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Journal of Clinical Medicine Jun 2024Floating-Harbor syndrome (FHS) is an extremely rare genetic disorder connected with a distinctive facial appearance, various skeletal malformations, delayed bone age,...
Floating-Harbor syndrome (FHS) is an extremely rare genetic disorder connected with a distinctive facial appearance, various skeletal malformations, delayed bone age, and expressive language delays. It is caused by heterozygous mutations in the Snf2-related CREBBP activator protein (SRCAP) gene. The aim of this paper is to describe the case of a 14-year-old male with FHS, referring to a review of the literature, and to collect all reported symptoms. In addition, the orthodontic treatment of the patient is described. For this, the electronic databases PubMed and Scopus were searched using the keyword "Floating-Harbor syndrome". Similar to previous cases in the literature, the patient presented with short stature; a triangular face with a large bulbous nose; deep-set eyes and narrow eyelid gaps; a wide mouth with a thin vermilion border of the upper lip; and dorsally rotated, small ears. They also presented some less-described symptoms, such as macrodontia and micrognathia. Moreover, mild mental retardation, microcephaly, and delayed psychomotor development were found. On the basis of an extraoral, intraoral examination, X-rays, and CBCT, he was diagnosed with overbite, canine class I and angle class III, on both sides. To the best of our knowledge, orthodontic treatment of this disease has not been assessed in detail so far, so this is the first case.
PubMed: 38929963
DOI: 10.3390/jcm13123435 -
International Journal of Paediatric... Mar 2020Malocclusion is a common oral health problem in schoolchildren. Literature describing the prevalence of malocclusion varies substantially across China. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Malocclusion is a common oral health problem in schoolchildren. Literature describing the prevalence of malocclusion varies substantially across China.
AIM
This study identified the epidemiological characteristics of malocclusion among Chinese schoolchildren from 1991 to 2018.
DESIGN
Six English and Chinese electronic databases were searched through November 2018. The search was supplemented by hand searching to identify relevant surveys. The overall prevalence of malocclusion was estimated by a random-effects meta-analysis model, and variations in different groups were assessed by subgroup meta-analysis.
RESULTS
Thirty-seven eligible articles describing 117 682 samples were investigated. The pooled national prevalence for malocclusion was 47.92% (95% CI: 58.6%-71.9%). For the Angle classification, the overall prevalence rates were 30.07% (95% CI: 25.37%-35.48%), 9.91% (95% CI: 7.41%-13.79%), and 4.76% (95% CI: 3.85%-6.54%) for Class I, Class II, and Class III malocclusion, respectively. A deep overbite (16.67%, 95% CI: 11.50%-23.08%) was shown to be the most common trait of malocclusion. When stratified by sex, males had a slightly higher prevalence than females (RR = 1.04, 95% CI: 1.01-1.06). More importantly, an ascending trend and substantial variations across the country were observed.
CONCLUSIONS
Our results confirmed that malocclusion has become a serious oral health problem in Chinese schoolchildren, highlighting the need for proactive interventions at an early age. Moreover, high-quality epidemiological studies on malocclusion are still required.
Topics: Child; China; Databases, Factual; Female; Humans; Male; Malocclusion; Prevalence; Surveys and Questionnaires
PubMed: 31677307
DOI: 10.1111/ipd.12591 -
European Journal of Orthodontics Sep 2022To systematically evaluate all the evidence assessing variations in the depth of the curve of Spee (COS) according to the presence/absence of different dentoskeletal... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically evaluate all the evidence assessing variations in the depth of the curve of Spee (COS) according to the presence/absence of different dentoskeletal characteristics.
SEARCH METHODS AND ELIGIBILITY CRITERIA
The eligibility criteria were outlined following the PECO framework, as follows: studies evaluating individuals with complete permanent dentition including second molars (P), which compared a group with a certain dentoskeletal variation (E) versus another group without the variation (C), regarding the depth of the COS (O). MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library, LILACS and BBO (via Virtual Health Library), OpenGrey, and Google Scholar were searched up to September 2021 to identify eligible reports.
DATA COLLECTION AND ANALYSIS
Duplicates were removed from all the records retrieved. The selection process and data collection were performed independently by two review members. The risk of bias was also assessed independently and in duplicate, using the guideline described by Fowkes and Fulton. Several meta-analyses (α = 0.05) were conducted to estimate the mean differences (MD) or standardized mean differences (SMD) in the depth of COS between individuals presenting or not certain dentoskeletal characteristics. The certainty of evidence was assessed using the GRADE tool.
