Evaluation of patient-reported outcome measures (PROMs) during surgically-assisted acceleration of orthodontic treatment: a systematic review and meta-analysis.

BACKGROUND: With the widespread of surgically-assisted orthodontic acceleration, the analysis of patient-reported outcome measures (PROMs) has become very important to assure patient acceptance and satisfaction before adopting any acceleration procedure. OBJECTIVE: This review aimed to critically appraise the available evidence regarding the levels of pain, discomfort, functional impairments, and other patient-reported outcome measures during surgically-assisted acceleration of orthodontic treatment compared with the traditional non-accelerated treatment. SEARCH METHODS: Eight electronic bibliographic databases were searched from January 1990 till May 2022. A manual search of the selected orthodontic journals was also undertaken. SELECTION CRITERIA: Randomized controlled trials (RCTs) were included in this systematic review on patients undergoing orthodontic treatment with one group subjected to an acceleration procedure. DATA COLLECTION AND ANALYSIS: Cochrane's risk of bias tool (RoB2 tool) was used to assess the risk of bias of the included RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence. RESULTS: Thirteen RCTs were included in this review (333 patients), and only minimally invasive surgically-assisted acceleration studies were included. Two RCTs were included in the quantitative synthesis of data. After the first day of surgical intervention, the levels of pain and discomfort ranged from mild to moderate in the surgical groups (mean values ranged from 0.8 to 6.8), while it was mild in the control groups. However, on the seventh day after the surgical intervention, the levels of pain, discomfort, swelling, and functional impairments were almost similar between groups. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low. CONCLUSIONS: All surgical interventions were minimally invasive. There was very low to low evidence that acceleration caused mild to moderate pain and discomfort on the first day after the surgical intervention and disappeared completely at one week following surgery. Functional impairments were found within acceptable limits immediately and in the short-term follow-up. More high-quality randomized controlled clinical trials are needed to establish good evidence in this field. REGISTRATION: The protocol of this systematic review was registered in PROSPERO database (CRD42021274481) during the first stages of this review.

The impact of non-extraction orthodontic treatment on oral health-related quality of life: clear aligners versus fixed appliances-a randomized controlled trial.

OBJECTIVE: To assess the impact of clear aligner treatment on oral health-related quality of life (OHRQoL) compared to fixed appliance treatment. TRIAL DESIGN: Two-arm parallel group single-centre randomized controlled trial. METHODS: Forty-four adult patients (8 males, 36 females) were randomly and equally assigned to either the fixed appliances group (FA) or the clear aligners group (CA). Randomization with an allocation ratio of 1:1 was performed by a researcher who is not involved in the study using a random sample table. Non-extraction cases were included in this study. Outcome measures were the OHRQoL of patients and the duration of orthodontic treatment. The OHRQoL of patients was assessed by the short-form Oral Health Impact Profile (OHIP-14) at the following assessment times: before the start of treatment (T0), 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after the start of orthodontic treatment and post-treatment (T5). The assessor was blinded during outcomes assessment and statistical analysis. RESULTS: Two hundred and eighteen patients were evaluated for eligibility, 44 of them fulfilled the inclusion criteria and were randomly allocated to treatment groups. None of the patients was lost to follow-up. Accordingly, the results of 44 patients were statically analysed. The total OHIP-14 score was not statistically different between the FA and the CA groups at T0 (P = 0.91) and T5 (P = 0.16), whereas it was significantly lower in the CA group as compared to the FA group at T1 (mean difference [MD] = 11.04, 95% CI 8.7 to 13.42, P < 0.001), T2 (MD = 6.00, 95% CI: 4.3 to 7.7, P < 0.001), T3 (MD = 3.37, 95% CI: 1.5 to 5, P < 0.01), and T4 (MD = 3.32, 95% CI: 1.7 to 4.9, P < 0.001). Treatment duration in the CA group was significantly shorter than in the FA group (MD = 4.18, 95% CI: 2.8 to 5.5, P < 0.001). No harms were observed. LIMITATIONS: The results were limited to the non-extraction treatment of mild to moderate crowding cases. CONCLUSIONS: Patients treated with clear aligners reported higher OHRQoL and shorter treatment duration as compared to those treated with fixed appliances. TRIAL REGISTRATION: Retrospectively registered (DRKS-ID: DRKS00023977).

Effects of Treatment with Nociceptive Trigeminal Inhibition Splints on Electromyography in Temporomandibular Joint Disorder Patients.

