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The Angle Orthodontist Jan 2024To compare four first premolar extraction and nonextraction treatment effects on intra-arch width, profile, treatment duration, occlusal outcomes, smile aesthetics and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To compare four first premolar extraction and nonextraction treatment effects on intra-arch width, profile, treatment duration, occlusal outcomes, smile aesthetics and stability.
MATERIALS AND METHODS
An electronic search of the literature to June 2, 2023 was conducted using health science databases, with additional search of gray literature, unpublished material, and hand searching, for studies reporting nonsurgical patients with fixed appliances regarding sixteen sub-outcomes. Data extraction used customized forms, quality assessed with ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions) and Cochrane RoB 2 (risk-of-bias) tool. GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessed certainty of evidence.
RESULTS
Thirty (29 retrospective studies, 1 randomized controlled trial) studies were included. Random-effect meta-analysis (95% CI) demonstrated maxillary (MD: -2.03 mm; [-2.97, -1.09]; P < .0001) and mandibular inter-first molar width decrease (MD: -2.00 mm; [-2.71, -1.30]; P < .00001) with four first premolar extraction; mandibular intercanine width increase (MD: 0.68 mm; [0.36, 0.99]; P < .0001) and shorter treatment duration (MD: 0.36 years; [0.10, 0.62]; P = .007) in the nonextraction group. Narrative synthesis included three and five studies for upper and lower lip-E plane, respectively. For American Board of Orthodontics Objective Grading System and maxillary/mandibular anterior alignment (Little's irregularity index), each included two studies with inconclusive evidence. There were no eligible studies for UK Peer Assessment Rating (PAR) score. Class I subgroup/sensitivity analyses favored the same results. Prediction interval indicated no significant difference for all outcomes.
CONCLUSIONS
Four first premolar extraction results in maxillary and mandibular inter-first molar width decrease and retraction of upper/lower lips. Nonextraction treatment results in mandibular intercanine width increase and shorter treatment duration. There was no significant difference between the two groups regarding maxillary intercanine width, US PAR score, and posttreatment smile esthetics. Further high-quality focused research is recommended.
Topics: Humans; Orthodontics, Corrective; Retrospective Studies; Tooth Extraction; Esthetics, Dental; Bicuspid
PubMed: 37899069
DOI: 10.2319/021123-98.1 -
Journal of Dentistry Jul 2024This study aimed to systematically review the effect of sugar substitute consumption on caries prevention in permanent teeth among children and adolescents. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study aimed to systematically review the effect of sugar substitute consumption on caries prevention in permanent teeth among children and adolescents.
DATA
Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing the clinical effect of sugar substitutes (both high- and low-intensity sweeteners) in preventing caries in permanent teeth among children and adolescents aged 6-19 were included.
SOURCES
A systematic search was conducted in three databases (PubMed, Web of Science and Embase) without any restrictions on publication year.
STUDY SELECTION
The initial search found 1,859 items, and finally, 15 studies (11 RCTs and 4 CCTs) with a total of 6325 participants (age: 6-18 years) were included. The Cochrane risk-of-bias assessment tools were used for quality assessment. Most (80%, 12/15) were graded as having a 'moderate' or 'high' risk of bias. All trials investigated sugar alcohol, which is a low-intensity sweetener. Xylitol was the most commonly investigated (73.3%, 11/15), followed by sorbitol (46.7%, 7/15), and erythritol (13.3%, 2/15). Results of the meta-analysis showed that both xylitol (standardized mean difference [SMD]: -0.50, 95% confidence interval [CI] -0.85 to -0.16, P = 0.005) and sorbitol (SMD: -0.10, 95% CI: -0.19 to -0.01, P = 0.03) had a significant effect in preventing dental caries compared to no treatment/placebo. No clinical trials on high-intensity sweeteners such as aspartame and saccharin were found.