RESULTS
Thirty-five studies were selected for qualitative synthesis, and 29 of them for quantitative synthesis. All studies had methodological limitations that affected the risk of bias and increased the likelihood that results were due to chance. Syntheses showed that Class II malocclusion (SMD = 0.87; 95% CI: 0.61, 1.13; P < 0.00001; six datasets including 260 subjects analysed), Class II division 1 (SMD = 1.09; 95% CI: 0.62, 1.56; P < 0.00001; 14 datasets including 823 subjects analysed) and Class II division 2 (SMD = 2.65; 95% CI: 1.51, 3.79; P < 0.00001; eight datasets including 476 subjects analysed) had deeper COS than Class I malocclusion. The skeletal Class II also presented higher COS values than skeletal Class I (SMD = 0.57; 95% CI: 0.02, 1.12; P = 0.04; four datasets including 299 subjects analysed). Individuals with Class III malocclusion had flatter COS than the subjects having Class I malocclusion (SMD = -0.57; 95% CI: -1.07, -0.08; P = 0.02; nine datasets including 505 individuals analysed). No difference was shown in the COS depth between skeletal Class III and Class I (P > 0.05). Deep bite individuals had higher COS depth than those with normal overbite (MD = 0.61; 95% CI: 0.41, 0.82; P < 0.00001; two datasets including 250 subjects analysed). In addition, hypodivergent individuals presented deeper COS than normodivergents (SMD = 0.62; 95% CI: 0.37, 0.86; P < 0.00001; six datasets including 305 subjects analysed), and there was no significant difference in the COS depth between hyperdivergent and normodivergent individuals (P = 0.66). The certainty of evidence was rated as very low for all the syntheses.
LIMITATIONS
All the quantitative syntheses included results from studies with methodological flaws. Therefore, they are potentially biased. Moreover, the evidence was also mainly affected in terms of the inconsistency of the results and the imprecision of the estimates.
CONCLUSIONS
Although an apparent influence of dentoskeletal Class II, Class III malocclusion, deep bite, and the hypodivergent skeletal pattern on the depth of the COS is suggested, it is not possible to make definitive conclusions on the matter due to the very low certainty of the evidence. Further high-quality research is necessary.
Topics: Cephalometry; Dental Arch; Humans; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Molar; Overbite
PubMed: 35108382
DOI: 10.1093/ejo/cjab078 -
Clinical Oral Investigations Feb 2024To compare dental caries, oral hygiene, periodontal status, bruxism, malocclusion, tooth loss, and salivary alterations between autistic and typical developing... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare dental caries, oral hygiene, periodontal status, bruxism, malocclusion, tooth loss, and salivary alterations between autistic and typical developing individuals.
MATERIAL AND METHODS
Observational studies presenting clinical measures of oral outcomes between autism spectrum disorder (ASD) individuals and controls. EMBASE, LILACS, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, and ProQuest were searched up to June 26, 2023. Pairs of reviewers independently conducted study selection, data extraction, and assessments of methodological quality and certainty of evidence. Meta-analyses of standardized mean differences (SMD) and risk ratio (RR) were performed.
RESULTS
A total of 47 studies comprising 6885 autistic individuals were included in the review. Autistic individuals had significantly higher severity of dental-caries experience in primary teeth (SMD 0.29, 95%CI 0.02, 0.56), of dental plaque presence (SMD 0.59, 95%CI 0.24, 0.94), and of gingivitis (SMD 0.45, 95%CI 0.02, 0.88). Autistic individuals showed higher probability of occurrence of gingivitis (RR 1.34, 95%CI 1.08, 1.66,), bruxism (RR 4.23, 95%CI 2.32, 7.74), overjet (RR 2.16, 95%CI 1.28, 3.64), overbite (RR 1.62, 95%CI 1.02, 2.59), crossbite (RR 1.48, 95%CI 1.02, 2.13), and openbite (RR 2.37, 95%CI 1.46, 3.85), when compared to neurotypical individuals. Most estimates showed a small effect size with very low certainty of evidence.
CONCLUSION
Autistic individuals show worse oral health status than controls.
CLINICAL RELEVANCE
The findings reported herein can help to build health policies to better serve autistic individuals including prevention actions and access to specialized dental care.
