-
Journal of Functional Biomaterials May 2024The objective of this study was to explore the effects of fixed orthodontic appliances on enamel structure by assessing microfractures, surface roughness, and... (Review)
Review
AIM
The objective of this study was to explore the effects of fixed orthodontic appliances on enamel structure by assessing microfractures, surface roughness, and alterations in color.
METHODS
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of online databases was conducted using the keywords 'enamel' AND 'orthodontic debonding'. Eligibility criteria included both in vivo and ex vivo clinical trials conducted on human teeth.
RESULTS AND DISCUSSION
A total of 14 relevant papers were analyzed. Various instruments and techniques were utilized across different studies to assess surface roughness, color change, and surface fractures.
CONCLUSIONS
The findings of this study suggest that ceramic brackets may lead to an increase in enamel fractures, particularly during bracket removal. The surface roughness of enamel exhibits variability depending on the adhesive substance and polishing methods used post-removal. Fixed orthodontic appliances could induce changes in enamel color, which may be alleviated by the use of nano-hydroxyapatite or specific polishing techniques. Further research is necessary to identify effective strategies for managing these color changes and improving the overall outcomes of fixed orthodontic treatment.
PubMed: 38786634
DOI: 10.3390/jfb15050123 -
Polymers May 2024Polyetheretherketone (PEEK), an organic thermoplastic polymer, has gained interest in dentistry due to its excellent mechanical strength, flexibility, and... (Review)
Review
Polyetheretherketone (PEEK), an organic thermoplastic polymer, has gained interest in dentistry due to its excellent mechanical strength, flexibility, and biocompatibility. Furthermore, the ability to utilize CAD/CAM in the fabrication of PEEK enhances accuracy, reliability, and efficiency while also saving time. Hence, several orthodontic studies have explored the utilization of PEEK in various applications, such as archwires, brackets, fixed lingual retainers, palatal expansion devices, transpalatal arches, Tübingen palatal plates, different types of space maintainers, mini-implant insertion guides, and more. However, a complete systematic review of the available data comparing the performance of PEEK with traditional orthodontic materials has not yet been conducted. Therefore, this systematic review seeks to assess if PEEK material meets the required mechanical criteria to serve as an alternative to conventional orthodontic appliances. To ensure clarity and precision, this review will specifically concentrate on fixed appliances. This systemic review followed the PRISMA guidelines and utilized databases including PubMed/MEDLINE, Embase, Springer, Web of Science, and Wiley. Searches were restricted to English language articles from January 2013 to February 2024. Keywords such as "Polyetheretherketone" or "PEEK" and "Orthodontic" or "Orthodontic device" or "Orthodontic materials" were employed across all databases. Nine studies were incorporated, covering orthodontic archwires, brackets, and fixed lingual retainers. Based on the reviewed literature, PEEK demonstrates promising potential in orthodontic fixed appliances, offering advantages in force delivery, friction reduction, and aesthetic appeal. Further research is needed to fully explore its capabilities and optimize its application in clinical practice.
PubMed: 38732740
DOI: 10.3390/polym16091271 -
Cureus Apr 2024Orthodontists have a variety of options available for retainers. Research in Orthodontics focuses on assessing outcomes important to clinicians; however, there is... (Review)
Review
Orthodontists have a variety of options available for retainers. Research in Orthodontics focuses on assessing outcomes important to clinicians; however, there is inconsistency in how these outcomes are selected and evaluated. This review sought to assess the effects of different orthodontic retainers on patients' quality of life (QoL). Various approaches were employed in this systematic review, and a thorough search was conducted across six databases. The review involved a comprehensive evaluation of six included studies, highlighting changes in dental structure post-treatment, emphasizing the role of extraction procedures and the quality of debonding in improving retention. The study identified key outcomes for orthodontic clinical trials, highlighting orthodontists' preferences for specific retainer types. Moreover, it discussed the impact of sociocultural influences on retention care. Involving patients actively in discussions about whether to end or extend the retention phase was deemed essential. Noteworthy improvements in occlusal outcomes were linked to extraction treatments. Gender and malocclusion severity influenced QoL before and after orthodontic treatment. The degree of improvement observed in the Class III malocclusion group was comparatively lower than that in the Class I and Class II groups. Orthodontic treatment was found to yield favorable psychological outcomes, as evidenced by notable enhancements in self-esteem and social engagement among individuals. Fixed appliances were shown to negatively affect oral health-related quality of life (OHRQoL), particularly for those with aesthetic and functional concerns. A consensus has been reached on the essential themes and outcomes that should be incorporated in clinical trials related to orthodontic retention for non-cleft and non-surgical cases.