CONCLUSION
The consumption of xylitol or sorbitol is potentially effective in preventing caries in permanent teeth among children and adolescents. No clinical evidence is available regarding the role of high-intensity sweeteners in caries prevention.
CLINICAL SIGNIFICANCE
The use of xylitol or sorbitol as sugar substitutes has a beneficial effect in preventing dental caries among children and adolescents.
Topics: Humans; Dental Caries; Adolescent; Child; Xylitol; Dentition, Permanent; Sorbitol; Sweetening Agents; Erythritol; Randomized Controlled Trials as Topic
PubMed: 38762077
DOI: 10.1016/j.jdent.2024.105069 -
Journal of Endodontics Aug 2023The aim of this study was to identify specific clinical signs or symptoms and potential risk factors which are most likely associated with the presence of a vertical... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The aim of this study was to identify specific clinical signs or symptoms and potential risk factors which are most likely associated with the presence of a vertical root fracture (VRF) in endodontically treated teeth (ETT).
METHODS
Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Scopus, and Web of Science) were searched by 2 reviewers in October 2022 for clinical studies, in which at least either the clinical presentation or potential risk factors associated with a VRF were assessed. Risk of bias was assessed using the Newcastle-Ottawa scale. Meta-analyses of odds ratios (ORs) were performed separately for several signs or symptoms and risk factors.
RESULTS
Fourteen sources reporting on 2877 teeth (489 with VRF and 2388 without VRF) were included in the meta-analyses. Regarding the clinical presentation, the presence of sinus tracts (OR = 4.87; 95% confidence interval [CI], 1.58-15.0), increased periodontal probing depths (OR = 13.24; 95% CI, 5.44-32.22), swelling/abscess (OR = 2.86; 95% CI, 1.74-4.70), and tenderness to percussion (OR = 1.76; 95% CI, 1.18-2.61) were significantly associated with the presence of a VRF (P value < .05). None of the assessed risk factors (sex, type of teeth, tooth location, posts, indirect restoration, and apical extension of the root canal filling) were found to be significantly associated with the presence of a VRF (P value > .05).
CONCLUSIONS
Four clinical presentations were identified to be the most significant signs or symptoms for a VRF in ETT: presence of sinus tracts, increased probing depths, swelling/abscess, and tenderness to percussion. None of the assessed risk factors pointed out to be significantly associated with a VRF.
REGISTRATION
CRD42022354108 (PROSPERO).
Topics: Humans; Tooth Root; Root Canal Therapy; Tooth Fractures; Tooth, Nonvital; Abscess; Risk Factors
PubMed: 37307871
DOI: 10.1016/j.joen.2023.06.004 -
International Endodontic Journal Oct 2023Apical periodontitis (AP) is a chronic inflammatory response of microbial aetiology. Pathological changes associated with AP may not be visible on radiographic images... (Review)
Review
BACKGROUND
Apical periodontitis (AP) is a chronic inflammatory response of microbial aetiology. Pathological changes associated with AP may not be visible on radiographic images and may linger without causing any symptoms. Clinicians rely mostly on clinical examination and imaging techniques to establish a diagnosis.
OBJECTIVES
The aim of this review was to answer the following question using the PICO format: In the adult human permanent dentition (P), what is the efficacy of diagnostic imaging of the periapical tissues (I) using histopathology as a reference standard (C) in the diagnosis of apical periodontitis, in terms of diagnostic accuracy (O).
METHODS
MEDLINE, EMBASE, Scopus and Cochrane Library were searched for English articles published through October 2021. At least two independent reviewers evaluated the study design, imaging modality used, histopathological assessment, outcome measures, results and conclusions for each article. The risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2.
RESULTS
The initial search strategy identified 544 articles. Seven articles were included for analysis in the final review, all of which involved tissue samples obtained from cadavers. No clinical studies were identified that met the eligibility criteria. A consistently low sensitivity score and negative predictive value were reported for periapical radiography, especially in comparison to CBCT, which scored highly. Both modalities achieved high scores for specificity and positive predictive value. Diagnostic accuracy of CBCT was lower for root-filled teeth in comparison to non-root-filled teeth.
