Association between genetic variants in key vitamin-D-pathway genes and external apical root resorption linked to orthodontic treatment.

This study evaluated the association between single-nucleotide polymorphisms (SNPs) in vitamin-D-related genes and the amount of external apical root resorption linked to orthodontic treatment. One hundred and forty-three individuals were assessed. The amount of external apical root resorption of upper central incisors (EARRinc ) and lower first molars (EARRmol ) were evaluated in radiographs. Seven SNPs were genotyped across four genes including the vitamin D receptor [VDR], group-specific component [GC], cytochrome P450 family 27 subfamily B member 1 [CYP27B1], and cytochrome P450 family 24 subfamily A member 1 [CYP24A1]. Linear regressions were implemented to determine allele-effects on external apical root resorption. Individuals carrying the AA genotype in VDR rs2228570 had a 21% higher EARRmol than those having AG and GG genotypes (95% CI: 1.03,1.40). EARRmol in heterozygous rs2228570, was 12% lower than for homozygotes (95%CI: 0.78,0.99). Participants with the CCG haplotype (rs1544410-rs7975232-rs731236) in VDR had an EARRmol 16% lower than those who did not carry this haplotype. Regarding CYP27B1 rs4646536, EARRinc in participants who had at least one G allele was 42% lower than for homozygotes AA (95%CI: 0.37,0.93). Although these results did not remain significant after multiple testing adjustment, potential associations may still be suggested. Further replication studies are needed to confirm or refute these findings.

Particle Size, Mass Concentration, and Microbiota in Dental Aerosols.

Many dental procedures are considered aerosol-generating procedures that may put the dental operator and patients at risk for cross-infection due to contamination from nasal secretions and saliva. This aerosol, depending on the size of the particles, may stay suspended in the air for hours. The primary objective of the study was to characterize the size and concentrations of particles emitted from 7 different dental procedures, as well as estimate the contribution of the nasal and salivary fluids of the patient to the microbiota in the emitted bioaerosol. This cross-sectional study was conducted in an open-concept dental clinic with multiple operators at the same time. Particle size characterization and mass and particle concentrations were done by using 2 direct reading instruments: Dust-Trak DRX (Model 8534) and optical particle sizer (Model 3330). Active bioaerosol sampling was done before and during procedures. Bayesian modeling (SourceTracker2) of long-reads of the 16S ribosomal DNA was used to estimate the contribution of the patients' nasal and salivary fluids to the bioaerosol. Aerosols in most dental procedures were sub-PM1 dominant. Orthodontic debonding and denture adjustment consistently demonstrated more particles in the PM1, PM2.5, PM4, and PM10 ranges. The microbiota in bioaerosol samples were significantly different from saliva and nasal samples in both membership and abundance (P < 0.05) but not different from preoperative ambient air samples. A median of 80.15% of operator exposure was attributable to sources other than the patients' salivary or nasal fluids. Median operator's exposure from patients' fluids ranged from 1.45% to 2.75%. Corridor microbiota showed more patients' nasal bioaerosols than oral bioaerosols. High-volume saliva ejector and saliva ejector were effective in reducing bioaerosol escape. Patient nasal and salivary fluids are minor contributors to the operator's bioaerosol exposure, which has important implications for COVID-19. Control of bioaerosolization of nasal fluids warrants further investigation.

Perioral muscle activity changes after Lip Bumper treatment.

AIM: This prospective non-randomised case-control study analysed lip muscle activity after Lip Bumper (LB) treatment thought surface electromyography. METHODS: The study group was composed of 40 young patients with a mean age of 10 years and 1 month, treated with LB in the lower arch, while 40 children who did not undergo any treatment, matched for sex and age with the previous sample, constituted the control group. Measurements were performed at the beginning and after 1 year for both groups. Electromyographic recordings were obtained in rest position and during the swallowing of 50 ml of water. RESULTS: In the study group, after 1 year of LB treatment, a statistically significant decrease in values was found; specifically, in upper lip muscle activities at rest position with the appliance in situ (p <0.002) and both with (p <0.001) and without (p <0.001) the appliance for the lower lip. CONCLUSION: One year of LB treatment significantly reduced lip muscle activities at both rest position and during swallowing compared with the untreated sample. These results indicated a potential short-term of upper and lower lip muscle adaptation to the new balance induced by LB treatment.

Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children.

INTRODUCTION: Evidence from the adult population suggests that sleep-disordered breathing (SDB) (i.e., obstructive sleep apnea [OSA]) is negatively associated with bone mineral density. Whether a similar association exists in children with SDB has not been investigated. Using the mandibular cortical width (MCW) as a proxy for skeletal bone density, we investigated if children at risk of SDB or diagnosed with OSA have a reduced mandibular cortical width compared to children without SDB. METHODS: Two retrospective cross-sectional studies were performed. The first study included comparison of MCW between 24 children with polysomnographically (PSG) diagnosed OSA and 72 age- and sex-matched control children. The second study included a cohort of children in which SDB was suggested by the Pediatric Sleep Questionnaire (PSQ) ( n = 101). MCW was measured from panoramic radiographs. RESULTS: Multiple-predictors regression analysis from the first study indicated that in children with a severe form of SDB, as induced by OSA severity, there was a negative association with MCW (ß = -0.290, P = 0.049). Moreover, PSG-diagnosed OSA children had thinner MCW (2.9. ± 0.6mm) compared to healthy children (3.5 ± 0.6 mm; P = 0.002). These findings were further supported by the second study illustrating that PSQ total scores were negatively associated with MCW (ß = -0.391, P < 0.001). CONCLUSIONS: Findings suggest that children at risk for or diagnosed with SDB exhibit reduced mandibular cortical width that purportedly may reflect alterations in bone homeostasis. KNOWLEDGE TRANSFER STATEMENT: We report that sleep-disordered breathing (including its severe form, obstructive sleep apnea) in children is associated with reduced mandibular cortical width. This association might be a direct consequence of reduced bone health to sleep-disordered breathing or a reflection that reduced bone formation underlies the development of sleep-disordered breathing. Our findings suggest that mandibular cortical width can be used as an adjunct diagnostic parameter for the diagnosis of sleep-disordered breathing.

Secondary alveolar bone grafting using autologous versus alloplastic material in the treatment of cleft lip and palate patients: systematic review and meta-analysis.

BACKGROUND: A systematic review assessing autologous versus alloplastic bone for secondary alveolar bone grafting in patients with cleft lip and palate was published in 2011 and included only one randomized controlled trial comparing traditional iliac bone graft to recombinant human bone morphogenetic protein-2 (rh-BMP2). OBJECTIVES: To perform a systematic review with meta-analysis on the use of secondary alveolar bone grafting (autologous bone and rh-BMP2 graft) in order to improve bone volume and height in patients with cleft lip and palate. DATA SOURCES: An electronic search was conducted via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CONTROL) via Cochrane Library, EMBASE via Ovid, and LILAC for studies published between January 2008 and September 2018. The systematic review registration number at PROSPERO was 42018085858. ELIGIBILITY CRITERIA: Only RCTs were included. Inclusion criteria were patients with the diagnosis of unilateral cleft lip and palate older than 5 years of age, radiographic evaluation (CT and/or CBCT) of the cleft area, and at least a 6-month follow-up. MAIN OUTCOME MEASURES: Bone formation and bone height by radiographic CT evaluation (preoperatively, after 6 months and after 1 year of follow-up) and length of hospital stay were assessed. RESULTS: Four studies met strict inclusion criteria. Autologous bone graft showed statistically significant higher bone formation after 6-month follow-up (MD - 14.410; 95% CI - 22.392 to - 6.428; p = 0.000). No statistically significant difference was noted after a 1-year follow-up (MD 6.227; 95% CI - 15.967 to 28.422; p = 0.582). No statistically significant difference in bone height was noted after 6-month (MD - 18.737; 95% CI - 43.560 to 6.087; p = 0.139) and 1-year follow-up (MD - 4.401; 95% CI - 30.636 to 21.834; p = 0.742). Patients who underwent rh-BMP2 graft had a statistically significant reduced hospital stay (MD - 1.146; 95% CI - 2.147 to - 0.145; p = 0.025). LIMITATIONS: The main limitation is the high risk of bias among included studies. CONCLUSION: Autologous bone and rh-BMP2 graft showed a similar effectiveness in maxillary alveolar reconstruction in patients with unilateral cleft lip and palate assessing bone graft volume and height although rh-BMP2 graft showed a relative shorter length of hospital stay (high uncertainty level).

