Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross-over randomized controlled trial.

OBJECTIVE: To determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea-hypopnea index (AHI) and minimum oxygen saturation (MinSaO2) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship. STUDY DESIGN/METHODS: Thirty-two nonobese children with balanced maxillomandibular relationship and a mean age of 8.8 years, with a graded III/IV tonsillar hypertrophy and maxillary constriction, participated in a cross-over randomized controlled trial. As the first intervention, one group underwent AT while the other underwent RPE. After 6 months, interventions were switched in those groups, but only to participants with an AHI > 1 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T0), 6 months after the first (T1) and the second (T2) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO2 severity, and intervention sequence were evaluated using linear regression analysis. Intra- and intergroup comparisons for AHI and MinSaO2 were performed using ANOVA and Tukey's test. RESULTS: The initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO2 severity accounted for 83.1% of MinSaO2 improvement changes. Most AHI reductions and MinSaO2 improvements were due to AT. CONCLUSIONS: Initial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO2 severity alone accounted for the most changes in MinSaO2 increase. In most cases, RPE had a marginal effect on AHI and MinSaO2 when adjusted for confounders.

Do statistical heterogeneity methods impact the results of meta- analyses? A meta epidemiological study.

BACKGROUND: Orthodontic systematic reviews (SRs) use different methods to pool the individual studies in a meta-analysis when indicated. However, the number of studies included in orthodontic meta-analyses is relatively small. This study aimed to evaluate the direction of estimate changes of orthodontic meta-analyses (MAs) using different between-study variance methods considering the level of heterogeneity when few trials were pooled. METHODS: Search and study selection: Systematic reviews (SRs) published over the last three years, from the 1st of January 2020 to the 31st of December 2022, in six main orthodontic journals with at least one MA pooling five or lesser primary studies were identified. Data collection and analysis: Data were extracted from each eligible MA, which was replicated in a random effect model using DerSimonian and Laird (DL), Paule-Mandel (PM), Restricted maximum-likelihood (REML), Hartung Knapp and Sidik Jonkman (HKSJ) methods. The results were reported using median and interquartile range (IQR) for continuous data and frequencies for categorical data and analyzed using non-parametric tests. The Boruta algorithm was used to assess the significant predictors for the significant change in the confidence interval between the different methods compared to the DL method, which was only feasible using the HKSJ method. RESULTS: 146 MAs were included, most applying the random effect model (n = 111; 76%) and pooling continuous data using mean difference (n = 121; 83%). The median number of studies was three (range 2, 4), and the overall statistical heterogeneity (I2 ranged from 0 to 99% with a median of 68%). Close to 60% of the significant findings became non-significant when HKSJ was applied compared to the DL method and when the heterogeneity was present I2>0%. On the other hand, 30.43% of the non-significant meta-analyses using the DL method became significant when HKSJ was used when the heterogeneity was absent I2 = 0%. CONCLUSION: Orthodontic MAs with few studies can produce different results based on the between-study variance method and the statistical heterogeneity level. Compared to DL, HKSJ method is overconservative when I2 is greater than 0% and may result in false positive findings when the heterogeneity is absent.

Impact of fixed orthodontic retainers on oral health-related quality of life: a longitudinal prospective study.

OBJECTIVE: The aim of the present study was to assess the impact of orthodontic retainers on oral health-related quality of life (OHRQoL) in the short and long terms after orthodontic treatment. METHODS: Data from 45 patients up to three years after orthodontic treatment (T0) were analyzed. Patients were reassessed four years (T1) after T0. OHRQoL was measured using the OHIP-14 (Oral Health Impact Profile-14) questionnaire. The presence of a fixed retainer in the upper and/or lower arches, sex, and age were the predictive variables evaluated at T0 and T1. The occurrence of retainer fracture at T0 was clinically evaluated. Due to the COVID-19 pandemic, clinical examination on T1 was not possible, so the OHIP-14 and the self-perception of changes in teeth position and fracture of retainers were examined using an on-line questionnaire. RESULTS: At the initial examination, the presence of upper retainers had a negative impact on quality of life (p=0.018). The OHIP-14 value increased significantly from T0 to T1 (p=0.014), regardless of the presence of retainers. The fracture or debonding of the retainer reported by the patient was the only variable that had a negative impact on OHRQoL (p=0.05). CONCLUSION: The use of fixed upper retainers suggests a negative impact on the quality of life of the orthodontic patient after the end of orthodontic treatment. This impact, however, is negligible in the long term, except when associated with fracture or debonding. This study emphasizes the need for continuous follow-up of orthodontic patients during the retention period.

