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Frontiers in Bioscience (Elite Edition) Jul 2022Orthodontic treatment has become increasingly popular due to its benefits in improving facial and smile aesthetics, self-esteem and the function of the stomatognathic...
Orthodontic treatment has become increasingly popular due to its benefits in improving facial and smile aesthetics, self-esteem and the function of the stomatognathic apparatus. However, orthodontic appliances make it more difficult to brush teeth effectively, as they interfere with tooth brushing and facilitate the accumulation of dental plaque (biofilm), which induces a quantitative and qualitative change in the oral microbiota. It can cause several adverse effects, such as gingivitis, periodontitis, white spot lesions (WSL), caries and halitosis, induced by an increase in periodontopathogenic and cariogenic bacteria. Therefore, this article resumes the main findings on the changes in the oral microbiota induced by different orthodontic appliances (removable, fixed and clear aligners) and gives some practical strategies in order to reduce the impact and/or incidence of local dental/periodontal complications.
Topics: Biofilms; Gingivitis; Humans; Microbiota; Orthodontic Appliances; Periodontitis
PubMed: 36137992
DOI: 10.31083/j.fbe1403019 -
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 -
Dental and Medical Problems 2022External apical root resorption (EARR) is a serious complication that should be avoided during orthodontic treatment; this pathology depends on multiple factors. Data... (Meta-Analysis)
Meta-Analysis Review
External apical root resorption (EARR) is a serious complication that should be avoided during orthodontic treatment; this pathology depends on multiple factors. Data from clinical studies should be assessed to determine the influence these factors have on the development of EARR. This systematic review aims to compare EARR produced by different factors (orthodontic systems, dental trauma, and dental vitality). The protocol was registered on the PROSPERO database. The search was performed on 5 databases. Accepted study designs included randomized controlled trials, nonrandomized clinical trials, and observational studies. Full-text articles from clinical studies of EARR associated with orthodontic treatment in English, Spanish, or Portuguese with no publication date restrictions were selected. Data from the studies, such as age, population, study groups, and outcome measures, were recorded. Multiple meta-analyses were performed with data from the included studies. Evidence suggests that EARR induced by orthodontic treatment is similar, regardless of the technique used. Evidence of the effect of previous dental trauma on EARR during orthodontic treatment is limited. There is less EARR associated with orthodontic treatment in endodontically treated teeth than in vital teeth. These conclusions should be considered with caution due to the low certainty of the evidence.
Topics: Humans; Orthodontic Appliances, Fixed; Root Resorption; Tooth, Nonvital; Clinical Trials as Topic
PubMed: 36206494
DOI: 10.17219/dmp/145369 -
European Journal of Orthodontics Jun 2020The use of orthodontic aligners to treat a variety of malocclusions has seen considerable increase in the last years, yet evidence about their efficacy and adverse... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The use of orthodontic aligners to treat a variety of malocclusions has seen considerable increase in the last years, yet evidence about their efficacy and adverse effects relative to conventional fixed orthodontic appliances remains unclear.
OBJECTIVE
This systematic review assesses the efficacy of aligners and fixed appliances for comprehensive orthodontic treatment.
SEARCH METHODS
Eight databases were searched without limitations in April 2019.
SELECTION CRITERIA
Randomized or matched non-randomized studies.
DATA COLLECTION AND ANALYSIS
Study selection, data extraction, and risk of bias assessment was done independently in triplicate. Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality.
RESULTS
A total of 11 studies (4 randomized/7 non-randomized) were included comparing aligners with braces (887 patients; mean age 28.0 years; 33% male). Moderate quality evidence indicated that treatment with orthodontic aligners is associated with worse occlusal outcome with the American Board of Orthodontics Objective Grading System (3 studies; MD = 9.9; 95% CI = 3.6-16.2) and more patients with unacceptable results (3 studies; RR = 1.6; 95% CI = 1.2-2.0). No significant differences were seen for treatment duration. The main limitations of existing evidence pertained to risk of bias, inconsistency, and imprecision of included studies.
