Accuracy and reproducibility of tablet-based applications for three-dimensional facial scanning: an in-vitro study.

AIM: An in-vitro study was performed to investigate the overall and regional accuracy and precision of digital three-dimensional facial scans obtained from four tablet-based applications (Bellus Dental Pro, Capture: 3D scan anything, Heges, and Scandy Pro 3D scanner) on an iPad Pro® (Apple Store, Cupertino, CA, USA), equipped with LiDAR and TrueDepth technology, compared to the validated manual measurements using a digital vernier caliper (DVC). MATERIALS AND METHODS: The accuracy of the various applications was determined through multiple scans of a three-dimensional (3D) printed mannequin face using iPad Pro®. For precision evaluation, the mannequin's face was scanned five times with each application, and these models were compared using the coefficient of variation (CV). The descriptive statistics were done from SPSS version 23 (IBM Company, Chicago, USA). One-sample t-test was used to analyze the difference between the control and the various scans. RESULTS: While the applications Capture, Heges, and Scandy tended to overestimate the measured values compared to DVC, the Bellus application underestimated these values. Scandy showed the highest mean difference in the Go - Ch (R) measurement, with a value of 2.19 mm. All the others average differences were less than 1.60mm. The assessment of precision showed that the coefficient of variation ranged from 0.16% and 6.34%. CONCLUSION: The iPad Pro® (2020) showed good precision and reasonable reliability, and it appears to be an interesting and favorable technology for the acquisition of surface images of facial-like structures. Moreover, further clinical investigations should be conducted.

Global survey to assess preferences for attending virtual orthodontic learning sessions: Pre-webinar settings.

OBJECTIVES: To assess technical factors and audience preferences before attending orthodontic online learning activity, the demand for which increased dramatically in the era of the COVID-19 pandemic. DESIGN: Cross-sectional study. SETTING: Online survey. PARTICIPANTS: Global orthodontic residents and specialists. METHODS: A validated and anonymous survey comprising 17 online questions was sent to 3000 individuals. The data were collected three months later. Descriptive statistics and non-parametric tests were applied. RESULTS: The participants' response rate was 19.9%, with almost equal gender participation. Most of the responders were based in Asia (51.4%). Almost half of the participants were aged 25-35 years with less than 5 years of clinical experience. Regardless of the age, gender or global distribution, 57.3% of respondents opted to share limited personal information with the host. One-third of the respondents preferred receiving webinar reminders via email, ideally a day and/or one hour before the webinar, especially being exportable to their calendars. Age played a major role in shaping this trend, as young participants favoured the one hour (1-h) pre-webinar reminder more than other age groups (P=0.02). Receiving information about the speaker, learning outcomes and pre-webinar reading material (WRM) were preferable, particularly among young participants in comparison with the older age groups (P<0.05). Male participants from Asia and Africa preferred to attend online lectures during the mid-evening on weekends compared with women who were in favour of early evening sessions (P<0.05). CONCLUSION: It must be borne in mind during the interpretation of the results that the data were collected during the COVID-19 pandemic. It is important to take into consideration the gender, age, cultural background and level of experience while setting up virtual orthodontic learning sessions. Organisers need to tailor their events to meet the needs of the attendees.

Comparison between two asynchronous teaching methods in an undergraduate dental course: a pilot study.

BACKGROUND: Properly designed and implemented eLearning can lead to improvement of dental teaching quality. Various strategies have been proposed to increase the effectiveness of eLearning in dental education, however, there is a lack of research to assess the effectiveness of these strategies. OBJECTIVE: To investigate dental students' learning performance and perception of a virtual flipped learning format compared to a virtual traditional learning method. METHODS: A crossover pilot study was conducted at the College of Dentistry, Princes Sattam Bin Abdulaziz University, Saudi Arabia. Computer-generated randomization, blinded from researchers who analyzed the results, was performed to allocate 32 participants (aged 23.27 ± 0.86 years) to one of two groups. Participants in the control group were taught through the virtual traditional learning method (VTL) using live video lectures. In contrast, participants in the intervention group were taught through the virtual flipped learning method (VFL) using recorded online lectures and post-lecture virtual discussions. Learning gain and preference were measured by pre- and post-test average score differences and a modified validated survey, respectively. RESULTS: There was no significant difference in learning performance between VFL and VTL groups (P > 0.05). However, students preferred VFL over VTL and the differences were significant among all survey items, except for the opportunity to ask questions. CONCLUSION: Health professions educators are encouraged to carefully design online curricula with efficient learning strategies that help students improve learning performance and foster self-directed learning skills while valuing active learning in an online environment. TRIAL REGISTRATION: NCT04692142 , 31/12/2020.

Global survey to assess preferences for attending virtual orthodontic learning sessions.