Orthodontic aligners: between passion and science.

INTRODUCTION: The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. METHODS: Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. CONCLUSIONS: There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.

Patients' perception of orthodontic retainers: a systematic review.

BACKGROUND: Orthodontic retainers are widely used to prevent relapses after orthodontic treatment; however, evidence about patients' perceptions of retainers is lacking. OBJECTIVE: To assess patients' perception of orthodontic retainers. SEARCH METHODS: PubMed, Web of Science, Scopus, LILACS, LIVIVO, Cochrane Library, and gray literature (Google Scholar) were searched without date or language restrictions. A manual search of the reference lists of the included articles was also performed. SELECTION CRITERIA: Studies comparing patients' perceptions of wearing orthodontic retainers were included. DATA COLLECTION AND ANALYSIS: According to the study design, the risk of bias (RoB) assessment was performed using RoB 2.0 or ROBINS-I. The level of evidence was assessed through the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) tool. RESULTS: Seventeen studies met the eligibility criteria. After the RoB assessment, 12 randomized controlled trials presented a high RoB, and 4 non-randomized controlled trials presented a moderate RoB. The certainty of evidence was classified as very low for the four assessed outcomes. The studies generally reported an initial temporary negative impact of orthodontic retainers. Different esthetic, functional, and ease-of-use advantages are reported using removable and fixed retainers. A quantitative analysis was not performed due to the considerable clinical and methodological heterogeneity among the studies. CONCLUSION: The current evidence, although very limited, suggests that orthodontic retainers have an initial negative impact related to discomfort and functional limitations, but they seem to regress over time. There is a preference for thermoplastic over Hawley-type retainers. However, thermoplastic retainers cause different functional difficulties, and bonded retainers present the advantage of affecting speech function less than orthodontic removable retainers, although they can facilitate oral hygiene problems. REGISTRATION: PROSPERO (CRD42022306665).

Impact of fixed orthodontic retainers on oral health-related quality of life: a longitudinal prospective study

ABSTRACT Objective: The aim of the present study was to assess the impact of orthodontic retainers on oral health-related quality of life (OHRQoL) in the short and long terms after orthodontic treatment. Methods: Data from 45 patients up to three years after orthodontic treatment (T0) were analyzed. Patients were reassessed four years (T1) after T0. OHRQoL was measured using the OHIP-14 (Oral Health Impact Profile-14) questionnaire. The presence of a fixed retainer in the upper and/or lower arches, sex, and age were the predictive variables evaluated at T0 and T1. The occurrence of retainer fracture at T0 was clinically evaluated. Due to the COVID-19 pandemic, clinical examination on T1 was not possible, so the OHIP-14 and the self-perception of changes in teeth position and fracture of retainers were examined using an on-line questionnaire. Results: At the initial examination, the presence of upper retainers had a negative impact on quality of life (p=0.018). The OHIP-14 value increased significantly from T0 to T1 (p=0.014), regardless of the presence of retainers. The fracture or debonding of the retainer reported by the patient was the only variable that had a negative impact on OHRQoL (p=0.05). Conclusion: The use of fixed upper retainers suggests a negative impact on the quality of life of the orthodontic patient after the end of orthodontic treatment. This impact, however, is negligible in the long term, except when associated with fracture or debonding. This study emphasizes the need for continuous follow-up of orthodontic patients during the retention period.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o impacto das contenções ortodônticas na qualidade de vida relacionada à saúde bucal (QVRSB) em curto e longo prazos após o tratamento ortodôntico. Métodos: Foram analisados dados de 45 pacientes até três anos após o tratamento ortodôntico (T0). Os pacientes foram reavaliados quatro anos (T1) após T0. A QVRSB foi mensurada usando o questionário OHIP-14 (Oral Health Impact Profile-14). A presença da contenção fixa nas arcadas superior e/ou inferior, o sexo e a idade foram as variáveis preditoras em T0 e T1. A ocorrência de quebra da contenção em T0 foi avaliada clinicamente. Em razão da pandemia da COVID-19, não foi possível o exame clínico em T1; assim, a autopercepção das alterações na posição dos dentes e a quebra ou descolagem das contenções foram registradas por meio de um questionário online. Resultados: No exame inicial, a presença da contenção superior apresentou um impacto negativo na qualidade de vida (p=0,018). Em T1, o valor de OHIP-14 aumentou significativamente em comparação a T0 (p=0,014), independentemente da presença das contenções. A quebra ou descolagem da contenção relatada pelo paciente foi a única variável que apresentou um impacto negativo na QVRSB (p=0,05). Conclusão: O uso de contenção fixa superior sugere um impacto inicial negativo na qualidade de vida do paciente após o fim do tratamento ortodôntico. Esse impacto, entretanto, é insignificante em longo prazo, exceto quando associado à descolagem ou quebra das contenções ortodônticas. Esse estudo enfatiza a necessidade de acompanhamento contínuo das contenções fixas após a finalização do tratamento ortodôntico.

