Evidence-based potential of generative artificial intelligence large language models in orthodontics: a comparative study of ChatGPT, Google Bard, and Microsoft Bing.

BACKGROUND: The increasing utilization of large language models (LLMs) in Generative Artificial Intelligence across various medical and dental fields, and specifically orthodontics, raises questions about their accuracy. OBJECTIVE: This study aimed to assess and compare the answers offered by four LLMs: Google's Bard, OpenAI's ChatGPT-3.5, and ChatGPT-4, and Microsoft's Bing, in response to clinically relevant questions within the field of orthodontics. MATERIALS AND METHODS: Ten open-type clinical orthodontics-related questions were posed to the LLMs. The responses provided by the LLMs were assessed on a scale ranging from 0 (minimum) to 10 (maximum) points, benchmarked against robust scientific evidence, including consensus statements and systematic reviews, using a predefined rubric. After a 4-week interval from the initial evaluation, the answers were reevaluated to gauge intra-evaluator reliability. Statistical comparisons were conducted on the scores using Friedman's and Wilcoxon's tests to identify the model providing the answers with the most comprehensiveness, scientific accuracy, clarity, and relevance. RESULTS: Overall, no statistically significant differences between the scores given by the two evaluators, on both scoring occasions, were detected, so an average score for every LLM was computed. The LLM answers scoring the highest, were those of Microsoft Bing Chat (average score = 7.1), followed by ChatGPT 4 (average score = 4.7), Google Bard (average score = 4.6), and finally ChatGPT 3.5 (average score 3.8). While Microsoft Bing Chat statistically outperformed ChatGPT-3.5 (P-value = 0.017) and Google Bard (P-value = 0.029), as well, and Chat GPT-4 outperformed Chat GPT-3.5 (P-value = 0.011), all models occasionally produced answers with a lack of comprehensiveness, scientific accuracy, clarity, and relevance. LIMITATIONS: The questions asked were indicative and did not cover the entire field of orthodontics. CONCLUSIONS: Language models (LLMs) show great potential in supporting evidence-based orthodontics. However, their current limitations pose a potential risk of making incorrect healthcare decisions if utilized without careful consideration. Consequently, these tools cannot serve as a substitute for the orthodontist's essential critical thinking and comprehensive subject knowledge. For effective integration into practice, further research, clinical validation, and enhancements to the models are essential. Clinicians must be mindful of the limitations of LLMs, as their imprudent utilization could have adverse effects on patient care.

Molecular insights into the role of electronic cigarettes in oral carcinogenesis.

Electronic cigarette (EC) usage or vaping has seen a significant rise in recent years across various parts of the world. They have been publicized as a safe alternative to smoking; however, this is not supported strongly by robust research evidence. Toxicological analysis of EC liquid and aerosol has revealed presence of several toxicants with known carcinogenicity. Oral cavity is the primary site of exposure of both cigarette smoke and EC aerosol. Role of EC in oral cancer is not as well-researched as that of traditional smoking. However, several recent studies have shown that it can lead to a wide range of potentially carcinogenic molecular events in oral cells. This review delineates the oral carcinogenesis potential of ECs at the molecular level, providing a summary of the effects of EC usage on cancer therapy resistance, cancer stem cells (CSCs), immune evasion, and microbiome dysbiosis, all of which may lead to increased tumor malignancy and poorer patient prognosis. This review of literature indicates that ECs may not be as safe as they are perceived to be, however further research is needed to definitively determine their oncogenic potential.

Evaluation of the Performance of Generative AI Large Language Models ChatGPT, Google Bard, and Microsoft Bing Chat in Supporting Evidence-Based Dentistry: Comparative Mixed Methods Study.

