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L' Orthodontie Francaise Apr 2023Several cross-sectional studies have shown the association of a dysfunctional orofacial environment with a greater prevalence of malocclusions. Orofacial myofunctional...
INTRODUCTION
Several cross-sectional studies have shown the association of a dysfunctional orofacial environment with a greater prevalence of malocclusions. Orofacial myofunctional reeducation (OFMR) is the rehabilitation of the muscles, functions and resting postures of the orofacial complex. It is used in the therapeutic management of orofacial dysfunction in patients of all ages and with a wide range of disorders and comorbidities. RMOF mainly uses isotonic and isometric exercises targeting the oral and oropharyngeal structures, combined with specific exercises for ventilation, swallowing and mastication. It may involve the use of prefabricated reeducation appliances (PRAs), which may also be prescribed to modify the shape and relationship of the dental arches.
OBJECTIVES
The primary objective of this systematic review of the literature was to describe and evaluate the efficacy of prefabricated reeducation appliance-assisted OFMR in orthodontics, occlusodontics and dental sleep medicine. Its secondary objective was to assess whether the use of currently available PRAs is associated with adverse effects.
MATERIALS AND METHODS
The systematic literature review was undertaken using five electronic databases: Medline (via PubMed), Web of Science, Cochrane Library, Embase, and Google Scholar, to identify studies evaluating the efficacy of PRA-assisted OFMR in the treatment of orofacial dysfunctions and parafunctions, temporo-mandibular dysfunction (TMD) or obstructive sleep apnea (OSA) in children, adolescents and adults, published until 20 March 2023. The primary outcome of interest was the therapeutic efficacy of PRA-assisted OFMR. In patients with obstructive sleep apnoea (OSA), efficacy was assessed primarily by a decrease in the apnoea/hypopnoea index (AHI) of at least five episodes per hour from baseline, improvement in subjective sleep quality, sleep quality measured by nocturnal polysomnography and subjectively measured quality of life. In patients with orofacial dysfunctions, parafunctions or TMD, efficacy was assessed mainly by electromyography (EMG), history and clinical examination. Secondary outcomes were dentoalveolar or skeletal improvements, and possible adverse effects of the PRAs used, including adverse effects on occlusion.
RESULTS
Only fourteen studies met all inclusion criteria: two randomised controlled trials, one non-randomised controlled trial, five prospective case-control studies, two retrospective case-control studies, two prospective case series and two retrospective case series. The two randomised controlled trials were assessed as "low risk of bias" according to the Cochrane Back Review Group's 12 risk of bias criteria. The methodological quality of the remaining 12 included studies was assessed using the ROBINS-I tool, according to the recommendations of the Cochrane Handbook. One was judged to have a measured risk of bias, eight a significant risk of bias and three a critical risk of bias. Based on the available evidence, PRA-assisted OFMR results in a statistically significant (p=0.0425) reduction in AHI in children with mild to moderate obstructive sleep apnea. In children with obstructive sleep apnoea undergoing adenoid and/or tonsil surgery, postoperative OFMR combined with a flexible PRA leads to a greater reduction in AHI compared to a control group and an improvement in SaO2 at 6 months and 12 months after surgery (p<0.01). It also contributes to greater improvement in sleep disturbance, physical fitness, daytime lethargy in the treated group than in the control group 6 months and 12 months after surgery (p<0.05). PRA-assisted OFMR provides correction of atypical swallowing and improvement in orofacial muscle balance. GRPs are generally less effective than activators for the treatment of Class II Division 1 malocclusions and appear to cause more adverse effects, mainly vestibuloversion of the mandibular incisors. The use of PRA-assisted OFMR for the management of TMD is not validated by current evidence.
CONCLUSIONS
Published data, albeit of uneven methodological quality, appear to show the superiority of OFMR combined with the use of a PRA, compared with the implementation of OFMR without PRA. Prospective studies with large sample sizes would be useful to better evaluate the new therapeutic possibilities brought by the combination of OFMR with a PRA. Continued attention should be paid to the monitoring of possible adverse effects of PRA-assisted OFMR on the dental arches, especially the vestibuloversion of the mandibular incisors. It might be useful to reflect on the relevance of the arguments put forward by manufacturers about the particularities of their devices and their supposed effects. PRA-assisted OFMR appears to be a necessary paradigm shift , which it seems useful to bring to our patients.