Self-correction of the ectopic eruption of the maxillary first permanent molar and its predictive factors: A systematic review.

BACKGROUND: Ectopic eruption of the maxillary first permanent molar is a local disturbance that affects the development of the occlusion. AIM: To evaluate the occurrence of self-correction of maxillary first permanent molar's ectopic eruption and its predictive factors. DESIGN: Five electronic databases and part of the gray literature were investigated. The risk of bias was assessed using the Newcastle-Ottawa scale and the certainty of evidence using the GRADE tool. RESULTS: Four studies were selected: Three had a low risk of bias, and one, moderate. Evidence with a moderate level of certainty was generated, indicating a possibility of 47%-78% of spontaneous correction up to 7 years of age. Supporting the prognosis, whether reversible or irreversible, there was a positive correlation between the severity of the atypical distal resorption of the second primary molar, a higher magnitude of impaction, a larger eruption angle, and a bilateral occurrence with the irreversibility of the cases. CONCLUSION: Spontaneous correction of the ectopic eruption of the maxillary first permanent molar is feasible and dependent on the severity of predictive factors. Early intervention is mandatory in irreversible cases.

Is teledentistry effective to monitor the evolution of orthodontic treatment? A systematic review and meta-analysis.

INTRODUCTION: With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments. OBJECTIVE: To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment. MATERIAL AND METHODS: Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed. RESULTS: Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low. CONCLUSION: With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = -2.75[-3.95, -1.55]; I2=41%; p<0.00001) and the time for starting refinement (mean difference = -1.21[-2.35, -0.08]; I2=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.

Self-correction of posterior crossbite in childhood: a systematic review of long-term follow-up studies.

BACKGROUND: The concept that posterior crossbite is not self-correcting has been controversial in the literature. OBJECTIVE: To evaluate the incidence of self-correction of crossbite in different stages of dentition in childhood. SEARCH METHODS AND SELECTION CRITERIA: A bibliographic search using the acronym PECOS was performed in five databases and in partial grey literature. Studies evaluating children with posterior crossbite in the deciduous or mixed dentition at initial examination and followed for at least 3 years were included. DATA COLLECTION AND ANALYSIS: The data extraction of the studies included presents information on authorship, clinical characteristics, main results, and conclusions. The risk of bias in the studies was evaluated through the Joanna Briggs Institute tool. The certainty of the evidence was assessed using the GRADE tool. RESULTS: Among the 3045 references identified, seven cohort studies met the eligibility criteria. The studies evaluated patients in transition from deciduous to mixed, mixed to permanent, and deciduous to mixed dentition. Two studies had a low risk of bias, three had a moderate risk, and two had a high risk of bias. The results showed posterior crossbite self-correction frequencies ranging from 12.2 to 77.1% during the transition from primary to mixed dentition, approximately 16% from mixed to permanent dentition, and a range from 20 to 82.8% from deciduous to permanent dentition. The level of certainty of the evidence generated ranged from very low to moderate. LIMITATIONS: The observational design of the studies, without adequate control for confounding factors, and non-classification of the samples considering the types or the severity of the posterior crossbite. CONCLUSION: The self-correction of posterior crossbite in childhood is possible. However, the results of this research do not allow to affirm how often the self-correction of posterior crossbite can occur. New studies that assess factors associated with the occurrence of self-correction of this malocclusion, including oral habits, may increase the certainty of the evidence. REGISTRATION: PROSPERO CRD42022311935.