BACKGROUND: The increasing application of generative artificial intelligence large language models (LLMs) in various fields, including dentistry, raises questions about their accuracy. OBJECTIVE: This study aims to comparatively evaluate the answers provided by 4 LLMs, namely Bard (Google LLC), ChatGPT-3.5 and ChatGPT-4 (OpenAI), and Bing Chat (Microsoft Corp), to clinically relevant questions from the field of dentistry. METHODS: The LLMs were queried with 20 open-type, clinical dentistry-related questions from different disciplines, developed by the respective faculty of the School of Dentistry, European University Cyprus. The LLMs' answers were graded 0 (minimum) to 10 (maximum) points against strong, traditionally collected scientific evidence, such as guidelines and consensus statements, using a rubric, as if they were examination questions posed to students, by 2 experienced faculty members. The scores were statistically compared to identify the best-performing model using the Friedman and Wilcoxon tests. Moreover, the evaluators were asked to provide a qualitative evaluation of the comprehensiveness, scientific accuracy, clarity, and relevance of the LLMs' answers. RESULTS: Overall, no statistically significant difference was detected between the scores given by the 2 evaluators; therefore, an average score was computed for every LLM. Although ChatGPT-4 statistically outperformed ChatGPT-3.5 (P=.008), Bing Chat (P=.049), and Bard (P=.045), all models occasionally exhibited inaccuracies, generality, outdated content, and a lack of source references. The evaluators noted instances where the LLMs delivered irrelevant information, vague answers, or information that was not fully accurate. CONCLUSIONS: This study demonstrates that although LLMs hold promising potential as an aid in the implementation of evidence-based dentistry, their current limitations can lead to potentially harmful health care decisions if not used judiciously. Therefore, these tools should not replace the dentist's critical thinking and in-depth understanding of the subject matter. Further research, clinical validation, and model improvements are necessary for these tools to be fully integrated into dental practice. Dental practitioners must be aware of the limitations of LLMs, as their imprudent use could potentially impact patient care. Regulatory measures should be established to oversee the use of these evolving technologies.

May alcoholic and non-alcoholic drinks affect the rate of orthodontic tooth movement? A systematic review of animal studies.

BACKGROUND: Humans may consume various beverages in everyday life. Previous research has shown that the administration of different substances (medicinal or not) may affect bone turnover and, thus, orthodontic tooth movement. It would be anticipated that the substances contained in beverages could have an impact on tooth movement, as well. OBJECTIVE: To investigate in a systematic way and appraise the quality of the available evidence from animal studies regarding the impact of various drinks or the main ingredients included in beverages on the rate of orthodontic tooth movement. SEARCH METHODS: Search without restriction in six databases (including grey literature) and hand searching were performed until March 2022. SELECTION CRITERIA: We looked for controlled animal studies investigating the effect of drinks, or the main ingredients included in beverages, on the rate of orthodontic tooth movement. DATA COLLECTION AND ANALYSIS: After study retrieval and selection, relevant data was extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. The quality of available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation. RESULTS: The initially identified records were finally reduced to nine studies conducted on animals. Carbonated soft drinks were shown to decrease the rate of tooth movement, but alcohol consumption did not have an impact. Exploratory meta-analysis showed that caffeine exhibited an acceleratory effect after 3 weeks of force application. Exploratory meta-regression results indicated that high dosages of caffeine reduced the rate of tooth movement. CONCLUSIONS: The located animal experiments reported that caffeine accelerates, carbonated drinks decelerate, while alcohol does not affect the rate of orthodontic tooth movement. However, due to various limitations it remains unclear whether caffeine, alcohol, or carbonated drinks finally influence tooth movement in animal studies. REGISTRATION: Open Science Framework (https://osf.io/jyhbd/).

Do the various interceptive treatment modalities improve the position of palatally displaced permanent canines? A meta-analysis.

BACKGROUND: Removal of maxillary primary canines and other interceptive treatment modalities in the mixed dentition have been suggested as methods used to increase the rate of normal eruption of palatally displaced permanent canines (PDCs). However, the information on the overall effect on PDCs' position has been inconclusive. OBJECTIVE: To assess whether this practice improves the position of PDCs and to investigate the quality of the evidence. SEARCH METHODS: Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to June 2022 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ClinicalTrials.gov, ProQuest Dissertations, and Theses Global). SELECTION CRITERIA: We looked for data on the positional changes of PDCs (mesial inclination, vertical position, canine crown cusp tip to midline) from randomized controlled trials assessing the various interceptive treatment modalities. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis and meta-regression were conducted using the random effects model and the overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS: Five studies (3 at low risk of bias) were identified, involving 238 individuals, followed for up to 18 months post-intervention with OPG (orthopantomogram) or CBCT (cone-beam computed tomography). Exploratory data synthesis showed that PDCs' position improved more in the extraction sites compared to non-extraction. Analysis of the studies at low risk confirmed the above observations (6- and 12-month). Improvements were observed in patients using headgear after extraction of primary canines compared to extraction alone, but not in patients with double extraction of primary canines and first molars. The quality of available evidence was rated at best as moderate. CONCLUSIONS: Interceptive treatment modalities in the mixed dentition may improve the position of PDCs. However, more studies are necessary in order to determine the clinical significance of the changes. REGISTRATION: PROSPERO (CRD42015029130).

