Exploring the knowledge and awareness on applications of virtual reality and augmented reality technology among dental healthcare professionals - a crosssectional survey.

OBJECTIVE: To assess the knowledge and awareness of Virtual Reality (VR) and Augmented Reality (AR) technology in dentistry. METHODS: A questionnaire survey-based study was conducted using Google forms on a sample of 273 dental healthcare professionals (DHCP) from October- November 2023, after obtaining ethical approval. A validated questionnaire, divided into three sections, was used to assess the knowledge and awareness of dental healthcare professionals on virtual and augmented reality. Section A was about demographic statistics, section B assessed knowledge and awareness regarding VR and AR and section C consisted of future acceptability of VR and AR among DHCP. The frequency of each question was reported in percentages. To assess the difference of knowledge and awareness of AR and VR among different specialties of DHCP, one-way ANOVA test was applied and in case of significant results pairwise comparison was performed by post-hoc Tukey test. RESULTS: There was a statistically significant difference of knowledge (1.40 ± 0.49) among different dental healthcare professionals. On pairwise comparison, a statistically significant difference (p = ˂0.05) of knowledge and awareness of AR and VR was found among dental specialist and other dental health professionals. CONCLUSIONS: A concerning lack of knowledge and awareness among dental healthcare professionals regarding AR and VR technology in dentistry was found. Interestingly, within the spectrum of specialties, dental specialists demonstrated a comparatively higher awareness than their counterparts in other specialties. Addressing barriers, notably a lack of knowledge, is crucial for successful technology adoption in dental education and practice.

Dental robotics: a groundbreaking technology with disruptive potential - review article.

Dental Robotics represent a groundbreaking technological frontier with the potential to disrupt traditional paradigms in oral healthcare. This abstract explores the transformative impact of robotic applications in dentistry, focussing on precision, reproducibility, and reliability. A comprehensive search was conducted on the PubMed database, Dental and Oral Science, and CINAHL to identify pertinent studies exploring the implications of robotics in dentistry. Studies incorporated in this analysis highlighted the significance of broadening the research scope beyond implantology. This review underscores the importance of integrating robotic dentistry into educational frameworks and advancing technological preparedness. As we navigate these challenges, the abstract underscores the pivotal role of robotic dentistry in shaping the future of oral healthcare. Robotic dentistry promises transformative advancements in oral healthcare with precision and reliability. Challenges like limited system availability and expertise highlight the need for increased dentist-engineer collaboration. Diversifying research, emphasizing non-invasive technologies, and integrating robotic dentistry into education are crucial for wider acceptance. Public awareness and regulatory clarity are pivotal for seamless integration, unlocking the vast potential of robotic technologies in the future of dental care.

The application of virtual reality and augmented reality in dentistry - a literature review.

In recent times, dentistry has seen significant technological advancements that have transformed various specialized areas within the field. Developed into applications for mobile devices, augmented reality (AR) seamlessly merges digital components with the physical world, enhancing both realms while maintaining their individual separateness. On the other hand, virtual reality (VR) relies on advanced, tailored software to visualize a digital 3D environment stimulating the operator's senses through computer generated sensations and feedback. The current advances use the application of VR, haptic simulators, the use of an AI algorithm and many more that provides new opportunities for smart learning and enhance the teaching environment. As this technology continues to evolve, it is poised to become even more remarkable, enabling specialists to potentially visualize both soft and hard tissues within the patient's body for effective treatment planning. This literature aims to present the newest advancements and ongoing development of AR and VR in dentistry and medicine. It highlights their diverse applications while identifying areas needing further research for effective integration into clinical practice.