AIM: This research aimed at evaluating the effects of the nociceptive trigeminal inhibition splint (NTIS) on electromyography (EMG) for masseter and temporalis muscles in patients with temporomandibular joint disorders (TMDs), and at detecting the discomfort degree originating from this splint. MATERIALS AND METHODS: The sample consisted of 15 patients having TMDs of muscular origin to be treated by NTIS. The activity degree of masseter and temporalis muscles was measured using the EMG two times: before the treatment and after 6 months. Besides, patients' discomfort was assessed after the start of treatment four times: 1 day, 2 weeks, 1 month, and 6 months. RESULTS: After the treatment, there was a significant decrease in masseter and temporalis muscles' activity in both right and left sides (p < 0.001). No significant differences were observed in the electrical muscular activity mean change between the masseter muscles (-43.87 ± 26.82) and the temporalis muscles (-54.91 ± 21.16) (p = 0.082), or between the right muscles (-51.97 ± 26.30) and the left muscles (-46.81 ± 22.90) (p = 0.422). In addition, the discomfort degree gradually decreased after 2 weeks (p < 0.01). CONCLUSION: The use of NTIS is associated with reduction in the masseter and temporalis muscles' activity. Also, the patients' discomfort degree from NTIS progressively decreases after 2 weeks of treatment. CLINICAL SIGNIFICANCE: The NTIS is an effective therapeutic approach for patients having TMDs of muscular origin.

Assessment of the Pubertal Growth Period using the Open Apices of the Lower Teeth.

AIM: The purpose of this study was to evaluate whether the open apex measurements of the lower teeth can be used for prediction of the pubertal growth spurt. MATERIALS AND METHODS: The study group consisted of 150 males and 142 females ranging in age from 10 to 16 years. A total of 292 panoramic and 292 hand-wrist radiographs were obtained and analyzed. The skeletal maturity was determined according to the skeletal maturity indicators (SMIs) developed by Fishman. The open apices measurements of the left lower teeth were made according to the method described by Cameriere. RESULTS: The Spearman rank order correlation coefficient revealed a relationship between the skeletal maturity stages and the open apex measurements. These correlations ranged from 0.577 for the lower second premolar to 0.830 for the lower canine. The measurement of the left lower canine showed the highest correlation, so its relationship with the SMIs was further investigated. The measurements of 6.07 (or greater) indicated to SMI4, and 2.485 (or lesser) indicated to SMI7. CONCLUSION: The skeletal maturity well related to the measurements of the open apices of the lower teeth. Lower canine open apex measurements could be used as an indicator of the SMI4 and SMI7. CLINICAL SIGNIFICANCE: The measurements of the open apices of the left lower canines from panoramic radiographs may be clinically useful as an indicator of the beginning and the ending of the pubertal growth period.

Use of the Tooth Coronal Pulp Index for Recognition of the Pubertal Growth Period.

AIM: The present study aimed to investigate the association between the tooth coronal index (TCI) and the pubertal growth stages (PGS) for children and adolescents. MATERIALS AND METHODS: A cross-sectional study was performed using retrospectively collected panoramic and hand-wrist radiographs of 262 individuals (125 males, 137 females). The coronal height (CH) and the coronal pulp cavity height (CPCH) of the left mandibular teeth were measured. Then the TCI for which was calculated according to Ikeda et al (1985). The estimated TCI for individuals with the following PGS after Fishman (1987) are: SMI 4 (S), SMI 5 (DP3 cap), SMI 6 (MP3 cap) and SMI 7 (Mp5 cap). The associations between the TCI and the PGS were investigated by correlation coefficient of Spearman's rho, and the validity values for the PGS were computed. RESULTS: Significant correlations were noted between the simple TCI values for premolars and molars and the PGS, and the highest correlation was for the summed TCI for both first and second molars. Utilizing the validity values of the summed TCI for both first and second mandibular molars, the PGS can be predicted as follows: S stage when TCI is 49.17 or lesser, DP3cap stage when TCI is 43.52 or lesser, MP3cap stage when TCI is 36.73 or lesser, and Mp5cap stage when TCI is 26.84 or lesser. CONCLUSION: The TCI values declined along with the maturational process in children and adolescents. The TCI for both first and second molars was the best predictor of the PGS. CLINICAL SIGNIFICANCE: Panoramic photographs can be beneficial for prediction of the skeletal maturity and treatment planning without resorting to hand-wrist radiographs.

Dentoskeletal Effects of the Modified Tandem Appliance vs the Facemask Appliance in the Treatment of Skeletal Class III Malocclusion: A Single-center, Randomized Controlled Trial.

