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The Cochrane Database of Systematic... Dec 2021Crowded teeth develop when there is not enough space in the jaws into which the teeth can erupt. Crowding can affect baby teeth (deciduous dentititon), adult teeth... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Crowded teeth develop when there is not enough space in the jaws into which the teeth can erupt. Crowding can affect baby teeth (deciduous dentititon), adult teeth (permanent dentition), or both, and is a common reason for referral to an orthodontist. Crowded teeth can affect a child's self-esteem and quality of life. Early loss of baby teeth as a result of tooth decay or trauma, can lead to crowded permanent teeth. Crowding tends to increase with age, especially in the lower jaw.
OBJECTIVES
To assess the effects of orthodontic intervention for preventing or correcting crowded teeth in children. To test the null hypothesis that there are no differences in outcomes between different orthodontic interventions for preventing or correcting crowded teeth in children.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 11 January 2021 and used additional search methods to identify published, unpublished and ongoing studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that evaluated any active interventions to prevent or correct dental crowding in children and adolescents, such as orthodontic braces or extractions, compared to no or delayed treatment, placebo treatment or another active intervention. The studies had to include at least 80% of participants aged 16 years and under.
DATA COLLECTION AND ANALYSIS
Two review authors, independently and in duplicate, extracted information regarding methods, participants, interventions, outcomes, harms and results. We resolved any disagreements by liaising with a third review author. We used the Cochrane risk of bias tool to assess the risk of bias in the studies. We calculated mean differences (MDs) with 95% confidence intervals (CI) for continuous data and odds ratios (ORs) with 95% CIs for dichotomous data. We undertook meta-analysis when studies of similar comparisons reported comparable outcome measures, using the random-effects model. We used the I statistic as a measure of statistical heterogeneity.
MAIN RESULTS
Our search identified 24 RCTs that included 1512 participants, 1314 of whom were included in analyses. We assessed 23 studies as being at high risk of bias and one as unclear. The studies investigated 17 comparisons. Twenty studies evaluated fixed appliances and auxiliaries (lower lingual arch, lower lip bumper, brackets, archwires, lacebacks, headgear and adjunctive vibrational appliances); two studies evaluated removable appliances and auxiliaries (Schwarz appliance, eruption guidance appliance); and two studies evaluated dental extractions (lower deciduous canines or third molars). The evidence should be interpreted cautiously as it is of very low certainty. Most interventions were evaluated by a single study. Fixed appliances and auxiliaries One study found that use of a lip bumper may reduce crowding in the early permanent dentition (MD -4.39 mm, 95% CI -5.07 to -3.71; 34 participants). One study evaluated lower lingual arch but did not measure amount of crowding. One study concluded that coaxial nickel-titanium (NiTi) archwires may cause more tooth movement in the lower arch than single-stranded NiTi archwires (MD 6.77 mm, 95% CI 5.55 to 7.99; 24 participants). Another study, comparing copper NiTi versus NiTi archwires, found NiTi to be more effective for reducing crowding (MD 0.49 mm, 95% CI 0.35 to 0.63, 66 participants). Single studies did not show evidence of one type of archwire being better than another for Titinol versus Nitinol; nickel-titanium versus stainless steel or multistrand stainless steel; and multistranded stainless steel versus stainless steel. Nor did single studies find evidence of a difference in amount of crowding between self-ligating and conventional brackets, active and passive self-ligating brackets, lacebacks added to fixed appliances versus fixed appliances alone, or cervical pull headgear versus minor interceptive procedures. Meta-analysis of two studies showed no evidence that adding vibrational appliances to fixed appliances reduces crowding at 8 to 10 weeks (MD 0.24 mm, 95% CI -0.81 to 1.30; 119 participants). Removable appliances and auxiliaries One study found use of the Schwarz appliance may be effective at treating dental crowding in the lower arch (MD -2.14 mm, 95% CI -2.79 to -1.49; 28 participants). Another study found an eruption guidance appliance may reduce the number of children with crowded teeth after one year of treatment (OR 0.19, 95% CI 0.05 to 0.68; 46 participants); however, this may have been due to an increase in lower incisor proclination in the treated group. Whether these gains were maintained in the longer term was not assessed. Dental extractions One study found that extracting children's lower deciduous canines had more effect on crowding after one year than no treatment (MD -4.76 mm, 95 CI -6.24 to -3.28; 83 participants), but this was alongside a reduction in arch length. One study found that extracting wisdom teeth did not seem to reduce crowding any more than leaving them in the mouth (MD -0.30 mm, 95% CI -1.30 to 0.70; 77 participants).
