-
Journal of Clinical Medicine Jun 2024Mandibular defects resulting from oncological treatment pose significant aesthetic and functional challenges due to the involvement of bone and soft tissues. Immediate... (Review)
Review
Mandibular defects resulting from oncological treatment pose significant aesthetic and functional challenges due to the involvement of bone and soft tissues. Immediate reconstruction is crucial to address complications such as malocclusion, mandibular deviation, temporomandibular joint (TMJ) changes, and soft tissue retraction. These issues can lead to functional impairments, including difficulties in chewing, swallowing, and speech. The fibula flap is widely used for mandibular reconstruction due to its long bone segment and robust vascular supply, though it may not always provide adequate bone height for optimal dental rehabilitation. This systematic review aims to determine if the double-barreled fibula flap (DBFF) configuration is a viable alternative for mandibular reconstruction and to evaluate the outcomes of dental implants placed in this type of flap. This study adhered to the Cochrane Collaboration criteria and PRISMA guidelines and was registered on the International Platform of Registered Systematic Review and Meta-Analysis Protocols Database (INPLASY2023120026). We included clinical studies published in English, Spanish, or French that focused on adult patients undergoing segmental mandibulectomy followed by DBFF reconstruction and dental rehabilitation. Data sources included Medline/PubMed, the Cochrane Library, EMBASE, Scopus, and manual searches. Two reviewers independently screened and selected studies, with discrepancies resolved by a third reviewer. Data extraction captured variables such as publication year, patient demographics, number of implants, follow-up duration, flap survival, implant failure, and aesthetic outcomes. The risk of bias was assessed using the JBI appraisal tool, and the certainty of evidence was evaluated using the GRADE approach. A total of 17 clinical studies were included, evaluating 245 patients and 402 dental implants. The average patient age was 43.7 years, with a mean follow-up period of 34.3 months. Flap survival was high, with a 98.3% success rate and only four flap losses. The implant failure rate was low at 1.74%. Esthetic outcomes were varied, with only three studies using standardized protocols for evaluation. The overall certainty of evidence for flap survival was moderate, low for implant failure, and very low for aesthetics due to the subjective nature of assessments and variability in reporting. The primary limitations of the evidence included in this review are the observational design of the studies, leading to an inherent risk of bias, inconsistency in reporting methods, and imprecision in outcome measures. Additionally, the subjective nature of aesthetic evaluations and the variability in assessment tools further limit the reliability of the findings. The DBFF technique demonstrates excellent outcomes for mandibular reconstruction, with high flap survival and low implant failure rates, making it a viable option for dental rehabilitation. However, the evidence for aesthetic outcomes is less certain, highlighting the need for more rigorous and standardized research. This review supports the DBFF as a good alternative for mandibular reconstruction with successful dental implant integration, although further studies are needed to enhance the reliability of aesthetic evaluations.
PubMed: 38930078
DOI: 10.3390/jcm13123547 -
Journal of Clinical Medicine Jun 2024: This study investigates the relationship between malocclusion and body posture, head posture, podal system, and gait parameters in children. : A systematic review of... (Review)
Review
: This study investigates the relationship between malocclusion and body posture, head posture, podal system, and gait parameters in children. : A systematic review of observational studies from 2010 to 2023 was conducted and 24 cross-sectional studies involving 6199 participants were identified. These studies were categorized into those dealing with body posture (10 studies, 3601 participants), cervical vertebral column and head posture (6 studies, 644 participants), the podal system (5 studies, 1118 participants), and gait (3 studies, 836 participants). : Evidence suggests a significant association between malocclusion and body posture, balance, podal system, and gait parameters. Notably, eight studies found a significant relationship between malocclusion and body posture, while five studies identified this relationship with the cervical vertebral column and head posture, five with the podal system, and three with gait parameters. : Overall, the quality of evidence was strong for the association between malocclusion and body posture and the podal system and moderate for head posture and gait parameters. These findings offer insights for therapists to design interventions tailored to children with malocclusion based on considerations of body posture, head posture, podal system, and gait parameters, though further longitudinal cohort studies are needed for better predictive understanding.
PubMed: 38929993
DOI: 10.3390/jcm13123463 -
Journal of Clinical Medicine Jun 2024Floating-Harbor syndrome (FHS) is an extremely rare genetic disorder connected with a distinctive facial appearance, various skeletal malformations, delayed bone age,...
