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The Cochrane Database of Systematic... Jun 2023Deviation from a normal bite can be defined as malocclusion. Orthodontic treatment takes 20 months on average to correct malocclusion. Accelerating the rate of tooth... (Review)
Review
BACKGROUND
Deviation from a normal bite can be defined as malocclusion. Orthodontic treatment takes 20 months on average to correct malocclusion. Accelerating the rate of tooth movement may help to reduce the duration of orthodontic treatment and associated unwanted effects including orthodontically induced inflammatory root resorption (OIIRR), demineralisation and reduced patient motivation and compliance. Several non-surgical adjuncts have been advocated with the aim of accelerating the rate of orthodontic tooth movement (OTM). OBJECTIVES: To assess the effect of non-surgical adjunctive interventions on the rate of orthodontic tooth movement and the overall duration of treatment.
SEARCH METHODS
An information specialist searched five bibliographic databases up to 6 September 2022 and used additional search methods to identify published, unpublished and ongoing studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of people receiving orthodontic treatment using fixed or removable appliances along with non-surgical adjunctive interventions to accelerate tooth movement. We excluded split-mouth studies and studies that involved people who were treated with orthognathic surgery, or who had cleft lip or palate, or other craniofacial syndromes or deformities.
DATA COLLECTION AND ANALYSIS
Two review authors were responsible for study selection, risk of bias assessment and data extraction; they carried out these tasks independently. Disagreements were resolved by discussion amongst the review team to reach consensus. MAIN RESULTS: We included 23 studies, none of which were rated as low risk of bias overall. We categorised the included studies as testing light vibrational forces or photobiomodulation, the latter including low level laser therapy and light emitting diode. The studies assessed non-surgical interventions added to fixed or removable orthodontic appliances compared to treatment without the adjunct. A total of 1027 participants (children and adults) were recruited with loss to follow-up ranging from 0% to 27% of the original samples. Certainty of the evidence For all comparisons and outcomes presented below, the certainty of the evidence is low to very low. Light vibrational forces Eleven studies assessed how applying light vibrational forces (LVF) affected orthodontic tooth movement (OTM). There was no evidence of a difference between the intervention and control groups for duration of orthodontic treatment (MD -0.61 months, 95% confidence interval (CI) -2.44 to 1.22; 2 studies, 77 participants); total number of orthodontic appliance adjustment visits (MD -0.32 visits, 95% CI -1.69 to 1.05; 2 studies, 77 participants); orthodontic tooth movement during the early alignment stage (reduction of lower incisor irregularity (LII)) at 4-6 weeks (MD 0.12 mm, 95% CI -1.77 to 2.01; 3 studies, 144 participants), or 10-16 weeks (MD -0.18 mm, 95% CI -1.20 to 0.83; 4 studies, 175 participants); rate of canine distalisation (MD -0.01 mm/month, 95% CI -0.20 to 0.18; 2 studies, 40 participants); or rate of OTM during en masse space closure (MD 0.10 mm per month, 95% CI -0.08 to 0.29; 2 studies, 81 participants). No evidence of a difference was found between LVF and control groups in rate of OTM when using removable orthodontic aligners. Nor did the studies show evidence of a difference between groups for our secondary outcomes, including patient perception of pain, patient-reported need for analgesics at different stages of treatment and harms or side effects. Photobiomodulation Ten studies assessed the effect of applying low level laser therapy (LLLT) on rate of OTM. We found that participants in the LLLT group had a statistically significantly shorter length of time for the teeth to align in the early stages of treatment (MD -50 days, 95% CI -58 to -42; 2 studies, 62 participants) and required fewer appointments (-2.3, 95% CI -2.5 to -2.0; 2 studies, 125 participants). There was no evidence of a difference between the LLLT and control groups in OTM when assessed as percentage reduction in LII in the first month of alignment (1.63%, 95% CI -2.60 to 5.86; 2 studies, 56 participants) or in the second month (percentage reduction MD 3.75%, 95% CI -1.74 to 9.24; 2 studies, 56 participants). However, LLLT resulted in an increase in OTM during the space closure stage in the maxillary arch (MD 0.18 mm/month, 95% CI 0.05 to 0.33; 1 study; 65 participants; very low level of certainty) and the mandibular arch (right side MD 0.16 mm/month, 95% CI 0.12 to 0.19; 1 study; 65 participants). In addition, LLLT resulted in an increased rate of OTM during maxillary canine retraction (MD 0.01 mm/month, 95% CI 0 to 0.02; 1 study, 37 participants). These findings were not clinically significant. The studies showed no evidence