Prognostic factors, outcomes, and complications for dental autotransplantation: an umbrella review.

BACKGROUND: Dental autotransplantation (DAT) is a biological way of replacing missing or compromised teeth for patients. The techniques often necessitate a multi-disciplinary approach. The prognosis and success of the procedure may be impacted by variable factors in varying degrees. OBJECTIVE: Evaluating outcomes and complications of DAT, including prognostic factors using an umbrella review. SEARCH METHODS: Six databases were searched for all relevant systematic reviews published up to 30 June 2022. No restrictions were applied to language or publication date. SELECTION CRITERIA: Systematic reviews and meta-analyses of DAT studies. DATA COLLECTION AND ANALYSIS: Identification, screening, eligibility, and quality assessment using the AMSTAR 2 tool were performed independently by two authors (M.C. and S.A.). Two studies (20%) scored moderate, six studies (60%) scored low, and two studies (20%) scored critically low. Data were analysed using a random effects meta-analysis, and meta-regression was performed to investigate the effect of open and closed apices on the dependent variables. The results were summarised as relative risk ratios. RESULTS: A total of 310 studies were eligible for inclusion, of which 20 studies were selected for full-text evaluation. Ten systematic reviews were included, 9 of which had a meta-analysis. Overall findings suggest that DAT offers favourable success and survival rates. Meta-regression results indicate that a closed apex increased the proportion of ankylosis and resorption, reduced survival but had no effect on success during the observational period. LIMITATIONS: A varying degree of heterogeneity and bias was present in all systematic reviews. The samples of donor teeth included in the systematic reviews also varied morphologically. CONCLUSIONS: DAT is a technique-sensitive procedure requiring a multidisciplinary team, vigilant case assessment and thorough consideration of the respective prognostic factors involved. Despite methodological limitations reported across studies, DAT shows favourable success and survival rates, with a distinctive advantage of bone induction and soft tissue thickness preservation, and should, therefore, be considered as a viable treatment modality. Standardisation of clinical guidelines and practice are highly recommended. REGISTRATION: CRD42020202484.

Quality-of-life improvement, psychosocial benefits, and patient satisfaction of patients undergoing orthognathic surgery: a summary of systematic reviews.

BACKGROUND: Function, aesthetics, and social and psychological well-being are all important aspects for patients undergoing orthognathic surgery. OBJECTIVE: To evaluate the impact of orthognathic surgery on patient perception and quality of life before, during and after treatment. SEARCH METHODS: All relevant systematic reviews published up to 31st July 2020 have been searched via MEDLINE via OVID, Scopus, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, PsycINFO, AMED (Allied and Complementary Medicine Database), and PubMed.Ongoing systematic reviews and grey literature were eliminated. A manual search was also undertaken, and no restrictions were applied to language or publication date. SELECTION CRITERIA: Systematic reviews involving dentofacial deformities related to systemic disorders, cleft lip and palate, facial trauma, and syndromes affecting cranial and dentofacial structures were excluded. DATA COLLECTION AND ANALYSIS: Identification, screening, eligibility, and quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)] were performed by two authors independently. Data were synthesized qualitatively using thematic analysis. RESULTS: A total of 662 eligible studies were obtained of which 24 studies were selected for full-text evaluation, resulting in 12 eligible systematic reviews. LIMITATIONS: Due to heterogeneity of data, quantitative analysis was not possible. CONCLUSIONS AND IMPLICATIONS: Aesthetics and function are the main motives for seeking orthognathic surgery. Patient assessment before, during, and after orthognathic surgery is necessary for a thorough evaluation of self-perception and satisfaction throughout treatment. While psychological and social domains improved after orthognathic surgery treatment, the quality of life can deteriorate transiently during the pre-surgical orthodontic phase of treatment. A standardized assessment tool needs to be developed to assess quality-of-life changes consistently and provide comparable results. REGISTRATION: CRD42020199091.

The current dental school applicant: an overview of the admission process for UK dental schools and the sociodemographic status of applicants.