AIMS: The aim of this randomized controlled trial was to compare the skeletal and dentoalveolar effects of the modified tandem appliance (MTA) vs the facemask (FM) with rapid maxillary expansion. MATERIALS AND METHODS: Thirty-two patients, aged 7 to 9 years were recruited. Eligibility criteria included skeletal class III malocclusion that resulted from the retrusion of the maxilla. Randomization was accomplished to divide the sample into two equal groups to be treated with either MTA or FM. Lateral cephalometric radiographs were obtained before treatment and after 2 mm positive overjet was achieved. Intragroup comparisons were performed using paired-sample t-test, and intergroup comparisons were performed using two-sample t-test at the p ≤ 0.05 level. RESULTS: Thirty-two patients (16 in each group) were available for statistical analysis. The pretreatment variables of both groups were similar. Both treatment therapies showed similar significant increase in the SNA and ANB angles, accompanied by slight decrease in the SNB angle. The increase in the SN:GoMe angle, Bjork's sum, and the overjet were significantly greater in the FM group. The forward movement of upper dentition was similar in both groups. Although the lower incisors retrusion was significantly greater in the FM group than in the MTA group, the uprighting of the lower molars was significantly greater in the MTA group. CONCLUSION: Both appliances showed similar effects apart from less clockwise rotation of the mandible, less retrusion of the lower incisors, and greater uprighting of the lower molars in the MTA group. CLINICAL SIGNIFICANCE: Both the MTA and the FM groups are effective in treating class III malocclusion. The MTA group is more efficient in controlling the clockwise rotation and gaining some space in the lower arch.

Dentoskeletal effects of the Bite-Jumping Appliance and the Twin-Block Appliance in the treatment of skeletal Class II malocclusion: a randomized controlled trial.

OBJECTIVES: The current parallel group, randomized controlled trial aimed to compare the dentoalveolar and skeletal changes resulting from treatment using two popular functional appliances: the Bite-Jumping Appliance (BJA) and the Twin-Block Appliance (TBA). STUDY DESIGN: This study is designed as a parallel-group, randomized controlled trial. MATERIALS AND METHODS: Patients were screened from the patients who were seeking treatment at the Department of Orthodontics, Al-Baath University. Eligibility criteria included skeletal Class II division 1 malocclusion resulting from the retrusion of the mandible. A computer-generated randomization list was used to randomly divide the patients into two equal groups to be treated with either the BJA or the TBA. Blinding was applicable for outcome assessment only. Forty-four patients (22 male and 22 female) aged 10.2-13.5 years were randomized in a 1:1 ratio to either the BJA or the TBA groups, and four patients were lost to follow-up (two from each group). Lateral cephalometric radiographs were obtained before treatment and after 12 months of active appliance therapy. Inter-group differences were evaluated with two-sample t-tests, and intra-group differences were assessed with paired-sample t-tests at the P <0.05 level. RESULTS: Forty patients (20 in each group) were available for the statistical analysis. Baseline characteristics were similar between groups. Similar changes were observed in the sagittal plane, including a significant increase in the SNB angle. No significant changes were observed in the maxilla. The lower incisors were significantly proclined, and the upper incisors significantly retruded. In the vertical plane, BJA induced mandibular clockwise rotation, and the SN:MP angle increased by 2.14 ± 2.97° (P = 0.002). Conversely, no significant changes took place in this angle in the TBA group 0.75 ± 2.37° (P = 0.096). Similarly, Jarabak ratio decreased significantly in the BJA group by -1.78 ± 0.85% (P = 0.002) and increased significantly in the TBA group by 1.26 ± 0.76% (P = 0.032), with significant differences between the two groups (P ≤ 0.001). No serious harm was observed. LIMITATIONS: A limitation of this research is a lack of an untreated control group. However, the resulting differences between the two groups can be attributed to the appliance differences, which fulfil the aim of the current research. CONCLUSIONS: Each of the two appliances is recommended for the functional treatment of skeletal Class II malocclusion resulting from the retrusion of the mandible. The BJA is recommended when clockwise rotation is desired, whereas the TBA is recommended to inhibit vertical development. REGISTRATION: This trial was registered at the Department of Orthodontics, Al-Baath University, Number 16, on 6/25/2012. PROTOCOL: The protocol was not published before trial commencement. FUNDING: No funding or conflict of interest to be declared.

Influence of the Rater's Gender on Assessing Facial Beauty in Adult Patients With Vertical and Horizontal Growth Patterns.

