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Dental Press Journal of Orthodontics Aug 2018Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea.
OBJECTIVE
This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea.
METHODS
An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria.
RESULTS
A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use.
CONCLUSION
The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.
Topics: Adult; Humans; Mandibular Advancement; Periodontal Splints; Sleep Apnea, Obstructive; Snoring
PubMed: 30304153
DOI: 10.1590/2177-6709.23.4.045-054.oar -
Journal of Orthodontic Science 2018The aim of this systematic review and meta-analysis is to quantitatively compare previous studies that evaluated skeletal and dentoalveolar effects of the Forsus™...
OBJECTIVE
The aim of this systematic review and meta-analysis is to quantitatively compare previous studies that evaluated skeletal and dentoalveolar effects of the Forsus™ Fatigue Resistance Device (FRD) in the treatment of Class II malocclusion with a matched untreated control group.
MATERIALS AND METHODS
Four electronic searches PubMed, Web of Science, Cochrane Library, and Science Direct that were limited to articles on human studies comparing the effect of Forsus appliance with a matched control group in the treatment of Class II malocclusion from the year (2000-2017). An additional manual search was carried out by examining the references of the included articles, SEARCH terms included; Forsus and Class II malocclusion. The quality of the included studies was assessed using the modified methodological score for clinical trials. The data were analyzed using Michael Borenstein's Comprehensive Meta-Analysis Software (V3.3.070, Biostat, Inc., US).
RESULTS
Seven studies were included comprising 273 participants (Forsus group = 142; control group = 131). The results indicated a statistical significant skeletal effect of the Forsus appliance on increasing the occlusal plane only ( < 0.001). The results also indicated a statistical significant ( < 0.001) dentoalveolar effects of the Forsus appliance on the following outcomes; protruding, proclining, and intruding lower incisors; retroclining upper incisors, distalizing and intruding upper molars, as well as reducing overjet and overbite.
CONCLUSIONS
The Forsus™ showed positive effects on the maxillary incisors and first molars as well as overjet and overbite. However, multiple negative effects were reported on the occlusal plane and lower incisors that need to be considered when using such appliance in treating Class II malocclusion.
PubMed: 29765917
DOI: 10.4103/jos.JOS_80_17 -
Scientific Reports Mar 2018Malocclusion is a common oral disease affecting children with various reported prevalence rates. This meta-analysis aimed to determine the epidemiological... (Meta-Analysis)
Meta-Analysis
Malocclusion is a common oral disease affecting children with various reported prevalence rates. This meta-analysis aimed to determine the epidemiological characteristics of malocclusion among pre-schoolers in mainland China from 1988 to 2017. A total of 31 qualified papers describing 51,100 Chinese children aged 2-7 years were selected. The pooled malocclusion prevalence was 45.50% (95% confidence interval (CI): 38.08-52.81%) with 26.50% Class I (CI: 19.96-33.12%), 7.97% Class II (CI: 6.06-9.87%) and 12.60% Class III (CI: 9.45-15.68%) cases. The most common type of malocclusion was overbite (33.66%, CI: 27.66-39.67%), and the flush terminal type (47.10%, CI: 28.76-65.44%) was the most common in the terminal plane relationship. An increasing trend and wide variations across the country were observed. Additionally, there was no significant difference in malocclusion by gender (relative risk (RR) = 1.01, [0.96-1.06]) or urban/rural area (RR = 0.99, [0.82-1.20]). Although this study represents a narrow view of deciduous-dentition malocclusion in mainland China, the results provide sample evidence that can aid clinicians and policy makers towards early prevention and timely treatment.
Topics: Case-Control Studies; China; Humans; Malocclusion; Prevalence; Tooth, Deciduous
PubMed: 29549346
DOI: 10.1038/s41598-018-22900-x -
Journal of Orofacial Orthopedics =... May 2018To systematically search the scientific literature concerning the influence of tooth position on wind instrumentalists' performance and embouchure comfort.
PURPOSE
To systematically search the scientific literature concerning the influence of tooth position on wind instrumentalists' performance and embouchure comfort.
METHODS
The PubMed, Cochrane, and Embase databases were searched up to November 2017. The main orthodontic journals were searched for papers older than the inception date of PubMed. Grey literature was sought via Google Scholar. Eligible studies were critically appraised and analysed.