Maxillary osteotomy complications in piezoelectric surgery compared to conventional surgical techniques: a systematic review.

A systematic review was conducted to investigate the available evidence on maxillary complications related to piezoelectric and conventional surgery. Seven databases were searched. A total of 996 maxillary osteotomies were analysed, 864 performed with conventional tools and 132 with a piezoelectric device. One hundred and fifty-six complication events were reported. The complications, in descending order of overall prevalence, were as follows: neurosensory disturbance (64.7%), haemorrhage (8.3%), oroantral communication (7.7%), soft tissue injury (7.7%), tooth injury (5.1%), infection (3.2%), osteonecrosis (1.9%), and permanent nerve injury (1.3%). Among the complications, the results showed the highest prevalence for neurosensory disturbance, and haemorrhage was the most reported complication and the second most prevalent complication. A three-fold meta-analysis was performed. Using GRADEpro, the level of evidence was determined for each complication. The current low level of evidence suggests that piezoelectric bone surgery reduces critical and important complications during maxillary osteotomy procedures, such as neurosensory disturbance, haemorrhage, oroantral communication, tooth injury, and permanent nerve injury. However, an effective comparison between the two techniques was difficult to perform with the current available literature. Due to the small sample sizes in the piezoelectric surgery studies, caution should be exercised when considering almost non-existent reported complications.

Malocclusion prevention through the usage of an orthodontic pacifier compared to a conventional pacifier: a systematic review.

AIM: This was to investigate the occurrence of malocclusion traits among children who were users of orthodontic or conventional pacifier by means of a systematic review. METHODS: Search for articles involved five electronic databases: Latin American and Caribbean Health Sciences (LILACS), PsycINFO, PubMed (including MedLine), Scopus and Web of Science. Grey literature was partially assessed. Observational studies with children aged 6-60 months who had used orthodontic or conventional pacifier were included. The risk of bias among included studies was assessed through the Joanna Briggs Institute Tool. RESULTS: From the 607 initially-identified papers only three were included after the selection process. All presented moderate risk of bias. Although an anterior open bite and accentuated overjet were identified among conventional users of pacifier in one study no differences were identified in the other two selected studies. Posterior crossbite frequency was not different in any of the included studies. There was also no difference regarding frequency and duration of use, except in the study that showed higher occurrence of open bite malocclusion in conventional pacifier users. CONCLUSIONS: The currently available evidence is insufficient to support the concept that the usage of orthodontic pacifiers is able to prevent malocclusion traits when compared to the usage of conventional pacifiers.

Association between chewing dysfunctions and temporomandibular disorders: A systematic review.

