Association between nasal airway minimal cross-sectional areas and obstructive sleep apnoea.

BACKGROUND/OBJECTIVES: Patients with obstructive sleep apnoea (OSA) frequently present with some form of upper airway anatomical impairment. Considerable research has been conducted on the role of the structures of the jaw and pharynx in the pathogenesis of OSA; however, the significance of the nose is somewhat unclear. Computed tomography is a widely used imaging modality for assessing the nasal cavity and paranasal sinuses, but only a small amount of the acquired data is used. Our aim was to ascertain whether the size of the cross-sectional areas of the nasal airway, measured from cone beam computed tomography (CBCT) images, is associated with OSA severity. MATERIALS/METHODS: A total of 58 patients with OSA, without any major paranasal sinus inflammatory pathology, were included in this register-based study. Patients had previously undergone ambulatory polysomnography and CBCT. The cross-sectional areas of the nasal cavity were measured in CBCT coronal sections. Statistical analyses were performed to determine any correlation between the cross-sectional area measurements and apnoea-hypopnoea index (AHI) or any significant difference in cross-sectional areas between AHI severity groups. RESULTS: No correlation was found between AHI and the smallest, total, or sum of the anterior cross-sectional areas of the nasal airway. Furthermore, there was no statistically significant difference in the cross-sectional areas between patients with the highest and lowest AHI. CONCLUSIONS/IMPLICATIONS: The small cross-sectional area of the anterior nasal cavity in patients without any major nasal pathology does not appear to be associated with OSA severity.

Aesthetic dental treatment, orofacial appearance, and life satisfaction of Finnish and Brazilian adults.

AIMS: To study the probability of seeking/undergoing aesthetic dental treatment (ADT) and compare self-perception of orofacial appearance (OA) based on sex, age, and monthly income; and to estimate the impact of OA on life satisfaction (LS) among Finnish and Brazilian adults, considering the indirect effect of receiving ADT and the moderating effects of those sociodemographic variables. METHODS: This was an online cross-sectional study. Orofacial Esthetic Scale (OES), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Satisfaction with Life Scale (SWLS) were used. Probability of seeking/receiving ADT was calculated using logistic regression and odds ratio (OR). OA scores were compared according to sociodemographic characteristics (ANOVA, α = 5%). Structural equations models estimated the impact of OA on LS. RESULTS: 3,614 Finns [75.1% female, 32.0 (SD = 11.6) years] and 3,979 Brazilians [69.9% female, 33.0 (SD = 11.3) years] participated in the study. Women were more likely to receive ADT than men in both countries (OR>1.3). However, no statistically or practical significant differences were observed in OA between sexes (p>0.05 or p<0.05, ηp2 = 0.00-0.02). In Finland, demand for ADT (OR = 0.9-1.0) and OA scores (p>0.05) were the same among different ages and monthly income. In Brazil, younger individuals (OR>1.6) and those with higher monthly income (OR>2.7) were more likely to receive ADT, while those with lower income had a greater psychosocial impact of OA (p<0.05; ηp2>0.07). Individuals who were more satisfied with their own OA and had less psychosocial impact from OA had higher levels of LS (ß = 0.31-0.34; p<0.01; explained variance: 9.8-13.1%). CONCLUSION: Demand for ADT is influenced by sociodemographic and cultural factors. Greater societal pressure on physical appearance is observed among women in Western countries. In countries with high socioeconomic inequalities, consumerism and social prestige are involved in this demand. Self-perception of orofacial appearance plays a significant role in individuals' subjective well-being. Therefore, the planning of aesthetic treatments in the orofacial region should consider the patient's perceptions and social context.

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations.

Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.

Εffect of cleansers on the composition and mechanical properties of orthodontic aligners in vitro.