Background The evaluation of attractiveness varies from one civilization, culture, and environment to another and between individuals. Gender can also play a role in determining the standards of attractiveness. The purpose of this study was to evaluate the effect of the rater's gender on the assessment of adult facial attractiveness with a vertical and horizontal growth pattern in patients with skeletal Class I malocclusion. Methodology The study sample comprised extraoral photos taken before the treatment of 120 patients (30 males and 30 females in each group) with skeletal Class I malocclusion and vertical and horizontal growth patterns according to the Bjork sum aged between 18 and 25 years. A panel of 30 laypersons (aged 19-25 years with an average age of 23 ± 0.53 years), including raters from both genders, were selected equally using a disproportionate stratified sampling method through a computer-generated list. The raters used the visual analog scale (VAS) to provide a score for each photograph's aesthetic quality. The most attractive group, which received the greatest aesthetic score, and the least attractive group, which received the lowest aesthetic score, were the two groups formed based on each photograph's mean aesthetic scores. Overall, 13 patients were chosen for each group. Subsequently, the average assessment score for every patient photo set was determined. Independent-sample t-tests were employed to ascertain if the raters' gender made a statistically significant difference in assessing patients with vertical and horizontal growth patterns. Results There were statistically significant differences between the gender of raters in evaluating female patients with vertical growth patterns (p < 0.001), where the average rating of the female raters was significantly greater than that of the male raters in evaluating female patients. In addition, there were statistically significant differences between the gender of raters in evaluating female patients with horizontal growth patterns (p = 0.009), where the average rating of the male raters was significantly greater than that of the female raters in evaluating female patients. Conclusions There is a limited effect of the rater's gender in evaluating facial aesthetics. However, the facial features of female patients with long faces are preferred by females more than males, and males are more critical in evaluating these patients. On the other hand, males favor the facial features of female patients with short faces more than females, and females are more critical in evaluating these patients. These results suggest considering patients' personal characteristics with vertical and horizontal growth patterns during diagnosis and treatment planning.

Temperature Changes in the Pulp Chamber During Orthodontic Bonding Using a High-Power Light-Emitting Diode Device With Two Different Exposure Times and Intensities: An In-Vitro Study.

OBJECTIVE: This study used a high-power light-emitting diode (LED) device to evaluate the effects of two exposure times and intensities on pulp chamber temperature and cooling time during bracket bonding. MATERIALS AND METHODS: Sixty upper premolars were used in the sample in this study. These premolars were split into two main groups based on the exposure time and intensity: the first group employed a traditional curing mode (TCG) for 20 seconds with an intensity of 1200 mw/cm2, whereas the second group had a quick curing mode (QCG) for 3 seconds with an intensity of 2500 mw/cm2. The pulp chamber's temperature variations and cooling times were recorded using a thermal imaging camera. The Mann-Whitney U test was used to find differences between the two-group comparison of the pulp chamber's temperature and cooling time. RESULTS: The two groups had statistically significant differences regarding the temperature increase in the pulp chamber and cooling time (p > 0.001). The mean temperature increase in the traditional curing group was 3.52°C, which is greater than that in the quick curing group (i.e., a mean value of 1.28°C). The mean cooling time in the traditional curing group was 38.83 seconds, which is greater than that in the quick curing group (9.97 seconds). CONCLUSIONS: Reducing the exposure time to 3 seconds and increasing the intensity to 2500 mw/cm2 is considered safer for the pulp chamber during and after the curing process.

Evaluation of the Best Method for Orthodontic Correction of Skeletal Deep Bites in Growing Patients: A Systematic Review.

This review aimed to evaluate the currently available evidence regarding the best method of correcting deep bites in growing patients. In September 2023, a search was conducted electronically across the following databases: PubMed®, Web of Science™, Scopus®, Embase®, Google™ Scholar, and Cochrane Library. In this systematic review, randomized control trials (RCTs), controlled clinical trials (CCTs), and cohort studies of growing patients with deep bite malocclusion who received treatment with the primary objective of treating the deep bite were included. Risk of bias of the included studies was assessed using two different tools; one tool was applied for RCTs and the other one for the CCTs and cohort studies. One RCT, one CCT, and one cohort study were included (85 patients). The flat fixed acrylic bite plane was superior in terms of duration of treatment when compared to the inclined fixed acrylic bite plane and the utility arch with posterior intermaxillary elastics. Limited evidence indicates that the inclined fixed acrylic bite plane causes a significant increase in the lower incisor inclination and a significant increase in the angle between the mandible and the anterior cranial base (SNB). However, limited evidence indicates that the utility arch with posterior intermaxillary elastics causes a significant decrease in the angle between the maxilla and the anterior cranial base (SNA). Regarding the vertical skeletal changes, it was found that the three methods were comparable; in each case, the vertical dimension of the face increased because of a significant increase in the lower first molar height. There is a need for further studies to strengthen the evidence of the treatment efficacy of the employed methods, with more RCTs to be conducted in this regard.