of a difference between groups for our secondary outcomes, including OIIRR, periodontal health and patient perception of pain at early stages of treatment. Two studies assessed the influence of applying light-emitting diode (LED) on OTM. Participants in the LED group required a significantly shorter time to align the mandibular arch compared to the control group (MD -24.50 days, 95% CI -42.45 to -6.55, 1 study, 34 participants). There is no evidence that LED application increased the rate of OTM during maxillary canine retraction (MD 0.01 mm/month, 95% CI 0 to 0.02; P = 0.28; 1 study, 39 participants ). In terms of secondary outcomes, one study assessed patient perception of pain and found no evidence of a difference between groups. AUTHORS' CONCLUSIONS: The evidence from randomised controlled trials concerning the effectiveness of non-surgical interventions to accelerate orthodontic treatment is of low to very low certainty. It suggests that there is no additional benefit of light vibrational forces or photobiomodulation for reducing the duration of orthodontic treatment. Although there may be a limited benefit from photobiomodulation application for accelerating discrete treatment phases, these results have to be interpreted with caution due to their questionable clinical significance. Further well-designed, rigorous RCTs with longer follow-up periods spanning from start to completion of orthodontic treatment are required to determine whether non-surgical interventions may reduce the duration of orthodontic treatment by a clinically significant amount, with minimal adverse effects.
Topics: Humans; Tooth Movement Techniques; Malocclusion; Dental Care; Pain; Low-Level Light Therapy
PubMed: 37339352
DOI: 10.1002/14651858.CD010887.pub3 -
European Archives of Paediatric... Aug 2023This study aims to evaluate whether there is a correlation between otitis and dental malocclusions.
PURPOSE
This study aims to evaluate whether there is a correlation between otitis and dental malocclusions.
METHODS
Electronic databases were searched for observational studies published until July 2021 without language or time restrictions.
PROSPERO
CRD42021270760. Observational studies on children with and without OM and/or malocclusion were included. After removing duplicates and excluding not-eligible articles, two reviewers screened relevant articles independently. Two reviewers independently extracted data and assessed data quality and validity through the Newcastle-Ottawa Scale (NOS) quality assessment tool for non-randomized studies.
RESULTS
Five studies met the selection inclusion criteria and were included in the studies for a total of 499 patients. Three studies investigated the relationship between malocclusion and otitis media, while the remaining two studies analyzed the inverse relationship and one of them considered eustachian tube dysfunction as a proxy of OM. An association between malocclusion and otitis media and vice versa emerged, although with relevant limitations.
CONCLUSION
There is some evidence that there is an association between otitis and malocclusion; however, it is not yet possible to establish a definitive correlation.
Topics: Humans; Child; Otitis Media; Malocclusion
PubMed: 37338742
DOI: 10.1007/s40368-023-00807-0 -
Journal of Medicine and Life Apr 2023This systematic review aimed to identify the main tools used to analyze the relationship between the postural and stomatognathic systems. The study followed the PRISMA... (Review)
Review
This systematic review aimed to identify the main tools used to analyze the relationship between the postural and stomatognathic systems. The study followed the PRISMA guidelines, and data were collected from Science Direct and PubMed databases to identify articles published until December 2022. After applying inclusion and exclusion criteria, 26 articles were selected from the initial 903 articles. The selected articles were full-text studies in English or Romanian, examining the relationship between dental occlusion and posture, measuring postural parameters using various tools, implementing occlusal changes, evaluating patients with permanent dentition, or analyzing the connection between occlusion and posture in a unidirectional manner. The findings indicate that orthognathic surgery and orthodontic mouthguards can significantly enhance postural balance and athletic performance. In addition, 63% of the studies concluded that varying modifications and occlusal conditions impact posture. Notable differences exist concerning posture and Angle dental occlusion classes, and different occlusal devices used to simulate malocclusion can affect patients' postural systems in response to external stimuli. The stabilometry platform is the predominant method for measuring postural parameters; however, other researchers have employed raster stereography, photogrammetry, mobile phone apps, and the Fukuda-Unterberger test. Consequently, interventions targeting the stomatognathic system should consider potential variations in the postural system.
