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European Journal of Paediatric Dentistry Jun 2020The aim of this review is to quantify the prevalence and type of malocclusion among children and adolescents during the different stages of dentition worldwide. (Meta-Analysis)
Meta-Analysis
AIM
The aim of this review is to quantify the prevalence and type of malocclusion among children and adolescents during the different stages of dentition worldwide.
MATERIALS AND METHODS
Recent studies (from 2009 to 2019), published in Medline, Web of Science and Embase and orthodontic text-books have been comprehensively reviewed herein. The methodological quality of the included studies was assessed using STROBE criteria.
RESULTS
After screening 450 records and analysing 284 relevant full-text publications, 77 studies were included in this review. A good degree of evidence was obtained due to the medium-high methodological quality level of included studies. The worldwide prevalence of malocclusion was 56% (95% CI: 11-99), without differences in gender. The highest prevalence was in Africa (81%) and Europe (72%), followed by America (53%) and Asia (48%). The malocclusion prevalence score did not change from primary to permanent dentition with a common score of 54%. Malocclusion traits such as Angle's classes, overjet, overbite, and asymmetrical midline shift essentially did not change their prevalence during different dentitions. Conversely, traits such as cross-bite and diastema reduced their prevalence during permanent dentition, while scissor-bite and dental crowding increased their scores.
CONCLUSION
The worldwide high prevalence of malocclusion and its early onset during childhood should induce policymakers as well as paediatric physicians and dentists to devise policies and adopt clinical strategies for preventing malocclusion since younger children's ages.
Topics: Adolescent; Child; Dentition; Europe; Humans; Malocclusion; Overbite; Prevalence
PubMed: 32567942
DOI: 10.23804/ejpd.2020.21.02.05 -
Journal of Orofacial Orthopedics =... Jul 2020To systematically search the scientific literature concerning the influence of playing a wind instrument on tooth position and/or facial morphology. (Meta-Analysis)
Meta-Analysis
PURPOSE
To systematically search the scientific literature concerning the influence of playing a wind instrument on tooth position and/or facial morphology.
METHODS
The PubMed, EMBASE and Cochrane databases were searched up to September 2019. Orthodontic journals were hand searched and grey literature was sought via Google Scholar. Observational studies and (randomized) controlled clinical trials that assessed tooth position and/or facial morphology by profile cephalograms, dental casts or clinical examination were included. The potential risk of bias was assessed. Data from wind instrument players and controls were extracted. Descriptive analysis and meta-analysis were performed.
RESULTS
In total, 10 eligible studies with a cross-sectional (n = 7) or longitudinal design (n = 3) and an estimated low to serious risk of bias were included. Sample sizes ranged from 36 to 170 participants, varying from children to professional musicians. Descriptive analysis indicated that adults playing a single-reed instrument may have a larger overjet than controls. Playing a brass instrument might be associated with an increase in maxillary and mandibular intermolar width among children. Longitudinal data showed less increase in anterior facial height among brass and single-reed players between the age of 6 and 15. Children playing a wind instrument showed thicker lips than controls. Meta-analysis revealed that after a follow-up of 6 months to 3 years, children playing brass instruments had a significant reduction in overjet as compared to controls. The magnitude of the effect was of questionable clinical relevance and the generalizability was limited.
CONCLUSIONS
Playing a wind instrument can influence tooth position and facial morphology in both children and adults. Aspects that stand out are overjet, arch width, facial divergence/convergence and lip thickness. However, evidence was sparse and the strength of the premise emerging from this review was graded to be "very low".
Topics: Adult; Child; Cross-Sectional Studies; Face; Humans; Music; Overbite; Tooth
PubMed: 32556368
DOI: 10.1007/s00056-020-00223-9 -
Journal of Orofacial Orthopedics =... Jul 2020There is no consensus regarding which mode of activation or mandibular advancement (stepwise [SW] or maximum bite-jumping [BJ]) of fixed or removable functional... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
There is no consensus regarding which mode of activation or mandibular advancement (stepwise [SW] or maximum bite-jumping [BJ]) of fixed or removable functional appliances (FFA; RFA) for correction of Angle class II malocclusion is advantageous to produce dental, skeletal or condylar effects and has the lowest rate of undesired dental or technical side-effects.