RESULTS
The searches retrieved 54 papers. Only two met the inclusion criteria. Searching the orthodontic journals and Google Scholar resulted in two additional eligible studies. All four studies had a cross-sectional design. The sample sizes ranged from 20-100 participants, varying from children to professional musicians. Because of a large heterogeneity in outcome variables, no meta-analysis could be performed. Descriptive analysis shows that there are indications that tooth irregularities have a negative influence on embouchure comfort and performance of a wind instrument player. A large overjet may impede the embouchure of brass musicians and may have a negative influence on trumpet player performance. A wide jaw form seems more beneficial to trumpet player performance than a small jaw form. Furthermore, players of all types of wind instruments can experience embouchure difficulties from extreme spacing or an open bite.
CONCLUSION
Tooth position can influence musical performance and embouchure comfort of wind instrumentalists. A Class I relationship without malocclusion seems appropriate for every type of wind instrument. The more extreme the malocclusion, the greater the interference with wind instrumentalists' performance and embouchure comfort. Evidence however is limited.
Topics: Diastema; Humans; Jaw; Lip; Malocclusion; Mouth; Music; Tongue; Tooth
PubMed: 29532091
DOI: 10.1007/s00056-018-0128-2 -
The Cochrane Database of Systematic... Feb 2018A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (deep... (Review)
Review
BACKGROUND
A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (deep overbite), which can cause oral problems and may affect appearance.This problem can be corrected by the use of special dental braces (functional appliances) that move the upper front teeth forward and change the growth of the upper or lower jaws, or both. Most types of functional appliances are removable and this treatment approach does not usually require extraction of any permanent teeth. Additional treatment with fixed braces may be necessary to ensure the best result.An alternative approach is to provide space for the correction of the front teeth by moving the molar teeth backwards. This is done by applying a force to the teeth from the back of the head using a head brace (headgear) and transmitting this force to part of a fixed or removable dental brace that is attached to the back teeth. The treatment may be carried out with or without extraction of permanent teeth.If headgear use is not feasible, the back teeth may be held in place by bands connected to a fixed bar placed across the roof of the mouth or in contact with the front of the roof of the mouth. This treatment usually requires two permanent teeth to be taken out from the middle of the upper arch (one on each side).
OBJECTIVES
To establish whether orthodontic treatment that does not involve extraction of permanent teeth produces a result that is any different from no orthodontic treatment or orthodontic treatment involving extraction of permanent teeth, in children with a Class II division 2 malocclusion.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following electronic databases: Cochrane Oral Health's Trials Register (to 13 November 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 10), MEDLINE Ovid (1946 to 13 November 2017), and Embase Ovid (1980 to 13 November 2017). To identify any unpublished or ongoing trials, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch) were searched. We also contacted international researchers who were likely to be involved in any Class II division 2 clinical trials.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the search results to find eligible studies, and would have extracted data and assessed the risk of bias from any included trials. We had planned to use random-effects meta-analysis; to express effect estimates as mean differences for continuous outcomes and risk ratios for dichotomous outcomes, with 95% confidence intervals; and to investigate any clinical or methodological heterogeneity.
MAIN RESULTS
We did not identify any RCTs or CCTs that assessed the treatment of Class II division 2 malocclusion in children.
AUTHORS' CONCLUSIONS
There is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children. This situation seems unlikely to change as trials to evaluate the best management of Class II division 2 malocclusion are challenging to design and conduct due to low prevalence, difficulties with recruitment and ethical issues with randomisation.
Topics: Child; Humans; Malocclusion, Angle Class II; Orthodontic Appliances, Functional; Orthodontics, Corrective; Tooth Extraction
PubMed: 29390172
DOI: 10.1002/14651858.CD005972.pub4 -
Journal of Istanbul University Faculty... 2017The objective of this systematic review was to compare the antero-posterior, vertical and angular changes of maxillary incisors with conventional anchorage control... (Review)
Review
PURPOSE
The objective of this systematic review was to compare the antero-posterior, vertical and angular changes of maxillary incisors with conventional anchorage control techniques and mini-implant based space closure methods.
MATERIALS AND METHODS
The electronic databases Pubmed, Scopus, ISI Web of knowledge, Cochrane Library and Open Grey were searched for potentially eligible studies using a set of predetermined keywords. Full texts meeting the inclusion criteria as well as their references were manually searched. The primary outcome data (linear, angular, and vertical maxillary incisor changes) and secondary outcome data (overbite changes, soft tissue changes, biomechanical factors, root resorption and treatment duration) were extracted from the selected articles and entered into spreadsheets based on the type of anchorage used. The methodological quality of each study was assessed.