AUTHORS' CONCLUSIONS
Most interventions were assessed by single, small studies. We found very low-certainty evidence that lip bumper, used in the mixed dentition, may be effective for preventing crowding in the early permanent dentition, and a Schwarz appliance may reduce crowding in the lower arch. We also found very low-certainty evidence that coaxial NiTi may be better at reducing crowding than single-stranded NiTi, and that NiTi may be better than copper NiTi. As the current evidence is of very low certainty, our findings may change with future research.
Topics: Adolescent; Dentition, Permanent; Humans; Orthodontic Brackets
PubMed: 34970995
DOI: 10.1002/14651858.CD003453.pub2 -
The Angle Orthodontist Mar 2022To compare the treatment and posttreatment effects of Invisalign aligners that incorporated SmartForce features and attachments to traditional fixed appliances. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare the treatment and posttreatment effects of Invisalign aligners that incorporated SmartForce features and attachments to traditional fixed appliances.
MATERIALS AND METHODS
This randomized controlled trial included 66 patients, 32 aligners, and 34 fixed-appliance patients. The median ages of the aligner and braces patients were 26.7 (interquartile range [IQR]: 9.8) and 25.9 (IQR: 16.6) years, respectively. Pretreatment occlusion was assessed using the ABO Discrepancy Index. Posttreatment (T1) and 6-month retention (T2) occlusions were quantified using the ABO Objective Grading System (OGS) scores.
RESULTS
The braces group finished treatment significantly (P < .001) earlier (0.4 years) than the aligner group. The median DI scores for the aligner and braces groups were 4.5 and 7.0, respectively, which was a statistically significant (P = .015), but clinically insignificant, difference. There were no statistically significant between-group differences for the total OGS scores or any of the individual component scores at debond (T1) or after 6 months of retention (T2). During the posttreatment period, alignment and overjet worsened significantly in the aligner group, while buccolingual inclinations and occlusal relations improved. Over the same period, alignment worsened in the braces group and buccolingual inclinations improved. There was no statistically significant between-group difference in posttreatment changes of the total OGS scores.
CONCLUSIONS
While patients with simple malocclusions require 4.8 months longer treatment times with aligners than traditional braces, the treatment and 6-month posttreatment occlusal outcomes are similar.
Topics: Child; Humans; Malocclusion; Orthodontic Appliances, Fixed; Orthodontic Appliances, Removable; Orthodontic Brackets; Overbite
PubMed: 35168256
DOI: 10.2319/032921-246.1 -
The Angle Orthodontist Jan 2021The purpose of this cohort study was to evaluate the effect of self-ligating brackets (SB) and other related factors that influence orthodontic treatment time. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The purpose of this cohort study was to evaluate the effect of self-ligating brackets (SB) and other related factors that influence orthodontic treatment time.
MATERIALS AND METHODS
This was a two-armed prospective study. Consecutively treated patients who were recruited from a private practice were enrolled and asked to choose between SB and conventional brackets (CB). If the patient did not have a preference, that patient was randomly allocated. An identical archwire sequence was used, and all patients were treated by a single orthodontist. Treatment duration, number of bracket failures, poor oral hygiene, poor elastic wear, whether or not to orthodontic mini-implants (OMI) were used, OMI failure, extraction, American Board of Orthodontics Discrepancy Index, and arch length discrepancy were measured and statistically analyzed using t-tests, correlation analysis, and analysis of covariance (ANCOVA). Stepwise regression analysis was conducted to generate an equation to predict treatment duration.
