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Dental Traumatology : Official... Feb 2024Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN.
MATERIALS AND METHODS
The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model.
RESULTS
A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures.
CONCLUSION
The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.
Topics: Female; Humans; Male; Cerebral Palsy; Delivery of Health Care; Overbite; Risk Factors; Tooth Injuries; Neurodevelopmental Disorders; Vision Disorders
PubMed: 37638637
DOI: 10.1111/edt.12882 -
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 -
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 -
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 -
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 -
Cureus Nov 2023Mandibular advancement devices (MADs) remain a popular non-invasive treatment modality for the management of obstructive sleep apnea (OSA). However, the occlusal side... (Review)
Review
Mandibular advancement devices (MADs) remain a popular non-invasive treatment modality for the management of obstructive sleep apnea (OSA). However, the occlusal side effects from long-term therapy may result in poor patient compliance and patient drop-outs. Hence, knowledge of the possible side effects of these devices on occlusion is necessary. This article attempts to systematically review the evidence available in support of the possible long-term effects of mandibular advancement therapy on occlusion in adult sleep apnea patients. A detailed search was conducted for unpublished and published literature and their references in various electronic databases. A grey literature search was also performed. Studies until June 30, 2022, were selected. Randomized controlled trials, non-randomized trials, and cohort studies investigating the occlusal side effects of MADs for the treatment of snoring or OSA with a follow-up of at least four years were included. Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate. The risk of bias was assessed by Cochrane tools for randomized and non-randomized studies. Fourteen studies were selected for the final qualitative analysis. The side effects reported were upper incisor retroclination, lower incisor proclination, decreased overjet and overbite, and change in the total occlusal contact area. The review concludes that long-term MAD therapy has statistically and clinically significant effects on occlusion.
PubMed: 38090465
DOI: 10.7759/cureus.48682 -
Journal of Orofacial Orthopedics =... Nov 2023This systematic review aimed to assess the effects of orthopedic functional appliances for anterior open bite (AOB) in primary or mixed dentition children. (Review)
Review
PURPOSE
This systematic review aimed to assess the effects of orthopedic functional appliances for anterior open bite (AOB) in primary or mixed dentition children.
METHODS
A search for randomized controlled trials (RCT) was conducted in November 2020 in electronic databases with no data or language restrictions. Primary outcomes were skeletal cephalometric variables and adverse events. We used the Cochrane risk-of-bias tool to assess methodological quality and the GRADE approach to assess the certainty of the evidence.
RESULTS
We identified five RCTs (220 participants). Very low certainty evidence showed an improvement in overbite (mean difference [MD] 3.60; 95% confidence interval [CI] 2.63-4.57) and in the angulation of the upper incisors to the palatal plane (MD 3.70; 95% CI 0.85-6.55) with Frankel's functional regulator, compared to no treatment. There was no difference in the measured cephalometric variables when comparing removable palatal crib to fixed palatal crib, bonded spurs, and chin cup. When comparing removable versus magnetic bite blocks, a beneficial effect was observed in overbite, overjet, skeletal anteroposterior angular measurements, and skeletal vertical linear measures in the magnetic group. No adverse events were reported.
CONCLUSION
There was insufficient evidence to infer the effects of these treatments for AOB, and high-quality RCTs are needed to increase the estimated effects.
PROSPERO REGISTER
CRD42020175634, prospectively registered (05 July 2020).
PubMed: 35438306
DOI: 10.1007/s00056-022-00388-5 -
European Journal of Orthodontics Sep 2022In recent years, digital models have become increasingly popular among orthodontists, both for clinical and scientific purposes. It is, therefore, crucial to... (Meta-Analysis)
Meta-Analysis
Assessment of the reliability of measurements taken on digital orthodontic models obtained from scans of plaster models in laboratory scanners. A systematic review and meta-analysis.
BACKGROUND
In recent years, digital models have become increasingly popular among orthodontists, both for clinical and scientific purposes. It is, therefore, crucial to appropriately investigate their reliability. To this date, however, there has been no scientific, statistical investigation of their reliability as compared to the traditional gold standard-plaster models in the form of a meta-analysis.