RESULTS
Six studies met the inclusion criteria. The amount of incisor retraction was greater with buccally placed mini-implants than conventional anchorage techniques. The incisor retraction with indirect anchorage from palatal mini-implants was less when compared with buccally placed mini-implants. Incisor intrusion occurred with buccal mini-implants, whereas extrusion was seen with conventional anchorage. Limited data on the biomechanical variables or adverse effects such as root resorption were reported in these studies.
CONCLUSION
More RCT's that take in to account relevant biomechanical variables and employ three-dimensional quantification of tooth movements are required to provide information on incisor changes during space closure.
PubMed: 29354313
DOI: 10.17096/jiufd.52884 -
The Cochrane Database of Systematic... Oct 2017A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (deep... (Review)
Review
BACKGROUND
A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (deep overbite), which can cause oral problems and may affect appearance.This problem can be corrected by the use of special dental braces (functional appliances) that move the upper front teeth forward and change the growth of the upper or lower jaws, or both. Most types of functional appliances braces are removeable and this treatment approach does not usually require extraction of any permanent teeth. Additional treatment with fixed braces may be necessary to ensure the best result.An alternative approach is to provide space for the correction of the front teeth by moving the molar teeth backwards. This is done by applying a force to the teeth from the back of the head using a head brace (headgear) and transmitting this force to part of a fixed or removable dental brace that is attached to the back teeth. The treatment may be carried out with or without extraction of permanent teeth.If headgear use is not feasible, the back teeth may be held in place by bands connected to a fixed bar placed across the roof of the mouth or in contact with the front of the roof of the mouth. This treatment usually requires two permanent teeth to be taken out (one on each side).
OBJECTIVES
To establish whether orthodontic treatment that does not involve extraction of permanent teeth produces a result that is any different from no orthodontic treatment or orthodontic treatment involving extraction of permanent teeth, in children with a Class II division 2 malocclusion.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following electronic databases: Cochrane Oral Health's Trials Register (to 10 January 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 11), MEDLINE Ovid (1946 to 10 January 2017), and Embase Ovid (1980 to 10 January 2017). To identify any unpublished or ongoing trials, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch) were searched. We also contacted international researchers who were likely to be involved in any Class II division 2 clinical trials.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the search results to find eligible studies, and would have extracted data and assessed the risk of bias from any included trials. We had planned to use random-effects meta-analysis; to express effect estimates as mean differences for continuous outcomes and risk ratios for dichotomous outcomes, with 95% confidence intervals; and to investigate any clinical or methodological heterogeneity.
MAIN RESULTS
We did not identify any RCTs or CCTs that assessed the treatment of Class II division 2 malocclusion in children.
AUTHORS' CONCLUSIONS
It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children. Trials should be conducted to evaluate the best management of Class II division 2 malocclusion.
Topics: Child; Humans; Malocclusion, Angle Class II; Orthodontic Appliances, Functional; Orthodontics, Corrective; Overbite
PubMed: 28968484
DOI: 10.1002/14651858.CD005972.pub3 -
Turkish Journal of Orthodontics Mar 2017The present systemic review was conducted with the main purpose to evaluate the quantitative effects of orthognathic surgeries, extraction versus non-extraction... (Review)
Review
OBJECTIVE
The present systemic review was conducted with the main purpose to evaluate the quantitative effects of orthognathic surgeries, extraction versus non-extraction treatment, and the type of malocclusion in the stability of anterior open-bite (AOB) correction over the long-term.
METHODS
The systematic search for studies was conducted through MEDLINE, CINAHL, EMBASE, Scopus, PsychINFO, various key journals, and review articles; November 30, 2016, was the last date for the search. The Quality Assessment Tool for Quantitative Studies was used to grade the methodological quality of the studies.
RESULTS
The present review included 14 studies. Stability of the corrected AOB ranged from 61.9% to 100%. The studies with orthognathic surgeries showed a stability of 70-100%. The studies without orthognathic surgeries showed the stability of 61.9-96.7%. All of the studies were retrospective. The mean change in AOB before (T1) and after treatment (T2-T1) was 0.1 mm to 6.93 mm and the mean change in overbite from T2 to T3 (T3-T2) was -0.06 mm to 2.5 mm.