INTRODUCTION: Nowadays, there is a tremendous increase in the conducting of virtual orthodontic learning sessions (VOLSs). This study aimed to investigate the fundamental technical and settings aspects of VOLSs. METHODS: Three thousand orthodontic residents and specialists worldwide were invited via e-mail to complete an anonymous survey, including 23 prevalidated questions. Reminders were sent at 2-week intervals. When the sample size was reached, the survey was locked. Descriptive and inferential statistics were performed. RESULTS: Two hundred ninety-four males and 299 females of various age groups completed the survey; 61.9% of the participants opted to view the speaker's live video and the presentation's screen concurrently. Participants favored a speaker/screen ratio of 1:6 (57.5%), e-housekeeping before VOLSs (58%), appointed moderators for each VOLS (8.31 out of 10; 95% CI: 8.13, 8.48), and a nondistractive virtual background for the speakers/moderators (21.9%). Participants supported broadcasting before the start of the lecture of the VOLS (6.7 out of 10; 95% CI: 6.50, 6.95), with this being significantly influenced by the gender of participants and their continent of residence (P <0.001). Only 17.4% opted against live streaming of the VOLSs. Muting the attendees' microphones (90.5%) and having their videos switched off (62.39%) was preferable; 49.4% used their personal computers to view the lecture, whereas 27.5% used mobile phones. A webinar of 60-90 minutes duration was preferred by 76.6% of the VOLSs participants; 53.1% of the participants opted for a questions and answers session at the end of VOLSs. CONCLUSIONS: Organizers should take into consideration the impact of the digital body language of the speaker, the role of the moderator, cultural background, and privacy concerns of the attendees while organizing VOLSs. Orthodontic clinicians prefer to spend 60-90 minutes attending an interactive online session in which they can raise their questions during and at the end of the VOLSs.

Do longitudinal orthodontic trials use appropriate statistical analyses? A meta-epidemiological study.

BACKGROUND: In orthodontic trials, longitudinal designs with multiple outcome measurements over time are common. The aim of this epidemiological study was to examine whether optimal statistical analysis approaches have been used in longitudinal orthodontic trials. METHODS: Pubmed was searched in August 2021 for longitudinal orthodontic trials with at least three time points of outcome assessment published in the 2017-20 period. Study selection and data extraction were done independently and in duplicate. The analysis approaches undertaken were tabulated and associations between study characteristics and the use of optimal analysis or not were assessed using Fisher's exact test and logistic regression. RESULTS: One hundred forty-seven out of 563 unique records were deemed eligible for inclusion. Only 26.50% of these trials used an optimal statistical analysis for longitudinal data where the data structure is accounted for. None of the study characteristics except the statistical significance of the results were associated with the appropriateness of the statistical analysis. The odds of significant results in studies with suboptimal analyses were higher than that in studies with optimal longitudinal analyses (odds ratio: 3.48, 95% confidence interval: 1.62, 7.46, P = 0.001). For the studies with optimal analysis, the most frequent test was repeated-measure analysis of variance (RM-ANOVA). The reporting of the statistical analysis section was suboptimal in the majority of the trials. CONCLUSION: Most longitudinal orthodontic trials are not analysed using optimal statistical approaches. Inferences and interpretation of their results are likely to be compromised.

Effect of mini-implant facilitated micro-osteoperforations on the alignment of mandibular anterior crowding: A randomised controlled clinical trial.

OBJECTIVE: To assess the effects of mini-implant assisted micro-osteoperforations (MI-MOPs) in the alignment of mandibular anterior teeth, and to explore the intervention's associated pain perception (PP) and root resorption (RR) in adults treated by fixed appliance. DESIGN: Multicentre, two-arm and single-blinded randomised clinical trial. SETTING: College of Dentistry, University of Baghdad. PARTICIPANTS: Adolescents (mean age = 18.97 years) undergoing non-extraction orthodontic therapy for the management of mandibular anterior crowding. METHODS: A total of 33 participants (mean age = 18.97 years) undergoing non-extraction orthodontic therapy for the management of moderate mandibular anterior crowding were allocated to the experimental (MI-MOPs, n = 17) or control groups (non-MI-MOPs, n = 16). A series of lower study models were obtained at week 4 (T1), week 8 (T2) and week 12 (T3) in the MI-MOPs group and continued to week 16 (T4) and week 20 (T5) in the non-MI-MOPs group, with all models analysed digitally. Periapical radiographs (PA) were taken before commencing treatment (T0) and T3. Participants were asked to complete a 10-point visual analogue scale (VAS) daily during the first week of treatment. RESULTS: At T0, the mean Little irregularity index (LII) was 5.1 mm (95% confidence interval [CI] = 4.95-5.23) with no statistically significant difference between groups (P = 0.766). At T1, T2 and T3, t-test showed statistically significant differences in the LII (P < 0.05) in favour of the MI-MOPs group; mean differences (MD) were -1.16mm (95% CI = -1.36 to -0.96), -1.77 mm (95% CI = -1.93 to -1.59) and -1.58 mm (95% CI = -1.67 to -1.48), respectively. Mean treatment time from baseline to final alignment was 10.41 weeks (95% CI = 9.92-10.89) in the MI-MOPs group and 16.62 weeks (95% CI = 16.11-17.13) in the non-MI-MOPs groups, which was statistically significant (MD -6.21 mm, 95% CI = -6.88 to -5.53, P < 0.05). Conversely, Mann-Whitney U-test and Wilcoxon signed-rank test showed no significant differences in terms of PP and RR between the groups (P > 0.05). The participants in the MI-MOPs group experienced a higher degree of RR (P < 0.05) secondary to intervention. No other significant adverse events were reported during the trial. CONCLUSION: This trial found that combining MI-MOPs with non-extraction-based fixed orthodontic therapy in adults mildly shortens the duration of the alignment phase. RR should be monitored throughout the treatment when using MI-MOPs (ClinicalTrials.gov NCT04778241).