Aims To determine the current processes used to assess dental school admissions in the UK as well as compare the applicants' demography.Methods All 16 dental schools in the UK were invited to complete a questionnaire analysing the admissions protocols between 2018-2019 and 2019-2020. These data were combined with the admission process information available online. Retrospective data from the University Clinical Aptitude Test including the sociodemographic status of dental applicants were collected. For the six dental schools that did not reply, data presented were collected from information available to the public.Results The majority of applicants were women (63.2% in 2019-2020), white (27.9%) and are sixth form attendees or attend a further education college (40.6%). Of those who apply to study dentistry, 15.5% are graduates who hold a first degree. For each undergraduate dental place available, there were 12.6 applicants and 9.4 applicants to each post-qualified dental undergraduate place.Conclusion Further advancements are required to widen participation and broaden the sociodemographic status of dental applicants. This area would benefit from a long-term prospective study about recruitment methods and its correlation with performance at dental school. COVID-19 is impacting the application process, the full extent of which is yet to be determined.

A cross-sectional study of exposure across social media platforms for the British Orthodontic Society retention awareness campaign: #HoldthatSmile.

OBJECTIVE: The use of media campaigns in health promotion has become more common in recent years. #HoldthatSmile is a British Orthodontic Society life-long retention awareness campaign aimed at the general public and dental profession launched in 2017. This study investigated #HoldthatSmile exposure on social media platforms over a 12-month period following campaign launch. DESIGN: A cross-sectional content analysis. SETTING: Public-facing, English-language posts tagged #HoldthatSmile on the Facebook, Instagram and Twitter social media platforms. METHODS: Data were collected relating to a 12-month period, from September 2017 immediately following campaign launch, to the end of September 2018. The primary outcome was exposure to the #HoldthatSmile campaign on the different platforms through analysis of posts, measurement of audience reached and engagement. Secondary outcomes included demographics of user-types and content analysis of reactive comments on posts. RESULTS: A total of 205 relevant posts with #HoldthatSmile were identified on Twitter (n=90, 43.9%), Facebook (n=64, 31.2%) and Instagram (n=51, 24.9%) with an overall calculated audience reach of 108,807 individuals. There were 1849 reactions across the three platforms. The percentage of reactions that generated comments was low at 3%, 6.1% and 5.7% for Twitter, Facebook and Instagram, respectively. Just over three-quarters of users were either Dental Surgeries (53%) or Professional Dental Bodies (28%) and the vast majority were from the United Kingdom. Overall, most comments were positive (46%, n=36) or neutral (44%, n=35) with only 10% (n=8) negative. The overriding theme was a person's name, with the user commonly typing a friend's name in order to bring their attention to the post. CONCLUSION: There were a relatively low number of posts relevant to #HoldthatSmile on Twitter, Facebook and Instagram over the campaign's first 12 months. However, the majority of these did convey positive or neutral messages.

Minimum intervention in orthodontics.

Minimum intervention is defined as the smallest value or number of interruptions. Intervention is defined as an action intended for a challenging situation to improve it or to prevent it from getting worse. This article defines what constitutes 'minimum intervention' in dentistry and specifically in orthodontics. It presents the clinical techniques that constitute the specialty of orthodontics and identifies the ones that are deemed as minimum interventions. This article also presents the scientific evidence backing several orthodontic techniques, rendering them acceptable by the profession over others with no or very poor scientific evidence, thus increasing the chances of suboptimal outcomes.

Survival probability of dental autotransplantation of 366 teeth over 34 years within a hospital setting in the United Kingdom.