METHODS
A systematic search was conducted up to Oct. 20, 2019 in the MEDLINE, EMBASE, Scopus, Central Cochrane Library, and BBO databases. Included were preadolescent, adolescent, and adult humans with initial (pretreatment) Angle class II malocclusion, without further restriction. The intervention group was composed of subjects treated with FFA or RFA in SW mandibular advancement; the control group received BJ advancement. Search terms included prospective randomized and nonrandomized trials in English, German, Spanish, and Portuguese with the primary outcomes of skeletal and dental class II correction, effects on condylar growth, lower incisor proclination, overjet and overbite reduction. The risk of bias (ROB) was assessed using the Cochrane Collaboration's ROB2 tool. Mean differences were calculated and pooled by a meta-analysis using a random effects model.
RESULTS
Data from five randomized controlled trials (RCT) with 401 participants (mean age 13.84 years; SD 1.53) were included; 331 derived from four studies were included in the meta-analysis. The ROB in the selected articles was high. We detected a slightly increased reduction of the ANB (mean difference [MD] -0.95°, 95% confidence interval [CI] -1.80 to -0.10°; I = 72%) that may be attributed to a slightly more pronounced increase of the SNB angle in SW-advanced mandibles (MD 0.27°; 95% CI -0.47 to 1.00°; I = 38%). SW advancement tended to reduce the undesired side effect of lower incisor proclination (MD = -1.59°; 95% CI -3.98 to 0.8°; I = 0%), indicating more pronounced mandibular incisor changes with bite-jumping advancement.
CONCLUSION
There is weak evidence indicating a slightly increased reduction of the ANB and less lower incisor proclination with SW advancement compared to BJ, but the clinical relevance is debatable due to the small overall magnitude and small number of high-quality papers.
REGISTRATION
Prospero #CRD42017075469 (www.crd.york.ac.uk/prospero).
Topics: Adolescent; Adult; Cephalometry; Humans; Malocclusion, Angle Class II; Mandible; Mandibular Advancement; Orthodontic Appliances, Functional; Orthodontics, Corrective; Overbite
PubMed: 32435862
DOI: 10.1007/s00056-020-00226-6 -
Dental and Medical Problems 2019Class III malocclusion is one the most challenging types of orthodontic problems. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Class III malocclusion is one the most challenging types of orthodontic problems.
OBJECTIVES
The aim of this study was to compare the dentoskeletal effects of facemasks and intraoral appliances in treating class III maxillary deficiency in growing patients through a systematic review of the available literature.
MATERIAL AND METHODS
Electronic and manual searches were performed in the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), MEDLINE (PubMed), Embase (OVID), and Scopus to find all the relevant studies published by January 2018. All randomized controlled trials (RCTs) recruiting 5-12-year-old patients who received maxillary protraction treatment with any type of facemask and comparing the facemasks with any type of intraoral appliance were included. The primary outcome measure was changes in the A point-nasion-B point angle (ANB), and the secondary outcomes included changes in the overjet, upper-1 (U1) inclination, the mandibular plane angle, and treatment time. The meta-analysis was carried out using the inverse variance-weighted random effects model.
RESULTS
Out of 1,629 articles found in the initial search, 5 studies met the inclusion criteria. The meta-analysis showed no differences in the duration of treatment or in any of the cephalometric variables, with the exception of the overjet.
CONCLUSIONS
It seems that intraoral appliances and facemasks are similar in terms of dentoskeletal effects in the treatment of class III malocclusion as well as treatment duration. However, due to a lack of a sufficient number of high-quality studies, these results should be viewed with caution. Further high-quality, long-term studies are recommended.
Topics: Cephalometry; Child; Child, Preschool; Extraoral Traction Appliances; Humans; Malocclusion, Angle Class III; Orthodontics, Corrective; Overbite
PubMed: 31895504
DOI: 10.17219/dmp/110738 -
The Angle Orthodontist Mar 2020To evaluate systematically the effectiveness of miniscrew-supported maxillary incisor intrusion compared with other nonsurgical intrusive mechanics for deep-bite... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate systematically the effectiveness of miniscrew-supported maxillary incisor intrusion compared with other nonsurgical intrusive mechanics for deep-bite correction.