Topics: Humans; Stomatognathic System; Athletic Performance; Malocclusion; Postural Balance; Posture
PubMed: 37305821
DOI: 10.25122/jml-2022-0327 -
Journal of Clinical Medicine Jun 2023Individuals with amelogenesis imperfecta (AI) often present with malocclusions, especially a dental or skeletal anterior open bite (AOB). (Review)
Review
BACKGROUND
Individuals with amelogenesis imperfecta (AI) often present with malocclusions, especially a dental or skeletal anterior open bite (AOB).
OBJECTIVES
To evaluate the craniofacial characteristics in individuals with AI.
MATERIAL AND METHODS
A systematic literature search was conducted with the PubMed, Web of Science, Embase and Google Scholar databases to identify studies relating to the cephalometric characteristics of individuals with AI, without any language or publication date restrictions. The grey literature was searched using Google Scholar, Opengrey and Worldcat. Only studies with a suitable control group for comparison were included. Data extraction and a risk of bias assessment were carried out. A meta-analysis was performed using the random effects model for cephalometric variables that were evaluated in at least three studies.
RESULTS
The initial literature search yielded 1857 articles. Following the removal of duplicates and a screening of the records, seven articles were included in the qualitative synthesis, representing a total of 242 individuals with AI. Four studies were included in the quantitative synthesis. The meta-analysis results showed that individuals with AI present a smaller SNB angle and larger ANB angle than those of control groups in the sagittal plane. In the vertical plane, those with AI present a smaller overbite and larger intermaxillary angle than those without AI. No statistically significant differences were found for the SNA angle when comparing the two groups.
CONCLUSIONS
Individuals with AI seem to present with more vertical craniofacial growth, leading to an increased intermaxillary angle and decreased overbite. This possibly leads to a more retrognathic mandible with a larger ANB angle due to an anticipated posterior mandibular rotation.
PubMed: 37298021
DOI: 10.3390/jcm12113826 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Jun 2023This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group.
METHODS
PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Abstracts Database, China Knowledge Network Database, Wanfang Database, and Weipu Database were used in this study. The two groups of researchers screened the literature and extracted data based on the inclusion and exclusion criteria established by PICOS entries, and used the ROBINS-I scale for quality evaluation. Revman 5.4 and Stata 17.0 software were used for meta-analysis.
RESULTS
Nine clinical controlled trials were included in this study with a total sample size of 283 cases. No significant difference was found in SNA, SNB, ANB, Go-Pog, U1-SN, Overjet, and other aspects between the invisible group and the traditional group in the treatment of skeletal class Ⅱ ma-locclusion patients; there was a 0.90° difference in mandibular plane angle between the two groups; the growth of the mandibular ramus (Co-Go) in the traditional group was 1.10 mm more than that in the invisible group; the lip inclination of the lower teeth in the invisible group was better controlled, 1.94° less than that in the control group.
CONCLUSIONS
The invisible group can better control the lip inclination of the mandibular anterior teeth when guiding the mandible. Furthermore, the mandibular plane angle (MP-SN) can remain unchanged, but the growth of the mandibular ramus is not as good as the traditional group, and auxiliary measures should be taken to improve it in clinical practice.
Topics: Humans; Malocclusion, Angle Class II; Mandibular Advancement; Orthodontics, Corrective; Orthodontic Appliances, Functional; Mandible; Orthodontic Appliances, Removable; Cephalometry
PubMed: 37277797
DOI: 10.7518/hxkq.2023.2022453 -
Progress in Orthodontics Jun 2023The etiology of open bite is complex, involving various genetic or environmental factors. Several treatment alternatives have been suggested for the correction of open... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The etiology of open bite is complex, involving various genetic or environmental factors. Several treatment alternatives have been suggested for the correction of open bite, yet their long-term effectiveness remains controversial.
OBJECTIVE
To assess the long-term effectiveness of open-bite treatment in treated with non-surgical approaches versus untreated patients, through lateral cephalometric radiographs.
SEARCH METHODS
Unrestricted search of 16 electronic databases and manual searches up to November 2022.
SELECTION CRITERIA
Randomized or non-randomized controlled trials reporting on the long-term effects of open-bite treatment through angular lateral cephalometric variables.
DATA COLLECTION AND ANALYSIS
Only angular variables on lateral cephalometric radiographs were considered as primary outcomes. For each outcome, the mean differences and 95% confidence intervals were calculated using the random-effects model to consider existing heterogeneity. The revised Cochrane risk-of-bias tool (R.o.B. 2.0) and the risk-of-bias tool for non-randomized studies for interventions (ROBINS-I) were utilized for the randomized and non-randomized trials, respectively.