The effectiveness of surgical adjunctive procedures in the acceleration of orthodontic tooth movement: A systematic review of systematic reviews and meta-analysis.

OBJECTIVE: To identify and evaluate the body of the evidence regarding the effectiveness of surgical adjunctive procedures (SAPs) in accelerating orthodontic tooth movement (OTM). DATA SOURCES: Unrestricted search of three electronic databases and manual search up to 12 June 2020 were undertaken. DATA SELECTION: All systematic reviews of randomised and non-randomised controlled trials that investigate the effectiveness of the SAPs in accelerating OTM were included. DATA EXTRACTION: Study selection and data extraction were undertaken independently and in duplicate by two reviewers. A random-effects model with a 95% confidence interval (CI) was generated for comparable outcomes. Two reviewers assessed the quality of the included studies using AMSTAR2 and GRADE. RESULTS: Fourteen systematic reviews were included; however, four systematic reviews were assessed quantitatively. Meta-analysis showed that mean difference (MD) of canine retraction rate, for the first month after SAPs, was mild (MD = 0.65 mm/month). Compared to control, micro-osteoperforations (MOPs) statistically but temporally accelerate lower canine retraction and en masse retraction by 0.25 mm/month and 0.31 mm/month, respectively. There was no significant effect (P>0.05) in terms of molar anchorage loss (MAL) between control and MOP groups. Piezocision non-significantly shortens the duration of en masse retraction (4.30 months, P>0.05), but significantly shortens incisors retraction (101.64 days, P<0.001). MAL is mild but significantly less in the piezocision group compared to the control group (MD = 0.53 mm, P=0.03). Low-level evidence showed that SAPs have no significant effect on root resorption or periodontal health; however, piezocision is associated with transient acute inflammation and noticeable scars. CONCLUSION: Low-level evidence concludes that SAPs accelerate OTMs and reduce treatment duration, but the acceleration is minor and transient. The effect on anchorage loss is variable and technique related. Side effects of SAPs are transient, but some might be aesthetically noticeable. A cost-benefit analysis of SAPs should be considered while making the treatment decision.

Are developmentally missing teeth a predictive risk marker of malignant diseases in non-syndromic individuals? A systematic review.

BACKGROUND: Different genes and loci that are associated with non-syndromic developmental tooth agenesis (TA) have the same causation pathway in the development of tumours including breast cancer (BC), epithelial ovarian cancer (EOC), colorectal cancer (CRC) and lung cancer (LC). OBJECTIVES: To assess the link between TA and the development of cancer. SEARCH SOURCES: This registered review included a comprehensive search of electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], LILACS, Scopus, Web of Science and Medline via Ovid) until 1 April 2020, supplemented by manual, grey literature and reference lists search. There was no restriction in term of date of publication, gender, race or type of hypodontia. DATA SELECTION: The primary outcome was the relationship between TA and cancer. The secondary outcome was to identify the genetic correlation between TA and cancer. DATA EXTRACTION: Study selection, data extraction and risk of bias assessment were performed independently and induplicate by two reviewers, with disputes resolved by a third reviewer. RESULTS: Eight studies with a moderate-high risk of bias were included in the final review, with a total of 5821 participants. Due to the heterogeneity among the included studies, the data were presented narratively. Limited studies reported a high prevalence of EOC (19.2%-20%) and CRC (82%-100%) in individuals with TA (depending on the study) compared to those without TA (3% for EOC and 0% for CRC). While others reported a weak correlation between EOC and CRC and TA (P > 0.05). Weak evidence suggested a strong correlation between breast, cervical uterine and prostate cancers and TA (P < 0.05). CONCLUSIONS: Though low-quality evidence suggests a link between TA and cancer, it was not possible to verify that TA can hold a predictive value as a marker for cancers. Further research is needed to confirm the association. REGISTRATION: PROSPERO (CRD42020139751).