Dental and Periodontal Changes After Accelerated Correction of Lower Anterior Teeth Crowding With Periodontally Accelerated Osteogenic Orthodontics (PAOO) Procedure: A Randomized Controlled Trial.

Objective To evaluate the relative efficacy of periodontally accelerated osteogenic orthodontics (PAOO) compared to conventional fixed appliances in correcting lower anterior teeth crowding using a non-extraction treatment approach. Material and methods A single-center, two-arm, parallel-group randomized controlled trial was conducted on 38 patients (9 males, 29 females) with moderate crowding. These patients did not require premolar extraction and were randomly allocated into two treatment groups: the PAOO group and the conventional orthodontic treatment group. The Little Irregularity Index (LII) measured crowding intensity on pre-treatment study models. Changes in this index were recorded monthly in both treatment groups. The inter-canine width, inter-second-premolar width, plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were also measured before and after the leveling and alignment stage. Statistical analysis between the two groups was performed using Mann-Whitney U tests. Results For the LII, the average time for irregularity resolution was three months in the PAOO group, compared to five months in the conventional orthodontic treatment group. Regarding changes in inter-second-premolar width, the PAOO procedure led to a significant decrease in the increase of inter-second-premolar width, with an average increase of +1.52 mm compared to +2.71 mm in the control group. For the GI and PBI, it was found that their values significantly increased with PAOO application, averaging 0.18 and 0.17, respectively, compared to 0.05 and 0.07 in the control group. Conclusions The use of PAOO in orthodontic treatment accelerated the leveling and alignment process by 40%. Changes in the inter-canine width, the inter-second-premolar width, and the status of periodontal tissues were minimal and clinically negligible.

Comparative assessment of dental and basal arch dimensions of passive and active self-ligating versus conventional appliances : A randomized clinical trial.

PURPOSE: In this parallel, three-arm, single-center randomized trial, the dental and basal arch dimensions after orthodontic treatment using conventional brackets and passive and active self-ligating (SL) brackets were compared. METHODS: Patients needing comprehensive orthodontic treatment were randomly allocated to the active SL, passive SL, or conventional brackets (control) group. All patients were treated with a standardized arch wires sequence. Eligibility criteria included class I malocclusion in the permanent dentition, crowding (4-6 mm), and adequate oral hygiene. The primary outcome was intermolar width, based on cone beam computed tomography (CBCT) scans. Secondary outcomes were maxillary and mandibular widths in the canines and premolars regions, dental arch depth, buccolingual inclination, and alignment duration. Blinding of outcome assessment was implemented. Patients were followed every 4 weeks until insertion of the stainless steel 0.019â€¯× 0.025 wire. Mean values were computed from CBCT sections, and data were analyzed using a one-way analysis of variance. RESULTS: In all, 66 patients (ages 18-25 years) were randomized into a 1:1:1 ratio; 7 patients dropped out before treatment initiation. Examining dental arch dimensions in the canine and premolar regions showed that expansion of the maxillary dental arch was greatest in the passive SL brackets group, less in the active SL brackets group, and lowest in the control group (P < 0.01). Changes in maxillary intermolar width between the three groups were not significant, and changes in basal arch dimensions, depth of dental and basal arches, buccolingual inclination, and alignment duration were similar in the three groups. CONCLUSIONS: Self-ligating brackets were not more effective than conventional brackets when examining intermolar width, basal transverse dimensions, depth of the arch, and alignment duration.

Effects of the conventional, soft start, and pulse delay modes produced by light-emitting diode device on microleakage beneath metal brackets: An in vitro comparative study.