RESULTS
A total of 134 patients with an average age of 22.73 years were included. The average treatment duration was 28.63 months. ANCOVA showed no significant difference in treatment duration between CB and SB. Stepwise regression analysis could explain 64.6% of the variance in treatment duration using five variables.
CONCLUSIONS
SB did not exhibit a significant reduction in treatment time as compared with CB. Patient cooperation, extractions, and malocclusion severity had a significant impact on treatment duration.
Topics: Adult; Cohort Studies; Dental Implants; Humans; Orthodontic Anchorage Procedures; Orthodontic Appliance Design; Orthodontic Brackets; Orthodontic Wires; Prospective Studies; Young Adult
PubMed: 33289803
DOI: 10.2319/050220-379.1 -
American Journal of Orthodontics and... Mar 2016
Topics: Cuspid; Dental Caries; Dental Cements; Dentist-Patient Relations; Humans; Incisor; Motivation; Oral Hygiene; Orthodontic Brackets; Patient Compliance; Patient Education as Topic; Self Care
PubMed: 26926012
DOI: 10.1016/j.ajodo.2016.01.002 -
Progress in Orthodontics Jun 2019The aim of this trial was to comparatively evaluate Icon® resin infiltration and Clinpro™ XT varnish in restoring aesthetics of white spot lesions (WSLs) present... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The aim of this trial was to comparatively evaluate Icon® resin infiltration and Clinpro™ XT varnish in restoring aesthetics of white spot lesions (WSLs) present post-orthodontic treatment.
MATERIALS AND METHODS
Two hundred forty WSLs were detected in 193 teeth of 12 patients. The participants were analysed-before intervention (T), immediately after intervention (T), 3 months later (T) and 6 months later (T), with a 1:1 allocation ratio for the application of Icon® resin infiltration and Clinpro™ XT varnish. Using a computer-generated allocation sequence, block randomization was done. A spectrophotometer was used to assess the colour of WSLs and the adjacent enamel, while a DIAGNOdent® was used to assess the fluorescence loss.
RESULTS
Immediately after the intervention, Icon® resin infiltration showed statistically significant better improvement than Clinpro™ XT varnish in restoring the colour (p = 0.000); however, at 3 (p = 0.001) and 6 months (p = 0.000), this was reversed. Except at 3 months, the fluorescence loss sequentially reduced more for Icon® resin infiltration (4.48 ± 1.42 at T to 1.48 ± 0.81 at T) and was not statistically significant.
CONCLUSIONS
Clinpro™ XT varnish showed significantly better improvement than Icon® resin infiltration in restoring the colour and lightness of the WSLs at 3 and 6 months. The fluorescence loss significantly recovered with both intervention methods between immediate application and at 6 months. However, Clinpro™ XT varnish-treated WSLs showed a statistically significant difference compared to the adjacent sound enamel at 6 months.
Topics: Color; Dental Caries; Esthetics, Dental; Humans; Orthodontic Brackets; Paint
PubMed: 31204437
DOI: 10.1186/s40510-019-0276-y -
The Cochrane Database of Systematic... Apr 2018Bonding of orthodontic brackets to teeth is important to enable effective and efficient treatment with fixed appliances. The problem is bracket failure during treatment... (Review)
Review
BACKGROUND
Bonding of orthodontic brackets to teeth is important to enable effective and efficient treatment with fixed appliances. The problem is bracket failure during treatment which increases operator chairside time and lengthens treatment time. A prolonged treatment is likely to increase the oral health risks of orthodontic treatment with fixed appliances one of which is irreversible enamel decalcification. This is an update of the Cochrane Review first published in 2003. A new full search was conducted on 26 September 2017 but no new studies were identified. We have only updated the search methods section in this new version. The conclusions of this Cochrane Review remain the same.