CONCLUSIONS
Orthodontic treatment with aligners is associated with worse treatment outcome compared to fixed appliances in adult patients. Current evidence does not support the clinical use of aligners as a treatment modality that is equally effective to the gold standard of braces.
REGISTRATION
PROSPERO (CRD42019131589).
Topics: Adult; Dental Care; Duration of Therapy; Humans; Malocclusion; Orthodontic Appliances; Orthodontic Appliances, Fixed; Treatment Outcome
PubMed: 31758191
DOI: 10.1093/ejo/cjz094 -
International Journal of Environmental... Mar 2021In recent years, clear aligners have diversified and evolved in their primary characteristics (material, gingival margin design, attachments, divots, auxiliaries),... (Review)
Review
In recent years, clear aligners have diversified and evolved in their primary characteristics (material, gingival margin design, attachments, divots, auxiliaries), increasing their indications and efficiency. We overviewed the brands of aligners used in Italy and reviewed the literature on the evolution of clear aligners based on their characteristics mentioned above by consulting the main scientific databases (PubMed, Scopus, Lilacs, Google Scholar, Cochrane Library). Inclusion and exclusion criteria were established. The data were collected on a purpose-made data collection form and analyzed descriptively. From the initial 580 records, 527 were excluded because they were not related to the subject of the review or because they did not meet the eligibility criteria. The remaining 31 studies were deemed comprehensive for the purpose of the review, although the "gingival margin design" feature and "auxiliaries" tool are not well represented in the more recent literature. Current knowledge on invisible aligners allows us to have a much clearer idea of the basic characteristics of aligner systems. There remains a need to deepen the use of systems other than Invisalign™ to give greater evidence to aligners that are very different based on the characteristics analyzed here and that are very widespread on the market.
Topics: Durable Medical Equipment; Italy; Orthodontic Appliances, Removable; Referral and Consultation
PubMed: 33799682
DOI: 10.3390/ijerph18062870 -
The Angle Orthodontist Mar 2022To compare the treatment and posttreatment effects of Invisalign aligners that incorporated SmartForce features and attachments to traditional fixed appliances. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare the treatment and posttreatment effects of Invisalign aligners that incorporated SmartForce features and attachments to traditional fixed appliances.
MATERIALS AND METHODS
This randomized controlled trial included 66 patients, 32 aligners, and 34 fixed-appliance patients. The median ages of the aligner and braces patients were 26.7 (interquartile range [IQR]: 9.8) and 25.9 (IQR: 16.6) years, respectively. Pretreatment occlusion was assessed using the ABO Discrepancy Index. Posttreatment (T1) and 6-month retention (T2) occlusions were quantified using the ABO Objective Grading System (OGS) scores.
RESULTS
The braces group finished treatment significantly (P < .001) earlier (0.4 years) than the aligner group. The median DI scores for the aligner and braces groups were 4.5 and 7.0, respectively, which was a statistically significant (P = .015), but clinically insignificant, difference. There were no statistically significant between-group differences for the total OGS scores or any of the individual component scores at debond (T1) or after 6 months of retention (T2). During the posttreatment period, alignment and overjet worsened significantly in the aligner group, while buccolingual inclinations and occlusal relations improved. Over the same period, alignment worsened in the braces group and buccolingual inclinations improved. There was no statistically significant between-group difference in posttreatment changes of the total OGS scores.
CONCLUSIONS
While patients with simple malocclusions require 4.8 months longer treatment times with aligners than traditional braces, the treatment and 6-month posttreatment occlusal outcomes are similar.