BACKGROUND: This study aimed to evaluate microleakage beneath metal brackets cured by different light curing modes. MATERIALS AND METHODS: Sixty extracted human premolars were randomly divided into three groups according to the light curing mode. Metal brackets were bonded in all groups according to the manufacturer's recommendations with a light-emitting diode device. Light curing was applied as follows: group 1: conventional mode (10 s mesial+10 s distal); group 2: soft start mode (15 s mesial+15 s distal); group 3: pulse delay mode (3 s mesial+3 s distal, followed by 3min of no photoactivation, then 9 s mesial+9 s distal). Radiant exposure was the same in all study groups. After curing, the teeth were incubated at 37 degrees for 24hours, then thermocycled 500 times. Next, they were sealed with nail varnish, immersed in methylene blue 1% for 24hours, sectioned, and examined under a stereomicroscope. Microleakage was measured at both enamel-adhesive and bracket-adhesive interfaces, and the total microleakage for each tooth was computed. Statistical analyses were performed using Kruskal-Wallis and Welch test for comparing microleakage among groups. Wilcoxon signed ranks test was used for comparing microleakage between the bracket-adhesive and enamel-adhesive interfaces. RESULTS: There was no significant difference in microleakage at the bracket-adhesive interface among study groups. At the enamel-adhesive interface and total microleakage, the pulse delay group exhibited significantly lower microleakage than the conventional group. Whereas there was no significant difference between the soft start group and other study groups. In all study groups, microleakage at the enamel-adhesive interface was greater than that at the bracket-adhesive interface. CONCLUSION: The pulse delay mode caused lesser microleakage than the conventional mode. This supports the use of this mode in orthodontic bonding.

Adult periodontal comparison after treatment of palatally impacted canines aligned by conventional or accelerated minimally-invasive corticotomy-assisted orthodontic traction: A randomized controlled trial.

OBJECTIVE: To compare the post-treatment periodontal status of the palatally impacted canines and their adjacent teeth treated by an accelerated minimally-invasive corticotomy-assisted method versus the conventional traction method. MATERIAL AND METHODS: A parallel-group two-arm randomized controlled trial was conducted on patients with palatally or mid-alveolar unilateral impacted canines. Participants were randomly selected and allocated to receive the conventional treatment (CT) with a closed surgical approach, or accelerated treatment (CAT). The evaluated periodontal variables were periodontal pocket depth (PPD), keratinized tissue width (KTW), gingival recession level (GRL), papillary bleeding index (PBI) and Gingival Index (GI). All post-treatment periodontal measurements were performed two weeks after removing the fixed orthodontic appliance. RESULTS: In total, 46 patients were included (CT group: n=23; mean age: 20.26±2.17 years), or accelerated treatment (CAT group: n=23; mean age: 20.39±2.27 years). The differences between the two study groups were non-significant for all periodontal outcomes at all measurement points (P>.05). The mean total values of PPD around the aligned canine did not exceed 2mm (XPPD=1.99±0.25mm; 1.91±0.26mm, in the CT and CAT group, respectively, P=0.677). The results of total values of PPD on the adjacent teeth were nearly similar in the two study groups (mean difference: 0.12mm; 0.02mm, for the lateral incisor and the first premolar, respectively). Very low GRL values were detected in the two study groups. CONCLUSIONS: The use of corticotomy-assisted method did not impair the periodontal health in the short follow-up term. Both treatment modalities are considered acceptable in terms of post-treatment periodontal outcomes, as the gingival indices levels were at low values.

Evaluation of the dimensional changes in the mandible, condyles, and the temporomandibular joint following skeletal class III treatment with chin cup and bonded maxillary bite block using low-dose computed tomography: A single-center, randomized controlled trial.

Background: Insufficient evidence regarding the effects of chincup therapy on the mandibular dimensions and temporomandibular joint (TMJ) structures requires high-quality studies using three-dimensional (3D) imaging. This trial aimed to evaluate the 3D changes in the mandible, condyles, and glenoid fossa after chin cup therapy for skeletal Class III children compared to untreated controls. Methods: A 2-arm parallel-group randomized controlled trial on 38 prognathic children (21 boys and 17 girls), with mean ages 6.63±0.84 years. Patients were recruited and randomized into two equal groups; the experimental group (CC) was treated with occipital-traction chin cups in conjunction with bonded maxillary bite blocks. No treatment was provided in the control group (CON). Low-dose CT images were acquired before (T1) and after achieving  (2-4 mm) positive overjet (T2), and after 16 months apart in both groups. The outcome measures of the condyle-mandibular 3D distances, the condyles-glenoid fossa postional changes, and the quantitative displacement parameters of superimposed 3D models were compared statistically. Paired- and two-sample t-tests were used for intra- and inter-group comparisons, respectively. Results: Overall, 35 patients (18 and 17 in the CC and the CON groups, respetively) were enrolled in the statistical analysis. The mean mandibular and condylar volumes increased significantly by 777.24 mm 3 and 1,221.62 mm 3, 94.57 mm 3, and 132.54 mm 3 in the CC and CON groups, respectively. No statistically significant differences were observed between the groups regarding the volumes, superficial areas, and linear changes of the mandible and condyles, and part analysis measurements, except the changes of the relative sagittal and vertical positions of condyles, glenoid fossa, and posterior joint space, which were significantly smaller in the CC group (p<0.05) than the CON group. Conclusions: The chin cup did not affect the mandibular dimensions. Its primary action was confined to the condyles and the TMJ internal dimensions. Clinicaltrials.gov registration: NCT05350306 (28/04/2022).

