The Use of Microsensors to Assess the Daily Wear Time of Removable Orthodontic Appliances: A Prospective Cohort Study.

Orthodontic treatment with removable appliances is still common in children and adolescents. However, their effectiveness depends primarily on the patients' compliance. Currently, it is possible to check the daily wear time (DWT) of the removable appliances using special microsensors. The aim of this prospective cohort study was to assess the degree of patients' compliance depending on the type of removable appliance used. In total, 167 patients (87 F, 80 M) were enrolled in the study and were treated with block appliances (Klammt, Twin-Block), Schwarz plates, and block appliances in combination with headgear. All patients were followed up for 6 months with the mean daily wear time checked at followup visits using TheraMon® microsensors fitted in the appliances. It has been shown that the type of appliance influences the patients' compliance. The DWT for the Twin Block was significantly longer compared to the DWT for the other appliances. Girls have been shown to wear removable appliances better than boys. It has been proven that the majority of patients do not follow the orthodontist's recommendations, wearing removable appliances for just over half of the recommended time. Microsensors can be used for objective verification of patients' compliance, which allows for a reliable assessment of the effectiveness of treatment with removable appliances.

Assessment of the reliability of measurements taken on digital orthodontic models obtained from scans of plaster models in laboratory scanners. A systematic review and meta-analysis.

BACKGROUND: In recent years, digital models have become increasingly popular among orthodontists, both for clinical and scientific purposes. It is, therefore, crucial to appropriately investigate their reliability. To this date, however, there has been no scientific, statistical investigation of their reliability as compared to the traditional gold standard-plaster models in the form of a meta-analysis. OBJECTIVES: To evaluate the reliability and reproducibility of measurements taken on digital orthodontic models obtained from scanning plaster models in laboratory scanners compared to measurements taken directly on plaster models. SEARCH METHODS: Multiple electronic databases (PubMed, Scopus, Web of Science, Google Scholar and Cochrane Central Register of Controlled Trials) were searched for articles with no year or language limitations. SELECTION CRITERIA: The included original papers should have dealt with the accuracy and repeatability of the measurements conducted on plaster and digital models derived from laboratory scanners. In order to provide an adequate statistical analysis, the studies should have provided sufficient data, that is the difference of means (MDs) with standard deviations (SDs) for analysed measurements. DATA COLLECTION AND ANALYSIS: In total, 25 types of non-standardised measurements were found in the evaluated studies. The quantitative analysis included papers that compared at least one of the parameters: upper/lower intermolar width, upper/lower intercanine width, overjet and overbite and provided standard deviation of the mean differences between measurements obtained on plaster and digital models from a laboratory scanner. RESULTS: GRADE and QUADAS tools were used to assess the quality of evidence, and they revealed substantial heterogeneity. Random-effects meta-analysis revealed no statistically significant differences for analysed measurements. Four of the analysed papers reported differences that may be considered clinically significant. CONCLUSIONS: No statistical significance between the direct measurements on plaster models and the digital ones taken from laboratory scanners could be identified by means of random-effects meta-analysis. REGISTRATION: The systematic review was registered in the PROSPERO database (ID CRD42020215411).

Factors influencing an eruption of teeth associated with a dentigerous cyst: a systematic review and meta-analysis.