Dental students' and faculty perception of online exams with e-invigilation in Cyprus.

INTRODUCTION: During the recent pandemic, e-learning and e-assessment methods have been implemented worldwide, providing opportunities for further implementation in the dental curriculum. This study aims to research the dental students' and dental faculty's perceptions of online exams with e-invigilation. MATERIALS AND METHODS: Online questionnaires were developed and delivered, after three semesters of online exams, to all students and faculty. Descriptive statistics were performed, and answers were grouped into Principal Components (PC) using Principal Component Analysis (PCA). Statistical significance was set at p < .05. RESULTS: Two-hundred and sixty dental students (83.7%) and 24 dental faculty members (63.1%) answered the online questionnaires. PCA of students' responses revealed 4 PC, 'University support to students', 'Comparison between online and face-to-face exams', 'Preparation for the online exams' and 'Attitudes towards the technology used for the online exams'. PCA of faculty responses revealed 5 PC: 'Comparison between online and face-to-face exams', 'University support to faculty', 'Faculty attitudes towards the exam procedures', 'Human factors associated with the exam procedures' and 'Exam invigilation'. The overall satisfaction was high for both staff and students (higher for students and female staff). Students with previous experience in online exams scored more positively than first-year students. University support, process-related stress and e-invigilation were highlighted. CONCLUSIONS: The overall satisfaction with the e-exams was high, despite the technical problems, time-consuming processes and related stress. University support (training, IT support and resources) and mock exams emerged as important elements of online exams, as was the e-invigilation, which students perceived as efficient and non-intrusive.

Patient-reported experiences and preferences with intraoral scanners: a systematic review.

BACKGROUND: Intraoral scanners have become an increasingly popular alternative to conventional impression methods. Although their accuracy and validity have been examined thoroughly, patient-reported information including experiences, preferences, and satisfaction has not yet been investigated in a systematic way. OBJECTIVE: The objective of this systematic review is to investigate the available data and appraise the evidence on patient-reported experiences and preferences following impression taking with intraoral scanners. SEARCH METHODS: Unrestricted search of seven databases (Pubmed, CENTRAL, Cochrane reviews, Scopus, Web of Science, Clinical Trials, and ProQuest) and grey literature were conducted until October 2020. Detailed search strategies were developed for each database. SELECTION CRITERIA: Studies involving individuals of any gender or age, subjected to full arch impression taking with conventional and intraoral scanning methods were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Following the retrieval and selection of the studies, data extraction was performed. Risk of bias assessment was performed using the RoB 2 and ROBINS-I tools. RESULTS: From the initially identified records, nine studies [eight crossover (two of them randomized) and one parallel group] were eventually included in the present systematic review. Randomized studies were shown, overall, to have some concerns regarding bias, whereas the non-randomized studies were found to be at serious risk, mainly because of bias due to confounding. All studies demonstrated some benefit in favour of intraoral scanning compared with conventional techniques. More positive feelings were generally observed with the intraoral scanners regarding smell, taste, sound, vibration, nausea, and queasiness. Overall, comfort assessment mostly favoured digital methods. No differences were found concerning the level of anxiety between the two methods. Among the included studies, time perception was a parameter leading to contradictory results. LIMITATIONS: These emerge due to the nature and characteristics of the information retrieved from the included studies. The validation of the instruments to capture patient-reported outcomes needs to be further elaborated. CONCLUSIONS: Intraoral scanners seem to be a promising new asset in the orthodontic office from the perspective of individuals' experiences and preferences. Nevertheless, to investigate patient-reported outcomes correctly, further high-quality studies are required in the future. REGISTRATION: Open Science Framework (https://osf.io/ayug2/).