INTRODUCTION: The purpose of this retrospective study was to evaluate 34 years' experience of autotransplantation of teeth during orthodontic treatment. METHODOLOGY: Treatment was completed at Queen Mary's Hospital, Sidcup, Kent, UK, during the period 1969-2003. A total of 366 teeth were transplanted in 314 patients. RESULTS: Canines totalled 78 per cent of all autotransplanted teeth; mean age of patient was 19.4 years. Survival probability for the first 5 years post-autotransplantation was 95 per cent, 94 per cent for the subsequent 5 years, and 88 per cent after 15 years. The maximum observation period was 34 years, the median was 2.0 years, and the mean was 3.51 (standard deviation = 3.68) years. Of the observed teeth, 10 failed and these were lost due to unsuccessful periodontal ligament regeneration and persistent mobility grade III (or greater). Apical pathology was observed in 16 per cent of all autotransplanted teeth. In 79 per cent of this subgroup, apical pathology was evident in the first 3 years post-operatively. Seventy per cent of all external resorption also occurred within the first 3 years. Internal resorption was rare but its occurrence was mostly observed between the second and sixth year post-transplantation. A minority of autotransplanted teeth [14 per cent (n = 51)] needed root canal therapy, and this was completed within the first 6 months post-transplantation. CONCLUSIONS: Autotransplantation can be a justified procedure with good survival probability. It can be considered an alternative to other treatments, such as prosthodontic replacement of teeth.

Supernumeraries in Nicolaides-Baraitser Syndrome.

BACKGROUND: Nicolaides-Baraitser Syndrome(NCBRS) is an extremely rare condition which has been reported in only a few cases. NCBRS is a distinct clinical condition with typical clinical features of pre- and post-natal global developmental delay, impaired speech, and seizures. Microcephaly, sparse hair, anteverted alae nasi, undefined philtrum, prominence of distal phalanges and interphalangeal joints, and short metacarpals are also typical of NCBRS. CASE REPORT: There are no reported cases in the literature of patients with NCBRS presenting with multiple dental impactions, and to the authors' knowledge, this is the 28th fully documented case of NCBRS and only 75 cases identified as potentially having NCBRS. The clinical features, diagnosis, and course of management are also described. CONCLUSION: Although NCBRS is very rare, it is important to assess dental development in view of the possibility of multiple supernumerary teeth which can have detrimental effects on the occlusion.

Precision of Le Fort I osteotomy: planning versus outcome. A multi-centre retrospective study.

INTRODUCTION: The purpose of this study was to evaluate the accuracy of Le Fort I surgery by comparing planned surgical movements with actual outcomes. MATERIALS AND METHODS: A minimum number of seven consecutive cases that had undergone a Le Fort I osteotomy procedure alone or in combination with a mandibular osteotomy from six different hospital units in the East of England between 2009 and 2010 were identified. A total of 56 cases met the inclusion criteria where surgical splints were used and model surgery had been performed. Pre- and post-operative lateral cephalograms were digitised using Dolphin© imaging software (Version 10.0) and three cephalometric points were assessed to measure precision of surgical movements: A point (A-pt); Upper incisor tip (U1 tip); and Upper first molar occlusal point (U6 occ). The final position of the maxilla was compared to the planned position. RESULTS: In 71% of cases surgical movements were within 2 mm and 20% of this group were within 1 mm of the predicted position. The mean accuracy was 1.39 mm (SD 0.92 mm) for the former and 0.78 mm (SD 0.58 mm) for the latter. Accuracy correlated negatively with increased surgical complexity, particularly posterior differential impactions of the maxilla. There was no statistically significant difference between centres. CONCLUSIONS: Pre-operative surgical planning of Le Fort I osteotomies was generally accurate. This study demonstrates that different operators across six centres produced consistent surgical outcomes and this confirms previously reported data.

Comparison of validity, repeatability and reproducibility of the Peer Assessment Rating (PAR) between digital and conventional study models.

