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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 -
Indian Journal of Dental Research :... 2020The aim of this systematic review and meta-analysis was to estimate the prevalence of traumatic dental injuries (TDI) in India. The secondary objective was to evaluate... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review and meta-analysis was to estimate the prevalence of traumatic dental injuries (TDI) in India. The secondary objective was to evaluate the prevalence rate according to the differences in gender, age, regions, type of TDI and risk factors associated with TDI.
METHODS
The PubMed, LILACS, Web of Science, Cochrane, CINHAL, and Scopus databases, along with the Public Health Electronic Library, TRoPHI and DoPHER were searched from 1 March to 15April 2019 without any restriction of language and year of publication. The qualitative synthesis was done regarding the demographics, study methods, cause of trauma, geographic location, increased overjet and inadequate lip coverage. The meta-analysis was undertaken with STATA-14 software (USA). The pooled prevalence of TDI was calculated using data extracted from 48 studies included in qualitative synthesis and meta-analysis. A sub-group meta-analysis was done by extraction of the data for age groups of 6 years and >6 years.
RESULTS
The pooled prevalence of TDI in Indian population was 13 cases in 100 individuals. The prevalence of TDI for age groups of ≤6 was 15% (males, 15%; females, 16%) and for >6 years was 12% (males, 13%; females, 8%). The most common cause of TDI was falls, and most frequent location was home. The odds ratio for occurrence of TDI and inadequate lip-coverage was 3.35 and overjet greater than 3 mm was 3.53.
CONCLUSIONS
The pooled prevalence of TDI was 13% and slightly higher in children less than 6 years of age. Inadequate lip coverage and increased overjet are the risk factors associated with TDI. Heterogeneity was observed among the studies in terms of design, variables recorded, sampling, study methods and statistical methods. Majority of them also suffered from moderate to high risk of bias.
Topics: Accidental Falls; Child; Female; Humans; India; Male; Overbite; Prevalence; Tooth Injuries
PubMed: 33107464
DOI: 10.4103/ijdr.IJDR_953_19 -
Dental Traumatology : Official... Feb 2022Dental trauma (DT) occurs frequently in children and adolescents. Therefore, understanding the factors associated with its occurrence in these age groups is important to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
Dental trauma (DT) occurs frequently in children and adolescents. Therefore, understanding the factors associated with its occurrence in these age groups is important to establish specific preventive measures. The aim of this study was to investigate the relationships of lip coverage, overjet, and open bite to dental trauma in Brazilian children and adolescents.
MATERIAL AND METHODS
The review protocol was registered in the PROSPERO database (CRD42020156290) and the bibliographic search was performed in nine electronic databases until July 2020. The studies included were observational, performed in Brazil, with healthy children and adolescents (0-19 years old), and without the restriction of date or language. Two reviewers assessed the individual risk of bias of the eligible studies with a standardized checklist. The meta-analyses were stratified by dentition stage and age range using fixed or random effects, odds ratio (OR) as the effect measure, and 95% confidence interval. The heterogeneity across studies was assessed with the I² test and the GRADE approach assessed the certainty of evidence.
RESULTS
The search presented 2493 initial results, from which 55 met the eligibility criteria and were included. Most studies (67%) presented a low risk of bias and were published between 2000 and 2019. Children and adolescents with inadequate lip coverage are 1.86-2.36 times more likely to suffer from DT, while those with increased overjet are 1.94-3.11 times more likely. Children with primary dentitions and anterior open bites are 1.76 (95% CI: 1.20-2.59) times more likely to suffer from DT. The certainty of evidence varied from very low to moderate.
CONCLUSIONS
Inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of dental trauma in Brazilian children and adolescents.