Floating-Harbor syndrome (FHS) is an extremely rare genetic disorder connected with a distinctive facial appearance, various skeletal malformations, delayed bone age, and expressive language delays. It is caused by heterozygous mutations in the Snf2-related CREBBP activator protein (SRCAP) gene. The aim of this paper is to describe the case of a 14-year-old male with FHS, referring to a review of the literature, and to collect all reported symptoms. In addition, the orthodontic treatment of the patient is described. For this, the electronic databases PubMed and Scopus were searched using the keyword "Floating-Harbor syndrome". Similar to previous cases in the literature, the patient presented with short stature; a triangular face with a large bulbous nose; deep-set eyes and narrow eyelid gaps; a wide mouth with a thin vermilion border of the upper lip; and dorsally rotated, small ears. They also presented some less-described symptoms, such as macrodontia and micrognathia. Moreover, mild mental retardation, microcephaly, and delayed psychomotor development were found. On the basis of an extraoral, intraoral examination, X-rays, and CBCT, he was diagnosed with overbite, canine class I and angle class III, on both sides. To the best of our knowledge, orthodontic treatment of this disease has not been assessed in detail so far, so this is the first case.
PubMed: 38929963
DOI: 10.3390/jcm13123435 -
Journal of Personalized Medicine May 2024Over the years, various researchers have attempted to compare digital cephalometry with the conventional manual approach. There is a need to comprehensively analyze the... (Review)
Review
Over the years, various researchers have attempted to compare digital cephalometry with the conventional manual approach. There is a need to comprehensively analyze the findings from the earlier studies and determine the potential advantages and limitations of each method. The present systematic review aimed to compare the accuracy of digital and manual tracing in cephalometric analysis for the identification of skeletal and dental landmarks. A systematic search was performed using the keywords "Digital" AND "Manual" AND "Cephalometry" to identify relevant studies published in the English language in the past decade. The electronic data resources consulted for the elaborate search included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, PsycINFO, Scopus, ERIC, and ScienceDirect with controlled vocabulary and free text terms. A total of = 20 studies were identified that fulfilled the inclusion and exclusion criteria within the timeframe of 2013 to 2023. The data extracted from the included articles and corresponding meta-analyses are presented in the text. The findings of the present systematic review and meta-analysis revealed trends suggesting that digital tracing may offer reliable measurements for specific cephalometric parameters efficiently and accurately. Orthodontists must consider the potential benefits of digital cephalometry, including time-saving and user-friendliness.
PubMed: 38929786
DOI: 10.3390/jpm14060566 -
Journal of Maxillofacial and Oral... Jun 2024Facial anthropometric data vary significantly within the Indian population due to the racial, ethnic and geographic diversity. The anthropometric data of a given ethnic... (Review)
Review
OBJECTIVE
Facial anthropometric data vary significantly within the Indian population due to the racial, ethnic and geographic diversity. The anthropometric data of a given ethnic community may not match the other due to diverse ethnic variations, and hence, this study is intended to review the facial anthropometric data pertaining to the diverse Indian populace through a systematic literature survey.
MATERIALS AND METHOD
An electronic search done on Medline, Embase and Central databases was utilized to conduct a systematic review of literature. The available data were analyzed based on the various esthetic subunits of the face. The following inclusion criteria were considered: (1) studies depicting the anthropometric data of any ethnic group identified as belonging to India, (2) studies originating from Indian subcontinent, (3) studies which included data of male and female subjects separately and (4) articles in English language only. The following exclusion criteria were considered: (1) atudies conducted on participants with severe malocclusion, developmental craniofacial anomalies, post-traumatic facial deformities or with a history of previous craniofacial or cosmetic surgery, (2) studies which did not specify the anthropometric landmarks used to obtain the measurements, (3) studies in which the statistical analysis was not provided, or if data were grouped across genders and (4) editorials, commentaries, case reports, systematic reviews, meta-analyses and articles not available in English language.
RESULTS
Twenty-one articles met the inclusion criteria. Majority of the Indians, particularly men, seem to have a mesoproscopic facial phenotype. The vertical and horizontal facial dimensions of the Indian male are comparably larger than the Indian female. There is sexual dimorphism among the Indian population with regard to the upper and lower thirds of the face, with little or no gender difference as regards the middle third of the face. It was observed that the nasal dimensions of the Indian race were not compatible with that of the occidental, oriental or the western race. The overall facial structure and the upper half of the face were critical in determining facial attractiveness in Indian males while the lower half of the face and the mandibular contour were critical in determining facial attractiveness in females.
CONCLUSION
It is observed that there is a paucity of facial anthropometric data for the Indian population considering the ethnic, racial and geographic diversity. Since the prevalence of craniofacial anomalies and dentofacial deformities in India is high and thus the scope for corrective surgery, it is important to compile baseline facial anthropometric data based on the ethnic diversity of the Indian population.
