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The Cochrane Database of Systematic... Dec 2021A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. The prevalence of posterior crossbite is around 4% and 17% of children and... (Review)
Review
BACKGROUND
A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. The prevalence of posterior crossbite is around 4% and 17% of children and adolescents in Europe and America, respectively. Several treatments have been recommended to correct this problem, which is related to such dental issues as tooth attrition, abnormal development of the jaws, joint problems, and imbalanced facial appearance. Treatments involve expanding the upper jaw with an orthodontic appliance, which can be fixed (e.g. quad-helix) or removable (e.g. expansion plate). This is the third update of a Cochrane review first published in 2001.
OBJECTIVES
To assess the effects of different orthodontic treatments for posterior crossbites.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 8 April 2021 and used additional search methods to identify published, unpublished and ongoing studies.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults.
DATA COLLECTION AND ANALYSIS
Two review authors, independently and in duplicate, screened the results of the electronic searches, extracted data, and assessed the risk of bias of the included studies. A third review author participated to resolve disagreements. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous data (event), unless there were zero values in trial arms, in which case we used odds ratios (ORs). We used mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models. We used the GRADE approach to assess the certainty of the evidence for the main outcomes.
MAIN RESULTS
We included 31 studies that randomised approximately 1410 participants. Eight studies were at low risk of bias, 15 were at high risk of bias, and eight were unclear. Intervention versus observation For children (age 7 to 11 years), quad-helix was beneficial for posterior crossbite correction compared to observation (OR 50.59, 95% CI 26.77 to 95.60; 3 studies, 149 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 4.71 mm, 95% CI 4.31 to 5.10; 3 studies, 146 participants; moderate-certainty evidence). For children, expansion plates were also beneficial for posterior crossbite correction compared to observation (OR 25.26, 95% CI 13.08 to 48.77; 3 studies, 148 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 3.30 mm, 95% CI 2.88 to 3.73; 3 studies, 145 participants, 3 studies; moderate-certainty evidence). In addition, expansion plates resulted in higher inter-canine distances (MD 2.59 mm, 95% CI 2.18 to 3.01; 3 studies, 145 participants; moderate-certainty evidence). The use of Hyrax is probably effective for correcting posterior crossbite compared to observation (OR 48.02, 95% CI 21.58 to 106.87; 93 participants, 3 studies; moderate-certainty evidence). Two of the studies focused on adolescents (age 12 to 16 years) and found that Hyrax increased the inter-molar distance compared with observation (MD 5.80, 95% CI 5.15 to 6.45; 2 studies, 72 participants; moderate-certainty evidence). Intervention A versus intervention B When comparing quad-helix with expansion plates in children, quad-helix was more effective for posterior crossbite correction (RR 1.29, 95% CI 1.13 to 1.46; 3 studies, 151 participants; moderate-certainty evidence), final inter-molar distance (MD 1.48 mm, 95% CI 0.91 mm to 2.04 mm; 3 studies, 151 participants; high-certainty evidence), inter-canine distance (0.59 mm higher (95% CI 0.09 mm to 1.08 mm; 3 studies, 151 participants; low-certainty evidence) and length of treatment (MD -3.15 months, 95% CI -4.04 to -2.25; 3 studies, 148 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and Haas for posterior crossbite correction (RR 1.05, 95% CI 0.94 to 1.18; 3 studies, 83 participants; moderate-certainty evidence) or inter-molar distance (MD -0.15 mm, 95% CI -0.86 mm to 0.56 mm; 2 studies of adolescents, 46 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and tooth-bone-borne expansion for crossbite correction (RR 1.02, 95% CI 0.92 to 1.12; I² = 0%; 3 studies, 120 participants; low-certainty evidence) or inter-molar distance (MD -0.66 mm, 95% CI -1.36 mm to 0.04 mm; I² = 0%; 2 studies, 65 participants; low-certainty evidence). There was no evidence of a difference between Hyrax with bone-borne expansion for posterior crossbite correction (RR 1.00, 95% CI 0.94 to 1.07; I² = 0%; 2 studies of adolescents, 81 participants; low-certainty evidence) or inter-molar distance (MD -0.14 mm, 95% CI -0.85 mm to 0.57 mm; I² = 0%; 2 studies, 81 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: For children in the early mixed dentition stage (age 7 to 11 years old), quad-helix and expansion plates are more beneficial than no treatment for correcting posterior crossbites. Expansion plates also increase the inter-canine distance. Quad-helix is more effective than expansion plates for correcting posterior crossbite and increasing inter-molar distance. Treatment duration is shorter with quad-helix than expansion plates. For adolescents in permanent dentition (age 12 to 16 years old), Hyrax and Haas are similar for posterior crossbite correction and increasing the inter-molar distance. The remaining evidence was insufficient to draw any robust conclusions for the efficacy of posterior crossbite correction.