PubMed: 38659711
DOI: 10.7759/cureus.58843 -
European Journal of Orthodontics Apr 2024
PubMed: 38345244
DOI: 10.1093/ejo/cjae007 -
Cureus Dec 2023The present systematic review was done to assess the available literatures on changes in the number of occlusal contacts (NOC), occlusal contact surface areas, and... (Review)
Review
The present systematic review was done to assess the available literatures on changes in the number of occlusal contacts (NOC), occlusal contact surface areas, and occlusal force distribution (OFD) with vacuum-formed retainers (VFRs) or clear overlay retainers during retention and to compare them with other retainers. Six electronic databases (Web of Science, Scopus, PubMed, Cochrane Library, Lilacs, and Google Scholar) were searched. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) reporting on occlusal contact changes with VFRs were included. A total of nine articles were included in this review: three RCTs, five prospective controlled trials (PCTs), and one CCT. The Cochrane risk of bias tool and ROBINS-I tool were used for risk of bias assessment. The three RCTs showed moderate risk of bias, and out of five CCTs, four showed low risk of bias, and one showed moderate risk of bias. One CCT showed a low risk of bias in the ROBINS-I tool. Two out of four studies reported improved occlusal surface area (OSA) with VFRs when assessed at the end of six months and 12 months; one out of four studies reported improved NOC; and one study reported a decrease in OFD anteriorly and an increase in OFD posteriorly after two months of retention. On comparison between the groups, the other retainer groups showed more NOCs compared to VFRs. The limited available evidence suggests an increase in OSA and no change in NOCs and OFD with VFRs during retention. No significant differences between VFRs and other retainers for OSA and OFD were noted, and more NOCs were noted for other retainer groups.
PubMed: 38239549
DOI: 10.7759/cureus.50751 -
European Journal of Orthodontics Nov 2023To systematically assess the scientific literature for the prevalence of failure rate of fixed orthodontic bonded retainer (FOBR). (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To systematically assess the scientific literature for the prevalence of failure rate of fixed orthodontic bonded retainer (FOBR).
METHOD
Randomized clinical trials (RCTs) and prospective non-RCTs involving participants who had FOBR fitted were included. The Cochrane Central Register of Controlled Trials, Web of science, MEDLINE, and EMBASE via OVID were searched from inception to January 2023. Risk of bias was assessed using the Cochrane RoB 2 and Newcastle-Ottawa tools. The main outcome was the failure rate of FOBRs. The secondary outcome was to identify factors that can influence the failure of FOBR. Meta-analyses and sensitivity analyses were undertaken using Revman, version5.4. A random-effects model was used. Quality assessment using Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS
Thirty-four studies (25 RCTs and 9 prospective clinical studies) (3484 participants) were included in this review. The overall failure rate of bonded retainers, after excluding high-risk studies, was 35.22% (95% confidence interval [CI] 27.46-42.98). The failure rate is increased with the duration of follow up; with short-term follow-up rate 24.18% (95% CI 20.16-28.21), medium-term follow up 40.09% (95% CI 30.92-49.26), and long-term follow up 53.85% (95% CI 40.31-67.39). There is a low level of evidence to suggest there is no statistically significant difference in the failure rate of fixed retainers using direct versus indirect bonding methods, using liquid resin versus without liquid resin, and fibre-reinforced composite retainers compared to multi-stranded stainless steel retainers.
DISCUSSION
There is low-quality evidence to suggest that the failure rate of FOBR is relatively high. There is a need for high-quality, well-reported clinical studies to assess factors that can influence the failure rate of FOBR.
REGISTRATION
CRD42021190910.