PROTOCOL REGISTRATION
This protocol was registered on March 02, 2023 in the International Prospective Register of Systematic Review (PROSPERO) and received the CRD number: CRD42023400421.
Topics: Adolescent; Adult; Child; Humans; Cross-Sectional Studies; Prospective Studies; Quality of Life; Retrospective Studies; Sleep Apnea, Obstructive; Patient Education as Topic; Malocclusion; Controlled Clinical Trials as Topic
PubMed: 37114821
DOI: 10.1684/orthodfr.2023.126 -
Minerva Dental and Oral Science Aug 2023A systematic review of the literature available up to October 2020 has been conducted to determine which cranial plane could represent a stable and reliable parameter to...
INTRODUCTION
A systematic review of the literature available up to October 2020 has been conducted to determine which cranial plane could represent a stable and reliable parameter to evaluate the orientation of the occlusal plane in a frontal view.
EVIDENCE ACQUISITION
An electronic research was performed across the following electronic databases: PUBMED, EBSCO, SCOPUS, WoS, COCHRANE LIBRARY, SciELO, EMBASE and GOOGLE SCHOLAR. Observational studies based on imaging and anthropometry were identified, and all languages have been included. The articles were selected and analyzed by three authors independently. PICO format was adopted to analyze the studies and AXIS guidelines were used to assess the quality of evidence.
EVIDENCE SYNTHESIS
We found eleven articles eligible for full-text analysis. All studies included only young subjects and analyzed the occlusal plane in relation to the frontal plane traced between the right and left tragus (Camper's and Frankfurt planes), to the interpupillary plane, and to other soft and hard tissues references. The outcomes of selected studies were various, with a low quality of evidence, and they did not allow to infer a stable cranial relation between the occlusal plane and other bone structures.
CONCLUSIONS
The evidence does not support that the interpupillary plane represent a reliable parameter to evaluate the occlusal plane orientation in a frontal view; instead, the Frankfurt plane could be a much more stable reference parameter, from a morphological perspective. It is necessary to perform an observational study upon craniums to define which are the most stable cranial reference planes to determine the orientation of the occlusal plane in dentate subjects.
Topics: Humans; Dental Occlusion; Cephalometry; Face; Skull; Ear Auricle; Observational Studies as Topic
PubMed: 37066888
DOI: 10.23736/S2724-6329.22.04659-9 -
Journal of Clinical Medicine Apr 2023Temporomandibular disorders (TMDs) are a series of disorders that affect the muscles and joint. Symptoms include joint pain, muscle pain, and limitation of mouth... (Review)
Review
Correlation between Temporomandibular Disorders (TMD) and Posture Evaluated trough the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): A Systematic Review with Meta-Analysis.
Temporomandibular disorders (TMDs) are a series of disorders that affect the muscles and joint. Symptoms include joint pain, muscle pain, and limitation of mouth opening. One of several multifactorial diseases, temporomandibular dysfunction has mostly been linked to five etiological factors: occlusion, trauma, severe pain stimuli, parafunctional activities, and psychological elements, including stress, anxiety, and depression. The position of the human body as it is displayed in space is referred to as posture. Several nerve pathways regulate posture, and through ligaments, TMD and posture affect each other. The purpose of this study is to evaluate the possible correlation between posture and TMD through a meta-analysis of the literature; Methods: A literature search was performed on PubMed, Lilacs, and Web of science, and articles published from 2000 to 31 December 2022 were considered, according to the keywords entered. The term "temporomandibular disorders" has been combined with "posture", using the Boolean connector AND; Results: At the end of the research, 896 studies were identified from the search conducted on the 3 engines. Only three were chosen to draw up the present systematic study summarizing the article's main findings. The meta-analysis showed through forest plot analysis a correlation between posture and TMD Conclusions: This literature meta-analysis showed a correlation between posture and TMD. Nerve pathways probably regulate both body posture and mandibular posture. Further clinical studies will be needed to confirm this hypothesis and to indicate the main conclusions or interpretations.