Three-dimensional nasolabial changes after maxillary advancement osteotomy in class III individuals: a systematic review and meta-analysis.

Background Class III malocclusions with maxillary retrognathia are commonly treated with single jaw Le Fort I maxillary advancement. The three-dimensional (3D) effects of surgery on the nasolabial region varies among the clinical studies. Quantifying these changes is of great importance for surgical planning and obtaining valid consent. Objectives To investigate the 3D relationship between soft tissue and skeletal changes secondary to Le Fort I maxillary advancement surgery in skeletal class III patients.Search methods Comprehensive search of multiple electronic databases supplemented by a manual and grey literature search were undertaken from inception to 9 June 2020.Selection criteria Studies that evaluated the 3D soft tissue changes of patients before and after maxillary advancement surgery alone.Data collection and analysis Study selection, data extraction and risk of bias assessment were performed independently by two reviewers, with disputes resolved by a third reviewer. A quantitative synthesis of the data was pre-planned for pooling similar outcome measures.Results Four studies were included in the final review and meta-analysis, with a total of 105 patients (mean age 16.7 + 33.9 years). The mean maxillary advancement of the included studies was 5.58 mm (95% CI 5.20-5.96). The sagittal effects of surgery on nose tip projection and prominence were insignificant (P >0.05, two studies); however, subnasal projection (MD 1.7 mm, two studies) and upper lip projection (MD 2.90 mm, four studies) increased significantly in a forward direction after surgery (P <0.05). Le Fort I osteotomy widens the upper philtrum width (MD 0.84 mm, two studies) (P <0.05). Inconsistencies among the included studies were identified; therefore, the results should be interpreted with caution.Conclusions There is weak evidence based on quantitative assessments that Le Fort I maxillary advancement significantly affects the nasolabial soft tissue envelope mainly in a sagittal dimension. These changes are concentrated around the central zone of the nasolabial region. Future prospective studies on maxillary advancement osteotomy with a standardised method of assessment, taking into consideration the confounding factors, are required.

Phone-based audience response system as an adjunct in orthodontic teaching of undergraduate dental students: a cross-over randomised controlled trial.

BACKGROUND: The advent of electronic teaching facilities improves tutor-student communication. This study aims to explore the effectiveness of Phone-Based Audience Response System (PB-ARS), as an adjunctive pedagogy tool to enhance the retention of orthodontic information by dental students; and to explore the students' perception of PB-ARS. METHODS: This cross-over clustered randomised control trial included 34 males who were in the final year of their undergraduate dental training. Participants were allocated to one of two event groups (G1 and G2) using computer-generated randomisation. Both groups simultaneously attended two different traditional lectures (L 1 and L2) a week apart. During L1, PB-ARS was used as an adjunct to conventional presentation to teach G1 participants, (PB-ARS group) while G2's participants acted as a control group (CG), and were taught using a traditional presentation. In the second week (L2), the interventions were crossed-over. Participants from both groups completed pre- and post-lecture multiple-choice questionnaires (MCQ) to assess their short-term retention of information. Their performance in the final MCQ exam (10 weeks following L2) was tracked to assess the long-term retention of the information. Participants also completed post-lecture questionnaires to evaluate their perceptions. RESULTS: Twenty-nine and 31 participants from the CG and PB-ARS group completed this trial, respectively. Although 87.5% of students in the PB-ARS group showed an improvement in their immediate post-lecture scores compared with 79.3% for the CG, it was statistically insignificant (p = 0.465). Similarly, the intervention showed an insignificant effect on the long-term retention of the knowledge (p = 0.560). There was a mildly but favourable attitude of students towards the use of PB-ARS. However, the difference in the overall level of satisfaction between both groups was statistically insignificant (p = 0.183). CONCLUSION: PB-ARS has a minimal and insignificant effect on the short- and long-term retention of orthodontic knowledge by male undergraduate dental students. PB-ARS was the preferred adjunct tool to conventional classroom teaching. Due to the limitations of this trial, a long-term randomised controlled trial with a larger sample size is recommended.

Anchorage effectiveness of orthodontic miniscrews compared to headgear and transpalatal arches: a systematic review and meta-analysis.

