Effects of orthodontic appliances on the diagnostic capability of magnetic resonance imaging in the head and neck region: A systematic review.

OBJECTIVES: Patients in active fixed orthodontic treatment or fixed retention phase may require magnetic resonance (MR) scans of the head and neck region. Orthodontists are challenged to decide whether to keep or remove orthodontic appliances prior to the scans. The aim of this study was to determine the effect of orthodontic appliances on the diagnostic capability of MR images. METHODS: Four electronic databases were searched, with no language restrictions, from database inception to October 2016: PubMed, EMBASE, CINAHL, EBMR. A search in Google Scholar and ProQuest, as well as a manual search, were also conducted. Two independent reviewers assessed articles for inclusion. Original studies including any orthodontic appliance on human subjects were considered. Outcomes measured were development of artefacts, diagnostic quality, accuracy, and treatment outcomes. Risk of bias was assessed with the Cochrane Risk of Bias Assessment and QUADAS-2 tools. RESULTS: Five of 1052 studies identified were included in the final qualitative synthesis. A total of 90 adult human subjects were included. Orthodontic appliances evaluated were brackets, bands, archwires, and fixed retainers. The outcomes assessed were production of artefacts, diagnostic quality and diagnostic accuracy. Detrimental effects on diagnostic quality, and subsequently diagnostic accuracy, rose with increased stainless steel (SS) and proximity to anatomic area of interest. Orthodontic appliances may render images uninterpretable and non-diagnostic. CONCLUSIONS: There is fair evidence to suggest orthodontic appliances, mainly those with SS, cause MR artefacts. Removal of metal orthodontic appliances prior to MR scans is recommended, especially if the area of interest is near the orthodontic appliance. Additional evidence is needed to provide guidelines to clinicians.

Self-Report of Waking-State Oral Parafunctional Behaviors in the Natural Environment.

AIMS: To determine if retrospective self-report of oral parafunctional behaviors potentially relevant to pain conditions is valid, by comparing oral parafunctional behaviors via a self-report instrument (Oral Behaviors Checklist [OBC]) with in-field reports of oral parafunction. METHODS: Individuals with a range of oral parafunctional behaviors, as identified by the OBC, were recruited, and 22 completed the field study. Using the Ecological Momentary Assessment paradigm, each subject was randomly prompted about eight times per day, for a target of 7 days, via portable handheld computer to report current behaviors among 11 queried items. Before and after the field study, a paper version of the OBC was administered. Separately, 74 individuals participated in a test-retest study of the paper OBC. Analyses included regression, correlation, intraclass correlation coefficient (ICC) and area under the receiving operating curve (AUC). RESULTS: Pre- and postfield study administration of the OBC exhibited substantial reliability (ICC = 0.65), indicating no reactivity during the intervening in-field data collection. Reliability across in-field days was low, indicating high variability in which behavior occurred on which day. Nonobservable behaviors were reported more frequently than observable behaviors. Self-report via OBC was linear with in-field data collection methods (R2 values ranged from 0.1 to 0.7; most values were within 0.3 to 0.4). The predictive value of the self-report total score was AUC (0.88) relative to the in-field study score. Separate test-retest reliability of the OBC was almost perfect (ICC = 0.88). CONCLUSIONS: The OBC is a reliable and valid way to predict behaviors in the natural environment and will be useful for further pain research.