Topics: Adolescent; Bias; Child; Dental Care; Dentition, Permanent; Europe; Humans; Malocclusion
PubMed: 34951927
DOI: 10.1002/14651858.CD000979.pub3 -
The Cochrane Database of Systematic... Sep 2015Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to... (Review)
Review
BACKGROUND
Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root-filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite, directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth, and may influence durability and cost. The decision to use a post and core in addition to the crown is clinician driven. The comparative clinical performance of crowns or conventional fillings used to restore root-filled teeth is unknown. This review updates the original, which was published in 2012.
OBJECTIVES
To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials.
SEARCH METHODS
We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME. We also searched the reference lists of articles and ongoing trials registries.There were no restrictions regarding language or date of publication. The search is up-to-date as of 26 March 2015.
SELECTION CRITERIA
Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth that have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration or indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data from the included trial and assessed its risk of bias. We carried out data analysis using the 'treatment as allocated' patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI).
MAIN RESULTS
We included one trial, which was judged to be at high risk of performance, detection and attrition bias. The 117 participants with a root-filled, premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. None experienced a catastrophic failure (i.e. when the restoration cannot be repaired), although only 104 teeth were included in the final, three-year assessment. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes is very low. There was no evidence available for any of our secondary outcomes: patient satisfaction and quality of life, incidence or recurrence of caries, periodontal health status, and costs.
AUTHORS' CONCLUSIONS
There is insufficient evidence to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.
Topics: Adult; Crowns; Dental Restoration, Permanent; Female; Humans; Male; Middle Aged; Post and Core Technique; Randomized Controlled Trials as Topic; Tooth Root; Tooth, Nonvital
PubMed: 26403154
DOI: 10.1002/14651858.CD009109.pub3 -
The Cochrane Database of Systematic... Dec 2017Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. Conventional treatment methods (drill and fill) involve the use of rotary burs under local anaesthesia. The need for an electricity supply, expensive handpieces and highly trained dental health personnel may limit access to dental treatment, especially in underdeveloped regions.To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments alone, usually without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers).
OBJECTIVES
To assess the effects of Atraumatic Restorative Treatment (ART) compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 22 February 2017), Embase Ovid (1980 to 22 February 2017), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 22 February 2017) and BBO BIREME Virtual Health Library (Bibliografia Brasileira de Odontologia; 1986 to 22 February 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) with at least six months' follow-up that compared the effects of ART with a conventional restorative approach using the same or different restorative dental materials to treat caries lesions.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search results, extracted data from included studies and assessed the risk of bias in those studies. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. Where pooling was appropriate we conducted meta-analyses using the random-effects model. We assessed the quality of the evidence using GRADE criteria.