Temporomandibular disorder (TMD) is an umbrella condition presenting several signs and symptoms including pain in the temporomandibular joint (TMJ) and masticatory muscles, articular noises, earache, headache, irregular or restricted jaw function, chewing difficulty, and limited mouth opening. Such TMD impairment may cause disorders during the chewing process. Therefore, the purpose of this systematic review was to assess chewing dysfunctions measured by sEMG, and their association with TMD. A combination and variation in the descriptors "temporomandibular joint disorders", "masticatory dysfunctions", and electromyography were used to perform the searches across databases. The databases chosen were: LILACS, PubMed, Science Direct, Scopus, and Web of Science. Additionally, grey literature was assessed using Google Scholar, ProQuest, and OpenGrey. Studies in adults that diagnosed TMD through the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Helkimo Protocol were selected. Furthermore, those studies should have evaluated chewing processes through surface electromyography (sEMG). Risk of bias of the included studies was assessed through the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool. Eleven included studies shown significant results; however, they evaluated discrepant parameters, presented high inconsistency in the application, and had chosen different tasks to analyse the sEMG and hence, there was no consensus in the results of studies. In conclusion, strength of recommendations was very low due to a series of limitations on studies and it was not possible to made categorical statement about association between TMD and chewing dysfunctions in adults when parameters of sEMG were analysed.

Influence of occlusal characteristics, food intake and oral hygiene habits on dental caries in adolescents: a cross-sectional study.

AIM: Dental caries is one of the most common oral diseases affecting children. The complex multifactorial aetiology of caries involves host (saliva composition and tooth enamel characteristics), oral microflora and substrate (oral hygiene quality and dietary habits composition). Occlusal characteristics may be also a factor in dental caries development. The aim of this aepidemiologic study was to verify the association between DMFT (Decayed, Missed, Filled Teeth) index and occlusal characteristics, dietary habits, oral hygiene habits and parents' education level in a sample of 12-year-old schoolchildren from Southern Italy. MATERIALS AND METHODS: A sample of 536 children was examined to detect dental caries status and several occlusal variables (i.e. molar relationship, overjet and overbite, presence of crossbite, scissor bite, crowding, diastemas and/or midline deviation). A questionnaire to retrieve parents' educational level, patient's dietary and oral hygiene habits was administered. The associations among these variables were assessed statistically through the ?2 test. RESULTS: A positive association was found between caries, parents' social status and some occlusal disorders. va specificato, l'abstract non può essere una caccia al tesoro. In relation to occlusal variables, crossbite (?2=3.96, P=0.04) was significantly associated to caries. A significant association was also found between the education level of mothers (?2=7.74, P<0.01) and fathers (?2=6.35, P=0.01) and the presence of caries. Dietary habits, oral hygiene and remaining occlusal characteristics were not associated with caries presence (all P>0.05). CONCLUSIONS: Of the evaluated occlusal characteristics only posterior crossbite was associated with caries prevalence. Education level of the parents was the other factor significantly associated with caries. Dietary habits, oral hygiene frequency and the remaining occlusal characteristics were not associated with dental caries.

Association between psychotropic medications and presence of sleep bruxism: A systematic review.

The purpose of this study was to systematically review the literature for studies that investigated the association between use of psychotropic medications and presence of sleep bruxism (SB). Observational studies were selected in a two-phase process. Searches were performed on six electronic databases, and a grey literature search was conducted on three databases. SB diagnosis was based on questionnaires or clinical examinations; no polysomnography examinations were performed. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Overall quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation criteria. Five analytical cross-sectional studies were included, evaluating antidepressants, anticonvulsants and psychostimulants. One study was judged as low risk of bias, three as moderate risk and one high risk. Antidepressants were evaluated in adult populations only; duloxetine (Odds Ratio [OR] = 2.16; 95% Confidence Interval [95% CI] = 1.12-4.17), paroxetine (OR = 3.63; 95% CI = 2.15-6.13) and venlafaxine (OR = 2.28; 95% CI = 1.34-3.86) were positively associated with SB risk. No increased odds of SB were observed considering use of citalopram, escitalopram, fluoxetine, mirtazapine and sertraline. With regard to anticonvulsants, only barbiturates were associated with SB in children (OR = 14.70; 95% CI = 1.85-116.90), while no increased odds were observed for benzodiazepine, carbamazepine and valproate. The only psychostimulant evaluated was methylphenidate, and an association with SB was observed in adolescents (OR = 1.67; 95% CI = 1.03-2.68). Findings from this SR suggested that medications such as duloxetine, paroxetine, venlafaxine, barbiturates and methylphenidate might be associated with SB; however, overall quality of evidence was considered very low, and therefore, caution is recommended.