OBJECTIVES
To evaluate the effects of different orthodontic adhesives for bonding.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 26 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 8) in the Cochrane Library (searched 26 September 2017), MEDLINE Ovid (1946 to 26 September 2017), and Embase Ovid (1980 to 26 September 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Trials were selected if they met the following criteria: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing two different adhesive groups. Participants were patients with fixed orthodontic appliances. The interventions were adhesives that bonded stainless steel brackets to all teeth except the molars. The primary outcome was debond or bracket failure.
DATA COLLECTION AND ANALYSIS
Data were recorded on decalcification as a secondary outcome, if present. Information regarding methods, participants, interventions, outcome measures and results were extracted in duplicate by pairs of review authors. Since the data were not presented in a form that was amenable to meta-analysis, the results of the review are presented in narrative form only.
MAIN RESULTS
Three trials satisfied the inclusion criteria. A chemical cured composite was compared with a light cured composite (one trial), a conventional glass ionomer cement (one trial) and a polyacid-modified resin composite (compomer) (one trial). The quality of the trial reports was generally poor.
AUTHORS' CONCLUSIONS
There is no clear evidence on which to make a clinical decision of the type of orthodontic adhesive to use.
Topics: Compomers; Decalcification, Pathologic; Dental Bonding; Dental Cements; Glass Ionomer Cements; Humans; Orthodontic Brackets; Randomized Controlled Trials as Topic
PubMed: 29630138
DOI: 10.1002/14651858.CD002282.pub2 -
British Dental Journal Apr 2021
Topics: Dental Alloys; Orthodontic Appliance Design; Orthodontic Brackets
PubMed: 33893403
DOI: 10.1038/s41415-021-2970-7 -
BioMed Research International 2022Failure of brackets is a common problem in orthodontics. This affects the treatment time, cost, and compliance of the patient. This study was conducted to estimate the...
Failure of brackets is a common problem in orthodontics. This affects the treatment time, cost, and compliance of the patient. This study was conducted to estimate the bracket failure rate and the related factors for the long term. This ambidirectional cohort study included 150 nonsyndromic orthodontic patients undergoing fixed appliance therapy for the last two years. The same patients were followed for 7 months. Different variables related to bracket failure were evaluated. The available data were analyzed descriptively, and the Kaplan-Meier estimate was used to measure the bracket survival rate from the date of bonding to failure. . A total of 180 bracket bond failures in the 150 included patients (52.2% males and 47.8% females) with a median age of 17 years (range 10-25 years). 69% of brackets failures were reported within the first 6 months after bonding. About 58.3% of bracket failure was noticed in adolescent patients before the age of 18 years. The majority of the cohort (81.1%) has good oral hygiene. The failure rate in patients with normal overbite was 41.1%, in decreased overbite cases was 15%, while in deep bite cases the failure rate was 43.9% with a statistically significant difference. Adults show less bracket failure (41.7%) than adolescent patients (58.3%). More bracket failure was noted in the lower arch (55%) than the upper arch (45%), and there were more bond failures posteriorly (61%) than on the anterior teeth (39%). Majority (41.1%) of the bracket failed on round NiTi wires. . The bracket failure rate was 6.4%, with most bracket failure occurring in the first 6 months after bonding with individual difference. There was more incidence of bond failure in an increased overbite, adolescents, lower arch, posterior teeth, and lighter alignment wires.
Topics: Adolescent; Adult; Child; Equipment Failure Analysis; Female; Humans; Incidence; Male; Orthodontic Brackets
PubMed: 35059463
DOI: 10.1155/2022/5128870 -
The Angle Orthodontist May 2022To test a new concept in bracket design-the tip and torque adjustable bracket (TTAB)-to identify its integral ability to change both tip and torque.
OBJECTIVES
To test a new concept in bracket design-the tip and torque adjustable bracket (TTAB)-to identify its integral ability to change both tip and torque.