Do the Most Attractive Faces of Patients With Class II Division 1 Malocclusion Differ From Those With the Least Attractive Faces in Terms of Angular and Proportional Measurements Assessed on Frontal and Lateral Photographs?

Background This study investigated the facial angles and proportions affecting facial aesthetics in patients with skeletal class II division 1 malocclusion between those labeled the most attractive and least attractive in each gender. Methodology The study sample included pretreatment extraoral photographs of 60 patients (30 males and 30 females) with skeletal class II division 1 malocclusion according to the ANB angle aged between 18 and 21 years. A panel of 240 laypersons (aged 20-25 years; the average age of 22.5 ± 0.37 years; 120 males and 120 females) scored the aesthetic evaluation of photographs using the visual analog scale (VAS). Two groups were created according to the mean aesthetic scores of each photograph, namely, the most attractive group with the highest aesthetic scores, and the least attractive group with the least aesthetic scores. A total of 12 patients in each group were selected. Subsequently, their angular and proportional measurements on the frontal and lateral photographs were calculated. Independent-sample t-tests were used to determine if there were significant differences in these measurements between the two groups. Results There was no significant difference in frontal variables between the most attractive and least attractive groups in each gender. The angle NPog-FH was significantly greater in the most attractive males than in the least attractive males, while there was no significant difference between the most attractive and least attractive females regarding any of the profile variables. Conclusions The most attractive females with class II division 1 were similar to the least attractive on evaluating the frontal and profile variables. In contrast, the most attractive males with class II division 1 malocclusion had more protrusion in the chin than the least attractive male patients, with no differences in other profile and frontal variables. These findings suggest considering the chin position during the diagnosis and treatment planning of class II division 1 malocclusion patients.

Evaluation of Local Application of Glucosamine Sulfate and Chondroitin Sulfate on Temporomandibular Joint Response and Alleviation of Pain and Tension During the Functional Treatment of Skeletal Class II Patients: A Randomized Control Clinical Trial.

OBJECTIVE:  This study was conducted to assess the effects of applying a gel of combined glucosamine sulfate and chondroitin sulfate on the temporomandibular joint (TMJ) area in patients with skeletal Class II malocclusion treated by removable functional appliances in terms of TMJ internal proportions, levels of pain, and tension. MATERIALS AND METHODS: The study included 36 patients aged 10-13 years with skeletal Class II malocclusion due to retrusion of the mandible characterized by: 4-8 degrees of the sagittal skeletal discrepancy (ANB) angle, 4-7 mm of overjet, 72-76 degrees of the sagittal mandibular positioning (SNB) angle, and a bone maturity stage located at pubertal growth spurt. Patients were distributed to the experimental group (Twin-Block appliance + Jointance® gel) or the control group (conventional treatment with the Twin-Block appliance). An allocation ratio of 1:1 was employed. Pre- and post-treatment digital lateral cephalometric radiograms were taken, and the TMJ joint spaces were measured using the Viewbox software (dHAL Software, Kifissia, Greece). The pain and discomfort levels were evaluated using a questionnaire with a four-point Likert scale at three assessment times. RESULTS:  The anterior and posterior glenoid and anterior condylar distances to the pterygoid vertical (PTV) reference plane significantly decreased after treatment (p<.001), and the anterior joint space decreased significantly (p<.001). In contrast, the superior distance of the condyle to the Frankfort horizontal reference plane increased significantly after treatment, and the same results were found for the posterior and superior joint spaces (p<.05). There were no significant differences between the two groups in the evaluated linear variables. No significant differences were found when comparing pain and tension levels between the two groups at each assessment time. A gradual decrease in pain and tension levels was observed between the three evaluation times in both groups. CONCLUSIONS:  A combination of glucosamine sulfate and chondroitin sulfate did not affect the temporomandibular joint spaces, pain, and tension levels in patients with skeletal Class II malocclusions treated by removable functional appliances.

Effects of the conventional, soft start, and pulse delay modes produced by light-emitting diode device on metal brackets bond strength and enamel damage: An in vitro comparative study.