PubMed: 38911415
DOI: 10.1007/s12663-024-02185-6 -
Cureus Jun 2024This review aimed to evaluate the currently available evidence regarding the best method of correcting deep bites in growing patients. In September 2023, a search was... (Review)
Review
This review aimed to evaluate the currently available evidence regarding the best method of correcting deep bites in growing patients. In September 2023, a search was conducted electronically across the following databases: PubMed®, Web of Science™, Scopus®, Embase®, Google™ Scholar, and Cochrane Library. In this systematic review, randomized control trials (RCTs), controlled clinical trials (CCTs), and cohort studies of growing patients with deep bite malocclusion who received treatment with the primary objective of treating the deep bite were included. Risk of bias of the included studies was assessed using two different tools; one tool was applied for RCTs and the other one for the CCTs and cohort studies. One RCT, one CCT, and one cohort study were included (85 patients). The flat fixed acrylic bite plane was superior in terms of duration of treatment when compared to the inclined fixed acrylic bite plane and the utility arch with posterior intermaxillary elastics. Limited evidence indicates that the inclined fixed acrylic bite plane causes a significant increase in the lower incisor inclination and a significant increase in the angle between the mandible and the anterior cranial base (SNB). However, limited evidence indicates that the utility arch with posterior intermaxillary elastics causes a significant decrease in the angle between the maxilla and the anterior cranial base (SNA). Regarding the vertical skeletal changes, it was found that the three methods were comparable; in each case, the vertical dimension of the face increased because of a significant increase in the lower first molar height. There is a need for further studies to strengthen the evidence of the treatment efficacy of the employed methods, with more RCTs to be conducted in this regard.
PubMed: 38903977
DOI: 10.7759/cureus.62666 -
Evidence-based Dentistry Jun 2024A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. PubMed and Cochrane databases were...
DATA SOURCES
A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. PubMed and Cochrane databases were searched.
STUDY SELECTION
Journal articles published between January 2007 and January 2023 were identified. Studies that assessed malocclusion indices and oral function were included. Non-English articles and irrelevant studies were excluded. A total of 480 articles were identified. Following exclusion, 29 articles were included in the systematic review.
DATA EXTRACTION AND SYNTHESIS
Data was compiled using Microsoft Excel. Information from each article was extracted including study design, evaluation criteria of malocclusion and oral function, and findings. Studies were assessed using the STROBE GRADE approach. The results were compiled in a brief narrative review investigating the type and strength of the association between malocclusion and ingestion.
RESULTS
Malocclusion was recorded using Index of Treatment Need, Dental Aesthetic Index, Goslon Yardstick Index, Index of Complexity Outcomes and Need, Peer Assessment Rating, Angle's classification, Specific Severity Score, dental inter-arch relation and cephalometric analysis. Ingestion was measured by bite force, electromyography, mixing ability index, bolus granulometric analysis, video analysis of kinetic parameters during mastication, and subjective questionnaires. Of the 29 articles identified, 20 demonstrated a negative impact of malocclusion on oral ingestion, highlighting impaired masticatory efficiency, bite force and subjective difficulties. Eight studies found no significant association. One study, which used two questionnaires, found a significant relationship between eating and malocclusion using one questionnaire but not the other.
DISCUSSION
Limitations in current research methodologies were identified, particularly the heterogeneity in assessment tools. The indicators used to assess ingestion and malocclusion are flawed, with questionable reliability. No study was able to identify which features or severity of malocclusion impact ingestion. The relationship between ingestion and malocclusion could not be quantified and the need for longitudinal and case report studies was deemed essential to establish causality.
CONCLUSION
This review underscores the importance of considering how malocclusion impacts function in orthodontic treatment planning. Future research should focus on standardised assessment methods for measuring malocclusion and oral ingestion to establish the nature of the relationship between the two. This will ultimately guide orthodontic intervention aiming to enhance oral function.
Topics: Humans; Malocclusion; Eating; Mastication; Bite Force
PubMed: 38849573
DOI: 10.1038/s41432-024-01021-7 -
Microsurgery Jul 2024Vascularized free tissue transfer has been established as an effective method in the reconstruction of mandibular defects. However, a limited understanding of its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vascularized free tissue transfer has been established as an effective method in the reconstruction of mandibular defects. However, a limited understanding of its efficacy in pediatric patients persists due to its infrequent presentation. The aim of this study is to systematically consolidate the survival and infection rates of free flaps in pediatric mandibular reconstruction.