INTRODUCTION: The validity, reliability and inter-method agreement of Peer Assessment Scores (PAR) from acrylic models and their digital analogues were assessed. METHOD: Ten models of different occlusions were digitised, using a 3 Shape R700 laser scanner (Copenhagen, Denmark). Each set of models was conventionally and digitally PAR-scored twice in random order by 10 examiners. The minimum time between repeat measurements was two weeks. The repeatability was assessed by applying Carstensen's analysis. Inter-method agreement (IEMA) was assessed by Carstensen's limit of agreement (LOA). RESULTS: Intra-examiner repeatability (IER) for the unweighted and weighted data was slightly better for the conventional rather than the digital models. There was a slightly higher negative bias of -1 .62 for the weighted PAR data for the digital models. IEMA for the overall weighted data ranged from -8.70 - 5.45 (95% Confidence Interval, CI). Intra-class Correlation Coefficients lICC) for the weighted data for conventional, individual and average scenarios were 0.955 0.906 - 0.986 CI), 0.998 (0.995 - 0.999 CII. ICC for the weighted digital data, individual and average scenarios were 0.99 (0.97 - 1.00) and 1.00. The percentage reduction required to achieve an optimal occlusion increased by 0.4% for the digital scoring of the weighted data. CONCLUSION: Digital PAR scores obtained from scanned plastic models were valid and reliable and, in this context, the digital semi-automated method can be used interchangeably with the conventional method of PAR scoring.

Orthodontic treatment in cherubism: an overview and a case report.

INTRODUCTION: Cherubism is a rare hereditary disease that frequently manifests as a painless enlargement of the mandible and/or maxilla. The disease usually progresses rapidly during the first and second decades of life but it is self-limiting and often regresses. Although few orthodontic case reports describing cherubic patients exist, the timing and extent of surgical intervention is controversial. AIM: This present paper aims to review the treatment literature and provide a case report of a patient who underwent orthodontic/surgical management. METHODS: The patient presented with severe cherubism in her late teenage years; her main complaint was poor facial and dental appearance. Multiple teeth were missing and those present demonstrated significant preoperative root resorption. Treatment consisted of orthodontic alignment of the upper anterior teeth and a recontouring osteotomy. RESULTS: Confirmed by the patient, the combination approach led to a significant improvement in facial aesthetics and better self-esteem. Tooth movement through the osseous lesions was uneventful and no further root resoption was observed. CONCLUSION: Orthodontic treatment may be undertaken in those affected by Cherubism even with pre-existing idiopathic root resorption, but patients need to be appropriately informed and consented.

What you need to know about bisphosphonates: an overview and general recommendations for orthodontic treatment.

The orthodontic treatment of patients on bisphosphonates is becoming an increasing aspect of contemporary practice. This article will draw attention to the chemical structure and effects of these drugs on bone and will provide the latest recommendations to avoid potential sequelae.

Treatment time and occlusal outcome of orthognathic therapy in the East of England region.

OBJECTIVES: To evaluate the process of combined orthognathic and orthodontic care. To identify factors that affect treatment time and percentage Peer Assessment Rating (PAR) reduction, and the PAR efficiency factor for such cases. DESIGN AND SETTING: Retrospective multi centre study of patients who underwent orthognathic treatment in the East of England region. METHODS: Analysis of consecutive cases that underwent orthognathic surgery in 2008. Inclusion criteria included pre- and post-surgery orthodontic treatment. RESULTS: Ten orthodontic units submitted data for a total of 118 patients. Within the sample, 64% were class III, 35% class II/1 and 1% class II/2. Overall extraction rate, excluding third molars, was 58%. Median age at bond up was 17 years. Mean total number of orthodontic attendances was 23. Median length of pre-surgical orthodontics was 23 months and post-surgical orthodontics was 7 months. Median length of total treatment was 29 months. Mean wait for surgery was 3·6 months. Diagnosis of incisor relationship and skeletal base, transfer of operator, total number of visits, tooth extraction and treatment unit affected treatment duration. Median pre- and post-treatment PAR scores were 43 and 4, respectively. Median change in PAR score was 38·5. Median per cent reduction in PAR was 90·6%. The median PAR efficiency factor (reduction in PAR score divided by treatment time in months) was 1·24. Diagnosis of incisor relationship and skeletal base correlated with percentage reduction in PAR score. CONCLUSIONS: Combined orthognathic treatment was effective. Factors affecting treatment duration and percentage reduction in PAR have been established.