Topics: Child; Humans; Malocclusion; Orthodontic Appliances, Fixed; Orthodontic Appliances, Removable; Orthodontic Brackets; Overbite
PubMed: 35168256
DOI: 10.2319/032921-246.1 -
Head & Face Medicine Jul 2021Orthodontic retention aims to maintain optimal teeth positions after active treatment. The stability is affected by numerous factors, including patients' individual... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Orthodontic retention aims to maintain optimal teeth positions after active treatment. The stability is affected by numerous factors, including patients' individual features, thus retention should be adjusted in the most optimal way. Bonding a retainer makes retention less dependent on patient's compliance.
QUESTIONS ARISE
What wire or fiber splint type provides the best treatment stability? What materials should be used to bond the wire or fiber splint? Should be the bonding procedure be direct or indirect? The aim of the study is to assess and synthesize available controlled trials investigating failures of fixed retainers.
METHODS
Literature searches of free text and MeSH terms were performed in Scopus, Web of Science, Embase and PubMed Central in order to find studies, referring to failures of fixed retention (12th February 2021). The keywords were: ("orthodontic retainers AND failure AND wire"). The framework of this systematic review according to PICO was: Population: orthodontic patients; Intervention: fixed orthodontic retainer bonding; Comparison: Different protocols of fixed orthodontic retention applied; Outcomes: failure rate, survival rate. Three different specific scales from the Cochrane Collaboration Handbook were used, according to each study type. Additionally, a meta-analysis was conducted to compare the effectiveness of retention using fiber reinforced composite and multistranded steel wire.
RESULTS
The search identified 177 potential articles: 114 from PubMed, 41 from Scopus, 20 from Web of Science and 2 from Embase. After excluding studies inconsistent with selection criteria, 21 studies were included and subjected to qualitative analysis. The main outcome investigated was failure rate. This systematic review has some potential limitations due to the heterogeneity of design between included studies.
CONCLUSIONS
No retainer is proved to guarantee a perfect stability of dental alignment. The retainer should be bonded to all adherent teeth, preferably with additional use of bonding resin. No wire or fiber splint present superior characteristics concerning failure rate. Fiber reinforced composite retention is more sensitive to operator skills, and with imperfect bonding technique, failure rate is much higher. During the first 6 months after bonding retainer the patient should be under frequent control. The study protocol was registered in PROSPERO database with the number CRD42021233406.
Topics: Dental Bonding; Humans; Orthodontic Appliance Design; Orthodontic Retainers; Orthodontic Wires
PubMed: 34301280
DOI: 10.1186/s13005-021-00281-3 -
Progress in Orthodontics Jan 2023The present study was designed to define: (1) which are the less predictable OTM with Invisalign aligners when the treatment plan is designed by expert operators, (2) if...
BACKGROUNDS
The present study was designed to define: (1) which are the less predictable OTM with Invisalign aligners when the treatment plan is designed by expert operators, (2) if the presence and shape of attachments influence the predictability of OTM and (3) if patients' demographics influence OTM predictability. The sample comprises 79 prospectively recruited patients (mean age 30.8 years; SD 12.0; 23 M, 56 F), treated by expert operators with an average of 27 aligners (SD 15) in the maxillary arch and 25 aligners (SD 11) in the mandibular arch. Post-treatment digital models and final virtual treatment plan models were exported from ClinCheck software as STL files and subsequently imported into Geomagic Qualify software, to compare final teeth positions. The differences were calculated and tested for statistical significance for each tooth in the mesial-distal, vestibular-lingual and occlusal-gingival directions, as well as for angulation, inclination and rotation. In addition, the statistical significance of categorical variables was tested.
RESULTS
The lack of correction was significant for all movements and in all group of teeth (P < 0.01) except for the rotation of maxillary first molar. The prescribed OTM, the group of teeth and movement, the frequency of aligner change and the use of attachment influence the outcome. The greatest discrepancies in predicted and achieved tooth position were found for angular movements and rotation of teeth characterized by round-shaped crowns, for a ratio of approximately 0.4° per 1° prescribed. Optimized attachments for upper canines and lower premolar rotation seem not working properly. Second molar movements are mostly unexpressed. Furthermore, changing the aligner every 14 days will reduce the lack of correction of the 12% with respect to 7 days aligner change.