DISCUSSION
Assessment of the periapical tissues using periapical radiographs was shown to have a low to moderate agreement with the histopathological assessment. CBCT was reported to be more accurate than PR and demonstrated a good agreement with histopathology, especially for non-root-filled teeth.
CONCLUSIONS
This review identified a need for greater standardization in methodology and reporting, and as the findings are based on cadaver studies, their clinical relevance must be interpreted with caution.
REGISTRATION
PROSPERO (CRD42021272147).
Topics: Adult; Humans; Cone-Beam Computed Tomography; Periapical Periodontitis; Periapical Tissue; Cadaver; Reference Standards; Root Canal Therapy
PubMed: 37067066
DOI: 10.1111/iej.13921 -
BMC Oral Health Sep 2023The review aims to determine the risk predictability of mutans streptococci in the development of carious lesions in children with primary dentition. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The review aims to determine the risk predictability of mutans streptococci in the development of carious lesions in children with primary dentition.
METHODS
Longitudinal observational studies with at least 6 months follow-up and evaluating mutans streptococci presence in caries-free children under 6 years of age for the development of any cavitated or non-cavitated carious lesion. Six databases and grey literature were searched without any restrictions. Risk of bias was evaluated using the New Castle Ottawa scale for longitudinal studies, and the certainty of the evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation using GRADEpro software. Meta-analysis was performed using a random effect (DerSimonian and Laird, DL) model, and heterogeneity was evaluated using tau-squared, I statistics and prediction interval. Sensitivity analysis was performed to assess the relationship between the mutans streptococci presence at baseline and the caries development, according to the sample and methods used for the microbiological assessment and the length of follow-up of the studies. Publication bias was checked by funnel plot using a random effect (DerSimonian and Laird, DL) model.
RESULTS
Twelve studies met the inclusion criteria and were included in the review. Four studies received a maximum of 9 stars, and among the remaining eight studies, six received 8 stars and the rest two studies were assigned 7 stars in the risk of bias scale. After pooling the results quantitatively, odds ratio (OR) was found to be 4.13 (95% CI: 3.33, 5.12), suggesting that children with mutans streptococci had 4 times higher odds of developing caries later (p < 0.001). Four studies were pooled to compare future caries experience among children with and without mutans streptococci at baseline, obtaining standardized mean difference (SMD) of 0.85 (95% CI: 0.33, 1.37), indicating a large effect (p < 0.001). Certainty of evidence was found to be moderate, and no publication bias was reported by the funnel plot criteria of symmetry.
CONCLUSIONS
Presence of mutans streptococci in a preschool child is a risk predictor for future caries experience. Early identification of children with increased caries-risk may facilitate in implementation of appropriate preventive strategies.
Topics: Humans; Child, Preschool; Dental Caries; Databases, Factual; Odds Ratio; Publication Bias; Software; Streptococcus mutans
PubMed: 37679718
DOI: 10.1186/s12903-023-03346-8 -
BMC Oral Health Aug 2023This study aims to assess the scientific evidence regarding the clinical outcomes of Invisalign therapy in controlling orthodontic tooth movement.
OBJECTIVE
This study aims to assess the scientific evidence regarding the clinical outcomes of Invisalign therapy in controlling orthodontic tooth movement.
MATERIALS AND METHODS
An electronic search was conducted on PubMed, Cochrane Library, Web of Science, Embase, and Scopus from November 2015 to November 2022 to identify relevant articles. Methodological shortcomings were highlighted, and an evaluation of the quality of the included studies was completed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool.
RESULTS
Fifteen non-randomized controlled trials were included in the analysis. Most non-randomized controlled trials (n=11; 73%) were rated with a moderate risk of bias according to the ROBINS-I tool. There were statistically significant differences between the pretreatment and posttreatment arches. The average expansion was significantly different from that predicted for each type of tooth in both the maxilla and mandible. Furthermore, the efficiency decreased from the anterior area to the posterior area in the upper arch.