BACKGROUND: The aim of the study was to investigate the effect of three aligner cleaners on the composition and mechanical properties of two types of orthodontic aligners. MATERIALS AND METHODS: The cleaners tested were two alkaline peroxide solutions (Retainer Brite-RB; Retainer Cleaner-RC) and one peroxide-free (Steraligner-ST) and the aligners Clear Aligner (C, polyester) and Invisalign (I, polyester-urethane). The aligners were immersed in the cleaner solutions as instructed every day (15 min for RB, RC; 5 min for ST) for a two-week period. The acidity of the solutions was tested with a pH meter. The changes in the chemical composition of the aligners were studied by attenuated total-reflection Fourier transform infrared spectrometry (ATR-FTIR), while Instrumented Indentation Testing (IIT) was used for assessment of changes in Martens Hardness (HM), modulus (EIT), elastic index (nIT) and relaxation (RIT). RESULTS: RB and RC were weakly acidic (pH = 6.3), whereas ST was mildly acidic (pH = 4.8). The ATR-FTIR analysis demonstrated evidence of acidic hydrolysis of C in ST and I in RB. The IIT-derived properties of I were not affected by the cleaners. However, for C a significant change was found in HM (all cleaners), nIT (all cleaners) and RIT (RB, ST). Although the chemical changes support a hydrolytic material deterioration, the results of mechanical properties may interfere with the material residual stresses during fabrication. CONCLUSIONS: Caution should be exerted in the selection of aligner cleaners. The mild acidic cleanser was more aggressive to the polyester, whereas an alkaline peroxide to the polyester-urethane aligner.

Impact of body and orofacial appearance on life satisfaction among Brazilian adults.

AIMS: 1. to elaborate a general model of physical appearance taking into account body image (BI) and orofacial appearance (OA) components; and 2. to evaluate the impact of BI and OA on life satisfaction among Brazilian adults. METHODS: This is a cross-sectional observational study. The cognitive, behavioral, affective, and satisfaction/dissatisfaction aspects of BI, the satisfaction and psychosocial impact of OA, and life satisfaction were evaluated by self-reported psychometric scales. Principal Component Analysis and Parallel Analysis were performed. Structural equation models were elaborated to estimate the impact of BI and OA on life satisfaction. The fit of the models was verified and the significance of the path estimates (ß) was evaluated using z-tests (α = 5%). RESULTS: A total of 1,940 individuals participated in the study (age: mean = 24.8, standard deviation = 5.7 years; females = 70.1%). In the male sample, three physical appearance factors were retained (OA, cognitive and behavioral components of BI, and affective and satisfaction/dissatisfaction components of BI). In the female sample, two factors were retained (OA and all components of BI). All factors had significant impact on life satisfaction (ß = |0.26|-|0.48|, p<0.001) in both samples. Individuals dissatisfied with BI and OA had lower levels of life satisfaction. For men, the affective and satisfaction components of BI had a greater impact on life satisfaction (ß = 0.48, p<0.001) than the other factors (ß =] -0.30;-0.25[, p<0.001). For women, both BI and OA had a similar impact (BI: ß = -0.30, p<0.001; OA: ß = -0.32, p<0.001). CONCLUSION: BI and OA formed distinct clusters in the physical appearance evaluation. Physical appearance was perceived differently by men and women, fostering discussion about the sociocultural construction of the body. BI and OA had a significant impact on life satisfaction and should be considered in assessment and treatment protocols.

Self-perception of orofacial appearance: Brazil-Finland cross-national study.

OBJECTIVE: (i) To study the measurement invariance of Orofacial Esthetic Scale (OES) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), (ii) to compare the perception of orofacial appearance (OA) and (iii) to study the frequency of individuals who have sought or received aesthetic dental treatment between Brazil and Finland. METHODS: This was a cross-sectional observational study with snowball non-probability sample selection. Students and staff from universities in Finland and Brazil were invited to participate. Data were collected online using a demographic questionnaire, OES and PIDAQ. The samples consisted of 3636 Finns (75.0% female; age: 32.0 years) and 1468 Brazilians (72.6% female; age: 33.2 years). The frequency of receiving aesthetic dental treatment was estimated. If configurational invariance was observed, cross-national measurement invariance was verified by multigroup analysis. When measurement invariance was attested, factor scores were compared using Welch's t-test. RESULTS: OES showed configurational and measurement invariance and no significant difference between the countries. Despite similarity in satisfaction with OA, 71.9% of Brazilians had received aesthetic dental treatment, while 59.4% of Finns had never sought such treatments. PIDAQ did not present configurational invariance between the countries. CONCLUSION: Although there is no difference in satisfaction with OA, seeking and receiving aesthetic dental treatment is significantly greater for Brazilians. Psychosocial impact of OA is perceived differently in the studied countries.

Effects of force magnitude on dental arches in cervical headgear therapy.