BACKGROUND: Anchorage in orthodontics can be provided through several extra- and intra-oral sources including headgear, teeth, cortical bone and soft tissue. OBJECTIVE: The aim of this review was to systematically review the effectiveness of miniscrews in reinforcing anchorage during en-masse retraction of anterior teeth in comparison to conventional anchorage appliances. Search method: Comprehensive searching of the electronic databases was undertaken up to March 2018 in the Cochrane Database of Systematic review, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed and Scopus databases. Additional searching for on-going and unpublished data and hand search of relevant journals were also undertaken, authors were contacted, and reference lists screened. Eligibility criteria: Searches were restricted to randomized clinical trials (RCTs) published in English, which compared anchorage reinforcement using mechanically-retained miniscrews (diameter of 2 mm or less) to conventional anchorage appliances during en-masse retraction of anterior teeth in participants of any age treated with fixed appliances combined with extraction of maxillary premolars. DATA COLLECTION AND ANALYSIS: Blind and induplicate study selection, data extraction and risk of bias assessment were undertaken. The primary outcome was the amount of mesial movement of the upper first permanent molar (anchorage loss) while secondary outcomes included treatment duration, number of visits, adverse effects and patient-centered outcomes. The risk of bias was assessed using Cochrane risk of bias tool. A random-effects model with its corresponding 95% confidence interval (CI) were generated for comparable outcomes. Statistical heterogeneity across the studies were assessed using the I2 and Chi2 test. Additional sensitivity tests were implemented. RESULTS: Seven RCTs met the inclusion criteria, however, data of 241 participants from 6 RCTs (250 miniscrews and 134 conventional anchorage appliances) were meta-analyzed. Qualities of the included RCTs varied from low to high. The standardized mean difference (SMD) of the anchrage loss between the two intervention groups was 2.07 mm ((95% CI (-3.05) to (-1.08), p < .001, I2 = 88%, 6 RCTs)) in favour of miniscrews, which was also preserved after excluding the high risk of bias studies (SMD 1.94 mm, 95% CI (-2.46) to (-0.42) p < .001, I2 = 93%, 3 RCTs)). Information on overall treatment duration, space closure duration, quality of treatment, patient-reported outcomes, adverse effects and number of visit were limited. CONCLUSION: The result of the meta-analysis suggested that there is moderate quality of evidence that miniscrews are clinically and statistically more effective in preserving orthodontic anchorage than conventional appliances. However, this conclusion is supported by a small number of studies with variable qualities. High-quality RCTs would give a better understanding of miniscrews effectiveness in providing orthodontic anchorage.

Reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis.

BACKGROUND: Reminders are implemented in healthcare services to increase compliance with treatment and to decrease the rate of failed appointments. Their effects in the provision of orthodontic care are not yet fully understood. OBJECTIVES: The main objectives of this review were to assess the effectiveness of reminder systems in improving oral hygiene (OH) and adherence to appointments in orthodontic patients. SEARCH METHODS: An unrestricted search was conducted in six electronic databases and was supplemented by an extensive manual search up to January 2018. SELECTION CRITERIA: Only randomized controlled trials (RCTs) evaluating the effectiveness of reminders in orthodontics were included. DATA COLLECTION AND ANALYSIS: Two authors were independently involved in study selection, data extraction, and bias assessment. A random-effects model with its corresponding 95% confidence interval (CI) was generated for comparable outcomes. Periodontal parameters were evaluated in the short term (1-3 months) and in the long term (>3 months). Cochrane risk of bias tool was utilized for bias assessment and the quality of the resultant evidence was graded. Additional subgroup and sensitivity analyses were implemented. RESULTS: Fourteen RCTs involving 2078 participants met the inclusion criteria; five studies were excluded from the quantitative synthesis due to high risk of bias. Small but statistically significant standardized mean differences in the plaque index scores were recorded favoring patients receiving reminders in the short-term (-0.38; 95% CI: -0.65 to -0.10) and in the long-term (-1.51; 95% CI: -2.72 to -0.30). Patients receiving reminders were less likely to miss their appointments with a relative risk of (0.39; 95% CI: 0.22 to 0.70) and less likely to develop white spot lesions (0.45; 95% CI: 0.31 to 0.65). CONCLUSIONS: There is moderate-to-high quality of evidence that reminders have a positive effect on OH and adherence to appointments in orthodontic patients. These effects were demonstrated in the short- and long-term. Future high-quality RCTs should be designed with longer follow-up periods. REGISTRATION: PROSPERO (CRD42017084479). CONFLICT OF INTEREST: None.

Effectiveness of different debonding techniques and adjunctive methods on pain and discomfort perception during debonding fixed orthodontic appliances: a systematic review.