Effect of bonded and removable retainers on occlusal settling after orthodontic treatment: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to summarize the effectiveness of bonded and removable retainers (the Hawley and Essix retainers) in terms of improving occlusal settling (occlusal contact points/areas) after orthodontic treatment. We searched the Cochrane Library, PubMed, CINAHL Plus, and Dental & Oral Sciences Source (DOSS), as well as SIGLE, Google Scholar and ClinicalTrials.gov for eligible studies. We included randomized and non-randomized controlled trials along with cohort studies. Studies that reported occlusal contacts/areas during retention with fixed bonded and removable retainers were included. To assess the quality of the randomized controlled trials (RCTs), the Cochrane Collaboration risk-of-bias (RoB) tool was utilized, whereas the Newcastle-Ottawa Scale (NOS) was used to assess the quality of cohort studies.We included 6 articles in our systematic review after scrutinizing 219 articles and eliminating the illegible ones based on duplication, titles, abstracts, and objectives. Bonded retainers (BRs) allowed faster and better posterior occlusal settling as compared to the Hawley retainer (HR). However, HR showed good occlusal settling in the anterior dental arch. The Essix retainer (ER) showed a decrease in occlusal contact during the retention phase. Meta-analysis showed no statistically significant difference between BRs and removable retainers. In conclusion, HR allowed better overall occlusal settling as compared to other retainers. However, BRs allowed faster settling in the posterior tooth region. The Essix retainer showed poor settling of occlusion. Overall, there is an insufficient number of high-quality RCTs to provide additional evidence, and further high-quality RCTs are needed.

Comparison of mesiodistal root angulation of teeth by conventional panoramic and cone beam computed tomography images - A cross-sectional study.

INTRODUCTION: Accurate bracket positioning is required for proper root parallelism and for stable orthodontic treatment outcomes. This study aimed to determine the difference in mesiodistal root angulation of teeth measured on three radiographic images. MATERIAL AND METHODS: A cross-sectional study was conducted using orthopantomogram (OPG), panoramic images of cone beam computed tomography (Pan-CBCT) and cone beam computed tomography (CBCT). An occlusal plane was constructed in OPG and Pan-CBCT for angular measurements. The axial and sagittal views were used for assessing the mesiodistal root angulation on CBCT. Mesiodistal root angulation differences among three radiographs were assessed using the Kruskal-Wallis test. Mann-Whitney U test was applied for pairwise comparison and multinomial logistic regression was used to determine the association of sexual dimorphism with the direction of root angulation. RESULTS: On comparing the mesiodistal root angulation in degrees (DE) among all three groups, upper right (UR2) and left lateral incisors (UL2) were found to be statistically significant with P=0.033 and P=0.050 respectively. On pair-wise comparison, we found a statistically significant difference for upper right lateral incisor (UR2) between OPG and Pan-CBCT (P=0.045). Upper left lateral (UL2) (P=0.024) was significant in OPG and Pan-CBCT while upper left first molar (UL6) (P=0.043) in OPG and CBCT group. On comparing the sexual dimorphism in the direction of root angulation, females showed a greater tendency of mesial root angulation (5.62) times for upper right second premolar (UR5) as compared to males. CONCLUSIONS: There were no significant difference in mesiodistal root angulation between panoramic CBCT and CBCT images. The angulation of the upper lateral incisors was found to be significant between OPG and panoramic CBCT images, whereas the angulation of the upper right lateral incisors and left first molars was significant between OPG and CBCT images. In terms on sexual dimorphism, females showed greater mesial angulation of teeth than males.

Knowledge and awareness of dental stem cells among dental healthcare professionals - a cross-sectional study.

Objectives: To assess knowledge and awareness of dental healthcare professionals on dental stem cells. METHODS: A questionnaire survey-based study was conducted using Google forms on a sample of 69 dental healthcare professionals (DHCP) from September - October 2022, after obtaining ethical approval. A validated questionnaire was used to assess the knowledge and awareness of dental healthcare professionals on stem cells, which was then divided into three sections. The section A was about demographic statistics, section B assessed knowledge and awareness regarding dental stem cells and section C consisted of 5 score VAS scale to assess the acceptability of future research and increase implication of dental stem cells (DSC) among DHCP. The frequency of each question was reported in percentages. To assess the difference of knowledge and awareness of DSC among different specialties of DHCP, one-way ANOVA test was applied and incase of significant results pairwise comparison was performed by post-hoc Tukey test. RESULTS: Mean scores of knowledge and awareness of DSC among female DHCP were 54.26 ± 11.73 and males were 53.50 ±8.19. There was a statistically significant difference of knowledge (p= 0.02) among different dental healthcare professionals. On pairwise comparison by post-hoc Tukey HSD we found statistically significant difference (p = 0.03) of knowledge and awareness of dental stem cells among general dentists and operative dentistry specialists. CONCLUSIONS: We found poor knowledge and awareness of dental healthcare professionals regarding dental stem cells. However, operative and endodontic specialty had more awareness on dental stem cells as compared to any other specialty. There was positive approach for further future researches on stem cells.