MAIN RESULTS
We included a total of 15 eligible studies randomising 3760 participants in this review. The age of participants across the studies ranged from 3 to 101 years, with a mean of 25.42 years. 48% of participants were male. All included studies were published between 2002 and 2016. Two of the 15 studies declared that the financial support was from companies that manufacture restorative material. Five studies were individually randomised parallel-group studies; six were cluster-randomised parallel-group studies; and four were randomised studies that used a split-mouth design. Eleven studies evaluated the effects of ART on primary teeth only, and four on permanent teeth. The follow-up period of the included studies ranged from 6 months to 36 months. We judged all studies to be at high risk of bias.For the main comparison of ART compared to conventional treatment using the same material: all but two studies used high-viscosity glass ionomer (H-GIC) as the restorative material; one study used a composite material; and one study used resin-modified glass ionomer cement (RM-GIC)).Compared to conventional treatment using H-GIC, ART may increase the risk of restoration failure in the primary dentition, over a follow-up period from 12 to 24 months (OR 1.60, 95% CI 1.13 to 2.27, five studies; 643 participants analysed; low-quality evidence). Our confidence in this effect estimate is limited due to serious concerns over risk of performance and attrition bias. For this comparison, ART may reduce pain during procedure compared with conventional treatment (MD -0.65, 95% CI -1.38 to 0.07; 40 participants analysed; low-quality evidence)Comparisons of ART to conventional treatment using composite or RM-GIC were downgraded to very low quality due to indirectness, imprecision and high risk of performance and attrition bias. Given the very low quality of the evidence from single studies, we are uncertain about the restoration failure of ART compared with conventional treatment using composite over a 24-month follow-up period (OR 1.11, 95% CI 0.54 to 2.29; one study; 57 participants) and ART using RM-GIC in the permanent teeth of older adults with root caries lesions over a six-month follow-up period (OR 2.71, 95% CI 0.94 to 7.81; one study; 64 participants).No studies reported on adverse events or costs.
AUTHORS' CONCLUSIONS
Low-quality evidence suggests that ART using H-GIC may have a higher risk of restoration failure than conventional treatment for caries lesions in primary teeth. The effects of ART using composite and RM-GIC are uncertain due to the very low quality of the evidence and we cannot rely on the findings. Most studies evaluated the effects of ART on the primary dentition.Well-designed RCTs are required that report on restoration failure at clinically meaningful time points, as well as participant-reported outcomes such as pain and discomfort. Due to the potential confounding effects from the use of different dental materials, a robust body of evidence on the effects of ART compared with conventional treatment using the same restoration material is necessary. We identified four ongoing trials that could provide further insights into this area.
Topics: Adult; Child; Dental Atraumatic Restorative Treatment; Dental Caries; Dental Restoration Failure; Dentition, Permanent; Female; Glass Ionomer Cements; Humans; Male; Randomized Controlled Trials as Topic; Tooth, Deciduous; Toothache
PubMed: 29284075
DOI: 10.1002/14651858.CD008072.pub2 -
Journal of Dentistry Nov 2023Literature was systematically reviewed to identify salivary characteristics and their association with tooth wear. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Literature was systematically reviewed to identify salivary characteristics and their association with tooth wear.
DATA
A protocol was developed a priori (PROSPERO CRD42022338590). Established systematic review methods were used for screening, data extraction, and synthesis. Risk of bias and the certainty of evidence were assessed using the JBI tools and GRADE, respectively. Direct and indirect association between tooth wear and salivary components and characteristics were assessed.
SOURCES
MEDLINE, Embase, SCOPUS, Web of Science, CINAHL, and additional sources were searched.
STUDY SELECTION
Studies reporting salivary characteristics in patients with tooth wear or models thereof were included. Animal and in-vitro studies and case reports were excluded.
RESULTS
One-hundred eleven studies were included. Qualitative analyses showed a negative association between tooth wear and salivary pH and flow rate in many studies. The higher the study size the higher the chances that an association with pH and flow rate was found. Xerostomia, buffer capacity and salivary consistency/viscosity had also some degree of association with tooth wear in fewer studies. Associations with the 39 salivary components were scarcer. Random effects meta-analyses (7 studies) showed that pH levels in stimulated whole saliva were lower in patient with tooth wear compared to controls (-0.07 [-0.10 to -0.04]). However, there was not enough evidence to establish a quantitative association with flow rate. The general risk of bias was unclear and the certainty of evidence was low or very low. A large diversity of methodologies limited the inclusion of all studies in quantitative synthesis.
CONCLUSION
From all potential risk factors, stimulated whole saliva pH showed a negative association, both quantitatively and qualitatively with tooth wear, indicating potential usefulness of pH monitoring in these patients. Moreover, associations between flow rate and tooth wear were observed qualitatively. However, in both cases the risk of bias was mostly unclear, and the certainty of evidence was low. No causal associations could be observed.