PubMed: 37048735
DOI: 10.3390/jcm12072652 -
The Angle Orthodontist Sep 2023To evaluate the efficacy of chewing gum on the intensity of pain in patients undergoing orthodontic treatment. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the efficacy of chewing gum on the intensity of pain in patients undergoing orthodontic treatment.
MATERIALS AND METHODS
A search strategy that included both a manual search and a search of electronic databases was implemented; the electronic databases included PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Scopus, and EBSCO. Only randomized controlled trials were included in this study. All of the studies were assessed independently and in duplicate in accordance with the exclusion and inclusion criteria. The Cochrane risk of bias tool was used to evaluate the risk of bias within the included studies, and the GRADE approach was used to evaluate the certainty of evidence.
RESULTS
Sixteen RCTs were included in the final analysis. The meta-analysis revealed that chewing gum significantly reduced pain intensity in comparison to pharmacologic agents (mean difference [MD] -0.50 [95% confidence interval {CI} -0.90 to -0.10], P = .01). When compared with a placebo, chewing gum significantly reduced pain intensity (MD -0.60 [95% CI -1.06 to -0.13], P = .01), while bite wafer and chewing gum groups had the same levels of reduction in pain intensity (MD -0.15 [95% CI -0.56 to 0.26], P = .48).
CONCLUSIONS
In patients undergoing fixed orthodontic treatment, chewing gum was significantly more effective than both pharmacologic agents and placebo in reducing orthodontic pain 24 hours after the initial placement of the archwire.
Topics: Humans; Chewing Gum; Pain; Dental Occlusion; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 37043773
DOI: 10.2319/110622-760.1 -
Dental Press Journal of Orthodontics 2023This systematic review aims to answer the following focus question: "Is there an association between atypical swallowing and malocclusions?".
OBJECTIVE
This systematic review aims to answer the following focus question: "Is there an association between atypical swallowing and malocclusions?".
METHODS
Appropriate word combinations were chosen and tailored specifically for each of the following electronic databases: EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, Web of Science, and gray literature, without any restrictions, up to February 2021. According to the selection criteria, only cross-sectional studies were included. The following inclusion criteria were considered: a sample composed of children, adolescents, and adults; patients clinically diagnosed with atypical swallowing; patients with normal swallowing; and outcome of interest of atypical swallowing in patients with malocclusion. The data consisted of study characteristics, sample characteristics, results, and conclusion of each study. The risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, and the certainty of evidence was assessed using the GRADE tool.
RESULTS
4,750 articles were identified. After a two-step selection, four studies were included. A higher frequency of distal occlusion, extreme maxillary overhang, and open bite was related to swallowing disorders; most studies pointed to posterior crossbite as a malocclusion more associated with atypical swallowing. All studies had a moderate to high risk of bias, and the certainty of evidence was very low.
CONCLUSION
The results indicate that atypical swallowing is associated with malocclusions and that posterior crossbite is the main malocclusion found, but only in the young population (3-11 years).
REGISTRATION
PROSPERO (42020215203).
Topics: Child; Adult; Adolescent; Humans; Deglutition; Cross-Sectional Studies; Malocclusion; Open Bite
PubMed: 36995845
DOI: 10.1590/2177-6709.27.6.e2221285.oar -
Otolaryngology--head and Neck Surgery :... May 2023The aim of this study is to review the current literature on treatment of subcondylar fractures using traditional open reduction internal fixation (ORIF), closed... (Review)
Review
OBJECTIVE
The aim of this study is to review the current literature on treatment of subcondylar fractures using traditional open reduction internal fixation (ORIF), closed reduction with maxillomandibular fixation (MMF), and endoscopic open approaches.
DATA SOURCES
PubMed, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and WHO ICTRP.
REVIEW METHODS
A comprehensive database search was performed in accordance with PRISMA guidelines. All English-only texts published in the last 20 years with ≥10 patients were included. Studies that included patients <16 years old were excluded.
RESULTS
Thirty-two studies met the final inclusion criteria. Nine studies compared ORIF with closed reduction using MMF, 12 studies evaluated ORIF via different approaches, and 10 studies evaluated outcomes after endoscopic approaches. Five studies reported significant improvement in mouth opening with ORIF compared to closed reduction. In 1 study that recorded patient-reported outcomes measure (FACE-Q scale), quality of life scores and patient satisfaction were significantly higher in the ORIF group. Among the 10 studies that used the endoscopic approach, transient facial nerve injury ranged from 0% to 10%.