METHODS
A systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library for studies published up to January 2024. We included peer-reviewed studies reporting on survival and infection outcomes associated with free flap mandibular reconstruction in pediatric patients (<18 years). We performed a random-effects meta-analysis with the inverse-variance weighted approach to estimate survival and infection rates. Heterogeneity was assessed by I, and publication bias was examined using Egger's test.
RESULTS
A total of 26 studies, reporting on 463 free flaps and 439 pediatric patients with a mean age of 10.7 years, were included in our study. Most free flaps originated from the fibula (n = 392/463, 84.7%) and benign tumors were the most common cause for mandibular reconstruction (n = 179/463, 38.7%). The pooled estimate for survival of flaps was 96% (95% CI: 93-97, I = 0%), and recipient-site infections were estimated to occur in 9% (95% CI: 6-13, I = 0%) of cases. The most common reported complications within the study timeframe were early malocclusion (n = 28/123, 21.4%) and bite abnormalities (18/131, 13.7%).
CONCLUSION
Free tissue transfer for mandibular reconstruction in pediatric patients is effective and safe. Further research is required to explore functionality following mandibular reconstruction in diverse pediatric populations.
Topics: Humans; Free Tissue Flaps; Mandibular Reconstruction; Child; Graft Survival; Surgical Wound Infection
PubMed: 38828556
DOI: 10.1002/micr.31200 -
Dentistry Journal May 2024To evaluate differences in the morphology of the frontal sinus in adolescents and adults with different craniofacial patterns, searches up to April 2024 were conducted... (Review)
Review
To evaluate differences in the morphology of the frontal sinus in adolescents and adults with different craniofacial patterns, searches up to April 2024 were conducted in six databases and other information sources to identify observational studies. Study selection, data extraction, and quality assessment using the NOS scale were performed independently by two reviewers. Random effects meta-analyses were conducted to estimate the difference in frontal sinus measurements between different craniofacial skeletal patterns (α = 0.05). The certainty of the evidence was evaluated according to GRADE. Fourteen studies were included in the review. All studies had methodological limitations that affected their quality. The syntheses showed that skeletal Class II subjects presented a significantly smaller width of the frontal sinus than skeletal Class I subjects (MD = 0.56; 95% CI: 0.38, 0.74; < 0.0001; I = 3%). Skeletal Class III subjects showed a frontal sinus width (MD = -0.91; 95% CI: -1.35, -0.47; < 0.0001; I = 36%) and area (MD = -28.13; 95% CI: -49.03, -7.23; = 0.0084; I = 66%) significantly larger than those of the skeletal Class I subjects. The available evidence suggests a positive relationship between mandibular and frontal sinus size. There is limited evidence to make reliable estimates of the association of other craniofacial patterns and frontal sinus characteristics. These reported results are not conclusive and should be evaluated carefully due to the very low certainty of the evidence. The current evidence is scarce and consists of studies with methodological limitations; the results of the studies are often inconsistent, and the pooled estimates are imprecise. New high-quality research is still necessary.
PubMed: 38786541
DOI: 10.3390/dj12050143 -
Tooth movement with dental anchorage vs. skeletal anchorage: A systematic review of clinical trials.Journal of Orthodontic Science 2024The aim of this study is to compare the time and movement of orthodontic treatment using dental anchorage and skeletal anchorage in adolescent and adult patients with... (Review)
Review
The aim of this study is to compare the time and movement of orthodontic treatment using dental anchorage and skeletal anchorage in adolescent and adult patients with dental malocclusions. A systematic search was conducted in the Embase, PubMed, Lilacs, Cochrane, Trip, and Scopus databases up to October 2022. All the articles were selected using title and abstract, applying the inclusion and exclusion criteria. Disagreements were resolved with a third author. Finally, a full-text selection took place. The data extraction was conducted by two authors who independently evaluated the risk of bias. The methodological quality of the randomized clinical trials was evaluated using the Cochrane tool for the evaluation of the randomized clinical trials. Six articles were included in the data analysis. There were four clinical trials and two randomized clinical trials. A total of 176 patients was obtained with an age range between 14 and 46 years. Four studies showed significant differences when comparing the two anchorages in retraction or distalization of tooth groups, and two showed no differences when using dental and skeletal anchorage for vertical movements; only the articles with vertical movements showed relapse. We can conclude that skeletal anchorage generates precise and stable horizontal movements without overloading or changing the position of the molar. Future studies must incorporate three-dimensional technology for greater clinical accuracy.
PubMed: 38784081
DOI: 10.4103/jos.jos_4_23