CONCLUSION
Despite the fact that arch expansion with Invisalign® is not entirely predictable, clear aligner treatment is a viable option for addressing dentition crowding. The efficacy of expansion is greatest in the premolar area. More research focusing on treatment outcomes with different materials of aligners should be conducted in the future. Overcorrection should be considered when planning arch expansion with Invisalign. In the maxilla, the expansion rate decreases from the anterior to the posterior, and presetting sufficient buccal root torque of posterior teeth may result in improved efficiency of expansion.
Topics: Humans; Mandible; Orthodontic Appliances, Removable
PubMed: 37620781
DOI: 10.1186/s12903-023-03302-6 -
Odontology Oct 2023The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to AH Plus® sealer. This SRM was carried out in accordance with the items on the PRISMA 2020 checklist and Cochrane guidelines and registered in PROSPERO (CRD42021259283). Only randomized clinical trials (RCTs) were included. Meta-analysis was conducted using R software, the standardized means difference (SMD) measure of effect was calculated for quantitative variables, and the odds ratio (OR) for binary variables. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Qualitative and quantitative analysis included 18 and 17 studies, respectively. For quantitative variables, the bioceramic root canal sealer presented less occurrence of postoperative pain than the AH Plus® sealer in 24 h (SMD - 0.17 [- 0.34; - 0.01], p = 0.0340). For binary variables, there was no difference observed between the sealers evaluated, except for sealer extrusion where the bioceramic group had lower post-filling material extrusion (OR 0.52 [0.32; 0.84], p = 0.007). Regarding the risk of bias analysis, low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results showed that bioceramics sealers reduced postoperative endodontic pain only after 24 h and showed less sealer extrusion compared to the AH Plus® sealer. However, more robust and standardized clinical trials are needed to confirm the results with less heterogeneity and higher quality of evidence.
Topics: Humans; Root Canal Filling Materials; Epoxy Resins; Dental Pulp Cavity; Randomized Controlled Trials as Topic; Root Canal Obturation; Pain, Postoperative
PubMed: 37378833
DOI: 10.1007/s10266-023-00830-z -
Journal of Dentistry Dec 2023The aim of this scoping review was to summarize and discuss the morphological features and associated factors of pulpal mineralizations (PMs) as described within the...
OBJECTIVE
The aim of this scoping review was to summarize and discuss the morphological features and associated factors of pulpal mineralizations (PMs) as described within the literature.
DATA
The study protocol was registered on the Open Science Framework platform and is available at the following link: https://osf.io/hfqwe. This scoping review was developed according to the PRISMA-ScR guidelines.
SOURCES
A literature search of four electronic databases was performed in SCOPUS, MEDLINE (PubMed), EMBASE and Word of Science, with the last search on May 29, 2023. Study selection was completed by two reviewers independently. Data was extracted regarding study characteristics, types, and features of PM and associated factors.
STUDY SELECTION
Of 1016 studies initially identified ten which qualified were included in this scoping review. Systemic and local factors that result in pulpal insult can contribute to the development of PMs. Three forms of PM have been reported, pulp stones, diffuse mineralizations, and mineralized ectopic connective tissue, with discrete and diffuse mineralization being the two clinically relevant forms. The different forms of PMs exhibit dissimilar morphological features.
CONCLUSION
Pulpal mineralizations exist in two clinically relevant forms: diffuse and discrete mineralizations and are likely associated with a pulpal insult.
CLINICAL SIGNIFICANCE
Understanding the morphology of dental pulp mineralization is the first step to expanding the knowledge of pulp mineralization and could result in improved diagnosis of endodontic pathosis.