MATERIALS AND METHODS
Unrestricted electronic searches in Embase, Web of Science, MEDLINE, LILACS, and Cochrane's CENTRAL as well as manual searches were conducted up to August 2019. Only randomized clinical trials (RCTs) were included. Study selection, data extraction, and bias assessment were done by two independent reviewers. The Cochrane risk-of-bias tool was used, and the quality of evidence was graded using the GRADE approach. A random-effects meta-analysis of continuous data, with its 95% confidence intervals (CIs), was used.
RESULTS
Seven RCTs were included in the quantitative synthesis, and the overall quality of evidence was very low to low. When compared with intrusion arches, miniscrews resulted in a more efficient deep-bite reduction with a standardized mean difference (SMD) of -0.48 (95% CI, -0.89 to -0.07). When miniscrews were used, a statistically significant difference was observed favoring less maxillary molar extrusion (SMD, -0.86; 95% CI, -1.46 to -0.27) and more incisor intrusion as measured from centroid to palatal plane (SMD, -0.95; 95% CI, -1.41 to -0.49). Results also showed a statistically nonsignificant difference regarding the amount of resultant root resorption between miniscrews and intrusion arches.
CONCLUSIONS
There is weak evidence indicating efficient deep-bite correction using miniscrews. Root resorption seems to be an associated adverse effect that occurs regardless of the intrusive mechanics used. These conclusions should be viewed with great caution as further well-designed long-term research is recommended.
Topics: Bone Screws; Humans; Incisor; Orthodontic Anchorage Procedures; Overbite; Tooth Movement Techniques
PubMed: 31816252
DOI: 10.2319/061119-400.1 -
European Journal of Orthodontics Apr 2020The effects of mandibular propulsion appliances in adults have some controversial results. While some authors claim that its use in non-growing patients could produce... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The effects of mandibular propulsion appliances in adults have some controversial results. While some authors claim that its use in non-growing patients could produce some dentoskeletal effects, other studies indicate that Class II correction occurs only through significant dental effects.
OBJECTIVE
To evaluate the effects in non-growing Class II patients with mandibular retrusion, promoted by the treatment with mandibular propulsion appliances and determine if they produce mandibular changes.
METHODS
The research was carried out in nine electronic databases and additional manual searches up to July 2019. Selection criteria were no restriction was placed on date and publication language. Randomized or non-randomized clinical trials with/without control were included. They must evaluated non-growing patients with Class II malocclusion, treated with mandibular propulsion appliances; outcomes were assessed before and after treatment.
DATA COLLECTION AND ANALYSIS
Data were extracted by two independent examiners in duplicate. The ROBINS-I tool was used to assess the methodological quality of the included studies.
RESULTS
Of the 2824 articles identified, 11 non-randomized clinical articles were selected for qualitative analysis and 8 for quantitative analysis. SNB (0.87°, CI 95% 0.08, 1.66), ANB (-0.82°, CI 95% -1.24 to 0.40) and Pg/OLp [2.3 to 1.2 mm (P < 0.001)] presented smallest but significant mandibular changes with some differences regarding the used appliance. The Herbst appliance showed the largest mandibular changes followed by the SUS appliance when evaluated through Ar-Pg. SNA showed non-significant changes. Overbite (-2.85. CI 95% -3.06, -2.64), Overjet (-5.00.CI 95% -5.45, -4.55) showed significant changes in all devices. Class II correction occurs through a significant labial movement of the mandibular incisors, some lingual inclination of the maxillary incisors and minor skeletal changes.
CONCLUSIONS
All mandibular propulsion appliances examined, showed efficiency in normalizing the Class II malocclusion in adult patients; however, changes were acquired mainly through dentoalveolar changes. Some minor mandibular forward changes was noted, mainly in patients treated with the Herbst appliance. Randomized clinical trials are needed to improve scientific evidence.
REGISTRATION
PROSPERO (code CRD42017067384).
Topics: Adult; Cephalometry; Humans; Malocclusion, Angle Class II; Mandible; Orthodontic Appliances, Functional; Orthodontics, Corrective; Overbite
PubMed: 31786599
DOI: 10.1093/ejo/cjz089 -
International Journal of Paediatric... Mar 2020Malocclusion is a common oral health problem in schoolchildren. Literature describing the prevalence of malocclusion varies substantially across China. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Malocclusion is a common oral health problem in schoolchildren. Literature describing the prevalence of malocclusion varies substantially across China.