RESULTS
From the initially identified 26,527 hits, only 6 studies (1 randomized and 5 retrospective controlled trials) were finally included in this systematic review reporting on 244 open-bite individuals (134 patients and 110 untreated controls), while five of them were included in the meta-analyses, assessing either the interval ranging from treatment start to post-retention (T3-T1) or from end of treatment to post-retention period (T3-T2). Regarding the vertical plane, for the T3-T2 interval, no significant differences were found for the assessed skeletal measurements, indicating a relative stability of the treatment results. Similarly, with regard to the T3-T1 interval, no significant differences could be identified for the examined skeletal variables, implying that the produced effects are rather minimal and that the correction of the open bite was performed mainly through dentoalveolar rather than skeletal changes. Further, no significant changes could be identified regarding the inclination of the upper and lower incisors. Only the nasolabial angle was significantly reduced in the treated patients in the long term.
CONCLUSIONS
According to existing evidence, the influence of non-surgical treatment of open bite on the skeletal tissues and the inclination of the incisors is rather minimal in the long term, while only the nasolabial angle was significantly reduced.
Topics: Humans; Open Bite; Retrospective Studies; Treatment Outcome; Cephalometry; Incisor
PubMed: 37258750
DOI: 10.1186/s40510-023-00467-2 -
Progress in Orthodontics May 2023Dental crowding is the most prevalent malocclusion in the mixed and permanent detitions and can have a major impact on dentofacial esthetics. However, adjustments to the... (Review)
Review
INTRODUCTION
Dental crowding is the most prevalent malocclusion in the mixed and permanent detitions and can have a major impact on dentofacial esthetics. However, adjustments to the development and growth of the dentition can potentiate self-correction of dental crowding during childhood.
OBJECTIVE
To evaluate the physiological behavior of mandibular incisor crowding in the transition from mixed to permanent dentition.
METHODOLOGY
Five electronic databases (PubMed, Scopus, Web of Science, LILACS and LIVIVO) and part of the gray literature (Proquest and Google Scholar) were investigated, based on the eligibility criteria associated with the acronym PECO, until June 2022. The risk of bias was assessed using the ROBINS-E tool and the certainty of evidence, the GRADE tool.
RESULTS
Among the 2.663 studies identified, five were selected for qualitative analysis, of which one have a low risk of bias, and four, a moderate risk. A total of 243 patients were evaluated. Evidence with a high level of certainty was generated indicating a tendency for improvement in mandibular incisor crowding from mixed to permanent dentition, with mandibular incisor crowding decreasing from 0.17 to 4.62 mm on average. The mandibular incisor crowding reduction seems to be associated with the amount of initial crowding and spontaneous dental arch dimensional changes that occur in the mixed dentition and culminate in the increase in arch perimeter, leeway space, incisor protrusion and transverse growth of the maxillary and mandibular arch.
CONCLUSION
Based on moderate scientific evidence, spontaneous longitudinal changes in dental arch in the transition from the mixed to the permanent dentition demonstrate a spontaneous improvement in mandibular incisor crowding by up to 4.62 mm. These evidence provide a scientific basis for planning only longitudinal follow-up in patients with mild to borderline moderate mandibular incisor crowding in the mixed dentition avoiding overtreatment.
Topics: Humans; Dentition, Permanent; Incisor; Dental Arch; Malocclusion; Dentition, Mixed; Mandible
PubMed: 37150772
DOI: 10.1186/s40510-023-00466-3 -
BMC Oral Health May 2023The introduction of skeletal anchorage utilized for maxillary protraction with a face mask or class III elastics has been developed for the management of class III...
The introduction of skeletal anchorage utilized for maxillary protraction with a face mask or class III elastics has been developed for the management of class III malocclusions with minimal dental effect. The objective of the present review was to evaluate the current evidence regarding airway dimensional changes following bone-anchored maxillary protraction. A search was conducted by two authors (S.A & B.A) in the following databases: MEDLINE via PubMed, Cochrane Library, Web of Science, Scopus, Google Scholar and Open Grey; besides a hand search in references of selected articles and developing a search alert in electronic databases. Selection criteria comprised randomized as well as prospective clinical trials evaluating airway dimensional changes following bone-anchored maxillary protraction. Relevant data were extracted after studies retrieval and selection. The risk of bias was thereafter evaluated using the revised RoB 2 tool for randomized clinical trials and the ROBINS-I tool was used for non-randomized clinical trials. The quality of studies was assessed using the modified Jadad score. After examining (eligibility) full-text articles, four clinical trials were ultimately included. These studies evaluated the airway dimensional changes, following bone-anchored maxillary protraction in comparison to different control study groups. Based on the available evidence, all the bone-anchored maxillary protraction devices used in the eligible studies in the present systematic review resulted in an improvement in the airway dimensions. However, due to the few numbers of studies available and the guarded evidence due to the low quality of evidence of three out of four included articles, there is no strong evidence to support a significant increase in the airway dimensions following bone-anchored maxillary protraction. Therefore, there is a need for more randomized controlled clinical trials with similar bone-anchored protraction devices and similar assessment methods for more valid comparisons, excluding any confounding factors, on airway dimensional changes.