Could medications and biologic factors affect post-orthodontic tooth movement changes? A systematic review of animal studies.

Immediately after the removal of orthodontic appliances, the teeth might start to drift away from their corrected position in an attempt to reach a new equilibrium. Medications and biologic factors could potentially modulate these processes. The objective of the present systematic review is to systematically investigate and appraise the quality of the evidence regarding the effect of various medications and biologic factors on the rate of relapse following active tooth movement. Search without restrictions in eight databases and hand searching until April 2020 were conducted. Studies performed on animal models investigating the effects of medication and biologic factors on the rate of relapse following orthodontic tooth movement were considered. Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed. Seventeen studies were finally identified, mostly at either high or unclear risk of bias. Ketorolac did not show any significant effects on relapse, while the administration of tetracycline, atorvastatin, psoralen and raloxifene decreased it. Overall, the same result was observed with bisphosphonates with the exception of low dosage of risedronate, which did not have an effect. Osteoprotegerin and strontium resulted in reduced relapse, but not in the immediate post-administration period. Inconsistent or conflicting effects were noted after the use of simvastatin and relaxin. The quality of the available evidence was considered at best as low. It can be concluded that specific medications and biologic factors may have an effect on the rate of relapse following tooth movement. The orthodontist should be knowledgeable about the substances potentially affecting retention.

Effect of ovariectomy-induced osteoporosis on the amount of orthodontic tooth movement: a systematic review of animal studies.

BACKGROUND: Understanding the impact of osteopenia and osteoporosis on orthodontic tooth movement could be of benefit to the orthodontist, but research in humans presents practical and ethical problems. The ovariectomized animal model could provide useful information on osteoporosis. OBJECTIVE: To compare the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects. SEARCH METHODS: Unrestricted searches in seven databases and manual searching of the reference lists in relevant studies were performed up to February 2021 (PubMed, Central, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Arab World Research Source, ProQuest Dissertations, and Theses Global). SELECTION CRITERIA: We searched for studies quantitatively comparing the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model. RESULTS: Thirteen studies were finally selected and no specific concerns regarding bias were identified. During the active period, ovariectomy was associated with a statistically significant acceleratory effect on the rate of orthodontic tooth movement compared to non-treated rats (3 weeks; 4 studies, 0.15 mm more movement in the ovariectomized rats; 95 per cent confidence interval: 0.10-0.19; P = 0.000). Exploratory meta-regression showed that this difference could increase over time. Following force discontinuation, no statistically significant differences were observed [3 weeks; 1 study (median ± SE), Ovariectomy group: 0.30 ± 0.04 mm; Sham operation group: 0.18 ± 0.03; P = 0.1558]. CONCLUSIONS: Ovariectomy-induced osteoporosis may affect the rate of orthodontic tooth movement. Although animal studies should be approached with caution regarding their translational potential, the safe practice would suggest that one should consider potential implications. REGISTRATION: PROSPERO (CRD42018118003).

Does the rate of orthodontic tooth movement change during the estrus cycle? A systematic review based on animal studies.