Topics: Adolescent; Adult; Brazil; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Lip; Malocclusion; Malocclusion, Angle Class II; Overbite; Young Adult
PubMed: 34275184
DOI: 10.1111/edt.12707 -
Clinical Oral Investigations Jul 2015Class III therapy using a face mask is a common approach for treatment of a deficient maxilla and reverse overbite. Usually, maxillary protraction is combined with... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Class III therapy using a face mask is a common approach for treatment of a deficient maxilla and reverse overbite. Usually, maxillary protraction is combined with transverse palatal expansion using intraoral appliances. The purpose of this study was to systematically review the effectiveness of face mask therapy in combination with concepts of palatal expansion and compression.
MATERIAL AND METHODS
A systematic review and meta-analysis were performed to identify studies that address class III treatment using a face mask. The search was carried out using common electronic databases as well as hand search. Both screening and study eligibility analysis were performed with consideration of PRISMA and Cochrane Guidelines for systematic reviews. Several terms describing class III face mask treatment were searched. Particular attention was paid to new strategies of enhancing maxillary protraction.
RESULTS
The initial search identified 2048 studies. After a thorough selection process, a total of 22 articles met the inclusion criteria. After assessment of the individual quality scoring of each article, eight studies were provided for meta-analysis of the cephalometric parameters. The statistical analysis of treatment changes advocates a positive influence on sagittal maxillary development, which is not primarily influenced by transverse expansion. Dental side effects are more distinct when no expansion was carried out. For the concept of alternating activation/deactivation of the expansion appliance (alt-RAMEC), two articles of high methodological scoring were identified. They indicate an enhancement of face mask treatment.
CONCLUSIONS
The findings are consistent with results of previous literature studies regarding the efficiency of class III face mask treatment. A further need for more randomized controlled studies was identified especially with regard to the new concept of alternating maxillary expansion and compression, which showed a positive influence on the maxillary protraction based on two studies.
CLINICAL RELEVANCE
Class III therapy using extraoral face mask anchorage is effective for maxillary protraction. The recently discussed new protocols potentially improve this treatment.
Topics: Extraoral Traction Appliances; Humans; Malocclusion, Angle Class III; Orthodontic Appliance Design; Overbite; Palatal Expansion Technique
PubMed: 25982454
DOI: 10.1007/s00784-015-1478-4 -
International Journal of Paediatric... Nov 2022To evaluate the clinical effectiveness of the eruption guidance appliances (EGAs) in treating malocclusion in the early mixed dentition. (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the clinical effectiveness of the eruption guidance appliances (EGAs) in treating malocclusion in the early mixed dentition.
DESIGN
Electronic databases were comprehensively searched for the eligibility literature of the EGA treatment for a period spanning from the earliest available date in each database up to July 2021. Randomized controlled trials, controlled clinical trials, and prospective and retrospective cohort studies were included in the present review. The quality of clinical trials was assessed according to the Cochrane Collaboration's tools (RoB2.0 and ROBINS-I), whereas cohort studies were based on the Newcastle-Ottawa Scale (NOS). The data were gathered and synthesized with the Stata software (version 12).
RESULTS
The screen yielded 436 articles, of which 17 papers were potentially eligible, and 7 articles from 3 studies (1 RCT, 1 CCT, and 1 PCS) were qualified for the final review and analysis. The meta-analysis showed both favorable dentoalveolar and skeletal changes in short term. Both overjet and overbite had a significant decrease after treatment (MD = -2.38 mm, 95% CI: -2.82 to -1.94, p < .001, and MD = -2.43 mm, 95% CI: -3.52 to -1.35, p < .001, respectively), and SNB increased significantly by 0.73 degrees (95% CI: 0.17-1.28, p = .01). After the retention period, however, overbite had a significant increase of 0.88mm, which indicated the occurrence of a relapse (95% CI: 0.60-1.16, p < .001).
CONCLUSIONS
According to the existing evidence, the EGA treatment is effectively correcting overjet and overbite in the early mixed dentition in short term; furthermore, high-quality and long-term studies are warranted to determine its long-term effectiveness.