BACKGROUND: A dentigerous cyst (DC) is a pathology embracing the crown of an unerupted tooth at risk of malignant transformation. The causal tooth is usually removed together with the cyst. However, if there are orthodontic contraindications for extraction, two questions arise. (1) Which factors favor spontaneous eruption? (2) Which factors imply the necessity of applying orthodontic traction? This systematic review aimed to identify factors conducive/inconducive to the spontaneous eruption of teeth after dentigerous cyst marsupialization. METHODS: In accordance with the PRISMA guidelines, the main research question was defined in the PICO format (P: patients with dentigerous cysts; I: spontaneous tooth eruption after surgical DC treatment; C: lack of a spontaneous tooth eruption after surgical DC treatment; O: determining factors potentially influencing spontaneous tooth eruption). The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for keywords combining dentigerous/odontogenic/follicular cysts with teeth and/or orthodontics, as well as human teeth and eruption patterns/intervals/periods/durations. The following data were extracted from the qualified articles (4 out of 3005 found initially): the rate of tooth eruption after surgical treatment of the cyst, the age and sex of the patients, the perpendicular projection distance between the top of the tooth cusp and the edge of the alveolar process, tooth angulation, the root formation stage, the cyst area, and the eruption space. The articles were subjected to risk of bias and quality analyses with the ROBINS-I protocol and the modified Newcastle-Ottawa QAS, respectively. Meta-analyses were performed with both fixed and random effects models. The GRADE approach was used to evaluate the quality of the evidence. The systematic review was registered in PROSPERO under ID CRD42020189044. RESULTS: Nearly 62% of DC-associated premolars erupted spontaneously after cyst marsupialization/decompression. Young age (mean = 10 years) and root formation not exceeding 1/2 of its fully developed length were the factors likely to favor spontaneous eruption. CONCLUSION: The small number of published studies, as well as their heterogeneity and the critical risk of bias, did not allow the creation of evidence-based protocols for managing teeth with DC after marsupialization. More high-quality research is needed to draw more reliable conclusions.

Orthodontic Compliance Assessment: A Systematic Review.

OBJECTIVES: The aim of this review was to determine whether the type of removable appliance, as well as the age and sex of the patient, may affect the extension or reduction of wear time by assessing the correlation between the mean actual and orthodontist-recommended wear times. METHODS: Randomised case control trials, cohort studies, case series, observational studies, reviews, and retrospective analyses were identified. The quality of the studies was assessed using the Cochrane Collaboration Tool and modified Newcastle-Ottawa Scale. The electronic databases Embase, PubMed, Scopus, and Web of Science were reviewed, and 542 articles were obtained, of which 31 were qualified for qualitative synthesis. The data from 1674 participants were collected and a weighted average was determined for the mean wear time of each appliance. RESULTS: Regardless of the type of extra- or intraoral appliances, mean wear time was shorter than recommended, although patients using intraoral appliances cooperated more. The best compliance was noted for Schwarz appliances (73.70%) and plate retainers (85%). There was no evidence of an influence of patients' age and sex on compliance during treatment. CONCLUSIONS: The considerable inconsistency and imprecision of articles could affect the reliability of the results. Previous studies analysing the effectiveness of treatment with removable appliances based on an arbitrarily assumed average wear time need to be revised in order to verify the actual wear time with the use of microsensors.

Does daily wear time of Twin Block reliably predict its efficiency of class II treatment?

PURPOSE: The objective of this study was to investigate how daily wear time (DWT) influences class II malocclusion treatment efficiency. MATERIALS AND METHODS: The study group consisted of 55 patients (mean age 10.4 years) diagnosed with a class II/1 malocclusion. Twin block appliances, with built-in Theramon® microsensors (MC Technology, Hargelsberg, Austria) to monitor patients' cooperation (daily wear time assessment), were used for treatment. Cephalograms were taken and the following initial and final measurements were compared: Co-Gn, Co-Go, Co-Olp, Pg-Olp, WITS, SNA, SNB, ANB, Co-Go-Me, overjet, molar and canine relationships. The Shapiro-Wilk test, Wilcoxon signed-rank test, Student's t-test, Levene's test, Mann-Whitney U test, Kruskal-Wallis test, χ2 test, and Spearman's rank correlation coefficient with p < 0.05 set as the statistical significance level were used to determine the correlation of the outcomes with DWT; a ROC (receiver operating characteristic) curve was calculated to illustrate diagnostic ability of the binary classifier system. RESULTS: DWT was very highly positively correlated with change of the Pg-Olp parameter and highly with an improvement in the ANB, SNA, and SNB angles, an increase in the WITS parameter and an increase in Co-Gn distance. DWTs < 7.5 h correlated with significantly less improvement of the investigated variables. However, DWT > 7.5 h did not significantly correlate with the improvement of the overjet and most of the linear parameters in the mandible. The ROC curve and its AUC (area under curve) allowed the determination of a DWT of 7 h and 48 min to be capable of establishing a class I relationship with 83% probability. CONCLUSIONS: Class II treatment efficiency was influenced by DWT; an 8 h threshold value had an 83% probability of establishing a class I relationship.