Effects of glucosamine supplements on painful temporomandibular joint osteoarthritis: A systematic review.

The purpose of this study was to systematically review the literature for studies that assessed the effects of glucosamine supplements (GS) on pain and maximum mouth opening (MMO) restriction compared to other therapies, placebo or no intervention on painful temporomandibular joint osteoarthritis (TMJ OA). Randomised controlled trials were selected in a two-phase process. Seven electronic databases, in addition to three grey literature databases, were searched. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Twelve potentially eligible studies were identified, from which three were finally included. Furthermore, two were categorised at low risk and one at high risk of bias. Intervention groups were treated with glucosamine-sulphate, while controls were treated with placebo or ibuprofen. In two studies, GS were equally effective regarding pain reduction and mouth opening improvement compared to ibuprofen taken two or three times a day over 12 weeks; however, one study did not find significant differences in follow-up evaluations concerning these clinical variables in both glucosamine and placebo groups administered over six weeks. There is very low evidence regarding GS therapeutic effects on TMJ OA. Considering a follow-up of 12 weeks, GS were as effective as ibuprofen taken two or three times a day. However, over six weeks of medication intake, GS were not superior to placebo. Still, included studies presented major drawbacks, and therefore, conclusions must be interpreted with caution.

Application of the advanced system for implant stability testing (ASIST) to natural teeth for noninvasive evaluation of the tooth root interface.

In this paper we present the development of the Advanced System for Implant Stability Testing (ASIST) for application to natural teeth. The ASIST uses an impact measurement combined with an analytical model of the system and surrounding support to provide a measure of the interface stiffness. In this study, an analytical model is developed for a single-rooted natural tooth allowing the ASIST to estimate the stiffness characteristics of the periodontal ligament (PDL). The geometry and inertia parameters of the tooth model are presented in two ways: (1) using full CT scans of the individual tooth and (2) using an approximate geometry model with estimates of only the tooth length and diameter. The developed system is evaluated with clinical data for patients undergoing orthodontic treatment. This study shows that ASIST technique can be applied to natural teeth to estimate the stiffness characteristics of the PDL. The developed system can provide a valuable clinical tool for assessment of tooth stability properties and PDL stiffness in a variety of clinical situations such as dental trauma, orthodontics, and periodontology.

Impact of Selection Bias on Treatment Effect Size Estimates in Randomized Trials of Oral Health Interventions: A Meta-epidemiological Study.

Emerging evidence suggests that design flaws of randomized controlled trials can result in over- or underestimation of the treatment effect size (ES). The objective of this study was to examine associations between treatment ES estimates and adequacy of sequence generation, allocation concealment, and baseline comparability among a sample of oral health randomized controlled trials. For our analysis, we selected all meta-analyses that included a minimum of 5 oral health randomized controlled trials and used continuous outcomes. We extracted data, in duplicate, related to items of selection bias (sequence generation, allocation concealment, and baseline comparability) in the Cochrane Risk of Bias tool. Using a 2-level meta-meta-analytic approach with a random effects model to allow for intra- and inter-meta-analysis heterogeneity, we quantified the impact of selection bias on the magnitude of ES estimates. We identified 64 meta-analyses, including 540 randomized controlled trials analyzing 137,957 patients. Sequence generation was judged to be adequate (at low risk of bias) in 32% ( n = 173) of trials, and baseline comparability was judged to be adequate in 77.8% of trials. Allocation concealment was unclear in the majority of trials ( n = 458, 84.8%). We identified significantly larger treatment ES estimates in trials that had inadequate/unknown sequence generation (difference in ES = 0.13; 95% CI: 0.01 to 0.25) and inadequate/unknown allocation concealment (difference in ES = 0.15; 95% CI: 0.02 to 0.27). In contrast, baseline imbalance (difference in ES = 0.01, 95% CI: -0.09 to 0.12) was not associated with inflated or underestimated ES. In conclusion, treatment ES estimates were 0.13 and 0.15 larger in trials with inadequate/unknown sequence generation and inadequate/unknown allocation concealment, respectively. Therefore, authors of systematic reviews using oral health randomized controlled trials should perform sensitivity analyses based on the adequacy of sequence generation and allocation concealment.

