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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 -
Contemporary Clinical Dentistry 2022The objective of this study was to compare the effect of miniscrew-supported maxillary incisor intrusion and conventional intrusion mechanics on maxillary incisors and... (Review)
Review
Comparing the Effect of Miniscrew-Supported and Conventional Maxillary Incisor Intrusion on the Inclination of Maxillary Incisors and Molars - A Systematic Review and Meta-Analysis.
OBJECTIVE
The objective of this study was to compare the effect of miniscrew-supported maxillary incisor intrusion and conventional intrusion mechanics on maxillary incisors and molar inclination.
MATERIAL AND METHODS
Search databases (PubMed, Scopus, Web of Science, Embase, EBSCOhost, and the Cochrane Library) were searched for randomized trials on intrusion of maxillary incisors via miniscrew-supported and conventional mechanics. The revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0) was used. Five outcomes ([i] inclination change of upper incisors, [ii] inclination change of upper molars, [iii] intrusion of incisors, [iv] vertical change in upper first molars, and [v] overbite correction achieved) were statistically pooled using Review Manager 5.3. Subgroup analysis was conducted to receive sturdiness in meta-analysis. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation.
RESULTS
Out of 1777 studies, 7 were finally subjected to quality assessment, and 6 were included in the meta-analysis. The incisor inclination following maxillary incisor intrusion increased in miniscrew-supported intrusion in comparison to Connecticut intrusion arch (CTA) subgroup with standard mean difference of 0.66 mm (95% confidence interval = 0.16, 1.03, I = 0%). All the included studies showed an increase in molar inclination (distal tipping) in the CTA subgroup compared to the micro-implant group. Of all the seven included studies, only one study was identified with some concerns for the risk of bias, and the other six were judged to have an overall high risk of bias.
CONCLUSION
The incisal proclination during deep-bite correction by miniscrew-supported incisal intrusion is more than that in the CTA subgroup; however, the difference may not be clinically very relevant. There is a very low quality of evidence in favor of miniscrew-supported intrusion as compared to conventional intrusion, necessitating the need for good-quality trials.
PubMed: 36686998
DOI: 10.4103/ccd.ccd_385_22 -
Journal of Orofacial Orthopedics =... Jul 2020There is no consensus regarding which mode of activation or mandibular advancement (stepwise [SW] or maximum bite-jumping [BJ]) of fixed or removable functional... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
There is no consensus regarding which mode of activation or mandibular advancement (stepwise [SW] or maximum bite-jumping [BJ]) of fixed or removable functional appliances (FFA; RFA) for correction of Angle class II malocclusion is advantageous to produce dental, skeletal or condylar effects and has the lowest rate of undesired dental or technical side-effects.
METHODS
A systematic search was conducted up to Oct. 20, 2019 in the MEDLINE, EMBASE, Scopus, Central Cochrane Library, and BBO databases. Included were preadolescent, adolescent, and adult humans with initial (pretreatment) Angle class II malocclusion, without further restriction. The intervention group was composed of subjects treated with FFA or RFA in SW mandibular advancement; the control group received BJ advancement. Search terms included prospective randomized and nonrandomized trials in English, German, Spanish, and Portuguese with the primary outcomes of skeletal and dental class II correction, effects on condylar growth, lower incisor proclination, overjet and overbite reduction. The risk of bias (ROB) was assessed using the Cochrane Collaboration's ROB2 tool. Mean differences were calculated and pooled by a meta-analysis using a random effects model.
RESULTS
Data from five randomized controlled trials (RCT) with 401 participants (mean age 13.84 years; SD 1.53) were included; 331 derived from four studies were included in the meta-analysis. The ROB in the selected articles was high. We detected a slightly increased reduction of the ANB (mean difference [MD] -0.95°, 95% confidence interval [CI] -1.80 to -0.10°; I = 72%) that may be attributed to a slightly more pronounced increase of the SNB angle in SW-advanced mandibles (MD 0.27°; 95% CI -0.47 to 1.00°; I = 38%). SW advancement tended to reduce the undesired side effect of lower incisor proclination (MD = -1.59°; 95% CI -3.98 to 0.8°; I = 0%), indicating more pronounced mandibular incisor changes with bite-jumping advancement.
CONCLUSION
There is weak evidence indicating a slightly increased reduction of the ANB and less lower incisor proclination with SW advancement compared to BJ, but the clinical relevance is debatable due to the small overall magnitude and small number of high-quality papers.
REGISTRATION
Prospero #CRD42017075469 (www.crd.york.ac.uk/prospero).