Mesenchymal stem cells and its translation into clinical orthodontics: current trends and future perspectives.

Oral mesenchymal stem cell populations in humans have been discovered in close vicinity to oral mucosal tissues and both primary (deciduous) and secondary (permanent) teeth. All these different kinds of stem cells have the ability to divide and replenish themselves, however they vary in their gene expression profiles and their capacity to give rise to distinct cell lineages. They all have multipotentiality i.e. chondrogenic, osteogenic, adipogenic, and neurogenic. Due to their relative accessibility, these cell types may form a source of stem cells with substantial potential for application in tissue regeneration. In this review, discoveries outlining stem cell potential are discussed on various aspects as, are their various applications in orthodontics i.e. orthodontic tooth movement, fixing external root resorption, correcting craniofacial anomalies, accelerating craniofacial distraction osteogenesis, recreating the TMJ, and ensuring a stable maxillary expansion.

Soft tissue lasers: An innovative tool enhancing treatment outcomes in orthodontics - A narrative review.

Lasers have been utilised in the field of dentistry for over 40 years, but their use has been limited in the field of orthodontics. The advent of lasers with accompanying computer interfaces has made them significantly user-friendly, adding to their appeal in the orthodontic profession. Knowledge regarding the laser device's capabilities and limitations is essential to optimise patient care and to make a satisfactory investment return. For the effective and successful integration of lasers in orthodontic practice, adequate training is required, limited not only to the orthodontist but the dental assistants and auxiliaries as well. Orthodontists may safely and readily execute gingivectomy, exposure of teeth, frenectomy, circumferential supracrestal fiberotomy, ankyloglossia release and uvulopalatoplasty. The current narrative review was planned to introduce the benefits and general principles of soft tissue lasers in the field of orthodontics and recent surgical research comparing different laser-assisted surgeries against conventional scalpel surgeries.

Facial flow line and its effect on dental midline deviation on a female subject in an Asian population - A cross-sectional study.

INTRODUCTION: This study aims to understand the relationship between midline deviations and the inherent asymmetry that can be observed in a human face. MATERIALS AND METHODS: A cross-sectional study was conducted using a frontal smile photograph of a female which was altered on Adobe Photoshop software version 23.0 into eight different photographs by deviating the dental midlines by 2 mm, 4 mm, and 6 mm towards and away from the facial flow line (FFL). 4 mm of chin deviation was incorporated in all the pictures except for the first picture in which the midline and chin were kept symmetric. Orthodontic residents evaluated those photographs on an interrupted visual analogue scale (VAS) with 0 being the least attractive and 10 being the most. Simple linear regression was applied to observe factors associated with VAS score. RESULTS: Highest score was observed for picture with midline and chin on (MLCon) with a score of 9.4 ± 0.7, followed by picture with midline on and chin deviated (MLon) 8.7 ± 0.8. The deviations towards green zone received higher scores in comparison to deviations towards red zone. Linear regression revealed highly statistically significant differences between the constant and the rest of the pictures. CONCLUSIONS: The formation of green and red zones by the FFL influences the perception of midline deviation as judged by orthodontic residents. Midline when deviated towards the green zone, was judged to be more aesthetic than when shifted towards the red zones.

Analysis of facial proportions in skeletal Class II subjects treated with Clark's twin block appliance, followed by nonextraction fixed mechanotherapy: A retrospective longitudinal study.