CONCLUSIONS
Predictability of orthodontic movement with aligners still has limitations related to the biomechanics of the system: the shape of some attachments and the characteristics of aligner material need to be redefined. However, the results of this study allow to properly design the virtual treatment plan, revealing how much overcorrection is needed and which attachments are most effective.
Topics: Tooth Movement Techniques; Software; Orthodontic Appliances, Removable; Molar; Bicuspid
PubMed: 36642743
DOI: 10.1186/s40510-022-00453-0 -
The Angle Orthodontist Jul 2021To evaluate tooth movements during maxillary arch expansion with clear aligner treatment.
OBJECTIVES
To evaluate tooth movements during maxillary arch expansion with clear aligner treatment.
MATERIALS AND METHODS
The study group included 28 subjects (16 females, 12 males, mean age 31.9 ± 5.4 years) collected prospectively from January 2018 to May 2019. Inclusion criteria were European ancestry, posterior transverse discrepancy of 3-6 mm, permanent dentition stage, presence of second permanent molars, mild or moderate crowding, and good compliance with aligners. Treatment protocol included nonextraction strategies, application of Invisalign clear aligner system, and no auxiliaries other than Invisalign attachments. Linear and angular measurements were performed before treatment (T1), at the end of treatment (T2), and on final virtual models (T2 ClinCheck). A paired t-test was used to compare T2-T1 and T2-T2 ClinCheck changes. The level of significance was set at 5%.
RESULTS
Statistically significant differences were found for all measurements, except for ones at the upper second molars. The greatest increase in maxillary width was detected at the upper first and second premolars: +3.5 mm for the first premolar and +3.8 mm for the second premolar at T2. Comparison of T2-T1 angular outcomes showed statistically significant changes in the inclinations of all teeth except for the second permanent molars. T2-T2 ClinCheck showed significant differences for both linear and angular measurements for maxillary canines, resulting in poor predictability.
CONCLUSIONS
Maxillary arch development revealed a progressive reduction of the expansion rate and buccal tipping in the anterior, lateral, and posterior regions, with the greatest net increase at the first and second premolars. Clinical attention should be paid to maxillary canine movements, and overcorrection should be planned for them during dentoalveolar expansion.
Topics: Adult; Dental Arch; Female; Humans; Male; Malocclusion; Maxilla; Orthodontic Appliances, Removable; Palatal Expansion Technique; Tooth Movement Techniques
PubMed: 33570617
DOI: 10.2319/080520-687.1 -
International Dental Journal Oct 2023The demand for clear aligners has risen over the past decade because they satisfy patients' desire for less noticeable and more comfortable orthodontic appliances.... (Review)
Review
The demand for clear aligners has risen over the past decade because they satisfy patients' desire for less noticeable and more comfortable orthodontic appliances. Because clear aligners are increasingly used in orthodontics, there is a big push to learn more about the physiologic and microbial changes that occur during treatment. The present work highlighted further links between clear aligners and changes in oral health and the oral microbiome and provided plaque control methods for clear aligner trays. Existing literature revealed that clear aligners have no significant influence on the structure of the oral microbiome during orthodontic therapy. Clear aligner treatment demonstrated promising results in terms of controlling plaque index, gingival health, and the prevalence of white spot lesions. Nevertheless, grooves, ridges, microcracks, and abrasions on the aligner surface would provide a prime environment for bacterial adherence and the development of plaque biofilms. A combination of mechanical and chemical methods seems to be a successful approach for removing plaque biofilm from aligners whilst also preventing pigment adsorption.
Topics: Humans; Oral Health; Orthodontic Appliances, Removable; Dental Care; Bacteria; Dental Plaque; Microbiota
PubMed: 37105789
DOI: 10.1016/j.identj.2023.03.012