Topics: Adolescent; Adult; Cephalometry; Humans; Malocclusion, Angle Class II; Mandible; Mandibular Advancement; Orthodontic Appliances, Functional; Orthodontics, Corrective; Overbite
PubMed: 32435862
DOI: 10.1007/s00056-020-00226-6 -
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 -
American Journal of Orthodontics and... Mar 2023Bonded spurs, fixed or removable palatal cribs have been used to treat anterior open bite (AOB) in growing children. Different conclusions have been brought out by... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Bonded spurs, fixed or removable palatal cribs have been used to treat anterior open bite (AOB) in growing children. Different conclusions have been brought out by different authors. This meta-analysis aimed to evaluate the effect of bonded spurs, fixed and removable palatal cribs in the early treatment of AOB.
METHODS
A comprehensive electronic search was carried out through PubMed, Embase (via Ovid), MEDLINE (via Ovid), Cochrane Central Register of Controlled Trials, and Web of Science up to May 1, 2022. This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The work was carried out by 2 reviewers in duplicate and independently, including electronic searching, data extracting, risk of bias assessment, quality of evidence grading, heterogeneity and statistical power analysis, and eligibility evaluation of the retrieved articles.
RESULTS
Four studies out of 181 articles were recruited in the meta-analysis after applying the inclusion and exclusion criteria. The results showed that bonded lingual spurs and fixed palatal crib or spurs produced similar overbite changes (mean difference, -0.32; 95% confidence interval, -1.06 to 0.43; P = 0.41; I = 27%; meta power = 0.099). Fixed palatal crib and removable palatal crib also exhibited comparable effects in correcting AOB (mean difference, -0.02; 95% confidence interval, -0.90 to 0.86; P = 0.96; I = 0%; meta power = 0.2182). The quality of evidence about these 2 outcomes assessed with GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was low.
CONCLUSIONS
Bonded lingual spurs, fixed palatal crib or spurs, and removable palatal crib had similar effects in the early treatment of AOB. Because the number of included studies was limited and only the overbite changes before and after treatment were assessed, more clinical randomized controlled studies with longer follow-ups are needed to get more clinically significant advice.
Topics: Child; Humans; Open Bite; Overbite; Malocclusion, Angle Class II; Palate; Infant Equipment
PubMed: 36564317
DOI: 10.1016/j.ajodo.2022.10.017 -
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 -
The Cochrane Database of Systematic... Apr 2024Prominent lower front teeth (Class III malocclusion) may be due to jaw or tooth position or both. The upper jaw (maxilla) can be too far back or the lower jaw (mandible)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prominent lower front teeth (Class III malocclusion) may be due to jaw or tooth position or both. The upper jaw (maxilla) can be too far back or the lower jaw (mandible) too far forward; the upper front teeth (incisors) may be tipped back or the lower front teeth tipped forwards. Orthodontic treatment uses different types of braces (appliances) fitted inside or outside the mouth (or both) and fixed to the teeth. A facemask is the most commonly reported non-surgical intervention used to correct Class III malocclusion. The facemask rests on the forehead and chin, and is connected to the upper teeth via an expansion appliance (known as 'rapid maxillary expansion' (RME)). Using elastic bands placed by the wearer, a force is applied to the top teeth and jaw to pull them forwards and downward. Some orthodontic interventions involve a surgical component; these go through the gum into the bone (e.g. miniplates). In severe cases, or if orthodontic treatment is unsuccessful, people may need jaw (orthognathic) surgery as adults. This review updates one published in 2013.
OBJECTIVES
To assess the effects of orthodontic treatment for prominent lower front teeth in children and adolescents.
SEARCH METHODS
An information specialist searched four bibliographic databases and two trial registries up to 16 January 2023. Review authors screened reference lists.
SELECTION CRITERIA
We looked for randomised controlled trials (RCTs) involving children and adolescents (16 years of age or under) randomised to receive orthodontic treatment to correct prominent lower front teeth (Class III malocclusion), or no (or delayed) treatment.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Our primary outcome was overjet (i.e. prominence of the lower front teeth); our secondary outcomes included ANB (A point, nasion, B point) angle (which measures the relative position of the maxilla to the mandible).