Breastfeeding and Oral Health: Evidence and Methodological Challenges.

Breastfeeding is a powerful health-promoting behavior. A 2016 Lancet global collaboration to review the health implications of breastfeeding was among the first to consider oral health outcomes. While a role was suggested for breastfeeding in preventing malocclusion, caries was the only included disease condition unfavorably associated with breastfeeding. The present critical review examines the evidence connecting breastfeeding practices to these outcomes and discusses the methodological challenges inherent in reaching causal conclusions. Published systematic reviews show some evidence of a protective effect of breastfeeding against primary dentition malocclusion but no supportive evidence for mixed dentition and permanent dentition malocclusions. Regarding caries, well-conducted studies report a benefit with breastfeeding up to 12 mo but a positive association between caries and breastfeeding of longer duration, at times that vary between 12 and 24 mo, as well as nocturnal feeding. Future studies would be methodologically stronger if focused on specific malocclusion traits that are plausibly associated with sucking movements rather than using general malocclusion indices. Studies should use detailed and consistent terminology for breastfeeding definition, including frequency, intensity, and timing. Analytical studies should be carried out to distinguish between confounders (e.g., prematurity) and mediators (e.g., use of pacifier). Regarding a link to caries, standard terminology for exposures (e.g., nocturnal feeding) is recommended. Statistical analyses must account for known confounding factors (e.g., socioeconomic conditions) but avoid inappropriate adjustment for variables on a causal path between exposure and outcome or for variables not associated with breastfeeding (e.g., tooth brushing), as can be guided using tools such as direct acyclic graphs. For dental practice, the potential caries risk of long-duration breastfeeding should be part of individual patient counseling that incorporates patient values and circumstances. Given the unquestioned overall health benefits of breastfeeding, the dental community should support World Health Organization guidelines that encourage and promote breastfeeding.

Association between sleep apnea and low bone mass in adults: a systematic review and meta-analysis.

We performed a systematic review of the literature to assess the association between sleep apnea and bone metabolism diseases including osteoporosis in adult population. Results from clinical trials suggest that the association between sleep apnea and low bone mass in adults is possible. INTRODUCTION: This study aimed to synthesize existing evidence on the potential association between sleep apnea and low bone mass in adults. METHODS: Electronic searches of five databases were performed. The inclusion criteria consisted of studies in humans that assessed potential associations between sleep apnea and bone metabolic diseases in an adult population. For diagnosis of sleep apnea overnight polysomnography, home polygraphy, or validated records from healthcare databases were considered. Reduced bone density, osteoporosis, serum/urinary levels for markers of bone formation and resorption, or risk of fractures caused without history of trauma were considered indicators of low bone mass. A random-effects model meta-analysis was applied when possible. RESULTS: Of the 963 relevant references, 12 studies met our inclusion criteria and were assessed to be of medium to low bias. Nine out of 12 studies reported an association between sleep apnea and low bone mass (increased bone resorption markers, reduced bone density, and higher risk of osteoporosis). Two studies did not report a significant association, whereas one study reported an increase of bone density in sleep apnea patients compared to non-sleep apnea patients. Meta-analysis of 2 studies (n = 112,258 patients) showed that sleep apnea was a significant risk factor for osteoporosis (odds ratio (OR), 1.92; 95%CI, 1.24 to 2.97; I2 = 66%); females only had an OR of 2.56 (95% CI, 1.96 to 3.34; I2 = 0%) while the OR in males was 2.03 (95% CI, 1.24 to 3.35; I2 = 38%). CONCLUSIONS: An association between sleep apnea and low bone mass in adults is plausible, but supporting evidence has a risk of bias and is inconsistent.