CLINICAL SIGNIFICANCE
Tooth wear is a prevalent condition that may lead to functional or esthetic impairments and pain. Knowing the potential risk factors like salivary pH or flow rate and their dynamics could be relevant during tooth wear monitoring and to intervene accordingly, especially in conditions like gastroesophageal reflux disease.
Topics: Humans; Tooth Erosion; Tooth Wear; Tooth Attrition; Saliva; Xerostomia
PubMed: 37678744
DOI: 10.1016/j.jdent.2023.104692 -
The Cochrane Database of Systematic... Nov 2019Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC).
OBJECTIVES
To assess the effects of interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years of age).
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 14 January 2019), Cochrane Pregnancy and Childbirth Group's Trials Register (to 22 January 2019), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 14 January 2019), MEDLINE Ovid (1946 to 14 January 2019), Embase Ovid (1980 to 14 January 2019) and CINAHL EBSCO (1937 to 14 January 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing one or more interventions with pregnant women, mothers, or other caregivers of infants in the first year of life (intervention types included clinical, oral health education/promotion such as hygiene education, breastfeeding and other dietary advice, and policy or health service), versus standard care or placebo or another intervention. For inclusion, trials had to report at least one caries outcome.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence using the GRADE approach.
MAIN RESULTS
We included 17 RCTs (4 cluster-randomised), involving 23,732 caregivers (mainly mothers) and their children. Eleven RCTs assessed four oral health education/promotion interventions against standard care: child diet advice, child diet and feeding practice advice, breastfeeding promotion and support, and oral hygiene with child diet and feeding practice advice. Six trials assessed clinical interventions in mother's dentition, four trials chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo, and two trials xylitol against CHX or CHX + xylitol. At most, three trials (maximum of 1148 children and 130 mothers) contributed data to any comparison. For many trials, risk of bias was judged unclear due to lack of methodological details reported, and there was high risk of attrition bias in some trials. None of the included trials indicated receiving funding that is likely to have influenced their results. The trials were performed in high-, middle- and low-income countries. In nine trials, participants were socioeconomically disadvantaged. For child diet and feeding practice advice versus standard care, we observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a lower mean dmfs (decayed, missing, filled primary surfaces) score (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, we are uncertain regarding the difference between the groups in mean dmft (decayed, missing, filled teeth) score (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). For breastfeeding promotion and support versus standard care, we observed that there may be little or no a difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence), or mean dmft score (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). Dmfs was not reported for this comparison. We are uncertain whether child diet advice only compared with standard care reduces risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). Dmfs and dmft were not reported for this comparison. For oral hygiene, child diet and feeding practice advice versus standard care, we observed little or no reduced risk of caries presence in primary teeth (RR 0.91, 95% CI 0.75 to 1.10; 2 trials; 365 participants; low-certainty evidence), and are uncertain regarding difference between the groups in mean dmfs score (MD -0.99, 95% CI -2.45 to 0.47; 1 trial; 187 participants; very low-certainty evidence) and dmft score (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; very low-certainty evidence). We observed there may be little or no difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment in mother's dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trials assessing this comparison reported dmfs or dmft. For xylitol compared with CHX antimicrobial treatment, we observed there may be a lower mean dmft score with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence); however, we are uncertain regarding the difference between groups in caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence). Neither trial evaluating this comparison reported dmfs. No trials assessed a health policy or service intervention.
AUTHORS' CONCLUSIONS
Moderate-certainty evidence suggests that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very low certainty and is insufficient for determining which, if any, other interventions types and features may be effective for preventing ECC. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine effects and relative effects of different interventions and inform practice. We have identified 12 studies currently in progress. Those designing future studies should describe the intervention components, setting and participants, consider if and how effects are modified by intervention features and participant characteristics, and adopt a consistent approach to measuring and reporting ECC.
Topics: Adult; Caregivers; Child; Child Nutritional Physiological Phenomena; Child, Preschool; Dental Caries; Diet; Female; Health Education, Dental; Health Promotion; Humans; Infant; Male; Mothers; Oral Health; Pregnancy; Pregnant Women; Randomized Controlled Trials as Topic; Tooth, Deciduous
PubMed: 31745970
DOI: 10.1002/14651858.CD012155.pub2 -
International Dental Journal Aug 2012This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with... (Comparative Study)
Comparative Study Review
OBJECTIVES
This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol.