MAIN RESULTS
We identified 29 RCTs that randomised 1169 children (1102 analysed). The children were five to 13 years old at the start of treatment. Most studies measured outcomes directly after treatment; only one study provided long-term follow-up. All studies were at high risk of bias as participant and personnel blinding was not possible. Non-surgical orthodontic treatment versus untreated control We found moderate-certainty evidence that non-surgical orthodontic treatments provided a substantial improvement in overjet (mean difference (MD) 5.03 mm, 95% confidence interval (CI) 3.81 to 6.25; 4 studies, 184 participants) and ANB (MD 3.05°, 95% CI 2.40 to 3.71; 8 studies, 345 participants), compared to an untreated control group, when measured immediately after treatment. There was high heterogeneity in the analyses, but the effects were consistently in favour of the orthodontic treatment groups rather than the untreated control groups (studies tested facemask (with or without RME), chin cup, orthodontic removable traction appliance, tandem traction bow appliance, reverse Twin Block with lip pads and RME, Reverse Forsus and mandibular headgear). Longer-term outcomes were measured in only one study, which evaluated facemask. It presented low-certainty evidence that improvements in overjet and ANB were smaller at 3-year follow-up than just after treatment (overjet MD 2.5 mm, 95% CI 1.21 to 3.79; ANB MD 1.4°, 95% CI 0.43 to 2.37; 63 participants), and were not found at 6-year follow-up (overjet MD 1.30 mm, 95% CI -0.16 to 2.76; ANB MD 0.7°, 95% CI -0.74 to 2.14; 65 participants). In the same study, at the 6-year follow-up, clinicians made an assessment of whether surgical correction of participants' jaw position was likely to be needed in the future. A perceived need for surgical correction was observed more often in participants who had not received facemask treatment (odds ratio (OR) 3.34, 95% CI 1.21 to 9.24; 65 participants; low-certainty evidence). Surgical orthodontic treatment versus untreated control One study of 30 participants evaluated surgical miniplates, with facemask or Class III elastics, against no treatment, and found a substantial improvement in overjet (MD 7.96 mm, 95% CI 6.99 to 8.40) and ANB (MD 5.20°, 95% CI 4.48 to 5.92; 30 participants). However, the evidence was of low certainty, and there was no follow-up beyond the end of treatment. Facemask versus another non-surgical orthodontic treatment Eight studies compared facemask or modified facemask (with or without RME) to another non-surgical orthodontic treatment. Meta-analysis did not suggest that other treatments were superior; however, there was high heterogeneity, with mixed, uncertain findings (very low-certainty evidence). Facemask versus surgically-anchored appliance There may be no advantage of adding surgical anchorage to facemasks for ANB (MD -0.35, 95% CI -0.78 to 0.07; 4 studies, 143 participants; low-certainty evidence). The evidence for overjet was of very low certainty (MD -0.40 mm, 95% CI -1.30 to 0.50; 1 study, 43 participants). Facemask variations Adding RME to facemask treatment may have no additional benefit for ANB (MD -0.15°, 95% CI -0.94 to 0.64; 2 studies, 60 participants; low-certainty evidence). The evidence for overjet was of low certainty (MD 1.86 mm, 95% CI 0.39 to 3.33; 1 study, 31 participants). There may be no benefit in terms of effect on ANB of alternating rapid maxillary expansion and constriction compared to using expansion alone (MD -0.46°, 95% CI -1.03 to 0.10; 4 studies, 131 participants; low-certainty evidence).
AUTHORS' CONCLUSIONS
Moderate-certainty evidence showed that non-surgical orthodontic treatments (which included facemask, reverse Twin Block, orthodontic removable traction appliance, chin cup, tandem traction bow appliance and mandibular headgear) improved the bite and jaw relationship immediately post-treatment. Low-certainty evidence showed surgical orthodontic treatments were also effective. One study measured longer-term outcomes and found that the benefit from facemask was reduced three years after treatment, and appeared to be lost by six years. However, participants receiving facemask treatment were judged by clinicians to be less likely to need jaw surgery in adulthood. We have low confidence in these findings and more studies are required to reach reliable conclusions. Orthodontic treatment for Class III malocclusion can be invasive, expensive and time-consuming, so future trials should include measurement of adverse effects and patient satisfaction, and should last long enough to evaluate whether orthodontic treatment in childhood avoids the need for jaw surgery in adulthood.
Topics: Adolescent; Child; Humans; Child, Preschool; Orthodontics, Corrective; Orthodontic Appliances; Malocclusion, Angle Class III; Dental Care; Mouth
PubMed: 38597341
DOI: 10.1002/14651858.CD003451.pub3 -
Journal of Stomatology, Oral and... Feb 2023To compare the treatment outcomes and effectiveness of Anterior Maxillary Distraction (AMD) with the LeFort I Osteotomy and Total Maxillary Distraction Osteogenesis... (Meta-Analysis)
Meta-Analysis
Effects of anterior maxillary distraction compared to LeFort-1 osteotomy and total maxillary distraction osteogenesis for treating hypoplastic maxilla in patients with cleft lip and palate- A systematic review and meta-analysis.
OBJECTIVE
To compare the treatment outcomes and effectiveness of Anterior Maxillary Distraction (AMD) with the LeFort I Osteotomy and Total Maxillary Distraction Osteogenesis (TMDO) to treat cleft maxillary hypoplasia.