MATERIALS AND METHODS
The newly designed TTAB underwent independent testing using the orthodontic measurement and simulation system. The TTAB incorporated Roth tip and torque prescription values, with the unique quality of the bracket to enhance or reduce the innate prescribed values of tip (by either +10° or -10°) and torque (by either +7.5° or -7.5°). The TTAB was tested using both the incorporated standard Roth prescription on the rate of canine retraction (sliding mechanics), using 0.018-inch stainless-steel (SS) arch wire, and with alteration of tip values (-10° and +10°). Similarly, frictional measurements and torque evaluations using 0.019 × 0.025-inch SS arch wire were undertaken with the standard prescription and altered torque (+7.5° and -7.5°). In addition, a number of control investigations were performed. Differences were analyzed using analysis of variance.
RESULTS
The rate of observed tooth movement for the TTAB with its prescribed baseline values was comparable to that of the control brackets. Importantly, the alteration of TTAB tip to -10° and +10° significantly (P < .001) increased and reduced, respectively, the rates of canine retraction. In the alteration of torque, at +7.5° and -7.5°, the bracket delivered a moment of +9.3 (2.8) Nmm and -11.9 (3.8) Nmm, respectively, to the lateral incisor (P < .001).
CONCLUSIONS
This in vitro study demonstrates a new concept in preadjusted edgewise bracket design, offering adjustable tip and torque, with the potential for expanded clinical scope.
Topics: Dental Stress Analysis; Materials Testing; Orthodontic Appliance Design; Orthodontic Brackets; Orthodontic Wires; Stainless Steel; Torque
PubMed: 35061018
DOI: 10.2319/061421-474.1 -
BMC Oral Health Jul 2022Before the magnetic resonance imaging (MRI) examination fixed orthodontic devices, such as brackets and wires, cause challenges not only for the orthodontist but also...
BACKGROUND
Before the magnetic resonance imaging (MRI) examination fixed orthodontic devices, such as brackets and wires, cause challenges not only for the orthodontist but also for the radiologist. Essentially, the MRI-safe scan of the fixed orthodontic tools requires a proper guideline in clinical practice. Therefore, this systematic review aimed to examine all aspects of MRI-safe scan, including artifact, thermal, and debonding effects, to identify any existing gaps in knowledge in this regard and develop an evidence-based protocol.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was used in this study. The clinical question in "PIO" format was: "Does MRI examination influence the temperature of the orthodontic devices, the size of artifacts, and the debonding force in patients who have fixed orthodontic bracket and/or wire?" The search process was carried out in PubMed, PubMed Central, Scopus, and Google Scholar databases. The search resulted in 1310 articles. After selection according to the eligibility criteria, 18 studies were analyzed by two reviewers. The risk of bias was determined using the Quality In Prognosis Studies tool.
RESULTS
Out of the eligible 18 studies, 10 articles examined the heating effect, 6 were about the debonding effect, and 11 measured the size of artifact regarding brackets and wires. Considering the quality assessment, the overall levels of evidence were high and medium. The published studies showed that heating and debonding effects during MRI exposure were not hazardous for patients. As some wires revealed higher temperature changes, it is suggested to remove the wire or insert a spacer between the appliances and the oral mucosa. Based on the material, ceramic and plastic brackets caused no relevant artifact and were MRI-safe. Stainless steel brackets and wires resulted in susceptibility artifacts in the orofacial region and could cause distortion in the frontal lobe, orbits, and pituitary gland. The retainer wires showed no relevant artifact.
CONCLUSIONS
In conclusion, the thermal and debonding effects of the fixed orthodontic brackets and wires were irrelevant or resoluble; however, the size of the artifacts was clinically relevant and determined most significantly the feasibility of fixed brackets and wires in MRI examination.
Topics: Artifacts; Humans; Magnetic Resonance Imaging; Orthodontic Brackets; Orthodontic Wires; Stainless Steel
PubMed: 35854295
DOI: 10.1186/s12903-022-02317-9