Pharyngeal airway changes in pre-pubertal children with Class II malocclusion after Fränkel-2 treatment.

AIM: To evaluate two-dimensional changes in pharyngeal airway dimensions in pre-pubertal children with a Class II malocclusion treated with a Fränkel-2 appliance compared to a matched non-treated control sample. MATERIALS AND METHODS: Lateral cephalograms obtained from 28 consecutively treated pre-pubertal children before (T0) and after (T1) a one-year Fränkel-2 treatment were analysed. Fränkel-2 appliance was used for at least 18 hr/day during 12 months. The control group was matched as closely as possible. All the cases presented normal facial growth pattern. Sagittal and vertical cephalometric measurements assessing maxillary and mandibular skeletal positions, as well as sagittal pharyngeal airway dimensions, were calculated. Intraclass correlation coefficient was calculated in order to determine reliability. Differences based on age for all the outcome variables at T0 were compared with an independent t-test. A MANOVA was used thereafter to determine if any factors and their interactions were associated with changes in the outcome variables. Differences between T1 and T0 were evaluated with either a t-student test or a Mann Whitney U test. RESULTS: At T0 differences between groups were noted for several variables. These differences were considered during the follow-up statistical analysis. Changes between groups after treatment (T1-T0) were noted for SNB, PNS to Ba, McNamara Low and Middle to S (increase in treatment group), and ANB and AD1 to Ba (decrease in treatment group). CONCLUSIONS: Some pharyngeal two-dimensional airway dimensions changed in Class II malocclusion pre-pubertal patients during a one-year treatment with Fränkel-2 appliances.

Normal orbit skeletal changes in adolescents as determined through cone-beam computed tomography.

BACKGROUND: To determine three-dimensional spatial orbit skeletal changes in adolescents over a 19 to 24 months observation period assessed through cone-beam computed tomography (CBCT). METHODS: The sample consisted of 50 adolescents aged 11 to 17. All were orthodontic patients who had two CBCTs taken with an interval of 19 to 24 months between images. The CBCTs were analyzed using the third-party software Avizo. Sixteen anatomical landmarks resulting in 24 distances were used to measure spatial structural changes of both orbits. Reliability and measurement error of all landmarks were calculated using ten CBCTs. Descriptive and t-test statistical analyses were used to determine the overall changes in the orbits. RESULTS: All landmarks showed excellent reliability with the largest measurement error being the Y-coordinate of the left most medial point of the temporalis grooves at 0.95 mm. The mean differences of orbital changes between time 1 and time 2 in the transverse, antero-posterior and vertical directions were 0.97, 0.36 and 0.33 mm respectively. Right to left most antero-inferior superior orbital rim distance had the greatest overall transverse change of 4.37 mm. Right most posterior point of lacrimal crest to right most postero-lateral point of the superior orbital fissure had the greatest overall antero-posterior change of 0.52 mm. Lastly, left most antero-inferior superior orbital rim to left most antero-superior inferior orbital rim had the greatest overall vertical change of 0.63 mm. CONCLUSIONS: The orbit skeletal changes in a period of 19-24 months in a sample of 11-17 year olds were statistically significant, but are not considered to be clinically significant. The overall average changes of orbit measurements were less than 1 mm.

Digital Imaging Capability for Caries Detection: A Meta-analysis.