METHODS
(PROSPERO CRD42020223345) Thorough electronic search of seven databases, unpublished gray literature, and a hand search of the relevant studies reference lists was done. Studies assessing mid-facial skeletal, dentoalveolar, and soft-tissue outcomes of AMD in patients >8 years of age, hypoplastic cleft maxilla, and with either TMDO/LeFort 1/ both as control groups were included. Seven included articles were assessed for the study characteristics and qualitative synthesis. Three studies were analyzed quantitatively using the RevMan 5.4 software. The quality of studies was assessed using Cochrane ROB2 and the overall certainty of evidence using GRADE.
RESULTS
AMD was performed in 241 subjects, LeFort 1 in 145 subjects, and TMDO in 42 subjects. Maxillary advancement for AMD and LeFort 1 groups showed no statistically significant difference (Mean Difference, MD -0.64°) while TMDO showed statistically significant advancement than AMD (MD -1.44°). Statistically significant upward rotation of anterior maxilla was noted with AMD (MD -6.15 degrees) than Lefort 1. Upper incisor inclination improved in both AMD and TMDO groups (MD 1.5°). Improvement in the maxilla-mandibular relationship, convexity of face, lip and nose, and marked dentoalveolar changes in overjet and upper incisor position were noted in all the three groups. Discernible airway alterations were noted in LeFort 1 and TMDOs. Total relapse was the least with AMD.
CONCLUSION
Distraction osteogenesis exhibited better dento-skeletal outcomes and minor skeletal relapse than LeFort 1. TMDO is a preferred modality in treating severe maxillary hypoplasia associated with CLP than AMD. Further long-term prospective comparative studies are required, possibly involving the patient-centric merits.
Topics: Humans; Cleft Lip; Osteogenesis, Distraction; Cleft Palate; Prospective Studies; Cephalometry; Maxilla; Osteotomy, Le Fort; Recurrence
PubMed: 36220549
DOI: 10.1016/j.jormas.2022.10.007 -
Cureus Nov 2023The primary goal of orthodontic therapy in pseudo-class III is to restore the proper dental connection by rectifying the canine and molar relationship to Class I through... (Review)
Review
The primary goal of orthodontic therapy in pseudo-class III is to restore the proper dental connection by rectifying the canine and molar relationship to Class I through lower molar and premolar visualization, as well as providing normal anterior overjet. The purpose of this systematic study was to determine the efficacy of clear aligners in treating class III malocclusion with mandibular molar distalization. A wide range of searches were done on various search engines like Cochrane, Web of Science, Embase, PubMed, Scopus, and Google Scholar to collect relevant articles related to our study. This review's article selection was guided by the PRISMA flowchart. The electronic findings provided numerous articles with nearly 78 articles regarding clear aligners in class III malocclusion with molar distalization. From this, seven full-text papers were evaluated for eligibility criteria, with two articles being rejected with justification and five articles being elaborated in the current systematic review. The current evidence of this review suggested that the clear aligners were effective in correcting class III malocclusion with molar distalization. The amount of molar distalization is about 2 to 3 mm, which helps in achieving molar and canine relationship in class I, with a high compliance level and also improvement of the facial profile.
PubMed: 38046776
DOI: 10.7759/cureus.48134 -
Turkish Journal of Orthodontics Jun 2022The aim of this analysis was to evaluate the maxillary incisor intrusion and change in overbite achieved by micro-implants compared to Connecticut intrusion arches among...
The aim of this analysis was to evaluate the maxillary incisor intrusion and change in overbite achieved by micro-implants compared to Connecticut intrusion arches among post-pubertal patients with deep bite. Medline, PubMed, Cochrane, and Google scholar were searched for studies falling under the inclusion criteria. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) com- paring maxillary incisor intrusion among post-pubertal deep bite cases treated by mini-implants and Connecticut intrusion arches were to be included. Outcome data were extracted using guidelines published by the Cochrane Collaboration. A systematic review was conducted using Cochrane Program Review Manager, version 5. A random effects model was used to assess the mean difference in the amount of incisor intrusion and overbite correction achieved between the 2 methods. Statistical significance was set at P < .05. Assessment of certainty of evidence was conducted using GRADE analysis. Six trials met the inclusion criteria. Mean differences for incisor intrusion -0.67 [95% CI, 0.97, 0.38] I2 = 31%; P < .00001) and overbite correction -0.51 [95% CI, 0.85, 0.16] I2 = 50%; P = .004) achieved with mini-implants were found to be significantly effective when compared to the Connecticut intrusion arch. Low to mod- erate heterogeneity was noted for incisor intrusion and change in overbite analysis respectively. High certainty of evidence was noted for higher association of mini-implants with incisor intrusion and overbite correction. Our meta-analysis suggests that mini-implants are superior to the Connecticut intrusion arch with respect to the amount of incisor intrusion and overbite correction. Further studies are still needed to confirm the superiority.
PubMed: 35788440
DOI: 10.5152/TurkJOrthod.2022.21080