Methods of Anterior Torque Control during Retraction: A Systematic Review.

BACKGROUND: There are various methods of controlling the inclination of the incisors during retraction, but there is no evidence as to the advantages of some methods over others. The purpose of this systematic review and meta-analysis was to determine the effectiveness of the methods used to control torque during anterior teeth retraction. METHODS: In accordance with the PRISMA guidelines, the main research question was defined in the PICO format [P: patients with complete permanent dentition; I: the maxillary incisor torque after (I) and before I retraction with straight-wire appliance and different modes of torque control; O: statistically significant differences in torque values of the upper incisors after orthodontic treatment]. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for keywords combining: retraction orthodontics, torque control orthodontics, torque orthodontics, inclination orthodontics, torque control retraction. The articles were subjected to risk of bias and quality analyses with the ROBINS-I protocol and the modified Newcastle-Ottawa QAS, respectively. Meta-analyses were performed with both fixed- and random-effects models. RESULTS: 13 articles were selected in which total number of 580 subjects took part. In all studies, incisors were retroclined during retraction by 2.46° (mean difference), which was statistically significant. Considering the articles separately, the differences in torque between the study group and the control group were statistically significant in six articles. The Q statistic was 36.25 with p = 0.0003 and I2 = 66.9%, which indicated a high level of study heterogeneity. CONCLUSION: Both properly performed corticotomy and en-masse retraction using orthodontic microimplants seem to be the most effective and scientifically validated methods of torque control. Further high-quality research is needed to perform better quality analyses and draw more reliable conclusions.

Expression of syndecan-1 in oral cavity squamous cell carcinoma.

Syndecan-1 (SDC1) belongs to heparan sulfate proteoglycans which may interact with different growth factors, cytokines, morphogens and promote tumor growth and invasion. The aim of the present study was to assess the immunohistochemical expression of syndecan-1 in oral squamous cell carcinoma (OSCC) and oral cysts. Evaluation of the staining pattern with the clinico-histological characteristics of patients was performed. A total of 42 OSCC and 23 oral cysts tissue samples were examined. Statistical tests were used for the significance analysis. The positive expression of syndecan-1 was significantly higher in OSCC compared to cyst located in the oral cavity. Moreover, the results indicate that the intensity of the expression correlated with grading score (p = 0.046). The data indicate that syndecan-1 is altered in OSCC and its excessive amount relates in a predictive manner to neoplastic transformation. As such, SDC1 expression may be used as an adjunctive biomarker in molecular diagnostics of oral squamous cell carcinoma.

Oral cancer: The first symptoms and reasons for delaying correct diagnosis and appropriate treatment.

BACKGROUND: The first symptoms of oral cancer are nonspecific. They raise suspicions of other, less serious conditions. Treatment of oral cancer is challenging, and the time of its detection and the implementation of appropriate therapy affect the prognosis. OBJECTIVES: To identify predisposing factors, symptoms, time of, and reasons for delays in the diagnosis and appropriate treatment of oral cancer. MATERIAL AND METHODS: This retrospective analysis includes patients who were hospitalized with a diagnosis of carcinoma at the Clinical Department of Maxillofacial Surgery at the 4th Military Clinical Hospital and Polyclinic in Wroclaw, Poland, between 2008 and 2018, and at the Department of Maxillofacial Surgery at Wroclaw Medical University Hospital between 2010 and 2018. The analysis took into account the data obtained from the patients' medical records. RESULTS: This study comprised 305 patients (112 female; 36.7% and 193 male; 63.3%). The most frequent diagnosis was squamous cell carcinoma (N = 294; 96.4%). The floor of the mouth was the most frequent primary site (N = 103; 33.8%), followed by the anterior 2/3 of the tongue (N = 94; 30.8%) and lower gingiva (N = 43; 14.1%). A significant percentage were reported at an advanced stage (73.5% in stages III and IV combined). The reasons for the late-stage diagnoses depended on the patients (40.6%), the doctors (24.9%) or both (10.8%). Only 47.5% of patients reported because of the initial symptom noticed. Nearly half of the patients reported after 3-6 months of observing symptoms, usually to a general practitioner (GP; 35.7%) or a dentist (31.8%). CONCLUSIONS: The oncological awareness of patients and healthcare professionals is an essential issue. Doctors often recommend inappropriate treatment, sometimes without monitoring its effectiveness. Dentists should consider cancer in the differentiation of clinical manifestations of other oral disorders.