Topics: Orthodontic Anchorage Procedures; Malocclusion, Angle Class III; Palatal Expansion Technique; Maxilla; Humans; Respiratory System; Cephalometry; Radiography, Dental; Male; Female
PubMed: 37138306
DOI: 10.1186/s12903-023-02940-0 -
Brazilian Oral Research 2023This study aimed to assess the potential association between perception malocclusion and school performance in children and adolescents. An electronic search was...
This study aimed to assess the potential association between perception malocclusion and school performance in children and adolescents. An electronic search was performed in ten databases. Based on the PECO acronym (Population, Exposition, Comparator, and Outcome), the eligibility criteria included observational studies that compared the school performance of children and adolescents with and without the perception of malocclusion. There were no restrictions on the language or year of publication. Two reviewers selected the studies, extracted the data, and assessed the risk of bias by using the Joanna Briggs Institute tool for cross-sectional studies. School performance was measured by analyzing student grades; levels of absenteeism; and child or adolescent self-perception and/or the perception of parents, guardians, close friends, and teachers regarding the impact of malocclusion on school performance. The data were described narratively/descriptively. The search resulted in 3,581 registers, of which eight were included in the qualitative synthesis. These studies were published between 2007 and 2021. Two studies concluded that there was no significant association between school performance and perception of malocclusion, five studies found that only some of the children with malocclusion had their school performance affected, and one study concluded that there was a significant association between perception of malocclusion and low school performance. Considering all variables and the very low certainty of evidence, the perception of malocclusion seems to negatively impact school performance when associated with external and subjective factors. Further studies using additional measurement standards are required.
Topics: Child; Humans; Adolescent; Cross-Sectional Studies; Malocclusion; Students; Parents; Perception
PubMed: 37132722
DOI: 10.1590/1807-3107bor-2023.vol37.0033 -
Cureus Apr 2023This systematic review aimed to critically assess the available evidence regarding the effectiveness and efficiency of clear aligners in the comprehensive treatment of... (Review)
Review
This systematic review aimed to critically assess the available evidence regarding the effectiveness and efficiency of clear aligners in the comprehensive treatment of complex cases accompanied by premolars extraction. An electronic literature search by two reviewers was independently done on 27 February 2023 in the following databases without time and language limitations: Pubmed®, Scoups®, Google Scholar, Cochrane Library database, Web of Science™, and Proquest Database Open. Randomized controlled trials (RCTs) of any type, non-randomized clinical trials (CCT), cohort studies, and prospective, retrospective, and cross-sectional studies were reviewed. The risk of bias in included studies was assessed using the Risk of Bias (RoB 2.0) tool for randomized trials and the Risk of Bias in Non-randomized Studies (ROBINS-I) tool for non-randomized studies. After carefully searching the literature, six trials were included in this systematic review, three RCTs, two retrospective cohort studies, and one CCT. Two hundred eighty-three patients were included (186 females, 97 males). Three studies found that there were no differences between the clear aligners and fixed appliances when evaluations were done using the American Board of Orthodontists Objective Grading System (ABO-OGS) or the Peer Assessment Rating (PAR) index. Two studies found that there were some differences between predicted and achieved tooth movements when clear aligners were used in premolars extraction cases. Based on the included studies, the duration of treatment was shorter with fixed appliances than the clear aligners when applied to orthodontic extraction cases. Both clear aligners and fixed appliances were found effective in the orthodontic treatment of premolar extraction-based cases. Fixed appliances have the advantage of achieving better buccolingual inclination and occlusal contacts in a shorter treatment duration. Treatment with clear aligners might be associated with differences between predicted and achieved tooth movements. Therefore, the characteristics of these techniques should be considered when making a treatment decision.
PubMed: 37128600
DOI: 10.7759/cureus.38311