Efficacy of aloe vera and probiotic mouthwashes vs fluoride mouthwash on Streptococcus mutans in plaque around brackets of orthodontic patients: a randomized clinical trial.

OBJECTIVES: To compare efficacy of aloe vera and probiotic mouthwashes vs fluoride mouthwash on Streptococcus mutans (S. mutans) in the plaque of orthodontic patients and to assess patient-reported outcomes and compliance. MATERIALS AND METHODS: This prospective randomized clinical trial included 90 patients aged 12-35 years and in permanent dentition, who were randomly allocated in a 1:1:1 ratio to three mouthwash groups: aloe vera, probiotic, or fluoride. Smartphone-based applications were used to improve patient compliance. The primary outcome was the change in S. mutans levels in plaque between two times: pre-intervention and after 30 days using real-time polymerase chain reaction (Q-PCR). Secondary outcomes were the evaluation of patient-reported outcomes and compliance. RESULTS: Mean differences between aloe vera vs probiotic: -0.53 (95% CI: -3.57 to 2.51), aloe vera vs fluoride: -1.99 (95% CI, -4.8 to 0.82), and probiotic vs fluoride: -1.46 (95% CI: -4.74 to 1.82) were not significant, P = .467. Intragroup comparison demonstrated a significant mean difference in all three groups of -0.67 (95% CI: -0.79 to -0.55), -1.27 (95% CI: -1.57 to -0.97), and -2.23 (95% CI: -2.44 to -2.00) respectively, P < .001. Adherence was above 95% in all groups. No significant differences in frequency of responses to patient-reported outcomes were found among groups. CONCLUSIONS: No significant difference in efficacy among the three mouthwashes in reducing S. mutans level in plaque was found. Patient-reported assessments concerning burning sensation, taste, and tooth staining found no significant differences among mouthwashes. Smartphone-based applications can help improve patient compliance.

Orthodontic space closure in sliding mechanics: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: The aim of this systematic review was to compare the different force delivery systems for orthodontic space closure by sliding mechanics. SEARCH METHODS: Multiple sources including Cochrane Central, Ovid Medline, Embase etc. were used to identify all relevant studies. SELECTION CRITERIA: Randomized controlled trials (RCT) of parallel-group and split-mouth designs were included. PARTICIPANTS: Orthodontic patients of any age treated with fixed orthodontic appliances and requiring space closure. DATA COLLECTION AND ANALYSIS: Search result screening, data extraction and quality assessment were performed independently and in duplicate by 2 reviewers. The included studies were grouped into parallel-arm and split-mouth studies and subgroup analysis was then performed for the type of retraction subsets; en-masse and individual canine retraction. A traditional meta-analysis, and network meta-analysis (NMA) for direct and indirect comparisons for the rate of space closure were performed. RESULTS: Thirteen studies, six parallel-arm and seven split-mouth were included. The traditional meta-analysis comparing Nickel-titanium (NiTi) closed coil springs and elastomeric power chain for the rate of tooth movement showed statistically significant difference favouring NiTi springs (MD: 0.24; 95% CI, 0.03-0.45; I2 0%, P = 0.02) and the comparison between NiTi springs and active ligatures also showed statistically significant result favouring NiTi springs (MD: 0.53; 95% CI, 0.44-0.63; I2 0%, P ˂ 0.00001) for the rate of tooth movement. NMA for the rate of space closure showed fairly confident evidence for NiTi coil springs when compared with elastomeric chain and active ligatures. The NiTi coil spring ranked best between all methods of space closure. CONCLUSIONS: There is moderate quality evidence in favour of NiTi coil springs for the rate of space closure when compared with active ligature and low quality of evidence favouring NiTi springs when compared with elastomeric chain. The ranking from NMA showed NiTi coil springs to be the best method for space closure with 99% chance. An urgent need for standardization of study designs and the need for development of an agreed core outcome sets and core outcome instrument measurement sets is evident. REGISTRATION: PROSPERO CRD42020157811.

Alignment efficiency of coaxial tubular superelastic nickel-titanium vs single-stranded superelastic nickel-titanium in relieving mandibular anterior crowding in extraction cases: A single-centre randomized controlled clinical trial.

OBJECTIVES: To compare the alignment efficiency of coaxial tubular and single-stranded 0.016" superelastic NiTi archwires in relieving mandibular anterior crowding in extraction cases and to evaluate whether alignment efficiency differed as the initial irregularity increased. SETTING AND SAMPLE POPULATION: Forty female patients aged between twelve and twenty years from the postgraduate orthodontic clinic at the authors' centre. MATERIALS AND METHODS: All patients in this single-centre, 2-arm parallel trial were randomly allocated in a 1:1 ratio and the mandibular anterior irregularity was measured from the mandibular cast at 0-, 4-, 8- and 12-week intervals using a digital calliper. RESULTS: All forty patients (mean age, 15.08 ± 2.11) completed the study with either coaxial tubular superelastic NiTi (mean age, 15.30 ± 2.36) or single-stranded superelastic NiTi (mean age, 14.85 ± 1.84). The largest mean irregularity index reduction of -4.88 ± 2.74 and -6.17 ± 2.38 in the single-stranded superelastic NiTi and the coaxial tubular superelastic NiTi groups, respectively (P = 0.122) was at 4 weeks. Student's t test and repeated measures ANOVA indicated that none of the mean comparisons were statistically significant at a 5% level. Pearson's correlation value (r) indicated no statistically significant influence of initial crowding on alignment efficiency. CONCLUSIONS: There was no statistically significant difference between the alignment efficiency of coaxial tubular superelastic NiTi and single-stranded superelastic NiTi in extraction cases, and the degree of initial crowding had no influence on the alignment efficiency.

Mini-implants: new possibilities in interdisciplinary treatment approaches.

The introduction of mini-implants has broadened the range of tooth movements possible by fixed appliance therapy alone. The limits of fixed orthodontic treatment have become more a matter of facial appearance than anchorage. Many complex cases which would previously have required surgery or functional appliances can now be treated with fixed appliance therapy using mini-implants. A mutilated dentition case where mini-implants were used to provide anchorage for intrusion of molars and retraction of anterior teeth is reported here to illustrate this point.

Alignment efficiency of superelastic coaxial nickel-titanium vs superelastic single-stranded nickel-titanium in relieving mandibular anterior crowding: a randomized controlled prospective study.

OBJECTIVE: To clinically evaluate the alignment efficiency of 0.016-inch coaxial superelastic nickel-titanium (NiTi) and 0.016-inch superelastic NiTi in the lower anterior region over a period of 12 weeks. MATERIALS AND METHODS: A sample of 24 patients requiring lower anterior alignment were included in this single-center, single-operator, double-blind clinical trial and were randomly allocated into two groups of 12 patients. The type of wire selected for each patient was not disclosed to the provider or to the patient. Comparison of pretreatment characteristics of the archwire groups revealed no discrimination between two samples, thus verifying the random allocation of the intervention. An initial alginate impression of the lower arch was followed by impressions at 4-, 8-, and 12-week intervals. Casts were measured using the coordinate measuring machine to denote the degree of alignment. Duplicate readings of the cast series were taken to assess measurement variation. RESULTS: A statistically significant difference (P < .05) in the mean values of tooth movement demonstrated the superior aligning efficiency of coaxial superelastic NiTi over single-stranded superelastic NiTi in relieving lower anterior crowding. The measurement error recorded was within acceptable limits, with range values within 95% limits of agreement. CONCLUSION: Coaxial superelastic NiTi wire proved superior to single-stranded NiTi in its efficiency in relieving lower anterior crowding over a 12-week period.