AIM: To study the influence of different force magnitudes on dental arches in cervical headgear (CHG) treatment. MATERIAL AND METHODS: In this controlled clinical trial, patients (n = 40) were treated with CHG with light (L, 300 g, n = 22) or heavy force (H, 500 g, n = 18) magnitude. Subjects were asked to use CHG for 10 hours a day for 10 months. The outer bow of the CHG facebow was raised 10-20 degrees and the inner bow expanded 3-4 mm. Adherence to instructions and force magnitude were monitored with an electronic module (Smartgear, Swissorthodontics, Switzerland). Impressions for study models were taken before (T1) and after (T2) treatment and the study models were scanned into digital form (3Shape, R700 Scanner, Denmark). Measurements were made using the digital models (Planmeca Romexis, Model analyser, Finland). RESULTS: During the treatment (T1-T2) the upper inter-canine distance increased by 2.83 mm (P = 0.000) and 2.60 mm (P = 0.000) in the L and H force magnitude groups, respectively. Upper inter-molar width increased by 3.16 mm (P = 0.000) and 2.50 mm (P = 0.000) in the L and H groups, respectively. Maxillary total arch perimeter increased by 6.39 mm (P = 0.001) and 6.68 mm (P = 0.001) in the L and H groups, respectively. In the amount of change over time, T1-T2, in the upper arch measurements, no significant difference was found between the groups. Lower inter-canine width increased by 0.94 mm (P = 0.005) and 1.16 mm (P = 0.000) in the L and H groups, respectively; no difference between the groups. Lower inter-molar distance increased by 2.17 mm (P = 0.000) and 1.11 mm (P = 0.008) in the L and H groups, respectively. At the end of the study, upper and lower inter-molar width was larger in the L group than in the H group (P = 0.039 and P = 0.022, respectively). CONCLUSION: CHG therapy is an effective method for expanding and releasing moderate crowding of the upper dental arch. The lower arch spontaneously follows the upper arch in widening effects, and minor expansion can also be seen on the lower arch. In the L group, larger inter-molar width was achieved on the upper and lower arch; probably due to better adherence to instructions. Light force is recommended for use in CHG therapy.

Does orthognathic treatment improve patients' psychosocial well-being?

OBJECTIVE: To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed. MATERIALS AND METHODS: Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test. RESULTS: OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function. CONCLUSIONS: Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.

Use of Oral Health Impact Profile-14 (OHIP-14) in Different Contexts. What Is Being Measured?

The Oral Health Impact Profile-14 (OHIP-14) has been used to assess the impact that oral health problems can have on an individual's life. Different theoretical models were proposed to evaluate the results. The aims of this study were to evaluate the fit of different factorial models of the OHIP-14 to non-dental patients (NDP) and dental patients (DP) samples from Brazil and Finland and to estimate the differential functioning of the items in the OHIP-14 between the samples. Two studies were conducted, one in Brazil and the other in Finland, composed of five samples (Brazil-Sample 1 (S1): DP, n = 434, age: 25.3 [SD = 6.3] years; S2: NDP, n = 1486, age: 24.7 [SD = 5.6] years; S3: DP, n = 439, age: 29.0 [SD = 6.7] years; Finland-S4: DP, n = 482, age: 26.3 [SD = 5.4] years; S5: NDP, n = 2425, age: 26.7 [DP = 5.5] years). The fit of the OHIP-14 models to the data was estimated using a confirmatory strategy (validity based on the internal structure). Differential item functioning (DIF) between samples was estimated. For NDP from both countries, the response pattern severely violated the normality assumption in six items of the OHIP-14, indicating that the instrument does not fit for these samples. For DP, the model with the best fit was unifactorial, which deals with the estimation of the general impact of oral health on an individual's life, without addressing specific dimensions. Configural invariance was refuted between samples. DIF indicated that the characteristic of the sample (NDP and DP) in both countries interfered in the response given to the items, with the response level being more adequate for the latent PD trait. The validity of data related to the impact of oral health problems on an individual's life was confirmed through a unifactorial model. OHIP-14 works properly in DP samples and was limited in NDP samples, being also influenced by cultural context and age.

Late adverse effects of childhood acute lymphoblastic leukemia treatment on developing dentition.

