Malocclusion, Angle Class II; Orthodontic Appliances, Functional; Orthodontic Appliances, Removable; Outcome Assessment, Health Care; Overbite; Patient Outcome Assessment
PubMed: 26628629
DOI: 10.1093/ejo/cjv086