CONCLUSION
Studies with orthognathic surgeries presented with high amount of long-term stability in corrected AOB. No significant difference was noticed in relation to the type of malocclusion and extraction or non-extraction cases.
PubMed: 30112488
DOI: 10.5152/TurkJOrthod.2017.010 -
American Journal of Orthodontics and... Nov 2016The emphasis on dental esthetics has increased in recent years. There are, however, differences in esthetic perceptions among professional and lay groups. The aim of... (Review)
Review
INTRODUCTION
The emphasis on dental esthetics has increased in recent years. There are, however, differences in esthetic perceptions among professional and lay groups. The aim of this comprehensive review was to update previous reviews and answer the following research question: Can lay thresholds for acceptance of smile esthetic anomalies be defined?
METHODS
A systematic search in the medical literature (PubMed, PMC, NLM, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACs) was performed to identify all peer-reviewed articles reporting data regarding evaluations of laypeople's perceptions of dental esthetic factors.
RESULTS
Of the 6032 analyzed articles, 66 studies were selected for the final review process. Among the selected articles investigated perceptions of diastema, 15 analyzed modifications in tooth size and shape, 8 considered incisor positions, 15 evaluated midline discrepancies, 16 investigated buccal corridors, 26 analyzed gingival display and design, 3 considered lip height, and 20 investigated miscellaneous factors. Threshold values were identified for the following features: diastema (0-2 mm), tooth size and shape of incisor position, midline discrepancy (0-3 mm), buccal corridors (5-16 mm), gingival exposure (1.5-4 mm), occlusal canting (0°-4°), and overbite (2-5 mm). Furthermore, few other smile characteristics were found to be significantly associated with perception of smile aesthetics, even though any threshold could be detected.
CONCLUSIONS
On the basis of the obtained results, threshold values for the main features of smile and dental esthetics could be identified. Limitations of the present study were the heterogeneity of data which made it impossible to perform a meta-analysis, and the lack of information about sample selection and selective outcome reporting.
Topics: Attitude to Health; Esthetics, Dental; Facial Expression; Humans; Mouth; Tooth
PubMed: 27871700
DOI: 10.1016/j.ajodo.2016.06.022 -
Medicine Sep 2016Children with severe airway obstruction tend to have a vertical direction of growth, class II malocclusion, and narrow arches. Adenoidectomy and tonsillectomy were... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Children with severe airway obstruction tend to have a vertical direction of growth, class II malocclusion, and narrow arches. Adenoidectomy and tonsillectomy were recommended for the promotion of balanced dentition growth in these children.The aim of this study was to determine the effect of adenoidectomy and tonsillectomy on the growth of dental morphology in children with airway obstruction.
METHODS
A comprehensive search of the Medline, Embase, Web of science, and OVID databases for studies published through to January 17, 2016 was conducted. Prospective, comparative, clinical studies assessing the efficacy of adenoidectomy, or tonsillectomy in children with airway obstruction were included. The weighted mean difference (WMD) and 95% confidence interval (CI) were used for continuous variables. Forest plots were drawn to demonstrate effects in the meta-analyses.
RESULTS
Eight papers were included in our study. We found that adenoidectomy and tonsillectomy led to a significant change in nasal-breathing in children with airway obstruction. Children with airway obstruction had a significantly narrower posterior maxillary dental arch than children without airway obstruction (WMD = -0.94, 95% CI [-1.13, -0.76]; P < 0.001). After surgery, these children still had a significantly narrower dental arch than the nasal-breathing children (WMD = -0.60, 95% CI [-0.79, -0.42]; P < 0.001). In terms of dental arch width, malocclusion, palatal height, overjet, overbite, dental arch perimeter, and arch length, a tendency toward normalization was evident following adenoidectomy or tonsillectomy, with no significant differences evident between the surgical group and the normal group. The small number of studies and lack of randomized controlled trials were the main limitations of this meta-analysis.
CONCLUSIONS
Following adenoidectomy and tonsillectomy, the malocclusion and narrow arch width of children with airway obstruction could not be completely reversed. Therefore, other treatments such as functional training or orthodontic maxillary widening should be considered after removing the obstruction in the airway.
Topics: Adenoidectomy; Adolescent; Airway Obstruction; Child; Child, Preschool; Dental Arch; Female; Humans; Male; Malocclusion; Postoperative Period; Tonsillectomy; Treatment Outcome
PubMed: 27684847
DOI: 10.1097/MD.0000000000004976