Topics: Humans; Prevalence; Orthodontic Appliances, Fixed; Prospective Studies; Orthodontic Retainers; Stainless Steel
PubMed: 37824794
DOI: 10.1093/ejo/cjad047 -
Dental and Medical Problems 2023This systematic review and meta-analysis aimed to summarize the effectiveness of bonded and removable retainers (the Hawley and Essix retainers) in terms of improving... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis aimed to summarize the effectiveness of bonded and removable retainers (the Hawley and Essix retainers) in terms of improving occlusal settling (occlusal contact points/areas) after orthodontic treatment. We searched the Cochrane Library, PubMed, CINAHL Plus, and Dental & Oral Sciences Source (DOSS), as well as SIGLE, Google Scholar and ClinicalTrials.gov for eligible studies. We included randomized and non-randomized controlled trials along with cohort studies. Studies that reported occlusal contacts/areas during retention with fixed bonded and removable retainers were included. To assess the quality of the randomized controlled trials (RCTs), the Cochrane Collaboration risk-of-bias (RoB) tool was utilized, whereas the Newcastle-Ottawa Scale (NOS) was used to assess the quality of cohort studies.We included 6 articles in our systematic review after scrutinizing 219 articles and eliminating the illegible ones based on duplication, titles, abstracts, and objectives. Bonded retainers (BRs) allowed faster and better posterior occlusal settling as compared to the Hawley retainer (HR). However, HR showed good occlusal settling in the anterior dental arch. The Essix retainer (ER) showed a decrease in occlusal contact during the retention phase. Meta-analysis showed no statistically significant difference between BRs and removable retainers. In conclusion, HR allowed better overall occlusal settling as compared to other retainers. However, BRs allowed faster settling in the posterior tooth region. The Essix retainer showed poor settling of occlusion. Overall, there is an insufficient number of high-quality RCTs to provide additional evidence, and further high-quality RCTs are needed.
Topics: Humans; Orthodontic Retainers; Tooth; Malocclusion
PubMed: 37458399
DOI: 10.17219/dmp/146194 -
The Cochrane Database of Systematic... May 2023Without a phase of retention after successful orthodontic treatment, teeth tend to 'relapse', that is, to return to their initial position. Retention is achieved by... (Review)
Review
BACKGROUND
Without a phase of retention after successful orthodontic treatment, teeth tend to 'relapse', that is, to return to their initial position. Retention is achieved by fitting fixed or removable retainers to provide stability to the teeth while avoiding damage to teeth and gums. Removable retainers can be worn full- or part-time. Retainers vary in shape, material, and the way they are made. Adjunctive procedures are sometimes used to try to improve retention, for example, reshaping teeth where they contact ('interproximal reduction'), or cutting fibres around teeth ('percision'). This review is an update of one originally published in 2004 and last updated in 2016.
OBJECTIVES
To evaluate the effects of different retainers and retention strategies used to stabilise tooth position after orthodontic braces.
SEARCH METHODS
An information specialist searched Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase and OpenGrey up to 27 April 2022 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving children and adults who had retainers fitted or adjunctive procedures undertaken to prevent relapse following orthodontic treatment with braces. We excluded studies with aligners.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened eligible studies, assessed risk of bias and extracted data. Outcomes were stability or relapse of tooth position, retainer failure (i.e. broken, detached, worn out, ill-fitting or lost), adverse effects on teeth and gums (i.e. plaque, gingival and bleeding indices), and participant satisfaction. We calculated mean differences (MD) for continuous data, risk ratios (RR) or risk differences (RD) for dichotomous data, and hazard ratios (HR) for survival data, all with 95% confidence intervals (CI). We conducted meta-analyses when similar studies reported outcomes at the same time point; otherwise results were reported as mean ranges. We prioritised reporting of Little's Irregularity Index (crookedness of anterior teeth) to measure relapse, judging the minimum important difference to be 1 mm.