The objective of this study was to identify the diagnostic capability of photostimulable phosphor plates (PSPs) and direct digital sensors (DDSs) in the detection of interproximal caries. Studies were identified that evaluated the diagnostic capability of PSPs and DDSs in detecting interproximal caries in human teeth, in both dentin and enamel. Histologic sections were the gold standard. This systematic review searched several electronic databases. In addition, Google Scholar and reference lists of the finally included studies were screened. QUADAS-2 was applied to evaluate the risk of bias among included studies. Six studies were finally included; 4 of which were considered homogeneous enough to conduct a meta-analysis. The meta-analysis evaluated 668 interproximal human tooth surfaces. All studies used extracted human teeth ranging from no caries present to caries into dentin. Each tooth was radiographed by both PSP and DDS technologies and then submitted for histologic analysis as the gold standard. Meta-analysis showed that intraoral digital imaging is of high specificity but low sensitivity in the detection of interproximal caries. The sensitivity and specificity for different studies with PSPs varied substantially from 15% to 54% and from 84% to 100%, respectively. Direct sensor analysis sensitivity and specificity ranged from 16% to 56% and from 90% to 100%, respectively. Newer PSP and DDS technologies had statistically significant higher sensitivities, yet the differences in diagnostic capabilities between the older and newer technologies were clinically insignificant. Both digital systems were excellent in identifying surfaces without caries (specificity) but were not sensitive enough to reliably identify interproximal surfaces with caries. Clinicians must therefore remain vigilant in performing a careful clinical examination and other diagnostic tests rather than relying solely on radiographic imaging to diagnose interproximal caries. Knowledge Transfer Statement: This study will help clinicians make an evidence-based decision when deciding which digital radiography system to use when evaluating interproximal caries. Time, patient radiation safety, cost, and image quality are factors to be considered. The performance of the different available digital imaging systems was compared with the current gold standard-a histologic analysis-via meta-analysis.

Changes in temporomandibular joint morphology in class II patients treated with fixed mandibular repositioning and evaluated through 3D imaging: a systematic review.

To estimate the effects of skeletal class II malocclusion treatment using fixed mandibular repositioning appliances on the position and morphology of the temporomandibular joint (TMJ). Two independent reviewers performed comprehensive electronic searches of MEDLINE, EMBASE, EBM reviews and Scopus (until May 5, 2015). The references of the identified articles were also manually searched. All studies investigating morphological changes of the TMJ articular disc, condyle and glenoid fossa with 3D imaging following non-surgical fixed mandibular repositioning appliances in growing individuals with class II malocclusions were included in the analysis. Of the 269 articles initially reviewed, only 12 articles used magnetic resonance imaging and two articles used computed tomography (CT) or cone-beam CT images. Treatment effect on condyle and glenoid fossa was discussed in eight articles. Treatment effect on TMJ articular disc position and morphology was discussed in seven articles. All articles showed a high risk of bias due to deficient methodology: inadequate consideration of confounding variables, blinding of image assessment, selection or absence of control group and outcome measurement. Reported changes in osseous remodelling, condylar and disc position were contradictory. The selected articles failed to establish conclusive evidence of the exact nature of TMJ tissue response to fixed mandibular repositioning appliances.

Intra-arch dimensional measurement validity of laser-scanned digital dental models compared with the original plaster models: a systematic review.

A systematic review was undertaken to evaluate the validity of intra-arch dimensional measurements made from laser-scanned digital dental models in comparison with measurements directly obtained from the original plaster casts (gold standard). Finally included articles were only those reporting studies that compared measurements from digital models produced from laser scanning against their plaster models. Measurements from the original plaster models should have been made using a manual or digital caliper (gold standard). Articles that used scans from impressions or digital photographs were discarded. Detailed individual search strategies for Cochrane, EMBASE, MEDLINE, PubMed, and LILACS were developed. The references cited in the selected articles were also checked for any references that could have been missed in the electronic database searches. A partial gray literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item quality assessment tool for diagnostic accuracy studies (QUADAS). Only 16 studies were finally included for the qualitative/quantitative synthesis. The selected studies consistently agree that the validity of measurements obtained after using a laser scanner from plaster models is similar to direct measurements. Any stated differences would be unlikely clinically relevant. There is consistent scientific evidence to support the validity of measurements from digital dental models in comparison with intra-arch dimensional measurements directly obtained from them.