OBJECTIVES
To evaluate the reliability and reproducibility of measurements taken on digital orthodontic models obtained from scanning plaster models in laboratory scanners compared to measurements taken directly on plaster models.
SEARCH METHODS
Multiple electronic databases (PubMed, Scopus, Web of Science, Google Scholar and Cochrane Central Register of Controlled Trials) were searched for articles with no year or language limitations.
SELECTION CRITERIA
The included original papers should have dealt with the accuracy and repeatability of the measurements conducted on plaster and digital models derived from laboratory scanners. In order to provide an adequate statistical analysis, the studies should have provided sufficient data, that is the difference of means (MDs) with standard deviations (SDs) for analysed measurements.
DATA COLLECTION AND ANALYSIS
In total, 25 types of non-standardised measurements were found in the evaluated studies. The quantitative analysis included papers that compared at least one of the parameters: upper/lower intermolar width, upper/lower intercanine width, overjet and overbite and provided standard deviation of the mean differences between measurements obtained on plaster and digital models from a laboratory scanner.
RESULTS
GRADE and QUADAS tools were used to assess the quality of evidence, and they revealed substantial heterogeneity. Random-effects meta-analysis revealed no statistically significant differences for analysed measurements. Four of the analysed papers reported differences that may be considered clinically significant.
CONCLUSIONS
No statistical significance between the direct measurements on plaster models and the digital ones taken from laboratory scanners could be identified by means of random-effects meta-analysis.
REGISTRATION
The systematic review was registered in the PROSPERO database (ID CRD42020215411).
Topics: Computer Simulation; Humans; Models, Dental; Overbite; Reproducibility of Results
PubMed: 35363303
DOI: 10.1093/ejo/cjac005 -
International Journal of Clinical... 2023Skeletal class III malocclusion is a challenging condition that orthodontists frequently come across. The facemask (FM) is a device commonly used to treat this...
BACKGROUND
Skeletal class III malocclusion is a challenging condition that orthodontists frequently come across. The facemask (FM) is a device commonly used to treat this malocclusion. However, the stability of this orthopedic correction remains unclear, and collective documentation of the short-, mid-, and long-term stability after FM therapy is necessary.
AIM
The aim of the systematic review was to assess posttreatment stability following FM therapy in patients with skeletal class III malocclusion.
MATERIALS AND METHODS
Through a predefined search strategy, electronic searching was conducted in PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane, Ovid, Embase, Scopus, and Web of Science until 30 June 2022. Eligible study selection, data extraction, and evaluation of the risk of bias were performed independently by two review authors according to the Cochrane tool for assessing the risk of bias in randomized trials (RoB 2.0 tool) and the Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tool for nonrandomized trials. A total of 14 studies were finally considered eligible. The systematic review revealed that the maxillo-mandibular differential reverted to class III. The maxillary changes achieved were variable, with SNA angles ranging between -0.7° and 1.9°. Changes in the mandible were greater with an increase in the SNB angle ranging between 0.33° and 3.62°. The lower anterior facial height increased. The maxillary and mandibular incisors were proclined, and the overjet and overbite decreased. The soft tissue changes were insignificant.
CONCLUSION
The effects of FM therapy were found to be stable in the short-term follow-up period. The long-term follow-up revealed that the effects of FM therapy remained stable for the maxilla. However, the mandible continued to grow in a horizontal and unfavorable direction until the adolescent growth spurt.
CLINICAL SIGNIFICANCE
The major variable that determines the long-term success of FM therapy is the amount and direction of mandibular growth during the adolescent growth spurt. More focus on restricting unfavorable mandibular growth and duration of retention is needed for post-FM therapy.
OTHERS
PROSPERO (CRD42021218960).
HOW TO CITE THIS ARTICLE
Raghupathy Y, Ananthanarayanan V, Kailasam V, Posttreatment Stability Following Facemask Therapy in Patients with Skeletal Class III Malocclusion: A Systematic Review. Int J Clin Pediatr Dent 2023;16(6):897-907.
PubMed: 38344378
DOI: 10.5005/jp-journals-10005-2686