MAIN RESULTS
We included 47 studies, with 4377 participants. The studies evaluated: removable versus fixed retainers (8 studies); different types of fixed retainers (22 studies) or bonding materials (3 studies); and different types of removable retainers (16 studies). Four studies evaluated more than one comparison. We judged 28 studies to have high risk of bias, 11 to have low risk, and eight studies as unclear. We focused on 12-month follow-up. The evidence is low or very low certainty. Most comparisons and outcomes were evaluated in only one study at high risk of bias, and most studies measured outcomes after less than a year. Removable versus fixed retainers Removable (part-time) versus fixed One study reported that participants wearing clear plastic retainers part-time in the lower arch had more relapse than participants with multistrand fixed retainers, but the amount was not clinically significant (Little's Irregularity Index (LII) MD 0.92 mm, 95% CI 0.23 to 1.61; 56 participants). Removable retainers were more likely to cause discomfort (RR 12.22; 95% CI 1.69 to 88.52; 57 participants), but were associated with less retainer failure (RR 0.44, 95% CI 0.20 to 0.98; 57 participants) and better periodontal health (Gingival Index (GI) MD -0.34, 95% CI -0.66 to -0.02; 59 participants). Removable (full-time) versus fixed One study reported that removable clear plastic retainers worn full-time in the lower arch did not provide any clinically significant benefit for tooth stability over fixed retainers (LII MD 0.60 mm, 95% CI 0.17 to 1.03; 84 participants). Participants with clear plastic retainers had better periodontal health (gingival bleeding RR 0.53, 95% CI 0.31 to 0.88; 84 participants), but higher risk of retainer failure (RR 3.42, 95% CI 1.38 to 8.47; 77 participants). The study found no difference between retainers for caries. Different types of fixed retainers Computer-aided design/computer-aided manufacturing (CAD/CAM) nitinol versus conventional/analogue multistrand One study reported that CAD/CAM nitinol fixed retainers were better for tooth stability, but the difference was not clinically significant (LII MD -0.46 mm, 95% CI -0.72 to -0.21; 66 participants). There was no evidence of a difference between retainers for periodontal health (GI MD 0.00, 95% CI -0.16 to 0.16; 2 studies, 107 participants), or retainer survival (RR 1.29, 95% CI 0.67 to 2.49; 1 study, 41 participants). Fibre-reinforced composite versus conventional multistrand/spiral wire One study reported that fibre-reinforced composite fixed retainers provided better stability than multistrand retainers, but this was not of a clinically significant amount (LII MD -0.70 mm, 95% CI -1.17 to -0.23; 52 participants). The fibre-reinforced retainers had better patient satisfaction with aesthetics (MD 1.49 cm on a visual analogue scale, 95% CI 0.76 to 2.22; 1 study, 32 participants), and similar retainer survival rates (RR 1.01, 95% CI 0.84 to 1.21; 7 studies; 1337 participants) at 12 months. However, failures occurred earlier (MD -1.48 months, 95% CI -1.88 to -1.08; 2 studies, 103 participants; 24-month follow-up) and more gingival inflammation at six months, though bleeding on probing (BoP) was similar (GI MD 0.59, 95% CI 0.13 to 1.05; BoP MD 0.33, 95% CI -0.13 to 0.79; 1 study, 40 participants). Different types of removable retainers Clear plastic versus Hawley When worn in the lower arch for six months full-time and six months part-time, clear plastic provided similar stability to Hawley retainers (LII MD 0.01 mm, 95% CI -0.65 to 0.67; 1 study, 30 participants). Hawley retainers had lower risk of failure (RR 0.60, 95% CI 0.43 to 0.83; 1 study, 111 participants), but were less comfortable at six months (VAS MD -1.86 cm, 95% CI -2.19 to -1.53; 1 study, 86 participants). Part-time versus full-time wear of Hawley There was no evidence of a difference in stability between part-time and full-time use of Hawley retainers (MD 0.20 mm, 95% CI -0.28 to 0.68; 1 study, 52 participants).
AUTHORS' CONCLUSIONS
The evidence is low to very low certainty, so we cannot draw firm conclusions about any one approach to retention over another. More high-quality studies are needed that measure tooth stability over at least two years, and measure how long retainers last, patient satisfaction and negative side effects from wearing retainers, such as tooth decay and gum disease.