Spontaneous changes in mandibular incisor crowding from mixed to permanent dentition: a systematic 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.

Effect of the quality of orthodontic finishing on the stability of anterior tooth alignment.

OBJECTIVES: To evaluate whether the quality of orthodontic finishing influences long-term stability of anterior tooth alignment. MATERIALS AND METHODS: This retrospective study evaluated 38 patients. Data were obtained at the beginning of treatment (T0), at the end (T1), and at least 5 years after T1 (T2). At this point, the individuals were no longer wearing retainers. Anterior tooth alignment was measured using Little's index (LI). Effect on alignment stability was tested with multiple linear regression using LI-T0, LI-T1, intercanine width difference T1-T0, overbite (T1), overjet (T1), age, gender, time without retention, and presence of third molars as predictor variables. Well-aligned (LI < 1.5 mm) and misaligned (LI > 1.5 mm) cases were compared at T2. RESULTS: At T2, the alignment stability in the upper arch was inversely associated with the alignment quality (R2 = 0.378, P < .001) and directly associated with overbite (R2 = 0.113, P = .008) at T1. Posttreatment changes caused cases finished with poor alignment to become similar to those finished with excellent alignment (P = .917). In the mandible, posttreatment changes were directly associated only with overjet (R2 = 0.152, P = .015) and well-finished cases displayed better alignment than poorly finished cases (P = .011). Other variables showed no significant association. CONCLUSIONS: In arches without retention, better quality of orthodontic finishing does not guarantee the stability of anterior alignment. In the maxilla, long-term changes were more significant the greater the overbite and the better the quality of alignment at end of treatment. In the mandible, changes were not dependent on the quality of finishing but were associated with greater overbite at T2.

Can lingual spurs alter the oral health-related quality of life during anterior open bite interceptive treatment? A systematic review.

INTRODUCTION: The use of lingual spurs has been described as one efficient option, with great stability of results, but with scarce information of toleration for use in the mixed and permanent dentition phases. OBJECTIVE: The purpose of this study was to assess the impact of lingual spurs on the oral health-related quality of life of children and/or adolescents during anterior open bite treatment. METHODS: The review was recorded in the PROSPERO database. Eight electronic databases and partial gray literature were searched, without restrictions until march 2022. A manual search was also performed in the references of the included articles. Studies assessing the impact of lingual spurs on the oral health-related quality of life were included. Risk of bias was assessed using JBI or ROBINS-I tool, according to the study design. The level of evidence was assessed through GRADE. RESULTS: Five studies met the eligibility criteria. Two non-randomized clinical trials had a serious risk of bias. Of the case-series studies, two had a low risk of bias and the other, a moderate risk of bias. The certainty of the evidence was classified as very low for all the evaluated results. In general, the studies reported an initial negative impact with the use of lingual spurs, however this was transitory in nature. A quantitative analysis was not performed due to the great heterogeneity between the studies. CONCLUSION: Current evidence, although limited, suggests that lingual spurs have an initial transient negative impact during interceptive treatment. Additional well-conducted randomized clinical trials are needed.

Can lingual spurs alter the oral health-related quality of life during anterior open bite interceptive treatment? A systematic review

ABSTRACT Introduction: The use of lingual spurs has been described as one efficient option, with great stability of results, but with scarce information of toleration for use in the mixed and permanent dentition phases. Objective: The purpose of this study was to assess the impact of lingual spurs on the oral health-related quality of life of children and/or adolescents during anterior open bite treatment. Methods: The review was recorded in the PROSPERO database. Eight electronic databases and partial gray literature were searched, without restrictions until march 2022. A manual search was also performed in the references of the included articles. Studies assessing the impact of lingual spurs on the oral health-related quality of life were included. Risk of bias was assessed using JBI or ROBINS-I tool, according to the study design. The level of evidence was assessed through GRADE. Results: Five studies met the eligibility criteria. Two non-randomized clinical trials had a serious risk of bias. Of the case-series studies, two had a low risk of bias and the other, a moderate risk of bias. The certainty of the evidence was classified as very low for all the evaluated results. In general, the studies reported an initial negative impact with the use of lingual spurs, however this was transitory in nature. A quantitative analysis was not performed due to the great heterogeneity between the studies. Conclusion: Current evidence, although limited, suggests that lingual spurs have an initial transient negative impact during interceptive treatment. Additional well-conducted randomized clinical trials are needed.