BACKGROUND: Childhood cancer survivors show a variety of late adverse effects on dental health. The purpose of this study was to examine the prevalence and severity of dental abnormalities in permanent dentition in childhood leukemia survivors. MATERIALS AND METHODS: Retrospective analysis of panoramic radiographs was performed for 178 childhood leukemia survivors aged below 17 years at the time of diagnosis. Sex, age at diagnosis, interval between ALL diagnosis and the follow-up radiograph, treatment protocol, and risk grouping were recorded. Abnormalities of tooth development and defect index were used to assess the frequency and severity of dental abnormalities. RESULTS: One hundred eight (61%) patients had no dental abnormalities at follow-up examination at a median of 6.1 years after diagnosis. Microdontia was more frequent in children under 6 years of age at the time of diagnosis (5.7% vs. 0.6%, p < .001). Significant differences were noted between distinct ALL treatment protocols with more common microdontia in patients treated according to the NOPHO ALL2008 protocol. Tooth agenesis was more frequent in patients that underwent therapy according to high-risk arms compared to intermediate- or standard-risk arms (3.8% vs. 1.4%, p = .01). Patients under 6 years of age at diagnosis had a significantly higher average defect index score than older patients (7.0 vs. 2.8, p = .01). CONCLUSIONS: Children and adolescents who received ALL treatment were at risk for dental damage. Young age and high-intensity therapy were associated with the severity of dental abnormalities.

The impact of force magnitude on the first and second maxillary molars in cervical headgear therapy.

AIM: To study the effect of force magnitude on the maxillary first and second molars in cervical headgear (CHG) therapy. MATERIAL AND METHODS: In this controlled clinical trial, patients (n = 40) were treated with CHG with a light (L, 300 g, n = 22) or a heavy force (H, 500 g, n = 18) magnitude. The subjects were asked to wear CHG for 10 hours a day for 10 months. The outer bow of the CHG facebow was lifted up for 10-20 degrees and the inner bow was expanded 3-4 mm. Adherence to instructions and force magnitude were monitored using an electronic module (Smartgear, Swissorthodontics, Switzerland). Panoramic and lateral radiographs before (T1) and after treatment (T2) were analysed using a Romexis Cephalometric module (Planmeca, Finland) focussing on the angular, sagittal, and vertical positions of the permanent first and second molars. RESULTS: According to the cephalometric analysis of the maxillary first and second molars, distal tipping occurred during T1-T2 in the H group (P = 0.010 and 0.000, respectively), and the change was greater in the H group compared to the L group (P = 0.045 and 0.019, respectively). Based on the panoramic analysis, tipping occurred in the distal direction during therapy in the H group in the second molars compared to the midline or condylar line (P = 0.001 and 0.001; P = 0.008 and 0.003 on the right and left, respectively). CONCLUSION: With heavy force magnitude, the maxillary first and second molars can tilt more easily in the distal direction even if the CHG was used less. Distal tipping of the molar can be considered to be a side effect of CHG therapy.

Snoring toddlers with and without obstructive sleep apnoea differed with regard to snoring time, adenoid size and mouth breathing.

AIM: The difficulty of assessing the likelihood of obstructive sleep apnoea (OSA) in children who snore without full-night polysomnography is widely recognised. Our aim was to identify features that were characteristic of two-year-old children with OSA and evaluate whether this information could be used to assess the likelihood of OSA. METHODS: The study was carried out as part of the Child-Sleep Project, a longitudinal birth cohort study of children born at Tampere University Hospital, Finland. This part of the study focused on the children in the cohort who snored and was carried out between 2013 and 2015. The primary outcomes were measured using parental questionnaires, polysomnography and clinical examinations. RESULTS: In total, 52 children participated at a mean age of 27 months (range 23-34). Of these, 32 (44% male) snorers and 20 (70% male) controls. The most significant findings were that children who had OSA demonstrated longer snoring time (P = .003), a greater tendency for mouth breathing (P = .007) and bigger adenoid size (P = .008) than snorers without OSA. CONCLUSION: Snoring time, adenoid tissue size and mouth breathing were important features that identified the likelihood of OSA in snoring toddlers.

Mandibular movements in children with deciduous and mixed dentition and in young adults with permanent dentition-the association between movements and occlusal traits.

