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The Cochrane Database of Systematic... Dec 2021Crowded teeth develop when there is not enough space in the jaws into which the teeth can erupt. Crowding can affect baby teeth (deciduous dentititon), adult teeth... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Crowded teeth develop when there is not enough space in the jaws into which the teeth can erupt. Crowding can affect baby teeth (deciduous dentititon), adult teeth (permanent dentition), or both, and is a common reason for referral to an orthodontist. Crowded teeth can affect a child's self-esteem and quality of life. Early loss of baby teeth as a result of tooth decay or trauma, can lead to crowded permanent teeth. Crowding tends to increase with age, especially in the lower jaw.
OBJECTIVES
To assess the effects of orthodontic intervention for preventing or correcting crowded teeth in children. To test the null hypothesis that there are no differences in outcomes between different orthodontic interventions for preventing or correcting crowded teeth in children.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 11 January 2021 and used additional search methods to identify published, unpublished and ongoing studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that evaluated any active interventions to prevent or correct dental crowding in children and adolescents, such as orthodontic braces or extractions, compared to no or delayed treatment, placebo treatment or another active intervention. The studies had to include at least 80% of participants aged 16 years and under.
DATA COLLECTION AND ANALYSIS
Two review authors, independently and in duplicate, extracted information regarding methods, participants, interventions, outcomes, harms and results. We resolved any disagreements by liaising with a third review author. We used the Cochrane risk of bias tool to assess the risk of bias in the studies. We calculated mean differences (MDs) with 95% confidence intervals (CI) for continuous data and odds ratios (ORs) with 95% CIs for dichotomous data. We undertook meta-analysis when studies of similar comparisons reported comparable outcome measures, using the random-effects model. We used the I statistic as a measure of statistical heterogeneity.
MAIN RESULTS
Our search identified 24 RCTs that included 1512 participants, 1314 of whom were included in analyses. We assessed 23 studies as being at high risk of bias and one as unclear. The studies investigated 17 comparisons. Twenty studies evaluated fixed appliances and auxiliaries (lower lingual arch, lower lip bumper, brackets, archwires, lacebacks, headgear and adjunctive vibrational appliances); two studies evaluated removable appliances and auxiliaries (Schwarz appliance, eruption guidance appliance); and two studies evaluated dental extractions (lower deciduous canines or third molars). The evidence should be interpreted cautiously as it is of very low certainty. Most interventions were evaluated by a single study. Fixed appliances and auxiliaries One study found that use of a lip bumper may reduce crowding in the early permanent dentition (MD -4.39 mm, 95% CI -5.07 to -3.71; 34 participants). One study evaluated lower lingual arch but did not measure amount of crowding. One study concluded that coaxial nickel-titanium (NiTi) archwires may cause more tooth movement in the lower arch than single-stranded NiTi archwires (MD 6.77 mm, 95% CI 5.55 to 7.99; 24 participants). Another study, comparing copper NiTi versus NiTi archwires, found NiTi to be more effective for reducing crowding (MD 0.49 mm, 95% CI 0.35 to 0.63, 66 participants). Single studies did not show evidence of one type of archwire being better than another for Titinol versus Nitinol; nickel-titanium versus stainless steel or multistrand stainless steel; and multistranded stainless steel versus stainless steel. Nor did single studies find evidence of a difference in amount of crowding between self-ligating and conventional brackets, active and passive self-ligating brackets, lacebacks added to fixed appliances versus fixed appliances alone, or cervical pull headgear versus minor interceptive procedures. Meta-analysis of two studies showed no evidence that adding vibrational appliances to fixed appliances reduces crowding at 8 to 10 weeks (MD 0.24 mm, 95% CI -0.81 to 1.30; 119 participants). Removable appliances and auxiliaries One study found use of the Schwarz appliance may be effective at treating dental crowding in the lower arch (MD -2.14 mm, 95% CI -2.79 to -1.49; 28 participants). Another study found an eruption guidance appliance may reduce the number of children with crowded teeth after one year of treatment (OR 0.19, 95% CI 0.05 to 0.68; 46 participants); however, this may have been due to an increase in lower incisor proclination in the treated group. Whether these gains were maintained in the longer term was not assessed. Dental extractions One study found that extracting children's lower deciduous canines had more effect on crowding after one year than no treatment (MD -4.76 mm, 95 CI -6.24 to -3.28; 83 participants), but this was alongside a reduction in arch length. One study found that extracting wisdom teeth did not seem to reduce crowding any more than leaving them in the mouth (MD -0.30 mm, 95% CI -1.30 to 0.70; 77 participants).