RESUMO Introdução: O uso de esporões linguais tem sido descrito como uma opção eficiente, com grande estabilidade de resultados, mas com poucas informações quanto à tolerância de seu uso nas fases de dentição mista e permanente. Objetivo: O objetivo deste estudo foi avaliar o impacto dos esporões linguais na qualidade de vida relacionada à saúde bucal de crianças e/ou adolescentes durante o tratamento da mordida aberta anterior. Métodos: Essa revisão foi registrada no banco de dados PROSPERO. Oito bases de dados eletrônicas e parte da literatura cinzenta foram pesquisadas, sem restrições, até março de 2022. Uma busca manual também foi realizada nas referências dos artigos incluídos. Estudos avaliando o impacto dos esporões linguais na qualidade de vida relacionada à saúde bucal foram incluídos. O risco de viés foi avaliado usando a ferramenta JBI ou ROBINS-I, de acordo com o desenho do estudo. O nível de evidência foi avaliado por meio do GRADE. Resultados: Cinco estudos preencheram os critérios de elegibilidade. Dois ensaios clínicos não randomizados apresentaram sério risco de viés. Dos estudos de série de casos, dois tiveram baixo risco de viés e o outro, risco moderado de viés. A certeza da evidência foi classificada como muito baixa para todos os resultados avaliados. Em geral, os estudos relataram um impacto negativo inicial com o uso dos esporões linguais; porém, de caráter transitório. Não foi realizada análise quantitativa, devido à grande heterogeneidade entre os estudos. Conclusão: As evidências atuais, embora limitadas, sugerem que os esporões linguais têm um impacto negativo transitório inicial durante o tratamento interceptativo. São necessários mais ensaios clínicos randomizados bem conduzidos.

Orthodontic aligners: between passion and science

ABSTRACT Introduction: The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. Methods: Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. Conclusions: There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.

RESUMO Introdução: As vantagens e desvantagens do uso de alinhadores ortodônticos têm sido reportadas com base mais na experiência clínica e opinião de experts do que em evidências científicas. Outro aspecto importante é que os alinhadores estão em processo de evolução constante. Assim, torna-se importante obter evidências recentes, que abranjam as novas atualizações na tecnologia de confecção, no desenvolvimento de novos protocolos de planejamento para as movimentações, a incorporação e desenho dos attachments e o auxílio da ancoragem esquelética. Métodos: As evidências encontradas em seis bases de dados eletrônicas (CINAHL, MEDLINE, EMBASE, Psych Info, Biblioteca Cochrane e Biblioteca Joanna Briggs) serão apresentadas por meio de perguntas e respostas. Conclusões: Há evidências de que os alinhadores apresentam diferentes níveis de dificuldade para realizar cada tipo de movimento, sendo os movimentos rotacionais e verticais os mais difíceis de serem executados. Quanto à percepção da dor causada pela movimentação dentária, parece haver menos impacto no início do tratamento, mas os alinhadores produzem mais alterações fonoarticulatórias e parecem exigir mais tempo de tratamento em casos mais complexos. Não há evidência de diferença na estabilidade pós-tratamento, e os alinhadores não impedem a ocorrência de reabsorção radicular, apesar da incidência e a gravidade da reabsorção poderem ser menores, facilitam a higiene bucal, reduzindo o risco de manchas brancas, cáries e doenças periodontais. Dada a evidência conflitante, a liberação de bisfenol-A pelo alinhador não pode ser negada. É preciso encontrar soluções que reduzam o impacto ambiental do descarte dos alinhadores. Há uma necessidade urgente de ensaios clínicos randomizados bem desenhados.