AIM
This study identified the epidemiological characteristics of malocclusion among Chinese schoolchildren from 1991 to 2018.
DESIGN
Six English and Chinese electronic databases were searched through November 2018. The search was supplemented by hand searching to identify relevant surveys. The overall prevalence of malocclusion was estimated by a random-effects meta-analysis model, and variations in different groups were assessed by subgroup meta-analysis.
RESULTS
Thirty-seven eligible articles describing 117 682 samples were investigated. The pooled national prevalence for malocclusion was 47.92% (95% CI: 58.6%-71.9%). For the Angle classification, the overall prevalence rates were 30.07% (95% CI: 25.37%-35.48%), 9.91% (95% CI: 7.41%-13.79%), and 4.76% (95% CI: 3.85%-6.54%) for Class I, Class II, and Class III malocclusion, respectively. A deep overbite (16.67%, 95% CI: 11.50%-23.08%) was shown to be the most common trait of malocclusion. When stratified by sex, males had a slightly higher prevalence than females (RR = 1.04, 95% CI: 1.01-1.06). More importantly, an ascending trend and substantial variations across the country were observed.
CONCLUSIONS
Our results confirmed that malocclusion has become a serious oral health problem in Chinese schoolchildren, highlighting the need for proactive interventions at an early age. Moreover, high-quality epidemiological studies on malocclusion are still required.
Topics: Child; China; Databases, Factual; Female; Humans; Male; Malocclusion; Prevalence; Surveys and Questionnaires
PubMed: 31677307
DOI: 10.1111/ipd.12591 -
Journal of Orthodontics Dec 2019To assess the treatment efficacy/efficiency with prefabricated myofunctional appliances (PMA) for children with malocclusion. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the treatment efficacy/efficiency with prefabricated myofunctional appliances (PMA) for children with malocclusion.
DATA SOURCES
Nine databases searched without limitations till July 2019.
DATA SELECTION
Randomised trials comparing PMAs to functional appliance treatment or no treatment.
DATA EXTRACTION
Study selection, data extraction and risk of bias assessment were done in duplicate.
DATA SYNTHESIS
Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted on seven publications (three published and one unpublished trials; 232 patients; 53% male; mean age 10.2 years). Compared to no treatment, one trial indicated that PMAs were somewhat effective in reducing overjet (MD -2.4; 95% CI -3.3 to -1.5), reducing overbite (MD -2.5; 95% CI -3.2 to -1.8), reducing mandibular crowding (RR 0.4; 95% CI 0.2-0.8) and establishing Class I canine relationship (RR = 2.3; 95% CI 1.1-4.9). However, compared to custom-made functional appliances, three trials indicated that PMAs were less effective in reducing the ANB angle (MD 0.9; 95% CI 0.5-1.4), increasing mandibular ramus length (MD -2.2; 95% CI -2.9 to -1.51), reducing overjet (MD 1.5; 95% CI 0.9-2.1), establishing a solid Class I molar relationship (RR 0.3; 95% CI 0.2-0.7), reducing the nasolabial angle (MD 5.8; 95% CI 0.8-10.8) and reducing facial convexity (MD -2.6; 95% CI -4.3 to -0.9). Finally, the quality of evidence was moderate to low due to risk of bias.
CONCLUSIONS
PMAs are more effective in reducing overjet, overbite, mandibular crowding and establishing Class I canine relationship than no treatment. However, compared to custom-made functional appliances, PMAs are less effective in producing dental, skeletal or soft-tissue changes, even though they are less costly.
Topics: Child; Female; Humans; Male; Malocclusion, Angle Class II; Mandible; Myofunctional Therapy; Orthodontic Appliances, Fixed; Orthodontics, Corrective; Overbite; Randomized Controlled Trials as Topic
PubMed: 31597520
DOI: 10.1177/1465312519880558 -
European Journal of Orthodontics Apr 2020Prefabricated myofunctional appliances (PMAs) are widely advocated for correcting Class II division I malocclusion. However, their effectiveness is associated with a...