AUTHORS' CONCLUSIONS
Most interventions were assessed by single, small studies. We found very low-certainty evidence that lip bumper, used in the mixed dentition, may be effective for preventing crowding in the early permanent dentition, and a Schwarz appliance may reduce crowding in the lower arch. We also found very low-certainty evidence that coaxial NiTi may be better at reducing crowding than single-stranded NiTi, and that NiTi may be better than copper NiTi. As the current evidence is of very low certainty, our findings may change with future research.
Topics: Adolescent; Dentition, Permanent; Humans; Orthodontic Brackets
PubMed: 34970995
DOI: 10.1002/14651858.CD003453.pub2 -
L' Orthodontie Francaise May 2023
Topics: Humans; Orthodontics; Orthodontic Brackets; Dental Care
PubMed: 37249066
DOI: 10.1684/orthodfr.2023.124 -
Journal of the World Federation of... Aug 2023The straight-wire appliance is an individualized, fully-programmed appliance system that has been in clinical use since the early 1970s. A study of tooth positions in... (Review)
Review
The straight-wire appliance is an individualized, fully-programmed appliance system that has been in clinical use since the early 1970s. A study of tooth positions in individuals with naturally occurring harmonious occlusions led to the discovery of the Six Keys to Normal (Optimal) Occlusion which provided data for bracket features and prescription values incorporated into the straight-wire appliance. It was based on the notion that tooth anatomy, morphology, and optimal positions were alike enough among individuals, regardless of age, sex, or race to justify using prefabricated brackets with average prescription values. New technologies have led to advancements in appliance customization. Customized brackets can be made-to-order with one-of-a-kind prescription values and bracket base contours that fit precisely to the morphologic characteristics of the teeth. If costs and material qualities were comparable, would treatment efficiency or treatment outcomes be superior when using a customized appliance compared with a prefabricated straight-wire appliance? If not, why not?
Topics: Humans; Orthodontic Wires; Orthodontic Brackets; Dental Occlusion; Treatment Outcome
PubMed: 37419789
DOI: 10.1016/j.ejwf.2023.06.004 -
American Journal of Orthodontics and... Apr 2020
Topics: Algorithms; Humans; Joint Prosthesis; Open Bite; Orthodontic Brackets
PubMed: 32241343
DOI: 10.1016/j.ajodo.2020.01.006 -
BioMed Research International 2021To compare the orthodontic bracket debonding force and assess the bracket failure pattern clinically between different teeth by a validated prototype debonding device. ....
OBJECTIVE
To compare the orthodontic bracket debonding force and assess the bracket failure pattern clinically between different teeth by a validated prototype debonding device. . Thirteen (13) patients at the end of comprehensive fixed orthodontic treatment, awaiting for bracket removal, were selected from the list. A total of 260 brackets from the central incisor to the second premolar in both jaws were debonded by a single clinician using a validated prototype debonding device equipped with a force sensitive resistor (FSR). Mean bracket debonding forces were specified to ten (10) groups of teeth. Following debonding, Intraoral microphotographs of the teeth were taken by the same clinician to assess the bracket failure pattern using a 4-point scale of adhesive remnant index (ARI). Statistical analysis included one-way ANOVA with post hoc Tukey HSD and independent sample -test to compare in vivo bracket debonding force, Cohen's kappa (), and a nonparametric Kruskal-Wallis test for the reliability and the assessment of ARI scoring.
RESULTS
A significant difference ( < 0.001) of mean debonding force was found between different types of teeth in vivo. Clinically, ARI scores were not significantly different ( = 0.921) between different groups, but overall higher scores were predominant.
CONCLUSION
Bracket debonding force should be measured on the same tooth from the same arch as the significant difference of mean debonding force exists between similar teeth of the upper and lower arches. The insignificant bracket failure pattern with higher ARI scores confirms less enamel damage irrespective of tooth types.
Topics: Adult; Dental Cements; Device Removal; Equipment Failure; Humans; Mechanical Phenomena; Orthodontic Brackets; Tooth; Young Adult
PubMed: 33959664
DOI: 10.1155/2021/6663683 -
Journal of Dental Research Dec 2022White spot lesions and enamel cracks are the 2 most prominent diseases that occur after orthodontic treatment and are caused by enamel demineralization from accumulated...