METHODS
Databases were searched for clinical trials to 19 March 2011. Inclusion criteria required studies to: test a caries-related primary outcome; compare the effects of xylitol with those of sorbitol; describe a clinical trial with two or more arms, and utilise a prospective study design. Articles were excluded if they did not report computable data or did not follow up test and control groups in the same way. Individual dichotomous and continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias. Egger's regression and funnel plotting were used to investigate risk for publication bias.
RESULTS
Nine articles were identified. Of these, eight were accepted and one was excluded. Ten continuous and eight dichotomous datasets were extracted. Because of high clinical heterogeneity, no meta-analysis was performed. Most of the datasets favoured xylitol, but this was not consistent. The accepted trials may be limited by selection bias. Results of the sensitivity analysis indicate a high risk for attrition bias. The funnel plot and Egger's regression results suggest a low publication bias risk. External fluoride exposure and stimulated saliva flow may have confounded the measured anticariogenic effect of xylitol.
CONCLUSIONS
The evidence identified in support of xylitol over sorbitol is contradictory, is at high risk for selection and attrition bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed to show whether xylitol has a greater anticariogenic effect than sorbitol.
Topics: Cariostatic Agents; Clinical Trials as Topic; Dental Caries; Evidence-Based Dentistry; Humans; Outcome Assessment, Health Care; Sorbitol; Sweetening Agents; Xylitol
PubMed: 23016999
DOI: 10.1111/j.1875-595X.2011.00113.x -
Journal of Indian Prosthodontic Society 2021To systematically review the available literature on full mouth rehabilitation of the worn out dentition to help the clinician to choose a suitable philosophy to treat...
AIM
To systematically review the available literature on full mouth rehabilitation of the worn out dentition to help the clinician to choose a suitable philosophy to treat an individual Turner and Missirlian classification.
SETTINGS AND DESIGN
Systematic review following PRISMA guidelines.
MATERIALS AND METHODS
The electronic search engine explored for relevant published studies from the earliest available date, from January 1960 till October 2018. Search terms included were "full mouth rehabilitation OR occlusion OR philosophies of full mouth rehabilitation OR oral rehabilitation OR Pankey Mann Schuyler philosophy OR Hobo Twin stage OR Hobo Twin Table OR worn out dentition OR Turner and Missirlian classification". All collected studies were analyzed and a total of 54 articles and 2 hand searches were extracted, among which 32 articles were selected for the systematic review. Of these 32 articles, 8 were original research studies, 23 case reports and 1 study which comprised 3 case reports were incorporated. Hence, a total of 26 case reports were considered for this systematic review based on CAse REport guidelines.
STATISTICAL ANALYSIS USED
Qualitative analyisis.
RESULTS
Among 26 case reports, 15 cases (57.69%) were treated by Pankey Mann Schuyler philosophy, 2 cases (7.69%) by Hobo twin table and 9 cases (34.61%) by Hobo twin stage philosophy. 21 out of 26 cases were introduced for category no. 1 (80.76%) and 4 cases for category no. 2 (15.38%) and only 1case presented for category no.3 (3.84%) of Turner and Missirlian classification.
CONCLUSION
: No philosophies are universally applicable. Although the most commonly used philosophy is Pankey Mann Schuyler. Hobo Twin stage philosophy is the second most commonly used followed by Hobo Twin table. Maximum patients with worn out dentition are grouped under category no.1 of Turner and Missirlian classification system. Maximum cases of this category are treated by Pankey Mann Schuyler's philosophy.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Mouth Rehabilitation; Philosophy; Quality of Life; Reproducibility of Results; Tooth Attrition; Young Adult
PubMed: 33835065
DOI: 10.4103/jips.jips_397_19 -
Dental and Medical Problems 2020The aim of the paper was to appraise the current evidence of the effectiveness of low-level laser therapy (LLLT) in accelerating the tooth movement. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of the paper was to appraise the current evidence of the effectiveness of low-level laser therapy (LLLT) in accelerating the tooth movement.