A comparative study of osteopontin expression, Ki67 index and prognosis in squamous cell carcinoma and cysts of the oral cavity.

BACKGROUND: Recent studies have shown a strong relationship between the expression of osteopontin and oral carcinogenesis. Osteopontin (OPN) has been shown to play a major role in regulating the aggressiveness of cancer cells and promote tumor growth. Odontogenic cysts are an essential aspect of oral and maxillofacial pathology. They are relatively frequent lesions with different clinical behavior. Some of them may have a proliferative pattern of growth and neoplastic nature. Evaluation of osteopontin expression with Ki-67 index may help examine clinical behavior and recurrence of oral squamous cell cancer and radicular cyst patients. METHODS: A total of 44 oral cavity cancer cases and 21 cysts samples were analyzed by immunohistochemical staining. Data used for analysis were derived from medical records. The following information was obtained from all patients' medical records: survival, age, sex, lymph node status, tumor size, and location, as well as grade and histologic type of tumor. Expression status of OPN and Ki-67 was statistically assessed. RESULTS: Our data demonstrated that for summary immunoreactive scores of OPN and Ki-67 expressions in OSCC vs. RC patients statistical significance was found for both markers' between OSCC and RC groups. Moreover, osteopontin is significantly higher expressed in larger OSCC tumors. CONCLUSIONS: In conclusion, the role of OPN expression both in oral squamous cancer cells and radicular cyst and possible correlation with demographic and clinicopathological features remain undetermined in some aspects, further high-powered studies to develop a more standardized assessment of Ki-67 and osteopontin expression in OSCC and are needed.

Prevalence and Overlaps of Headaches and Pain-Related Temporomandibular Disorders Among the Polish Urban Population.

AIMS: To investigate the prevalence and overlaps of headaches and pain-related temporomandibular disorders (TMD) among the Polish urban population. METHODS: The study was conducted in four Polish cities (Wroclaw, Lublin, Katowice, and Lodz) between February and November 2017. Participation in the study was voluntary. The examination consisted of two parts: a clinical examination of TMD using the Diagnostic Criteria for TMD Examination Form and the Head-HUNT Study questionnaire filled in by the participants to determine the occurrence and type of headaches. An experienced and qualified clinician trained all the examiners in the clinical examination protocol. Statistical analyses were based on descriptive and nonparametric statistics. In addition, univariate logistic regression was used. The significance level was set at α = .05. RESULTS: Overall, 213 individuals were examined (149 women and 64 men). The mean age of the participants was 37 ± 15.82 years. The diagnosis for 55.9% of the participants was pain-related TMD, including myalgia (47.4%), myofascial pain (14.1%), arthralgia (21.1%), or headache attributed to TMD (10.3%). In the study population, 48.8% were diagnosed with temporomandibular joint disorders, most frequently disc displacement with reduction (47.9%). A total of 73% of the individuals had experienced headaches in the previous 12 months. The majority of the participants described the headache episodes as occurring less than 7 days/month and lasting less than 4 hours. Among people with painful TMD, the frequency of headaches was almost twice as high as that in nondisordered individuals (48.35% and 25.35%, respectively; P < .0001). The logistic regression model confirmed a significant overlap between headache and painful TMD (OR = 4.77, 95% CI 2.44-9.32, P = .0000). For the entire studied population, no statistically significant connections were established between the occurrence of identified TMJ disorders and headache reports or diagnoses (P > .05). CONCLUSION: Headaches and pain-related TMD are major problems among the Polish urban population. Headache was a much more frequent problem for participants with painful TMD. This issue requires further research and identification of cause-and-effect relationships. Considering the entire studied population, the relationship between identified TMJ disorders and headache is negligible.