The skeletal and dental age advancements of children and adolescents with overweight and obesity: A systematic review and meta-analysis.

INTRODUCTION: Over the past decades, a trend of increasing obesity among children has emerged. This study aimed to evaluate and summarize the impacts of overweight and obesity on children's and adolescents' skeletal and dental developmental advancement that may influence orthodontic management. METHODS: Registered with the Prospective Register of Systematic Reviews (registration no. CRD42022347488), this study complies with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Particularly, relevant original studies on skeletal or dental age evaluation were screened from accessible electronic databases and supplemented by hand-searching. Meta-analysis was recruited to calculate differences (and their 95% confidence interval [CI]) between subjects with overweight or obese and normal-weight counterparts. RESULTS: After applying the inclusion and exclusion criteria, 17 articles were selected for the final review. Two of the 17 selected studies were found to have a high risk of bias and moderate the other 15. A meta-analysis detected no statistically significant difference in skeletal age between children and adolescents with overweight and normal-weight counterparts (P = 0.24). However, the dental age of children and adolescents with overweight was found to be 0.49 years (95% CI, 0.29-0.70) advanced in comparison with normal-weight counterparts (P <0.00001). In contrast, children and adolescents with obesity were found to have advanced skeletal age by 1.17 (95% CI, 0.48-1.86) years (P = 0.0009) and dental age by 0.56 (95% CI, 0.37-0.76) years (P <0.00001) compared with their normal-weight counterparts. CONCLUSION: Because the orthopedic outcomes of the orthodontic intervention are closely tied to the skeletal age of the patients, these results suggest that the orthodontic evaluation and treatment of children and adolescents with obesity might occur earlier than that of the normal-weight population.

Mandibular transverse dentoalveolar and skeletal changes associated with lip bumper and rapid maxillary expander: A cone-beam computed tomography study.

INTRODUCTION: Currently, there is little consensus regarding the spontaneous uprighting of the mandibular dentoalveolar complex in response to maxillary expansion, which poses the question about the necessity of combining mandibular treatment with rapid maxillary expansion to coordinate the maxilla and mandible transversely. This study aimed to evaluate the effects of the bonded rapid maxillary expander (RME) alone compared with RME with lip bumper (LB) treatment on the mandibular transverse changes. METHODS: This retrospective study analyzed 3 groups: the control group with no orthodontic or orthopedic treatment (23 patients [14 females, 9 males]; mean age 9.13 years at T1 and 11.24 years at T2); the RME group with no mandibular treatment (22 patients [9 females, 13 males]; mean age 8.73 years at T1 and 12.04 years at T2); and RME + LB group (23 patients [16 females, 7 males]; mean age 9.45 years at T1 and 12.18 years at T2). Three-dimensional superimposition of the mandibular images was performed with cone-beam computed tomography taken at prephase and postphase I treatment (growth and development check records for the control group) to conduct the angular and linear measurements at the dental, alveolar, and skeletal levels. The intergroup comparisons were performed using the Mann-Whitney U-test. RESULTS: Accompanying slight molar self-uprighting during the normal mandibular growth period observed in the control group, transverse growth was also observed in both alveolar and basal bone levels of the mandible, but no significant changes in the alveolar bone inclination occurred. The bonded RME slightly increased the mandibular first molar uprighting but not the mandibular widths at the tooth or alveolar levels. Adding a LB significantly increased the intermolar width and molar uprighting while decreasing the alveolar bone inclination but did not increase the amount of mandibular transverse growth at the bone level. CONCLUSIONS: RME alone did not significantly increase the transverse dimension of the mandible. RME + LB significantly increased mandibular intermolar width, uprighted the mandibular molars, and reduced the alveolar bone inclination.

Asymmetric Maxillary Expansion Introduced by Surgically Assisted Rapid Palatal Expansion: A Systematic Review.

PURPOSE: A commonly reported complication of surgically assisted rapid palatal expansion (SARPE) that has not been explored extensively is uneven expansion between left and right sides, which requires secondary surgery for correction. This systematic review aims to analyze the prevalence and potential causes of asymmetric expansion in the transverse dimension after SARPE to guide the clinical practice. METHODS: Electronic databases and manual search were used to search for original articles published on SARPE on March 11, 2022. Original human studies that recorded the number and percentage of asymmetric expansion after two-piece SARPE were included. The 2020 Preferred Reporting Items for Systemic Reviews and Meta-Analyses guideline was implemented for the quality assessment and data analysis of the included articles. The study was registered at the International Prospective Register of Systematic Reviews under the number CRD42022300782. RESULTS: After applying inclusion and exclusion criteria, 13 articles were included in the final review. The risk of bias was high in 8 studies and medium in the other 5 studies. Overall, the prevalence of asymmetric expansion in the transverse dimension (different amount of expansion between left and right sides) was 7.52%, with 12.90% of patients involved receiving a second surgery for correction. Expander design did not significantly affect the rate of asymmetry expansion. Pterygomaxillary fissure release significantly increased the rate of asymmetry expansion (11.02% vs 5.08%, P < .001). In comparison, lateral nasal wall osteotomy (4.26% vs 14.77%, P < .001) and release of the nasal septum (5.22% vs 17.15%, P < .001) significantly lowered the rate of asymmetry expansion, respectively. CONCLUSIONS: Asymmetric dentoskeletal expansion between left and right sides is a common complication of SARPE procedures, mostly caused by variations in surgical cuts. However, the risk of bias in currently available publications is high. Further studies are warranted to fully understand the causes of asymmetric expansion.

American Board of Orthodontics: Time for change.

The American Board of Orthodontics (ABO) works to certify orthodontists in a fair, reliable, and valid manner. The process must examine an orthodontist's knowledge, abilities, and critical thinking skills to ensure that each certified orthodontist has the expertise to provide the highest level of patient care. Many medical specialty boards and 4 American Dental Association specialty boards use scenario-based testing for board certification. Changing to a scenario-based clinical examination will allow the ABO to test more orthodontists. The new process will not result in an easier examination; standards will not be lowered. It will offer an improved testing method that will be fair, valid, and reliable for the specialty of orthodontics while increasing accessibility and complementing residency curricula. The ABO's written examination will remain as it is.

Relationship between the maxillary transverse dimension and palatally displaced canines: A cone-beam computed tomographic study.

OBJECTIVES: To examine the relationship between palatally displaced maxillary canines (PDC) and the maxillary transverse dimension using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Thirty-three patients (11 males and 22 females, mean age 18.2 years) with PDC were matched to 66 patients (22 males and 44 females, mean age 18.1 years) without PDC (control) by gender, age, and posterior occlusion. A CBCT image was taken on all the patients prior to any orthodontic treatment. For each patient the maxillary basal bone widths and interdental widths at the maxillary first molars and first and second premolars were measured on axial and coronal sections of CBCT images. In addition, the presence of permanent tooth agenesis and the widths of maxillary incisors were recorded. RESULTS: Similar maxillary transverse dimensions, both skeletally and dentally, were found between the PDC and control groups. In the PDC group, the number of patients with permanent tooth agenesis was six times higher than in the control group. In addition, the maxillary lateral incisors on PDC-affected sides were smaller than those of control group (P < .05). CONCLUSIONS: The maxillary transverse dimension, both skeletally and dentally, had no effect on the occurrence of PDC. The higher prevalence of permanent tooth agenesis was found in the PDC group. Moreover, the mean mesiodistal width of maxillary lateral incisors in the PDC group was significantly smaller than in the control group (P < .05).