Topics: Humans; Dental Caries; Autistic Disorder; Autism Spectrum Disorder; Bruxism; Gingivitis; Malocclusion; Overbite
PubMed: 38321186
DOI: 10.1007/s00784-024-05500-0 -
BioMed Research International 2021We aimed to summarize the current evidence regarding the impact of extraction vs. nonextraction in orthodontic treatment on patients' soft-tissue profile with... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVES
We aimed to summarize the current evidence regarding the impact of extraction vs. nonextraction in orthodontic treatment on patients' soft-tissue profile with malocclusion.
METHODS
Between April 30 and November 30, 2020, we searched PubMed and SCOPUS for published papers from inception to November 2020 using "orthodontic," "extraction," "nonextraction," and "Malocclusion." Included studies were summarized, and relevant data were extracted and analyzed using Review Manager 5.4.
RESULTS
Pooled data from four controlled trials demonstrated a nonsignificant difference between extraction and nonextraction in terms of SNA (MD = 0.50, 95% CI: -0.37, 1.38; = 0.26), SNB (MD = 0.11, 95% CI: -1.23, 1.44; = 0.88), FMA (MD = 1.82, 95% CI: -2.39, 6.02; = 0.40), IMPA (MD = 0.06, 95% CI: -8.83, -8.94; = 0.99), overjet (MD = -1.47, 95% CI: -6.21, 3.26; = 0.54), and overbite (MD = 0.50, 95% CI: -1.40, 2.40; = 0.60). On the other hand, the extraction method significantly increased the ANB compared with the nonextraction group (MD = 0.78, 95% CI: 0.25, 1.31; = 0.004).
CONCLUSION
The current evidence demonstrated that nonextraction protocols for orthodontic treatment are a safe and effective alternative to extraction protocols; individually tailored treatment strategies should be applied. More randomized controlled trials are critically needed to safely make an evidence-based treatment conclusion.
Topics: Adolescent; Adult; Cephalometry; Female; Humans; Male; Malocclusion; Overbite; Publication Bias; Risk; Young Adult
PubMed: 34589550
DOI: 10.1155/2021/7751516 -
European Journal of Orthodontics Apr 2020The effects of mandibular propulsion appliances in adults have some controversial results. While some authors claim that its use in non-growing patients could produce... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The effects of mandibular propulsion appliances in adults have some controversial results. While some authors claim that its use in non-growing patients could produce some dentoskeletal effects, other studies indicate that Class II correction occurs only through significant dental effects.
OBJECTIVE
To evaluate the effects in non-growing Class II patients with mandibular retrusion, promoted by the treatment with mandibular propulsion appliances and determine if they produce mandibular changes.
METHODS
The research was carried out in nine electronic databases and additional manual searches up to July 2019. Selection criteria were no restriction was placed on date and publication language. Randomized or non-randomized clinical trials with/without control were included. They must evaluated non-growing patients with Class II malocclusion, treated with mandibular propulsion appliances; outcomes were assessed before and after treatment.
DATA COLLECTION AND ANALYSIS
Data were extracted by two independent examiners in duplicate. The ROBINS-I tool was used to assess the methodological quality of the included studies.
RESULTS
Of the 2824 articles identified, 11 non-randomized clinical articles were selected for qualitative analysis and 8 for quantitative analysis. SNB (0.87°, CI 95% 0.08, 1.66), ANB (-0.82°, CI 95% -1.24 to 0.40) and Pg/OLp [2.3 to 1.2 mm (P < 0.001)] presented smallest but significant mandibular changes with some differences regarding the used appliance. The Herbst appliance showed the largest mandibular changes followed by the SUS appliance when evaluated through Ar-Pg. SNA showed non-significant changes. Overbite (-2.85. CI 95% -3.06, -2.64), Overjet (-5.00.CI 95% -5.45, -4.55) showed significant changes in all devices. Class II correction occurs through a significant labial movement of the mandibular incisors, some lingual inclination of the maxillary incisors and minor skeletal changes.
CONCLUSIONS
All mandibular propulsion appliances examined, showed efficiency in normalizing the Class II malocclusion in adult patients; however, changes were acquired mainly through dentoalveolar changes. Some minor mandibular forward changes was noted, mainly in patients treated with the Herbst appliance. Randomized clinical trials are needed to improve scientific evidence.