Topics: Adult; Child; Humans; Orthodontic Brackets; Dental Care; Gingivitis; Periodontal Diseases; Drug-Related Side Effects and Adverse Reactions
PubMed: 37219527
DOI: 10.1002/14651858.CD002283.pub5 -
Children (Basel, Switzerland) Apr 2023Three-dimensional (3D) printing technology has shed light on many fields in medicine and dentistry, including orthodontics. Direct 3D-printed prosthetics, implants or... (Review)
Review
Three-dimensional (3D) printing technology has shed light on many fields in medicine and dentistry, including orthodontics. Direct 3D-printed prosthetics, implants or surgical devices are well-documented. The fabrication of orthodontic retainers using CAD technology and additive manufacturing is an emerging trend but the available data are scarce. The research approach of the present review included keywords in Medline, Scopus, Cochrane Library and Google Scholar up to December 2022. The searching process concluded with five studies eligible for our project. Three of them investigated directly 3D-printed clear retainers in vitro. The other two studies investigated directly 3D-printed fixed retainers. Among them, one study was in vitro and the second was a prospective clinical trial. Directly 3D-printed retainers can be evolved over time as a good alternative to all the conventional materials for retention. Devices that are 3D-printed are more time and cost efficient, offer more comfortable procedures for both practitioners and patients and the materials used in additive manufacturing can solve aesthetic problems, periodontal issues or problems with the interference of these materials with magnetic resonance imaging (MRI). More well-designed prospective clinical trials are necessary for more evaluable results.
PubMed: 37189925
DOI: 10.3390/children10040676 -
Dental Research Journal 2023An ever-increasing demand is seen for clear aligners and transparent vacuum-formed retainers. They are esthetic and convenient. However, the biomaterials used in these... (Review)
Review
A systematic review of biocompatibility and safety of orthodontic clear aligners and transparent vacuum-formed thermoplastic retainers: Bisphenol-A release, adverse effects, cytotoxicity, and estrogenic effects.
BACKGROUND
An ever-increasing demand is seen for clear aligners and transparent vacuum-formed retainers. They are esthetic and convenient. However, the biomaterials used in these appliances might pose biological safety and biocompatibility threats in terms of their bisphenol-A (BPA) release, cytotoxicity, adverse effects, and estrogenic effects. Due to the controversial results and the lack of any systematic reviews in this regard, we conducted this systematic review.
MATERIALS AND METHODS
Web of Science, PubMed, Cochrane, Scopus, and Google Scholar as well as references of the found articles were searched (independently by 3 researchers) up to December 22, 2021, to find studies relevant to the biocompatibility of clear aligners and thermoplastic retainers. The search keywords were a combination of the following (and more): Essix, vacuum-formed aligner, thermoplastic aligner, clear aligner, Invisalign, vacuum-formed retainer, BPA release, monomer release, cytotoxicity, estrogenicity, biocompatibility, chemical properties, and oral epithelial cell. As eligibility criteria, articles in all languages would be included as long as their text could be translated clearly using online translators or by professional translators; all types of publications (article, book, and thesis) would be included if containing relevant studies and information; they should have been on clear liners or thermoplastic retainers; and they should have been on biocompatibility, safety, cytotoxicity, or estrogenicity of clear aligners or thermoplastic retainers. There were no restrictions on the type of study (randomized clinical trials, experimental studies). Studies focusing merely on the mechanical properties of clear aligners or thermoplastic retainers (without examining their chemical properties) would be excluded. The risk of bias was assessed.
RESULTS
The risk of bias was rather low. However, the methodologies of the studies were quite different. Overall, 16 articles (1 randomized clinical trial and 15 studies) were identified. The data for BPA release were reported in four articles (1 clinical trial and 3 studies). Quantitatively speaking, the amount of released BPA reported by studies was very low, if not zero. However, the BPA level was very high in the only randomized clinical trial. Many adverse effects were linked to using clear aligners or transparent retainers, including pain and soft-tissue issues such as burning, tingling, sore tongue, lip swelling, blisters, ulceration, dry mouth, periodontal problems, and even systemic problems such as difficulty in breathing. Besides these biological adverse effects, oral dysfunctions and speech difficulties and tooth damage may be associated with clear aligners and should as well be taken into consideration.
CONCLUSION
Given the very high levels of BPA leach observed in the only clinical trial and considering other possible dangers of small traces of BPA (even at low doses) and also given the numerous adverse events linked to clear aligners or transparent retainers, it seems that safety of these appliances might be questionable and more clinical studies of biocompatibility are needed in this regard.
PubMed: 37180685
DOI: No ID Found