BACKGROUND: Pain is an unpleasant side-effect that can be experienced during orthodontic procedures including debonding of fixed appliances. Pain experience can vary depending on the appliance, debonding technique, as well as adjunctive measures used. OBJECTIVES: The primary objective of this systematic review was to assess the effectiveness of different debonding techniques and adjunctive methods on pain/discomfort perception during debonding procedure (PDP) of fixed orthodontic appliances. The secondary objective was to assess the effects of anatomic location and gender on PDP of fixed orthodontic appliances. SEARCH METHODS: Multiple electronic databases were searched from inception to August 2018. Reference lists of the included articles were manually screened. SELECTION CRITERIA: Randomized clinical trials (RCTs) and controlled clinical trials were included. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers according to Cochrane guidelines, with disputes resolved by a third reviewer. Clinical heterogeneity in study design and methodology prevented quantitative synthesis of the data. RESULTS: The search yielded 198 articles after the removal of duplicates. Seven studies were included in the final review with a total of 307 participants aged 12-60 years. Of the four studies comparing different debonding instruments of labial fixed appliances, two studies showed that the lift-off debonding instrument (LODI) produced lower PDP levels than ligature cutting pliers. Three studies compared adjunctive measures to reduce PDP of labial fixed appliances. Finger pressure and bite wafers significantly reduced PDP levels. Analgesics administration (ibuprofen + paracetamol tablets) 1 hour prior to debonding also reduced PDP. PDP was significantly higher in anterior segments and in females. LIMITATIONS: The authors acknowledge that there was clinical heterogeneity among the included studies and that the potential effect of diurnal variation on pain during debonding was not considered in any of the included trials. CONCLUSIONS AND IMPLICATIONS: There is weak evidence indicating that using the LODI may reduce PDP of labial fixed appliances. Adjunctive measures such as an intrusive force with finger pressure, bite wafers, and preoperative analgesia may further aid PDP control. Further well-designed parallel-group RCTs taking into consideration the diurnal variation in pain are required. REGISTRATION: PROSPERO (CRD42017084474). FUNDING: None. CONFLICT OF INTEREST: The authors declare that there is no conflict of interest.

Big toenail and hair samples as biomarkers for fluoride exposure - a pilot study.

BACKGROUND: Biomarkers can aid in detecting and preventing clinical disease through the recognition of change in biological samples. The objective of this case-control study was to further the knowledge on the use of big toenail and hair samples as biomarkers for fluoride exposure. METHODS: A total of 48 participants from an endemic (IC) and a non-endemic (SC) fluorosis region were included. Big toenail and hair samples were collected from each participant and the fluoride concentration was determined. The results of 42 participants were reported: 21 participants (11 males and 10 females, mean age 15.66 + 2.61 years) from IC and 21 participants (11 males and 10 females, mean age 15.06 + 0.79 years) from SC. RESULTS: The mean fluoride concentration of big toenail (2.34 ± 0.26 mg/kg) and hair (0.24 ± 0.04 mg/kg) in the endemic region was significantly higher than the mean fluoride concentration of big toenail (0.98 ± 0.08 mg/kg) and hair (0.14 ± 0.02 mg/kg) in the non-endemic region (p < 0.001 and p = 0.004, respectively). The Receiver Operating Characteristic (ROC) analysis showed that the Area Under the Curve (AUC) value was 0.889 for big toenail (p < 0.001) and 0.762 for hair (p = 0.004) samples. The fluoride assay for big toenails exhibits greater observed accuracy than does the fluoride assay for hair. CONCLUSION: Nail and hair samples can serve as biomarkers to detect biological fluoride exposure according to the data of this pilot study. Nevertheless, hair is less sensitive and specific as a biomarker when AUC values of big toenail and hair samples were compared.

The quality of reporting RCT abstracts in four major orthodontics journals for the period 2012-2017.

INTRODUCTION: Clear reporting of the abstracts of randomised controlled trials (RCTs) facilitates the assessment and identification of such trials. AIM: To assess whether authors in the orthodontic field of research currently report RCT abstracts adequately, as defined by the Consolidated Standards of Reporting Trials (CONSORT) statement. DESIGN: An observational retrospective study. METHODS: Electronic searches with supplementary hand searching were undertaken to identify RCTs published in (1) American Journal of Orthodontics and Dentofacial Orthopedics (AJO-DO), (2) Angle Orthodontist (AO), (3) European Journal of Orthodontics (EJO) and (4) Journal of Orthodontics (JO) for the period from January 2012 to December 2017. The completeness of the abstract reporting was evaluated using a modified CONSORT for abstract statement checklist. RESULTS: A total of 3678 articles were retrieved, but only 224 RCT abstracts were identified and assessed. A high volume of RCTs were published with either the AO (39%) or AJO-DO (32%); the majority of the RCT abstracts (93.6%) were structured. The mean overall abstract reporting quality score was 69.1% (95% confidence interval = 67.5-70.7). In relation to individual quality items, the majority of the RCT abstracts (range = 96-100%) demonstrated clear reporting of the author/contact details, trial design, participants, interventions, objectives, outcomes, number of participants randomised to each group, recruitment, results and conclusions. However, reporting of the title, trial registration, funding and number of analysed participants were only moderately adequate and reporting of the assessment of blinding and adverse events were the least-reported items in the identified abstracts. CONCLUSIONS: As several CONSORT reporting items were poorly reported, it is the responsibility of authors, referees and editors alike to ensure that the CONSORT guidelines are followed.