Topics: Dental Pulp; Dental Pulp Calcification; Humans
PubMed: 37866408
DOI: 10.1016/j.jdent.2023.104745 -
Journal of Dentistry Aug 2023This review aimed to assess the agreement of dental caries experience between monozygotic (MZ) and dizygotic (DZ) twins. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This review aimed to assess the agreement of dental caries experience between monozygotic (MZ) and dizygotic (DZ) twins.
DATA RESOURCES
This systematic review was performed by reviewers in the databases Embase, MEDLINE-PubMed, Scopus, Web of Science and manual searches and gray literature Google Scholar® and Opengray. Observational studies that evaluated dental caries in twins were included. The risk of bias was analyzed using the Joanna Briggs checklist. Meta-analyses were performed to assess the pooled Odds Ratio to estimate the agreement values of dental caries experience and DMF index between pairs of twins (p < 0.05). To assess the certainty of evidence, the GRADE scale was used.
STUDY SELECTION
2533 studies were identified, of which 19 were included in the qualitative analysis, six in the quantitative synthesis, with two meta-analyses being carried out. Association between genetics and the development of the disease was observed in most studies. In the risk of bias analysis, 47.4% had moderate risk. Higher agreement of dental caries experience was observed in MZ twins than DZ in both dentitions (OR: 5.94; 95% CI: 2.00-17.57). However, there was no difference between the MZ and DZ twin groups in the analysis comparing DMF index agreement (OR: 2.86; 95%CI: 0.25-32.79). The certainty of evidence was considered low and very low for all studies included in meta-analyses.
CONCLUSION
With very low certainty of the evidence, the genetic factor seems to influence the agreement of the caries experience.
CLINICAL RELEVANCE
Understanding the genetic influence on the disease has the potential to contribute to the development of studies that may use biotechnologies for prevention and treatment as well as guide future research involving gene therapies aiming to prevent the occurrence of dental caries.
Topics: Humans; Dental Caries; Bias; DMF Index; Odds Ratio
PubMed: 37339689
DOI: 10.1016/j.jdent.2023.104586 -
Dento Maxillo Facial Radiology Jan 2024Improved tools based on deep learning can be used to accurately number and identify teeth. This study aims to review the use of deep learning in tooth numbering and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Improved tools based on deep learning can be used to accurately number and identify teeth. This study aims to review the use of deep learning in tooth numbering and identification.
METHODS
An electronic search was performed through October 2023 on PubMed, Scopus, Cochrane, Google Scholar, IEEE, arXiv, and medRxiv. Studies that used deep learning models with segmentation, object detection, or classification tasks for teeth identification and numbering of human dental radiographs were included. For risk of bias assessment, included studies were critically analysed using quality assessment of diagnostic accuracy studies (QUADAS-2). To generate plots for meta-analysis, MetaDiSc and STATA 17 (StataCorp LP, College Station, TX, USA) were used. Pooled outcome diagnostic odds ratios (DORs) were determined through calculation.
RESULTS
The initial search yielded 1618 studies, of which 29 were eligible based on the inclusion criteria. Five studies were found to have low bias across all domains of the QUADAS-2 tool. Deep learning has been reported to have an accuracy range of 81.8%-99% in tooth identification and numbering and a precision range of 84.5%-99.94%. Furthermore, sensitivity was reported as 82.7%-98% and F1-scores ranged from 87% to 98%. Sensitivity was 75.5%-98% and specificity was 79.9%-99%. Only 6 studies found the deep learning model to be less than 90% accurate. The average DOR of the pooled data set was 1612, the sensitivity was 89%, the specificity was 99%, and the area under the curve was 96%.
CONCLUSION
Deep learning models successfully can detect, identify, and number teeth on dental radiographs. Deep learning-powered tooth numbering systems can enhance complex automated processes, such as accurately reporting which teeth have caries, thus aiding clinicians in making informed decisions during clinical practice.
Topics: Humans; Deep Learning; Dental Caries; Radiography, Dental; Tooth
PubMed: 38183164
DOI: 10.1093/dmfr/twad001