CONCLUSION
Several studies report better mouth opening, dental occlusion, and functional outcomes after ORIF compared to closed reduction, while some found no significant difference. Endoscopic approaches provide ease of access to the condyle with a low incidence of facial nerve injury. However, limitations include special equipment, longer operative times, and a steep learning curve using an endoscope. This review provides surgeons with an overview of the current literature on subcondylar fractures to allow for an individualized management approach for each patient.
Topics: Humans; Adolescent; Treatment Outcome; Fracture Fixation, Internal; Mandibular Fractures; Facial Nerve Injuries; Quality of Life; Mandibular Condyle
PubMed: 36939481
DOI: 10.1002/ohn.185 -
International Journal of Computerized... Mar 2024Occlusion is associated with all disciplines of dentistry and plays a major role in the longevity of both implant- and tooth-borne restorations. Achieving occlusal...
STATEMENT OF THE PROBLEM
Occlusion is associated with all disciplines of dentistry and plays a major role in the longevity of both implant- and tooth-borne restorations. Achieving occlusal harmony ensures balance is established between the dental and myofascial structures, which can be measurably established to high numerical tolerances with the T-Scan digital occlusal analysis system.
PURPOSE
To describe and evaluate the known and proven applications of T-Scan digital occlusal analysis in various dental practice disciplines through a systematic review of the literature.
MATERIALS AND METHODS
An electronic, English-language PubMed/MEDLINE and Cochrane Central Registry of Controlled Trials database search using the keywords "T-Scan," "TMD," "Occlusion," "Implant Protected Occlusion," and "Orthodontics" was conducted without any date restrictions. The related journal findings were hand searched to determine studies that met the eligibility criteria for inclusion in the present systematic review.
RESULTS
The PubMed/MEDLINE search identified 423 articles. After removing duplicates, the titles and abstracts of the remaining 421 studies were screened. 274 ineligible articles were excluded, leaving 147 articles. Of those, 33 articles were not in English, 27 full-text articles were not available, 4 were comments and letters to editors, 1 was a review, and 2 described techniques. A total of 86 articles met the eligibility criteria for inclusion.
CONCLUSION
Much scientific evidence supports the use of T-Scan, as it measures relative occlusal contact forces and the time sequence durations of occlusal contacts objectively, accurately, and repeatedly for improved treatment outcomes. The system's hardware, sensor, and software evolution from T-Scan I to today's T-Scan 10 Novus system has overcome early sensor and system drawbacks to improve the clinical performance of T-Scan in many disciplines of dental medicine.
Topics: Humans; Dental Occlusion; Bite Force; Software; Dental Care; Orthodontics
PubMed: 36928754
DOI: 10.3290/j.ijcd.b3945153 -
Journal of Oral Rehabilitation Jul 2023One of the main goals of orthognathic surgery is to improve the masticatory performance in patients with maxillofacial deformities. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
One of the main goals of orthognathic surgery is to improve the masticatory performance in patients with maxillofacial deformities.
OBJECTIVE
The aim of this study was to evaluate the literature on assessing masticatory performance before, after orthognathic surgery and normal occlusion.
METHODS
An electronic search was performed via Pubmed, Scopus, LILACs and Web of Science without any restrictions until June 2022. The articles assessing masticatory performance using a comminution assay, bite force or occlusal contact area in patients undergoing orthognathic surgery with or without comparing controls were included. The risk of bias of the selected articles was assessed using the appropriate tools according to the study design.
RESULTS
Of the 2507 records identified, 21 studies were included in the qualitative evaluation and 17 studies in the meta-analysis. Nine articles were cohort studies, and the other eight were before-after studies. Moderate to high risks of bias were found among the articles. Comparing the values before and after surgery, the meta-analysis revealed a significant improvement in the bite force and occlusal contact area at 1- and 2-year post-surgery. However, regardless of the assessed parameters, the masticatory performance in patients with normal occlusion was significantly greater than those in patients undergoing orthognathic surgery at all evaluated time points.