BACKGROUND: Cross-sectional studies of mandibular movements provide data on developmental trends of dentition and support planning of public health services. OBJECTIVE: The aim of this study was to measure mandibular movement capacities in children with deciduous and mixed dentition and in young adults with permanent dentition. The influence of age and gender on mandibular movements and the association between mandibular movements and occlusal traits were analysed. METHOD: The sample consisted of 1172 Estonians: group 1: children with deciduous dentition; group 2: children with mixed dentition; and group 3: young adults with permanent dentition. Maximum opening, mandibular laterotrusion, and protrusion were registered. RESULTS: Age was correlated with mandibular movements. Young adults had statistically significantly larger mandibular movements as compared to children with deciduous and mixed dentition, and children with mixed dentition had larger mandibular movements as compared to children with deciduous dentition. Young adult males had larger mandibular movements than females of the same age. Associations were found between mandibular movement capacities and some occlusal traits. Mandibular movement capacities were smaller in children with crossbite and open bite as compared with children without corresponding occlusal traits. Mandibular movement capacities were larger in children with deep bite and increased overjet as compared with those without corresponding occlusal traits. CONCLUSION: Mandibular movement capacities are age and gender dependent. Maximum mouth opening, mandibular laterotrusion, and protrusion are related, and mandibular movement and some occlusal traits are associated.

Orofacial Esthetic Scale and Psychosocial Impact of Dental Aesthetics Questionnaire: development and psychometric properties of the Finnish version.

OBJECTIVE: To develop the Finnish version of the Orofacial Esthetic Scale (OES-Fi) and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ-Fi) and estimate the psychometric properties of these instruments applied to adult Finns. METHODS: The English versions of the instruments were translated into Finnish and back-translated. Thereafter, OES-Fi and PIDAQ-Fi were established in a pilot study. The factorial validity was estimated using Confirmatory Factor Analysis (CFI, TLI, SRMR) in independent samples (Test and Validation samples). The measurement invariance of the factorial models was tested using multigroup analysis (ΔCFI). Convergent validity [Average Variance Extracted (AVE)] and reliability [Composite Reliability (CR) and α] were estimated. RESULTS: A total of 3636 individuals [mean age = 32.0 (SD = 11.6) years, 75% women] participated in the study. After refinements, the factorial model of the instruments showed an adequate fit to the data (CFI ≥0.94, TLI ≥0.90, SRMR ≤0.07) and showed measurement invariance in two independent samples (|ΔCFI| <0.01). Convergent validity (AVE = 0.54-0.82) and reliability (α = 0.86-0.94) were adequate. CONCLUSION: The data obtained using OES-Fi and PIDAQ-Fi were valid and reliable. Thus, these instruments could be useful for evaluating individual satisfaction with orofacial appearance and the psychosocial impact of dental aesthetics in a clinical or research setting.

Randomized controlled and double-blinded study of Caphosol versus saline oral rinses in pediatric patients with cancer.

BACKGROUND: Oral mucositis (OM) is a significant side effect of cancer treatment. The purpose of this study was to compare topically administered Caphosol to saline rinses in the prevention of mucositis in pediatric cancer patients. PROCEDURE: A controlled, double-blinded, and randomized clinical crossover study recruited patients between 2 to 17.99 years of age who were diagnosed with a malignancy and were receiving either high-dose methotrexate (≥1 g/m2 ), anthracycline, or cisplatin chemotherapy (NCT0280733). All patients received two 7-day cycles of the mouth rinses; that is, one cycle of Caphosol and one cycle of saline in a randomized order. Oral changes and symptoms were evaluated using the World Health Organisation (WHO) toxicity scale and the Children's International Mucositis Evaluation Scale (ChIMES). The primary endpoint was the frequency and severity of OM and oral symptoms. RESULTS: A total of 56 patients were recruited to the study, of whom 45 were randomized with a median age of 6.5 years (range 2.1-17.1 years). No cases of severe OM were observed. Grade ≥ 3 oral symptoms were present at least once in six (13%) patients during the Caphosol cycle and 13 (29%) patients during the saline cycle (P = .12). The peak of symptom scores was evident at around day 4-7 after administration of the chemotherapy with no marked differences between the rinse solutions. Multivariable regression analysis did not indicate a benefit of using Caphosol over the saline solution. CONCLUSIONS: No difference in prevention of oral mucositis was observed between the use of Caphosol or saline rinses.