Topics: Dentition, Mixed; Humans; Malocclusion; Malocclusion, Angle Class II; Overbite; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 35191109
DOI: 10.1111/ipd.12961 -
Sleep Medicine Reviews Oct 2018An oral appliance (OA) is an effective treatment option for patients with obstructive sleep apnea (OSA), but dental and skeletal changes have been detected by many... (Meta-Analysis)
Meta-Analysis Review
An oral appliance (OA) is an effective treatment option for patients with obstructive sleep apnea (OSA), but dental and skeletal changes have been detected by many studies after long-term OA use. Better understanding of the long-term side effects may decrease discontinuation of OA use and assist clinicians to make informed decisions. Accordingly, a systematic review and meta-analysis were performed to evaluate the dental and skeletal changes associated with OAs designed to advance the mandible. The quality of the studies was determined by using the risk of bias assessment tool for non-randomized studies (RoBANS), and 12 studies were included in the meta-analysis. OA use was associated with a significant decrease of overjet (OJ) and overbite (OB), and it was suggested that both parameters decreased along with the duration of treatment. Meta-analysis also demonstrated a significant increase of L1-MP. However, there were no significant changes of skeletal modifications or mandibular rotation. Changes of incisor inclination were suggested to make a contribution to reduction of OJ and OB. In conclusion, long-term OA use was associated with dental changes. The results of this study provide information for clinicians about the long-term effects of OAs.
Topics: Cephalometry; Mandibular Advancement; Overbite; Sleep Apnea, Obstructive; Snoring
PubMed: 29628335
DOI: 10.1016/j.smrv.2018.02.006 -
Journal of Dental Research, Dental... 2023Posterior intrusion with skeletal anchorage is one of the effective methods in the treatment of anterior open bite. Knowing the effects of posterior intrusion, the... (Review)
Review
BACKGROUND
Posterior intrusion with skeletal anchorage is one of the effective methods in the treatment of anterior open bite. Knowing the effects of posterior intrusion, the amount of possible molar intrusion using skeletal anchorage, and its impact on clinical and cephalometric indicators can help the clinician choose the optimal treatment method, especially in borderline surgical cases.
METHODS
In this systematic review, a series of articles were collected through a systematic search in databases, and the titles and summaries of all these articles were reviewed. After removing the irrelevant articles, the full texts of the related articles were read carefully, and their validity was evaluated. Only RCTs and observational studies that complied with PICO questions were included. The Cochrane Risk of Bias 2.0 (RoB 2), ROBINS-I, and GRADE were used to assess the risk of bias in the included studies. The relevant information on selected articles was extracted, and a meta-analysis was performed with Review Manager 5.4 software.
RESULTS
The meta-analysis revealed a significant average molar intrusion of 2.89 mm using temporary anchorage devices (TADs). A subgroup analysis showed that miniplates achieved greater intrusion (3.29 mm) compared to miniscrews (2.25 mm) (=0.03). The level of applied force did not significantly affect the degree of intrusion. Dental parameters such as overbite and overjet were notably altered, with overbite increasing by 4.81 mm and overjet decreasing by 2.06 mm on average. As for the skeletal cephalometric characteristics, SNB, ANB, and SN-Pog increased while mandibular plane angle and lower anterior facial height (LAFH) decreased, and these changes were significant. Meanwhile, SNA and palatal angle changes were not significant.
CONCLUSION
TADs have proved effective in achieving significant intrusion of maxillary molars, leading to marked improvements in dental and skeletal characteristics in patients with open bite malocclusion. Miniplates proved more effective in achieving greater intrusion.
PubMed: 38584993
DOI: 10.34172/joddd.2023.40754 -
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 -
Biomimetics (Basel, Switzerland) Mar 2023Deep bite is known as one of the most common malocclusions, and its treatment and retention are often challenging. The use of mini-screws has been suggested as an ideal... (Review)
Review
BACKGROUND
Deep bite is known as one of the most common malocclusions, and its treatment and retention are often challenging. The use of mini-screws has been suggested as an ideal method for the intrusion of incisors in deep-bite patients. Still, there are conflicting reports regarding the superiority of this method compared to other common treatments.