BACKGROUND: As the fluctuation of sex hormone levels in menstruating women results in periodical effects in bone metabolism, understanding the implications for tooth movement could be of benefit to the orthodontist. This type of research presents practical and ethical problems in humans, but animal models could provide useful information. Our objective was to systematically investigate the available evidence on the question whether the rate of orthodontic tooth movement varies between the different stages of the estrus cycle in animals. METHODS: Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to February 2021 (Medline [PubMed], CENTRAL [Cochrane Library; includes records from Embase, CINAHL, ClinicalTrials.gov, WHO's ICTRP, KoreaMed, Cochrane Review Groups' Specialized Registers, and records identified by handsearching], Cochrane Database of Systematic Reviews [Cochrane Library], Scopus, Web of Knowledge [including Web of Science Core Collection, KCI Korean Journal Database, Russian Science Citation Index, SciELO Citation Index and Zoological Record], Arab World Research Source [EBSCO] and ProQuest Dissertation and Theses [ProQuest]). Our search focused on prospective controlled animal studies, whose samples included female subjects of any species that were quantitatively comparing the amount of tooth movement in the different stages of the estrus cycle. Following study retrieval and selection, relevant data was extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. RESULTS: From the finally assessed records, 3 studies met the inclusion criteria. Two of the studies experimented on Wistar rats, whereas the other on cats. Tooth movement was induced by expansion or coil springs. The rate of orthodontic tooth movement was increased during the stages of the estrus cycle when oestrogen and/or progesterone levels were lower. The risk of bias in the retrieved studies was assessed to be unclear. CONCLUSION: Hormonal changes during the estrus cycle may affect the rate of orthodontic tooth movement. Although these animal experiment results should be approached cautiously regarding their translational potential, it could be useful to consider the possible impact of these physiological changes in the clinical setting until more information becomes available. Registration: PROSPERO (CRD42021158069).

Do analgesics used for the pain experienced after orthodontic procedures affect tooth movement rate? A systematic review based on animal studies.

BACKGROUND: Using analgesics for a short period to relieve the pain following specific orthodontic procedures is common. Such medications may influence orthodontic tooth movement biochemical pathways; however, the information originating from human studies is limited. OBJECTIVES: To systematically investigate current evidence from animal experiments on the effect of administering analgesics for a few days, which is consistent with usual clinical practice, on the speed of orthodontic tooth movement. SEARCH METHODS: Eight databases were searched without restrictions, and hand searching was conducted until June 2019. SELECTION CRITERIA: Animal controlled studies assessing the short-term impact of analgesics that can be consumed for orthodontic pain on the speed of orthodontic tooth movement. DATA COLLECTION AND ANALYSIS: Subsequent to retrieving relevant studies and information extraction, the SYRCLE's Risk of Bias Tool was used for risk of bias assessment. RESULTS: Finally, seven studies were selected, and most of them were assessed at unclear risk of bias. Short-term administration of acetaminophen did not affect significantly the speed of tooth movement, while ibuprofen and indomethacin were reported to decrease it. After administering acetylsalicylic acid and celecoxib, the noted effects were inconsistent. The quality of the available evidence for the animal setting was considered as moderate at most. CONCLUSIONS: Consuming specific analgesics for a few days may influence the speed of orthodontic tooth movement in animals. Clinicians should be aware of the relevant implications and be capable to identify those substances that may not interfere with treatment processes.

Effects of systematic bisphosphonate use in patients under orthodontic treatment: a systematic review.

BACKGROUND: Bisphosphonates are a class of drugs prescribed for several osseous related disorders owing to their ability to regulate bone turnover, which could in turn affect orthodontic treatment outcomes. OBJECTIVE: To examine the effect of bisphosphonate (BP) use on orthodontic patients through clinical and radiographic measurements. SEARCH METHODS: Systematic and unrestricted search of 17 databases complemented with additional hand-searches were performed up to March 2019. SELECTION CRITERIA: Articles reporting on human patients with a history of BPs administration that received orthodontic treatment were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Data regarding the medical profile of the patients, the specific type of malocclusion and the performed treatment plan, as well as the clinical and radiographic outcomes were extracted. Quality assessment was performed by the ROBINS-I tool for the cohort studies and by a slightly modified checklist from the original one proposed by Agbabiaka et al. for the case reports. RESULTS: 7 articles (1 retrospective cohort study and 6 case reports) were eventually included in the present review including 122 subjects (29 patients and 93 controls) reporting on the clinical and radiographic changes following orthodontic treatment of patients during or after BPs use. BPs seem to have a controversial effect on the clinical and patient-reported variables, even though the majority of the included patients presented with compromised treatment results and a rather slow rate of tooth movement. Most radiographic findings revealed mild root resorption, widened periodontal ligament spaces and sclerotic changes on the surrounding alveolar bone. However, these results should be interpreted with caution, due to the limited number of the eligible articles and their limitations. LIMITATIONS: The included studies were of rather low quality due to study design and incomplete reporting. CONCLUSIONS AND IMPLICATIONS: BP administration seems to be associated with compromised clinical outcomes, prolonged treatment time, and moderate changes on the roots and surrounding tissues of orthodontic patients. REGISTRATION: Non-registered. FUNDING: None.