Does rapid maxillary expansion affect nasopharyngeal airway? A prospective Cone Beam Computerised Tomography (CBCT) based study.

BACKGROUND AND PURPOSE: There is limited literature discussing the three dimnesional (3D) impact of rapid maxillary expansion (RME) on upper airway. The purpose of this prospective Cone Beam Computerised Tomography (CBCT) based study is to assess the immediate 3D effects and to correlate the volumteric changes in the upper naspharyngeal airway spaces secondary to RME. MATERIALS AND METHODS: Seventeen participants (8 male, 9 female, with a mean age of 12.6 ± 1.8 years), who required RME for the management of narrow maxillary arch, were recruited for this study. The prescribed expansion regimen was quarter turn (0.25 mm), twice a day until over-expansion was achieved. The mean period for the active phase was 14 days with a range of 12-21 days. Pretreatment (T1) and immediate post-expansion (T2) CBCT images were obtained and then processed using ITK snap and OnDemand3D softwar packages. Paired t-test and Interclass Correlation Coefficient (ICC) were used to assess the reproducibility of the measurements, student t-test (P < 0.05) and Pearson Correlation Coefficient (PCC) were applied to evaluate the volumetric changes in the nasopharyngeal airway spaces, linear dentolaveolar changes and correlate these changes. MAIN FINDINGS: Though, the data of one patient was excluded from the study, owing to major differences (>5 degrees) in the head and neck posture between T1 and T2 CBCT scans, the study' findings shows that bonded RME is an effective dentoalveolar expander in growing patients (P= 0.01) with an average expansion of 3.7 mm and 2.8 mm in males and females respectively. Likewise, the upper nasopharynx (UNP) expanded significantly (15.2% in males and 12% in females). In comparison, the upper retropalatal space (URP) was significantly reduced, by almost one sixth of its original volume, more in males than females, 11.2% and 2.8% respectively. A strong direct correlation between the maxillary sinus volumetric changes, and between appliance expansion and dentoalveolar expansion were evident (PCC = 0.86, 0.75, respectively). There was also a moderate correlation between changes in the UNP and URP spaces. CONCLUSIONS: RME was found to be an effective dentoalveolar expander and significantly augment the UNP and minimize the URP space. A similar comparative clinical study with long-term follow-up would be beneficial in accurately deteremining the clinical impact of RME on the airway and breathing as well as the stability of these effects.

Miniscrews failure rate in orthodontics: systematic review and meta-analysis.

Background: Miniscrews in orthodontics have been mainly used for anchorage without patient compliance in orthodontic treatment. The literature has reported changing failure rates. Objective: The aim of this review was to provide a precise estimation of miniscrew failure rate and the possible risk factors of the mechanically-retained miniscrews. Search method: Electronic search in database was undertaken up to July 2017 through the Cochrane Database of Systematic Reviews, MEDLINE, Scopus, and Ovid. Additional searching for on-going and unpublished data, hand search of relevant journals and grey lietraure were also undertaken, authors were contacted, and reference lists screened. Eligibility criteria: Randomised controlled trials (RCTs) and prospective cohort studies (PCSs), published in English were obtained, which reported the failure rate of miniscrews, as orthodontic anchorage, with less than 2 mm diameter. Data collection and analysis: Blind and induplicate study selection, data extraction, and risk of bias assessment were undertaken in this research. Failure rates and relevant risk factors of miniscrews with the corresponding 95 per cent confidence intervals (CIs) were calculated by using the random-effects model. The heterogeneity across the studies was assessed using the I2 and Chi2 test. The risk of bias was assessed using Cochrane risk of bias and Newcastle-Ottawa Scale. Subgroup and sensitivity analyses were performed in order to test the robustness of the results in meta-analysis. Results: The 16 RCTs and 30 PCSs were included in this research. Five studies were not included in the meta-analysis due to a lack of the statistical information needed to compute the effect sizes. About 3250 miniscrews from 41 studies were pooled in a random-effect model. The overall failure rate of miniscrews was 13.5 per cent (95% CI 11.5-15.9). Subgroup analysis showed that miniscrews 'diameter, length and design, patient age, and jaw of insertion had minimal effect on rate of miniscrews failure while the type of the gingivae and smoking had statistically significant effect. Conclusion: Miniscrews have an acceptably low failure rate. The findings should be interpreted with caution due to high-level of heterogeneity and unbalanced groups in the included studies. High quality randomized clinical trial with large sample sizes are required to support the findings of this review.