Is teledentistry effective to monitor the evolution of orthodontic treatment? A systematic review and meta-analysis

ABSTRACT Introduction: With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments. Objective: To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment. Material and Methods: Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed. Results: Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low. Conclusion: With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = −2.75[−3.95, -1.55]; I2=41%; p<0.00001) and the time for starting refinement (mean difference = −1.21[−2.35, -0.08]; I2=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.

RESUMO Introdução: Com o advento da COVID-19, a teleodontologia e o monitoramento remoto tornaram-se uma realidade iminente, permitindo ao ortodontista acompanhar o tratamento ortodôntico por meio de checkups virtuais, que complementam as consultas presenciais. Objetivo: Avaliar a eficácia do uso da teleodontologia no acompanhamento da evolução do tratamento ortodôntico. Material e Métodos: Buscas foram realizadas em bases de dados on-line. A estratégia PECO focou na comparação de pacientes ortodônticos expostos e não expostos à teleodontologia. As buscas e a extração dos dados seguiram a metodologia PRISMA. A avaliação do risco de viés e da certeza da evidência foi realizada com as ferramentas ROBINS-I e GRADE, respectivamente. Uma metanálise também foi realizada. Resultados: Dos 1.178 estudos encontrados, 4 atenderam aos critérios e foram incluídos na análise qualitativa. O risco de viés para a avaliação do acompanhamento de tratamentos com alinhadores foi baixo a moderado; enquanto para o tratamento interceptativo, foi alto. Os estudos são favoráveis ao uso da teleodontologia. A meta-análise foi realizada apenas com estudos de alinhadores, devido à heterogeneidade. A certeza da evidência foi considerada muito baixa. Conclusão: Com muito baixo nível de certeza da evidência, a teleodontologia utilizando o software Dental Monitoring® é eficaz para auxiliar no acompanhamento da evolução do tratamento ortodôntico interceptativo (alto risco de viés) e, principalmente, do tratamento realizado com alinhadores (risco de viés baixo a moderado). A metanálise evidenciou redução no número de atendimentos presenciais (diferença média = −2,75[−3,95, -1,55]; I2=41%; p<0,00001) e no tempo para início do refinamento (diferença média = −1,21[−2,35, -0,08]; I2=49%; p=0,04). Estudos randomizados adicionais avaliando o tratamento ortodôntico corretivo com braquetes e fios são bem-vindos.

Orthodontic Retainers and the Stability of the Maxillary Arch in Unilateral Cleft lip and Palate Patients: A Systematic Review.

OBJECTIVE: The aim of this systematic review was to elucidate the role of orthodontic retainers on the stability of compensatory orthodontic treatment in patients with unilateral cleft lip and palate. METHODS: Five electronic databases (PubMed, Scopus, Web of Science, LILACS, and LIVIVO) and the grey literature (OpenGrey and Google Scholar) were investigated, according to the population, exposure, comparator, outcomes and Study design eligibility criterion. The risk of bias assessment was determined based on the Risk of Bias In Nonrandomized Studies of Exposure (ROBINS-E) and the level of evidence with the GRADE tool. RESULTS: Three studies were included: two presented moderate risk of bias and one high. A moderate level of evidence revealed a mean value of 0.6 mm of intercanine relapse distance, and great variability between the data, regardless of the use or type of retention or rehabilitation. Relapse in the posterior region showed clinical significance, from -1 to -1.7 mm, especially in individuals who did not use retention, except in patients with symmetrical arches with Hawley retainer, where this value varies from -0.2 ± 0.63 mm. CONCLUSIONS: Orthodontic retainers do not seem essential to prevent relapse at anterior maxillary dimensions after compensatory orthodontic treatment in patients with unilateral cleft lip and palate. Relapse in the posterior region can achieve greater clinical significance, which highlights the need for prolonged use of Hawley retainers and periodic evaluation of the stability of treatment results. Prospective studies with a longer follow-up can improve the certainty of the evidence.

The impact of COVID-19 pandemic on total treatment time of fixed appliances.