OBJECTIVES: This study aimed to compare the bond strength and enamel damage following debonding of metal brackets cured by different light-curing modes: conventional, soft start, and pulse delay modes. MATERIAL AND METHODS: Sixty extracted upper premolars were randomly divided into three groups according to the used light-curing mode. Metal brackets were bonded with a light-emitting diode device employing different modes. Group 1: conventional mode (10s mesial+10 s distal); group 2: soft start mode (15s mesial+15s distal); group 3: pulse delay mode (3s mesial+3s distal, followed by 3min of no photoactivation, then 9s mesial+9s distal). Radiant exposure was the same in all study groups. Shear bond strengths of the brackets were tested with a universal testing machine. A stereomicroscope was used to determine the number and length of enamel microcracks. One-Way ANOVA and Kruskal-Wallis tests were used to detect significant differences in shear bond strength and microcracks number and length among groups. RESULTS: The soft start and pulse delay modes produced significantly greater shear bond strength than the conventional mode (19.46±4.90MPa; 20.47±4.97MPa; 12.14±3.79MPa, respectively, P<0.001). However, there was no significant difference between the soft start and pulse delay groups (P=0.768). The number and length of microcracks increased significantly after debonding in all study groups. The change in microcracks length was not different among study groups. CONCLUSION: The soft start and pulse delay modes produced greater bond strength than the conventional mode without predisposing enamel to higher risk of damage. Conservative methods for debonding are still required.

The effectiveness of minimally-invasive corticotomy-assisted orthodontic treatment of palatally impacted canines compared to the traditional traction method in terms of treatment duration, velocity of traction movement and the associated dentoalveolar changes: A randomized controlled trial.

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (P<0.05). The mean velocity of traction movement in the CAT group was greater than the TT group ( x velocity=1.15±0.35 mm/month; 0.70±0.33 mm/month, P=0.027, respectively). The duration of the active traction and the overall orthodontic treatment in the CAT group were significantly shorter than the TT group by 36% and 29%, respectively. The mean bone support ratios of the aligned canines did not differ significantly between the two groups (88% vs. 89% in the CAT and TT groups, respectively). No significant differences were found between the two groups regarding the mean amount of root resorption on the adjacent laterals ( x resorption = 1.30±1.18 mm; 1.22±1.02 mm, P=0.612, in CAT and TT groups, respectively). Conclusions: The traction movement velocity of the palatally impacted canines can be increased using minimally-invasive corticotomy-assisted orthodontic treatment. The side effects of the acceleration procedure were minimal and almost similar to those of the traditional technique.

Adult patient expectations and satisfaction: Can they be influenced by viewing the three-dimensional predicted outcome before fixed orthodontic treatment of dental crowding?

BACKGROUND: Investigating the possible changes in patients' expectations of and satisfaction with the orthodontic treatment outcomes when they were given the three-dimensional digital prediction of their teeth alignment before the beginning of treatment. METHODS: A prospective non-controlled single-group clinical trial was conducted on 28 (18 females, 10 males, mean age: 20.68 ± 1.91 years) patients with Class I malocclusion and moderate dental crowding who required a nonextraction orthodontic treatment. Patients were given the expectations questionnaire on their first visit (T0). Then, patients were shown a three-dimensional digital setup-created by Orthoanalyzer software (3Shape, Copenhagen, Denmark)-of the proposed treatment results before orthodontic treatment (T1) and received two questionnaires, the second expectations questionnaire and the satisfaction with the proposed changes questionnaire. Treatment was then initiated using the fixed appliances and completed. After debonding, a question about patients' satisfaction with the achieved changes was completed (T2). RESULTS: Patients' expectations level significantly increased after watching the predicted alignment of teeth compared with the initial levels in terms of chewing (x¯ = 5.54 and x¯= 6.71), speech (x‾ =5.93 and x¯= 6.93), and oral hygiene improvement (x‾= 7.93 and x¯=8.61 ± 1.06; at T0 and T1, respectively). The remaining items showed no significant differences between the two assessment times. Patients had a higher level of satisfaction at the end of treatment than after watching the proposed outcome. There were significant statistical differences in the items related to teeth appearance (x¯= 9.12 and x¯= 9.60 at T1 and T2, respectively), and teeth engagement (x¯= 8.92 and x¯= 9.40 at T1 and T2, respectively) CONCLUSIONS: Watching the predicted alignment outcome increased patients' expectations of chewing, speech, and oral hygiene improvement compared with the initially recorded levels. Patients were more satisfied with the final result than what was recorded after viewing the predicted plan. However, these results were not clinically significant.