Is securing normal dentofacial development an indication for tonsil surgery in children? A systematic review and meta-analysis.

OBJECTIVE: Tonsil surgeries are common operations in the field of paediatric otorhinolaryngology. Often, the indication for these operations is hypertrophied tonsils. Paediatric sleep-disordered breathing and mouth-breathing are conventional situations caused by the hypertrophied tonsils. Both of these are further associated with dentofacial development alterations. Securing normal dentofacial development, or restoring it, is often used as an indication for tonsil surgery. In this review and meta-analysis, we assessed the contemporary literature to clarify whether tonsil surgery has an effect on dentofacial development in children. METHODS: Studies with children aged 3-10 years who underwent tonsil surgery and were compared to non-operated controls using dentofacial parameters were included to the review. Search strategies were planned for specific databases. The Newcastle-Ottawa scale was used to assess the risk of bias. A meta-analysis was performed when the data was methodologically homogenous enough to be pooled. RESULTS: The inclusion criteria for the review were fulfilled in 8 studies. The overall quality of the individual studies was judged to be moderate at best. The data were methodologically homogenous enough to be pooled for the meta-analysis in only 2 studies. The results of the meta-analysis revealed that tonsil surgery has a positive effect on the growth direction of the mandible (p < 0.001). CONCLUSIONS: There is modest evidence that suggests that tonsil surgery has a positive effect on the dentofacial development in children with hypertrophied tonsils. Securing normal dentofacial development should be one component, but not the only one, when the indications for tonsil surgery in children are considered.

Quality of life several years after orthodontic-surgical treatment with bilateral sagittal split osteotomy.

Objective: To analyse oral health related quality of life (OHRQoL) several years after orthognathic treatment in patients who had Class II malocclusion with retrognathic mandible.Material and methods: The initial study cohort comprised 151 patients with orthognathic treatment in 2007-2011. Of them, 77 patients (Group 1, mean age 41 years, range 19-71 years, 71% women) were clinically examined 6 years (range 4-8 years) after bilateral sagittal split osteotomy (BSSO). Group 2 included 24 former patients (mean 48 years, range 25-79 years, 50% women) who were willing to participate in a structured telephone interview. Group 3 consisted of 22 prospective patients (mean 35 years, range 18-56 years, 86% women) with a recent orthognathic treatment plan and awaiting treatment. QoL was assessed using two questionnaires, OHIP-14 and OQLQ.Results: Based on responses, patients who had received orthognathic treatment (Groups 1 and 2) had better QoL than those awaiting treatment (Group 3).Conclusion: Conventional orthognathic treatment, including mandibular advancement with BSSO, seems to have a positive long-term effect on patients' QoL. More long-term follow-up studies are needed to assess the real impact of treatment on patients' lives in the long run.

Treatment outcome with orthodontic aligners and fixed appliances: a systematic review with meta-analyses.

BACKGROUND: The use of orthodontic aligners to treat a variety of malocclusions has seen considerable increase in the last years, yet evidence about their efficacy and adverse effects relative to conventional fixed orthodontic appliances remains unclear. OBJECTIVE: This systematic review assesses the efficacy of aligners and fixed appliances for comprehensive orthodontic treatment. SEARCH METHODS: Eight databases were searched without limitations in April 2019. SELECTION CRITERIA: Randomized or matched non-randomized studies. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and risk of bias assessment was done independently in triplicate. Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality. RESULTS: A total of 11 studies (4 randomized/7 non-randomized) were included comparing aligners with braces (887 patients; mean age 28.0 years; 33% male). Moderate quality evidence indicated that treatment with orthodontic aligners is associated with worse occlusal outcome with the American Board of Orthodontics Objective Grading System (3 studies; MD = 9.9; 95% CI = 3.6-16.2) and more patients with unacceptable results (3 studies; RR = 1.6; 95% CI = 1.2-2.0). No significant differences were seen for treatment duration. The main limitations of existing evidence pertained to risk of bias, inconsistency, and imprecision of included studies. CONCLUSIONS: Orthodontic treatment with aligners is associated with worse treatment outcome compared to fixed appliances in adult patients. Current evidence does not support the clinical use of aligners as a treatment modality that is equally effective to the gold standard of braces. REGISTRATION: PROSPERO (CRD42019131589).