BACKGROUND: Several aspects of the orthodontic routine seem to have been affected since the emergence of SARS-CoV-2. We aimed to evaluate the impact of the COVID-19 pandemic on the duration of fixed orthodontic treatment. METHODS: This retrospective study evaluated consecutive cases of patients undergoing fixed orthodontic treatment that completed treatment before (n = 37) or during (n = 26) the COVID-19 pandemic. The impact of the pandemic on treatment time was adjusted for the patient's initial age, sex, number of debonds/breakages, number of missing teeth, initial PAR (Peer Assessment Rating) index (T0) and operator (n = 2), through multiple linear regression. The impact generated by months of treatment conducted during the pandemic period was also examined. Seven poorly finished cases were previously excluded, including five finished during the pandemic. RESULTS: Although the number of absences/missed appointments of patients treated during the pandemic was four months more than those treated in the previous period (p < 0.001), there was no significant effect of the pandemic on total orthodontic treatment time for both operators. There was also an effect of operator (ß = 10.42, p < 0.001) and gender, which was lower in females (ß = 4.77, p = 0.03), on treatment time (R2 = 0.27). The other variables showed no significant association (p > 0.05). CONCLUSION: The COVID-19 pandemic did not have a significant effect on total orthodontic treatment time, although a greater number of absences/missed appointments were observed.

The impact of the loss of first permanent molars on the duration of treatment in patients treated with orthodontic space closure and without skeletal anchorage.

BACKGROUND: This study aims to evaluate the impact of the loss of permanent molars on the duration of orthodontic treatment for space closure and without skeletal anchorage. METHODS: Records at the beginning (T0) and the end (T1) of orthodontic treatment were selected retrospectively. Patients were divided into two groups: loss of molar (n = 19) and control, without loss (n = 24). The impact of loss on treatment time was assessed using multiple linear regression adjusted for the number of absences, bonding failures, age, sex, PAR index at T0 and T1 at p<0.05. Treatment time was also evaluated by the number of losses and which arches were involved (upper, lower). The systematic and random errors for the PAR index were verified using the intraclass correlation coefficient (ICC) and the Dahlberg formula, respectively. RESULTS: A small random error (1.51) and excellent replicability (ICC = 99.6) were observed. Overall average treatment time was 22.5 months (± 7.95) for the group without loss and 44.7 months (± 17.3) with a loss. Treatment time was longer in cases where there was a higher number of missing molars and when both arches were involved. In addition to the loss (ß = 4.25, p < 0.001), the number of missed appointments (ß = 2.88, p < 0.001) had a significant effect and increased treatment time. Bonding failures, gender, age, and PAR index at T0 and T1 were not significantly associated with treatment time in the multivariate model (p > 0.05). CONCLUSION: Loss of the first permanent molar has a negative impact on orthodontic treatment time in cases of space closure. The treatment time is longer when there are more tooth losses and arches involved. Treatment time also increases with greater numbers of missed clinical appointments.

Effects of oral appliances on serum cytokines in adults with obstructive sleep apnea: a systematic review.

PURPOSE: This review aimed to evaluate the effects of oral appliance (OA) therapy on serum inflammatory cytokines in adults diagnosed with obstructive sleep apnea (OSA). METHODS: Seven electronic databases and partial gray literature were searched without restrictions through March 2021. Articles evaluating the levels of serum inflammatory cytokines in patients with OSA after OA treatment were included. The risk of bias (RoB) was assessed using the before-and-after tool or RoB 2.0. The level of certainty was assessed using the GRADE tool. RESULTS: Five studies met the eligibility criteria. One was a randomized clinical trial (RCT), while four were non-randomized clinical trials (NRCTs). Among the studies, C-reactive protein (CRP), IL-6, IL-10, IL-1ß, and tumor necrosis factor α (TNF-α) were investigated. The RCT reported no significant differences in marker levels after 2 months of OA therapy, while the NRCTs showed improvement on CRP, TNF-α, and IL-1ß levels after longer follow-up periods. The RoB was evaluated as showing some concern in the RCT. Three NRCTs presented good RoB, and one showed a fair RoB. The level of certainty was graded as moderate quality for inflammatory marker levels assessed in the RCT The levels of certainty evaluated in NRCTs were classified as very low. CONCLUSIONS: Although limited, existing scientific evidence showed that OA therapy may improve serum cytokine levels in adults with OSA. However, short treatment periods are not effective in reducing markers of systemic inflammation which may require extended time and a decrease of in apneic events to improve.