REGISTRATION
PROSPERO (code CRD42017067384).
Topics: Adult; Cephalometry; Humans; Malocclusion, Angle Class II; Mandible; Orthodontic Appliances, Functional; Orthodontics, Corrective; Overbite
PubMed: 31786599
DOI: 10.1093/ejo/cjz089 -
The Angle Orthodontist Mar 2021To compare the effects of Forsus appliances with and without temporary anchorage devices (TADs) for patients with skeletal Class II malocclusion. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To compare the effects of Forsus appliances with and without temporary anchorage devices (TADs) for patients with skeletal Class II malocclusion.
MATERIALS AND METHODS
Through a predefined search strategy, electronic searching was conducted in PubMed, Embase, Web of Science, CENTRAL, ProQuest Dissertations & Theses, and SIGLE with no language restrictions. Eligible study selection, data extraction, and evaluation of risk of bias (Cochrane Collaboration tool) were conducted by two authors independently and in duplicate. Any disagreement was solved by discussion or judged by a third reviewer. Statistical pooling, sensitivity analysis, subgroup analysis, and assessment of small-study effects were conducted by using Comprehensive Meta-Analysis and Stata 12.0. Heterogeneity was analyzed for different types of study designs, TADs, and radiographic examinations.
RESULTS
Electronic search yielded a total of 256 studies after removing duplicates. Among them, six studies were finally included. All articles were of high quality. The pooled mean differences were -0.27 (95% confidence interval [CI]: -0.59, 0.05) for SNA, 0.58 (95% CI: -0.07, 1.23) for SNB, -0.86 (95% CI: -1.74, -0.03) for ANB, 1.63 (95% CI: 0.46, 2.80) for Co-Po, 0.75 (95% CI: 0.28, 1.23) for SN-MP, -7.56 (95% CI: -11.37, -3.76) for L1-MP, 0.47 (95% CI: -0.98, 1.91) for overjet, 0.39 (95% CI: -0.57, 1.35) for overbite, -1.84 (95% CI: -5.15, 1.47) for SN-OP, and 4.97 (95% CI: -1.22, 11.17) for nasolabial angle.
CONCLUSIONS
TADs (especially miniplates) were able to eliminate dental adverse effects of Forsus appliances for correction of skeletal Class II malocclusion.
Topics: Humans; Malocclusion, Angle Class II; Mandible; Orthodontic Appliances, Functional; Orthodontics, Corrective; Overbite
PubMed: 33378419
DOI: 10.2319/051120-421.1 -
Dental and Medical Problems 2019Class III malocclusion is one the most challenging types of orthodontic problems. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Class III malocclusion is one the most challenging types of orthodontic problems.
OBJECTIVES
The aim of this study was to compare the dentoskeletal effects of facemasks and intraoral appliances in treating class III maxillary deficiency in growing patients through a systematic review of the available literature.
MATERIAL AND METHODS
Electronic and manual searches were performed in the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), MEDLINE (PubMed), Embase (OVID), and Scopus to find all the relevant studies published by January 2018. All randomized controlled trials (RCTs) recruiting 5-12-year-old patients who received maxillary protraction treatment with any type of facemask and comparing the facemasks with any type of intraoral appliance were included. The primary outcome measure was changes in the A point-nasion-B point angle (ANB), and the secondary outcomes included changes in the overjet, upper-1 (U1) inclination, the mandibular plane angle, and treatment time. The meta-analysis was carried out using the inverse variance-weighted random effects model.
RESULTS
Out of 1,629 articles found in the initial search, 5 studies met the inclusion criteria. The meta-analysis showed no differences in the duration of treatment or in any of the cephalometric variables, with the exception of the overjet.
CONCLUSIONS
It seems that intraoral appliances and facemasks are similar in terms of dentoskeletal effects in the treatment of class III malocclusion as well as treatment duration. However, due to a lack of a sufficient number of high-quality studies, these results should be viewed with caution. Further high-quality, long-term studies are recommended.
Topics: Cephalometry; Child; Child, Preschool; Extraoral Traction Appliances; Humans; Malocclusion, Angle Class III; Orthodontics, Corrective; Overbite
PubMed: 31895504
DOI: 10.17219/dmp/110738 -
Journal of Orthodontics Dec 2019To assess the treatment efficacy/efficiency with prefabricated myofunctional appliances (PMA) for children with malocclusion. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the treatment efficacy/efficiency with prefabricated myofunctional appliances (PMA) for children with malocclusion.