METHODS
A comprehensive search was performed in 9 databases up to June 2019. Only randomized controlled trials (RCTs) were included. The risk of bias was assessed using the Cochrane Collaboration tool. The quantitative data synthesis was attainable only for the studies evaluating the effect of laser on canine retraction; the qualitative description was used for the rest of the studies. The overall quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
RESULTS
A total of 25 RCTs were included in this review. The radiated upper canines showed a greater retraction – 0.50 mm and 0.49 mm at months 2 and 3, respectively. The radiated lower canines showed a greater retraction – 0.28 mm and 0.52 mm at months 2 and 3, respectively. No statistically significant differences were observed among the upper and lower canines after the 1st month of retraction. When the GRADE approach was utilized, the overall quality of evidence limited confidence in the estimates. The qualitative description revealed enhanced tooth movement when LLLT was applied. The attrition bias was the main risk factor affecting the methodology of the studies.
CONCLUSION
Low-level laser therapy can speed up the rate of the tooth movement. However, the overall quality of evidence ranged from low to very low and the clinical significance of the obtained statistically significant differences is questionable. Hence, more precise studies are needed. As discussed in this review, it is highly recommended to express and compare the laser dosage with the total number of joules applied per month rather than the previously used J/cm2. Moreover, the previous recommendation indicating that lower energy densities (2.5, 5 and 8 J/cm2) are more effective than 20 and 25 J/cm2 is misleading.
Topics: Databases, Factual; Low-Level Light Therapy; Mental Processes; Social Behavior; Tooth Movement Techniques
PubMed: 32314880
DOI: 10.17219/dmp/112446 -
Archives of Oral Biology Oct 2021This systematic review aimed to assess whether hard or soft foods interfere with the pattern of occlusal changes in nonhuman mammals. (Review)
Review
OBJECTIVES
This systematic review aimed to assess whether hard or soft foods interfere with the pattern of occlusal changes in nonhuman mammals.
DESIGN
The electronic databases PubMed, Scopus, Web of Science, Cochrane Library, LILACS, OpenGrey and Google Scholar were examined. Only studies investigating the effects of dietary consistency on the occlusal characteristics in animal models were included. The risk of bias was performed based on the SYRCLE's tool, which assigned a low, high or uncertain assessment to each domain.
RESULTS
After the removal of duplicates, a total of 8,977 articles remained. From those, 19 studies met the eligibility criteria. Although a great methodological heterogeneity was observed, the results of the included studies as a whole points to homogeneity in the findings obtained on rats, pigs, and monkeys. The increase in the masticatory load was associated with larger dental arch dimensions. Dental wear and dento-alveolar changes were more evident with an increase of diet consistency. Baseline characteristics, blinding of outcome assessors, other sources of bias, incomplete outcome data, and selective outcome reporting were best assessed, denoting a lower risk of bias. In sequence generation and allocation concealment, insufficient details were provided to improve the classification. Random housing and outcome assessment and blinding of researchers were poorly evaluated.
CONCLUSION
Considering the limited evidence obtained from these findings, it seems that food consistency may interfere with the development of occlusal patterns and arch dimensions among growing animals. The findings suggest an environmental effect, even if minimal, on the occlusal characteristics.
Topics: Animals; Databases, Factual; Diet; Mammals; Rats; Swine
PubMed: 34358808
DOI: 10.1016/j.archoralbio.2021.105217 -
British Dental Journal Feb 2020Objectives To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism).Data...
Objectives To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism).Data sources Four databases including MEDLINE and EMBASE were searched from inception until 1 October 2018.Data selection and extraction Randomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome of pain, using random effects models in TMD patients.Data synthesis Thirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all subtypes of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95% CI -0.42 to 0.06); 13 trials, 1,076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome. No trials measured tooth wear in patients with bruxism. There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain.Conclusions The very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.
Topics: Bruxism; Humans; Splints; Temporomandibular Joint Disorders; Tooth Attrition
PubMed: 32060462
DOI: 10.1038/s41415-020-1250-2