AIM
The aim of this systematic review and meta-analysis was to evaluate the effects of the intrusion of anterior teeth by skeletal anchorage in deep bite patients.
METHODS
From the beginning to 15 September 2022, articles on the topic of interest were searched in electronic databases including PubMed, Web of Science, Scopus, EMBASE, and Cochrane's CENTRAL. Additionally, a hand search for pertinent studies and a search of the grey literature were carried out. After the selection of eligible studies, data extraction was performed using piloted forms. Inverse-variance random-effects meta-analyses were used to combine the outcome measures of dental indices, skeletal cephalometric indices, and dental cephalometric indices.
RESULTS
A total of 15 studies (6 RCT; 9 CCT) were included in the systematic review and 14 were used in the meta-analyses. The differences in overbite changes (MD = -0.45, = 0.04), true incisor intrusion [u1-pp] (MD = -0.62, = 0.003) and molar extrusion [u6-pp] (MD = -0.40, = 0.01) were statistically significant and TADs showed better treatment results than other intrusion methods (segmented intrusion arch, utility arch, J hook headgear). No significant differences regarding overjet, molar and incisor tipping, and skeletal indices between mini-screw and other intrusion methods could be found.
CONCLUSION
The use of mini-screws leads to lower overbite and higher true intrusion (about 0.45 and 0.62 mm, respectively) compared to the use of other methods for intruding upper incisors. Furthermore, the effect of TAD on extrusion of molar teeth is less (by 0.4 mm) than other methods.
PubMed: 36975331
DOI: 10.3390/biomimetics8010101 -
European Journal of Orthodontics Apr 2016To systematically search for scientific evidence concerning the stability of treatment (Tx) results achieved by means of Class II fixed functional appliance therapy and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To systematically search for scientific evidence concerning the stability of treatment (Tx) results achieved by means of Class II fixed functional appliance therapy and to assess possible differences between appliances.
SEARCH METHODS
An electronic search of databases and orthodontic journals was carried out (until December 2013), with supplemental hand searching. In addition to the names of all identified appliances, the term fixed functional was used in combination with each of the following search terms: long-term, post-Tx, relapse, retention, stability.
SELECTION CRITERIA
To be included in the review, the articles had to contain clear data on: Class II Tx with a fixed functional appliance (>5 patients), post-Tx period ≥ 1 year, assessment of ANB angle, Wits appraisal, molar relationship, soft-tissue profile convexity excluding the nose, overjet and/or overbite.
DATA COLLECTION AND ANALYSIS
The literature search revealed 20 scientific investigations which corresponded to only two of the 76 identified appliances (Herbst and Twin Force Bite Corrector). As only one publication was found for the Twin Force Bite Corrector, a meta-analysis could only be performed for Herbst Tx. The data were extracted, pooled and weighted according to the number of patients in each study.
RESULTS
The mean values for post-Tx relapse (percentages relative to the Tx changes) were: ANB angle 0.2 degrees (12.4 per cent), Wits appraisal 0.5mm (19.5 per cent), sagittal molar relationship 1.2mm/0.1 cusp widths (21.8 per cent /6.5 per cent); soft-tissue profile convexity excluding nose less than 0.1 degrees (1.0 per cent), overjet 1.8mm (26.2 per cent), overbite Class II:1 1.4mm (44.7 per cent), overbite Class II:2 1.0mm (22.2 per cent).
CONCLUSIONS
The scientific evidence concerning the stability of Tx results is inexistent for most fixed functional appliances for Class II correction except for Herbst appliance Tx. Even if the evidence level of most included studies is rather low, good dentoskeletal stability without clinically relevant changes was found for most variables.
Topics: Cephalometry; Humans; Malocclusion, Angle Class II; Mandible; Maxilla; Molar; Orthodontic Appliances, Functional; Overbite; Recurrence; Treatment Outcome
PubMed: 25820407
DOI: 10.1093/ejo/cjv009