DATA SOURCES
Nine databases searched without limitations till July 2019.
DATA SELECTION
Randomised trials comparing PMAs to functional appliance treatment or no treatment.
DATA EXTRACTION
Study selection, data extraction and risk of bias assessment were done in duplicate.
DATA SYNTHESIS
Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted on seven publications (three published and one unpublished trials; 232 patients; 53% male; mean age 10.2 years). Compared to no treatment, one trial indicated that PMAs were somewhat effective in reducing overjet (MD -2.4; 95% CI -3.3 to -1.5), reducing overbite (MD -2.5; 95% CI -3.2 to -1.8), reducing mandibular crowding (RR 0.4; 95% CI 0.2-0.8) and establishing Class I canine relationship (RR = 2.3; 95% CI 1.1-4.9). However, compared to custom-made functional appliances, three trials indicated that PMAs were less effective in reducing the ANB angle (MD 0.9; 95% CI 0.5-1.4), increasing mandibular ramus length (MD -2.2; 95% CI -2.9 to -1.51), reducing overjet (MD 1.5; 95% CI 0.9-2.1), establishing a solid Class I molar relationship (RR 0.3; 95% CI 0.2-0.7), reducing the nasolabial angle (MD 5.8; 95% CI 0.8-10.8) and reducing facial convexity (MD -2.6; 95% CI -4.3 to -0.9). Finally, the quality of evidence was moderate to low due to risk of bias.
CONCLUSIONS
PMAs are more effective in reducing overjet, overbite, mandibular crowding and establishing Class I canine relationship than no treatment. However, compared to custom-made functional appliances, PMAs are less effective in producing dental, skeletal or soft-tissue changes, even though they are less costly.
Topics: Child; Female; Humans; Male; Malocclusion, Angle Class II; Mandible; Myofunctional Therapy; Orthodontic Appliances, Fixed; Orthodontics, Corrective; Overbite; Randomized Controlled Trials as Topic
PubMed: 31597520
DOI: 10.1177/1465312519880558 -
European Journal of Orthodontics Apr 2020Prefabricated myofunctional appliances (PMAs) are widely advocated for correcting Class II division I malocclusion. However, their effectiveness is associated with a...
BACKGROUND
Prefabricated myofunctional appliances (PMAs) are widely advocated for correcting Class II division I malocclusion. However, their effectiveness is associated with a high amount of uncertainty within contemporary literature.
OBJECTIVES
The aim of this review was to systematically examine the available literature regarding the effectiveness of PMAs in treating Class II division 1 malocclusion in children and adolescents.
SEARCH METHODS
Comprehensive unrestricted electronic searches in multiple databases as well as manual searches were conducted up to August 2018.
SELECTION CRITERIA
Randomized controlled trials (RCTs) and non-randomized studies (NRS) matching the eligibility criteria.
DATA COLLECTION AND ANALYSIS
Two independent review authors were directly involved in study selection, data extraction, and bias assessment. The Cochrane risk of bias tool and the ROBINS-I tool were used for assessing the risk of bias. Quantitative pooling of the data was undertaken with a random-effects model with its 95% confidence interval (CI).
RESULTS
Three RCTs comparing PMAs to activators and three NRS comparing PMAs to untreated controls met the inclusion criteria. On a short-term basis, exploratory quantitative synthesis indicated that the activators were more effective than the PMAs in correcting overjet with a mean difference of (1.1 mm; 95% CI: 0.44 to 1.77). On a long-term basis, there were no significant differences between the two appliances. Qualitative synthesis indicated less favorable soft tissue changes as well as patient experiences and compliance with the PMAs when compared to the activators. However, PMAs were associated with reduced costs compared to customized activators and modest changes when compared to untreated controls.
CONCLUSIONS
On a short-term basis, low quality of evidence suggests that PMAs were generally less effective than the activators in treating Class II division 1 malocclusion. The main advantage of PMAs seems to be their reduced costs. These results should be viewed with caution, as a definitive need for high-quality long-term research into this area is required.
REGISTRATION
PROSPERO (CRD42018108564).
Topics: Adolescent; Child; Costs and Cost Analysis; Humans; Malocclusion, Angle Class II; Overbite
PubMed: 31329848
DOI: 10.1093/ejo/cjz025