Does medication administration affect the rate of orthodontic tooth movement and root resorption development in humans? A systematic review.

BACKGROUND: Recently, the potential impact of different medications on the rate of orthodontic tooth movement and the associated root resorption has been systematically reviewed in animal studies and various effects have been shown. However, animal data cannot be extrapolated to human clinical situations directly. OBJECTIVES: To systematically investigate the most up to date available evidence from controlled human studies regarding the effect of medication administration on the rate of orthodontic tooth movement and associated root resorption development. SEARCH METHODS: We searched eight databases (covering also grey literature) without restrictions and we performed hand searching up until October 2018. SELECTION CRITERIA: Controlled studies in humans assessing the effect of various medications on the rate of orthodontic tooth movement and root resorption development. DATA COLLECTION AND ANALYSIS: Study selection was followed by data extraction and risk of bias assessment using the ROBINS-I tool for non-randomized and the Cochrane Risk of Bias Tool for randomized studies. RESULTS: Eight studies, at various risk of bias, were finally identified. With regard to the rate of orthodontic tooth movement, local injections of prostaglandin E1 were found to exert an increasing effect, whereas systemic intake of nabumetone decreased it. Following tenoxicam administration, drinking water with fluoride or local injections of calcitriol (vitamin D metabolite), no significant effects were demonstrated. Concerning root resorption development, nabumetone administration was shown to reduce it, whereas fluoride, overall, was not observed to exert any effect. Only in individuals subjected to heavy orthodontic forces, did fluoride show a protective effect for the period of force application, but not in the longer term during retention. CONCLUSIONS: The aforementioned substances may show varying effects on the rate of orthodontic tooth movement and root resorption development in human subjects. Despite the observed limitations, the orthodontist should be able to identify patients taking pharmaceuticals and consider any implications related to orthodontic treatment. REGISTRATION: PROSPERO (CRD42017078208).

Does the rate of orthodontic tooth movement change during pregnancy and lactation? A systematic review of the evidence from animal studies.

BACKGROUND: The changes in bone homeostasis observed during pregnancy and lactation could result in alterations in the rate of orthodontic tooth movement, but research in human subjects presents significant ethical and practical limitations. Our aim was to compare the amount of orthodontic tooth movement between pregnant/lactating or not animals. METHODS: We searched without restrictions 8 databases and performed hand searching until July 2019 (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ClinicalTrials.gov , ProQuest Dissertations and Theses Global). We searched for studies comparing quantitatively the amount of orthodontic tooth movement between pregnant/lactating or not animals. Following retrieval and selection of studies, the collection of related data was performed and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis was carried out using the random effects model. RESULTS: Four studies were finally identified raising no specific concerns regarding bias. One study showed that lactation increased the rate of tooth movement by 50 % [p < 0.05]. Although an overall increase was noted in the pregnancy group as well, it did not reach statistical significance [3 studies, Weighted Mean Difference: 0.10; 95% Confidence Interval: - 0.04 - 0.24; p = 0.165]. CONCLUSIONS: The metabolic changes occurring during pregnancy and lactation may have an impact on the rate of tooth movement in animals. Although these animal experimental results should be approached cautiously, it could be safe practice to consider the impact of these physiological changes in the clinical setting. REGISTRATION: PROSPERO (CRD42018118003).

Do probiotics promote oral health during orthodontic treatment with fixed appliances? A systematic review.