CONCLUSION
Although combined surgical orthodontic treatment can improve impaired masticatory function, assessed by the comminution method, bite force and occlusal contact area, the improvement may not reach that of normal occlusion.
Topics: Humans; Orthognathic Surgery; Dental Occlusion; Mastication; Bite Force; Cohort Studies
PubMed: 36920311
DOI: 10.1111/joor.13447 -
Clinical Oral Investigations May 2023To assess the pain profile of patients in the levelling/alignment phase of orthodontic treatment, as reported from randomized clinical trials. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the pain profile of patients in the levelling/alignment phase of orthodontic treatment, as reported from randomized clinical trials.
MATERIALS AND METHODS
Five databases were searched in September 2022 for randomized clinical trials assessing pain during levelling/alignment with a visual analogue scale (VAS). After duplicate study selection, data extraction, and risk-of-bias assessment, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression, and certainty analyses.
RESULTS
A total of 37 randomized trials including 2277 patients (40.3% male; mean age 17.5 years) were identified. Data indicated quick pain initiation after insertion of orthodontic appliances (n = 6; average = 12.4 mm VAS), a quick increase to a peak at day 1 (n = 29; average = 42.4 mm), and gradually daily decrease the first week until its end (n = 23; average = 9.0 mm). Every second patient reported analgesic use at least once this week (n = 8; 54.5%), with peak analgesic use at 6 h post-insertion (n = 2; 62.3%). Patients reported reduced pain in the evening compared to morning (n = 3; MD = - 3.0 mm; 95%CI = - 5.3, - 0.6; P = 0.01) and increased pain during chewing (n = 2; MD = 19.2 mm; 95% CI = 7.9, 30.4; P < 0.001) or occlusion of the back teeth (n = 2; MD = 12.4 mm; 95% CI = 1.4, 23.4; P = 0.3), while non-consistent effects were seen for patient age, sex, irregularity, or analgesic use. Subgroup analyses indicated increased pain among extraction cases and during treatment of the lower (rather than the upper) arch, while certainty around estimates was moderate to high.
CONCLUSIONS
Evidence indicated a specific pain profile during orthodontic levelling/alignment, without signs of consistent patient-related influencing factors.
Topics: Humans; Male; Adolescent; Female; Randomized Controlled Trials as Topic; Orthodontic Appliances, Fixed; Pain; Analgesics
PubMed: 36879148
DOI: 10.1007/s00784-023-04931-5 -
The Journal of Prosthetic Dentistry Feb 2023The advent of machine learning in the complex subject of occlusal rehabilitation warrants a thorough investigation into the techniques applied for successful clinical... (Review)
Review
STATEMENT OF PROBLEM
The advent of machine learning in the complex subject of occlusal rehabilitation warrants a thorough investigation into the techniques applied for successful clinical translation of computer automation. A systematic evaluation on the topic with subsequent discussion of the clinical variables involved is lacking.
PURPOSE
The purpose of this study was to systematically critique the digital methods and techniques used to deploy automated diagnostic tools in the clinical evaluation of altered functional and parafunctional occlusion.
MATERIAL AND METHODS
Articles were screened by 2 reviewers in mid-2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible articles were critically appraised by using the Joanna Briggs Institute's Diagnostic Test Accuracy (JBI-DTA) protocol and Minimum Information for Clinical Artificial Intelligence Modeling (MI-CLAIM) checklist.
RESULTS
Sixteen articles were extracted. Variations in mandibular anatomic landmarks obtained via radiographs and photographs produced notable errors in prediction accuracy. While half of the studies adhered to robust methods of computer science, the lack of blinding to a reference standard and convenient exclusion of data in favor of accurate machine learning suggested that conventional diagnostic test methods were ineffective in regulating machine learning research in clinical occlusion. As preestablished baselines or criterion standards were lacking for model evaluation, a heavy reliance was placed on the validation provided by clinicians, often dental specialists, which was prone to subjective biases and largely governed by professional experience.
CONCLUSIONS
Based on the findings and because of the numerous clinical variables and inconsistencies, the current literature on dental machine learning presented nondefinitive but promising results in diagnosing functional and parafunctional occlusal parameters.
PubMed: 36801145
DOI: 10.1016/j.prosdent.2023.01.013