BACKGROUND
Prefabricated myofunctional appliances (PMAs) are widely advocated for correcting Class II division I malocclusion. However, their effectiveness is associated with a high amount of uncertainty within contemporary literature.
OBJECTIVES
The aim of this review was to systematically examine the available literature regarding the effectiveness of PMAs in treating Class II division 1 malocclusion in children and adolescents.
SEARCH METHODS
Comprehensive unrestricted electronic searches in multiple databases as well as manual searches were conducted up to August 2018.
SELECTION CRITERIA
Randomized controlled trials (RCTs) and non-randomized studies (NRS) matching the eligibility criteria.
DATA COLLECTION AND ANALYSIS
Two independent review authors were directly involved in study selection, data extraction, and bias assessment. The Cochrane risk of bias tool and the ROBINS-I tool were used for assessing the risk of bias. Quantitative pooling of the data was undertaken with a random-effects model with its 95% confidence interval (CI).
RESULTS
Three RCTs comparing PMAs to activators and three NRS comparing PMAs to untreated controls met the inclusion criteria. On a short-term basis, exploratory quantitative synthesis indicated that the activators were more effective than the PMAs in correcting overjet with a mean difference of (1.1 mm; 95% CI: 0.44 to 1.77). On a long-term basis, there were no significant differences between the two appliances. Qualitative synthesis indicated less favorable soft tissue changes as well as patient experiences and compliance with the PMAs when compared to the activators. However, PMAs were associated with reduced costs compared to customized activators and modest changes when compared to untreated controls.
CONCLUSIONS
On a short-term basis, low quality of evidence suggests that PMAs were generally less effective than the activators in treating Class II division 1 malocclusion. The main advantage of PMAs seems to be their reduced costs. These results should be viewed with caution, as a definitive need for high-quality long-term research into this area is required.
REGISTRATION
PROSPERO (CRD42018108564).
Topics: Adolescent; Child; Costs and Cost Analysis; Humans; Malocclusion, Angle Class II; Overbite
PubMed: 31329848
DOI: 10.1093/ejo/cjz025 -
The association of overjet size and traumatic dental injuries-A systematic review and meta-analysis.Dental Traumatology : Official... Oct 2019Traumatic dental injuries are one of the most prevalent diseases globally, impacting people of different ages and socio-economic statuses. As disease prevention is... (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIMS
Traumatic dental injuries are one of the most prevalent diseases globally, impacting people of different ages and socio-economic statuses. As disease prevention is preferable to management, understanding when an individual's overjet is prone to dental trauma helps identify at-risk patients, so to institute preventive strategies. The aim of this study was to identify the different overjet sizes that present an increased risk for developing dental trauma across different ages and dentition stages.
METHODS
The title and protocol were registered and published a priori with the Joanna Briggs Institute (JBI) and PROSPERO (CRD42017060907) and followed the JBI methodology of systematic reviews of association (etiology). A three-step search strategy was performed, including electronic searches of gray literature and four databases. Studies of healthy human participants of any age and in any dental dentition stage were considered for inclusion. Only high methodological quality studies with low risk of bias were included. Where possible, meta-analyses were performed using the random-effects model, supplemented with the fixed-effects model in situations where statistical heterogeneity was ≤50%, assessed using the I statistic.
RESULTS
The study identified 3718 articles, 41 were included. An increased overjet was significantly associated with higher odds of developing trauma in all dentition stages and age groups. Children 0-6 years with an overjet ≥3mm have an odds of 3.37 (95%CI, 1.36-8.38, P = 0.009) for trauma. Children in the mixed and secondary dentition with an overjet >5mm have an odds of 2.43 (95%CI, 1.34-4.42, P = 0.004). Twelve-year-old children with an overjet >5mm have an odds of 1.81 (95%CI, 1.44-2.27, P < 0.0001).
CONCLUSIONS
The results confirm the association between increased overjet and dental trauma. A child in the primary dentition could be considered as having an overjet at risk for trauma when it is ≥3mm. In the early secondary dentition, the threshold for trauma is an overjet ≥5mm.
Topics: Child; Dentition, Permanent; Humans; Malocclusion, Angle Class II; Overbite; Tooth Injuries; Tooth, Deciduous
PubMed: 31062510
DOI: 10.1111/edt.12481