BACKGROUND: Treatment with fixed orthodontic appliances has been associated with significant biofilm accumulation, thus putting patients at a higher risk of oral health deterioration. The use of probiotics has been proposed to be useful in the prevention or treatment of oral pathologies such as caries and diseases of periodontal tissues. Our aim was to investigate the effects of probiotic use on inflammation of the gingival tissues and the decalcification of the enamel in patients being treated with fixed orthodontic appliances. METHODS: We searched without restrictions 8 databases and performed hand searching until September 2019. We searched for randomized controlled trials (RCTs) evaluating whether individuals with fixed orthodontic appliances benefit from probiotic treatment in terms of the inflammation of the gingivae and decalcification of the enamel. Following the selection of studies and the extraction of pertinent data, we appraised the risk of bias and the confidence in the observed effects based on established methodologies. RESULTS: From the final qualifying studies, three did not show any statistically significant effect on gingival inflammation after probiotic administration of up to 1 month. Similarly, non-significant differences were noted in another study regarding white spot lesions development (mean administration for 17 months). No adverse effects were reported and the level of evidence was considered moderate. CONCLUSIONS: Supplementation of orthodontic patients with probiotics did not affect the development of inflammation in the gingivae and decalcification in the enamel. Additional RCTs, with longer intervention and follow-up periods, and involving different combinations of probiotic strains are required. TRIAL REGISTRATION: PROSPERO (CRD42018118008).

Effects of systemic medication on root resorption associated with orthodontic tooth movement: a systematic review of animal studies.

BACKGROUND: Theoretically, root resorption could be modulated by any medication taken that exhibits possible effects on the implicated molecular pathways. OBJECTIVES: To systematically investigate and appraise the quality of the available evidence from animal studies, regarding the effect of commonly prescribed systemic medication on root resorption associated with orthodontic tooth movement. SEARCH METHODS: Search without restrictions in eight databases (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ClinicalTrials.gov, ProQuest Dissertations and Theses Global) and hand searching until April 2018 took place. One author developed detailed search strategies for each database that were based on the PubMed strategy and adapted accordingly. SELECTION CRITERIA: Controlled studies investigating the effect of systemic medications on root resorption associated with orthodontic tooth movement. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. RESULTS: Twenty-one studies were finally identified, most of which at unclear risk of bias. Root resorption was shown to increase in Vitamin C treated animals in comparison with the control group, whereas a comparative decrease was noted after the administration of the alendronate, ibuprofen, growth hormone, low doses of meloxicam, simvastatin, lithium chloride and strontium ranelate. No difference was noted for acetaminophen, aspirin, fluoxetine, atorvastatin, misoprostol, zoledronic acid and zinc. Finally, inconsistent effects were observed after the administration of celecoxib, prednisolone and L-thyroxine. The quality of the available evidence was considered at best as low. CONCLUSIONS: The pharmaceutical substances investigated were shown to exhibit variable effects on root resorption. Although the overall quality of evidence provides the clinician with a cautious perspective on the strength of the relevant recommendations, good practice would suggest that it is important to identify patients consuming medications and consider the possible implications. REGISTRATION: PROSPERO (CRD42017078208).

Does long-term use of pain relievers have an impact on the rate of orthodontic tooth movement? A systematic review of animal studies.

BACKGROUND: Pain relief drugs are used and misused widely and may theoretically affect the events leading to orthodontic tooth movement. OBJECTIVE: To systematically investigate and appraise the quality of the available evidence regarding the effect of pain relief medications on the rate of orthodontic tooth movement. SEARCH METHODS: Search without restrictions in eight databases (including grey literature) and hand searching until October 2018. SELECTION CRITERIA: Animal controlled studies investigating the effect of pain relievers on the rate of orthodontic tooth movement. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed using the SYRCLE's risk of bias tool. RESULTS: Fourteen studies were finally identified, most of which at unclear risk of bias. Ibuprofen and loxoprofen did not show any significant effects on the rate of orthodontic tooth movement, whereas indomethacin, ketorolac, morphine, and high doses of etoricoxib were found to decrease it. Inconsistent or conflicting effects were noted after the administration of acetaminophen, acetylsalicylic acid, celecoxib, meloxicam, and tramadol. The quality of the available evidence was considered at best as low. CONCLUSIONS: Long-term consumption of pain relievers may affect the rate of orthodontic tooth movement. The orthodontist should be capable of identifying patients taking pain relievers independently of orthodontic treatment and consider the possible implications. TRIAL REGISTRATION: PROSPERO (CRD42017078208).

Medication and orthodontic tooth movement.