The effectiveness of alternating rapid maxillary expansion and constriction combined with maxillary protraction in the treatment of patients with a class III malocclusion: a systematic review and meta-analysis.

OBJECTIVES: To establish the effectiveness of Alternate Rapid Maxillary Expansion and Constriction combined with Protraction Facial Mask (Alt-RAMEC/PFM) approach in treating Class III growing patients compared with PFM combined with conventional Rapid Maxillary Expansion (RME/PFM). Search sources: Unrestricted search in five electronic databases and manual searching were undertaken up to February 2018. DATA SELECTION: Randomised clinical trials (RCTs) evaluating the effectiveness of Alt-RAMEC/PFM were selected. DATA EXTRACTION: Screening of references, data extraction and assessment of bias risk were evaluated independently by two reviewers. RESULTS: Five RCTs comparing the Alt-RAMEC/PFM with RME/PFM met the inclusion criteria. Small but statistically significant mean differences favouring Alt-RAMEC/PFM protocol as measured by SNA angle (1.16°; 95% CI 0.65 to 1.66), SNB angle (0.67°; 95% CI 0.32 to 1.02) and ANB angle (0.66°; 95% CI 0.08 to 1.25) were noted. Alt-RAMEC/PFM exhibited a more favourable overjet correction when compared to RME/PFM, however, differences in other dental changes were insignificant. CONCLUSION: There is limited evidence with high risk of bias that Alt-RAMEC/PFM can result in a statistically significant increase in maxillary protraction compared with RME/PFM in Chinese subjects over the short-term. High-quality long-term RCTs with inclusion of patient-reported outcomes are required.

The extent of root resorption and tooth movement following the application of ascending and descending magnetic forces: a prospective split mouth, microcomputed-tomography study.

OBJECTIVE: Various factors have been examined in the literature in an attempt to reduce the incidence and severity of root resorption. The purpose of the present investigation is to test the null hypothesis that there is no difference in relation to force level using gradually increasing (ascending) and decreasing (descending) orthodontic force generated by magnets on the severity of Orthodontically Induced Inflammatory Iatrogenic Root Resorption (OIIRR) and amount of tooth movement. METHODS: Twenty maxillary first premolars from 10 patients were subjected to ascending (25-225 g, magnets in attraction) and descending (225 to 25 g, magnets in repulsion) buccal forces using a split mouth design over an 8-week period. Polyvinyl siloxane impressions were taken at week 0, 4, and 8 to record the tooth movement. After 8 weeks, the teeth were extracted, scanned, with micro-CT in 16.9 µm resolution, and the root resorption craters were localized circumferentially and quantified at each level of the root. RESULTS: The total volume of OIIRR with ascending force was 1.20 mm3, and with descending force was 1.25 mm3, and there was no statistically significant difference between them. OIIRR on the palatal surface (0.012 mm3) was significantly less than on the buccal surface (0.057 mm3) and than on the mesial surface (0.035 mm3). There is no statistically significant difference in the degree of OIIRR between different level of the root (cervical, middle, and apical) at different surfaces. Moreover, the amount of tooth movement, at 0-, 4-, and 8-week interval, secondary to an ascending and descending force application was not statistically significant. CONCLUSIONS: There is no short-term (8 weeks) statistically significant difference between orthodontic ascending and descending forces, from 25 to 225 g and from 225 to 25 g, respectively, in term of severity and location of OIIRR as well as the amount of tooth movement. The buccal surface of the root showed highest degree of OIIRR compared to other root's surfaces.

Does systemic administration of casein phosphopeptides affect orthodontic movement and root resorption in rats?

OBJECTIVES: To assess the potential effects of casein phosphopeptides (CPPs) on orthodontically induced iatrogenic root resorption (OIIRR) and orthodontic teeth movement. MATERIALS AND METHODS: Forty Wistar rats (aged 11 weeks) were randomly divided into experimental group (EG; n = 20) that received a diet supplemented with CPP and control group (CG; n = 20) devoid of diet supplement. A 150 g force was applied using nickel titanium (NiTi) coil that was bonded on maxillary incisors and extended unilaterally to a maxillary first molar. At Day 28, animals in both groups were euthanized. Volumetric assessment of root resorption craters and linear measurement of maxillary first molars movement were blindly examined using a micro-computed tomography scan. RESULTS: Nine rats were excluded from the experiment due to loss during general anesthesia or appliances' failure. Intra-operator reproducibility was high in both volumetric and linear measurements, 92.8 per cent and 98.5-97.6 per cent, respectively. The results reveal that dietary CPP has statistically insignificant effect on the overall OIIRR and orthodontic movement. CONCLUSIONS: CPP seems to have statistically insignificant effect on the volume of OIIRR and orthodontic movement in rats. A long-term study with larger sample size using a different concentration of CPP is required to clarify the dentoalveolar effect of CPP.