White spot lesions and enamel cracks are the 2 most prominent diseases that occur after orthodontic treatment and are caused by enamel demineralization from accumulated bacterial biofilms and/or enamel damage caused by the removal of residual adhesive after bracket debonding. Inspired by the self-assembled amelogenin nanoribbons in enamel, we developed an enamel coating with a self-assembling antimicrobial peptide, D-GL13K, to simultaneously reduce demineralization and residual adhesive. The self-assembled amphiphilic nanoribbons significantly increased the hydrophobicity of the etched enamel, which reduced the permeability of the coated enamel surfaces as desired. The antimicrobial activity of this coating was evaluated against by colony-forming unit counting and live/dead assays. The anti-demineralization effect was demonstrated by the reduced demineralization depth analyzed by optical coherence tomography and the increased Vickers hardness. The coatings did not reduce the shear bond strength but significantly reduced the adhesive remnant index score. This bioinspired enamel coating may provide a new strategy for preventing white spot lesions and enamel cracks after orthodontic treatment.
Topics: Humans; Orthodontic Brackets; Nanotubes, Carbon; Dental Enamel; Streptococcus mutans; Dental Caries; Dental Bonding; Tooth Demineralization
PubMed: 36271659
DOI: 10.1177/00220345221129806 -
BioMed Research International 2024To evaluate the enamel bonding ability and orthodontic adhesive resin degree of conversion using the experimental bracket design. . Thirteen bovine teeth were used in...
OBJECTIVE
To evaluate the enamel bonding ability and orthodontic adhesive resin degree of conversion using the experimental bracket design. . Thirteen bovine teeth were used in the study. The experimental bracket was modified with a translucent region in the center of its body. After enamel etching, Orthocem orthodontic adhesive (FGM, Joinville, Brazil) was applied on the bracket base for bonding. The groups were divided as follows ( = 10 per group): (1) control (CB) with standard brackets and (2) spot bracket (SB) with experimental brackets featuring a 0.8 mm translucent region at the center using carbide bur. Shear bond strength (SBS) was evaluated after 24 hours in a universal testing machine and adhesive remnant index (ARI). The degree of conversion (DC) was analyzed using Raman spectroscopy ( = 3 per group). Data were then analyzed using Student's -test and Mann-Whitney statistical methods.
RESULTS
The SB group exhibited a higher mean SBS (10.33 MPa) compared to the CB Group (8.77 MPa). However, there was no statistical difference between the groups ( = 0.376). Both SB and CB groups had a mean ARI score of 1. Raman analysis revealed a higher degree of conversion in the SB group (49.3%) compared to the CB group (25.9%).
CONCLUSIONS
The experimental support showed a higher degree of adhesive conversion, although there was no significant increase in bond strength.
Topics: Orthodontic Brackets; Animals; Cattle; Dental Bonding; Dental Enamel; Composite Resins; Shear Strength; Polymerization; Materials Testing; Dental Cements; Resin Cements
PubMed: 38884017
DOI: 10.1155/2024/7457900 -
Journal of the World Federation of... Dec 2022Digital technology is one of the major advancements during the past years that changed many aspects of our daily life. Medicine and dentistry were positively affected... (Review)
Review
Digital technology is one of the major advancements during the past years that changed many aspects of our daily life. Medicine and dentistry were positively affected from the very first years of this digital evolution. Orthodontics is not an exception to this global digitization. Intraoral scanners, computer-aided design software, three-dimensional printers, and new materials were invented and introduced in dentistry and orthodontics during the last 20 years. The ability to include a small digital laboratory in the orthodontic office helped the creation of the in-house manufacturing concept. Continuously, the ability to design appliances that fit exactly to the teeth of the patient allowed the digital customization of almost every orthodontic appliance. Lately, the development of computer-aided design software called Ubrackets enabled the orthodontist to design and print customized orthodontic brackets in the orthodontic office. The designing workflow follows a specific protocol, which makes designing fast and easy. Three-dimensional printing of brackets can be performed using hybrid ceramic resin or zirconia slurry. Although some controversial studies exist, customized brackets have not been extensively studied despite that. A new term, "biological customization" is proposed, which takes into consideration the different biology of each patient, as opposed to teeth roots, bone turnover, and characteristics. Complete treatment customization should necessarily include mechanical and biological customization.
Topics: Humans; Computer-Aided Design; Orthodontic Brackets; Orthodontic Appliances; Printing, Three-Dimensional; Ceramics
PubMed: 36347750
DOI: 10.1016/j.ejwf.2022.10.004 -
British Dental Journal Apr 2021
Topics: Dental Alloys; Orthodontic Appliance Design; Orthodontic Brackets
PubMed: 33893403
DOI: 10.1038/s41415-021-2970-7 -
British Dental Journal Feb 2021
Topics: Ceramics; Orthodontic Appliance Design; Orthodontic Brackets
PubMed: 33637907
DOI: 10.1038/s41415-021-2759-8