As any pharmaceutical substance may influence the events associated with orthodontic tooth movement, it is of importance for the clinician to be able to recognize any prospective patient's history and patterns of medicinal consumption. This review presents the effects of various commonly prescribed medications on the rate of orthodontic tooth movement. The article concludes that it remains, to a degree, unclear which types of medication may have a clinically significant effect in everyday clinical scenarios. However, since both prescription and over-the-counter medication use have recently increased significantly among all age groups, good practice suggests that it is important to identify patients consuming medications and consider the possible implications in orthodontic therapy.

Effectiveness of extraction of primary canines for interceptive management of palatally displaced permanent canines: a systematic review and meta-analysis.

Background: Although extraction of primary canines in the mixed dentition has been suggested as a measure to prevent impaction of palatally displaced permanent canines (PDCs), the relevant evidence has been inconclusive. Objective: To assess the effectiveness of this practice and investigate the quality of the evidence. Search methods: Search without restrictions in 15 databases and hand searching until April 2017. Selection criteria: Randomized clinical trials comparing extraction of primary canines in the mixed dentition to no treatment. Data collection and analysis: Following study retrieval and selection, data extraction, and individual study risk of bias assessment using the Cochrane Risk of Bias Tool, the random effects method of combining treatment effects was used. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. Results: Finally 5 studies were identified involving 214 individuals, followed for up to 48 months post-intervention. Two studies were at low and the rest at high risk of bias. Although at the 12-month evaluation, extraction of the primary canine did not result in a statistically significant difference [risk ratio (RR): 1.537; 95% confidence interval (CI): 0.656-3.601, P = 0.323; 1 study, n = 67 individuals], beyond 12 months a benefit was noted (RR: 1.784; 95% CI: 1.376-2.314, P = 0.000; 5 studies, n = 214 individuals; I2 = 0%). Analysis of the studies at low risk of bias confirmed the above-mentioned result (RR: 1.713; 95% CI: 1.226-2.394, P = 0.002; 2 studies, n = 91 individuals; I2 = 0%; moderate quality evidence). No difference was observed regarding root resorption of adjacent permanent teeth (RR: 0.602; 95% CI: 0.277-1.308, P = 0.200; 1 study; n = 67 individuals; moderate quality evidence). Conclusions: Extraction of primary canines in the mixed dentition may increase the chance of subsequent successful eruption of PDC in the long term. However, better study standardization is necessary.

Does common prescription medication affect the rate of orthodontic tooth movement? A systematic review.

Background: As the taking of any medication may theoretically affect the complex pathways responsible for periodontal tissue homeostasis and the events leading to orthodontic tooth movement, it is considered important for the orthodontist to be able to identify prospective patients' history and patterns of pharmaceutical consumption. Objective: To systematically investigate and appraise the quality of the available evidence regarding the effect of commonly prescribed medications on the rate of orthodontic tooth movement. Search methods: Search without restrictions in eight databases and hand searching until June 2017. Selection criteria: Controlled studies investigating the effect of commonly prescribed medications with emphasis on the rate of orthodontic tooth movement. Data collection and analysis: Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Results: Twenty-seven animal studies, involving various pharmacologic and orthodontic interventions, were finally identified. Most studies were assessed to be at unclear or high risk of bias. The rate of orthodontic tooth movement was shown to increase after the administration of diazepam, Vitamin C and pantoprazole, while simvastatin, atorvastatin, calcium compounds, strontium ranelate, propranolol, losartan, famotidine, cetirizine, and metformin decreased the rate of orthodontic tooth movement. No interference with the rate of orthodontic tooth movement was reported for phenytoin, phenobarbital and zinc compounds, whereas, inconsistent or conflicting effects were noted after the administration of L-thyroxine, lithium compounds, fluoxetine and insulin. The quality of the available evidence was considered at best as low. Conclusions: Commonly prescribed medications may exhibit variable effects on the rate of orthodontic tooth movement. Although the quality of evidence was considered at best as low, raising reservations about the strength of the relevant recommendations, the clinician should be capable of identifying patients taking medications and should take into consideration the possible implications related to the proposed treatment. Registration: PROSPERO (CRD42015029130).