INTRODUCTION: This study aimed to determine the influence of Clark's twin block (CTB) appliance therapy on achieving golden proportion in post-treatment facial profiles in skeletal Class II patients. METHODS: A retrospective longitudinal study was conducted on a sample of 44 skeletal Class II subjects treated with CTB, followed by nonextraction mechanotherapy. Ricketts' 13 dentoskeletal ratios were measured on pre- and post-treatment lateral cephalograms. Paired Student's t test was used to analyze the existence of golden proportion in the values of the pre- and post-treatment ratios. The influence of pretreatment variables was tested on post-treatment ratio 4 using simple and multiple linear regression analyses. RESULTS: A statistically significant difference in pre- and post-treatment values was found for ratios 4 (P = 0.02), 9 (P = 0.04), 10 (P < 0.001), and 13 (P = 0.01). Ratios 4, 9, and 13 moved closer to the golden proportion, whereas ratio 10 moved away from the golden proportion after CTB therapy. Simple linear regression analysis showed a statistically significant association of post-treatment ratio 4 with pretreatment ratios 1, 4, 8, 9, and 12. Multiple linear regression analysis showed a statistically significant association of post-treatment ratio 4 with pretreatment ratios 4 and 12. CONCLUSIONS: Treatment with CTB appliance may well move various facial ratios in individual patients toward the published Ricketts ideals. Ricketts' published golden proportion may be used as one guide when planning for attempted dentofacial change in individual patients.

A comparison of three different modalities in improving oral hygiene in adult orthodontic patients - An open label randomized controlled trial.

INTRODUCTION: The objective of the study was to compare outcomes in terms of Bleeding index (BI), Gingival Index (GI) and Orthodontic Plaque Index (OPI) with videographic and plaque disclosing tablets (PDT) versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment (FAT). MATERIALS AND METHODS: Adult orthodontic patients were recruited form outpatient orthodontic clinic who fulfilled the inclusion criteria and were randomly allocated to three groups i.e., video, PDT AND VERBAL GROUPS: Subjects who had gingivitis as assessed by the Bleeding Index (BI), Gingival Index (GI) and Orthodontic Plaque Index (OPI) were recruited. Pre- and post-interventional measurements were taken at two intervals only for BI, GI and OPI. The primary outcome was to evaluate mean change in the BI, GI and OPI in the three study groups after six weeks. A computer-generated randomization list was used to allocate subjects to one of the three study groups using a random permuted block sampling of 6 and 9 to randomize the samples. RESULTS: A total of 99 subjects were assessed for eligibility out of which 96 participants were randomized as three of the participants declined to be part of this trial. The mean change in the oral hygiene indices score were assessed and we found no statistically significant difference among the three interventional groups. Pre- and postinterventional results showed statistically significant improvement in the oral hygiene indices for video and PDT group. No statistically significant difference for age, gender and education level on oral hygiene indices. Simple linear regression showed that video group produced significantly higher mean OPI change as compared to other groups. CONCLUSIONS: Visual aids performed better than verbal instructions. Gender, age, and education level did not have a statistically significant impact on oral hygiene indices.

Comparison of bracket bond failure with the aerosol-generating and novel non-aerosol-generating bonding techniques during the SARS-CoV-2 pandemic among orthodontic patients: A retrospective cohort study.

BACKGROUND: As per the Centers for Disease Control and Prevention (CDC) guidelines, dentists must avoid the aerosol-generating procedures during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. OBJECTIVES: This study aimed to compare the rate of bracket bond failure with the aerosol-generating and non-aerosol generating bonding techniques. MATERIAL AND METHODS: A retrospective cohort study was conducted during the SARS-CoV-2 pandemic on a sample of 44 patients (880 teeth), equally divided into 2 groups: the conventional aerosol-generating bonding technique (ABT); and the novel non-aerosol-generating bonding technique (NABT). The rate of bracket survival and total number of bracket breakages in the 2 groups were assessed by means of the survival regression analysis. The influence of pre-treatment factors, such as the sagittal jaw relationship (ANB), the Frankfort-mandibular plane angle (FMA), overjet, overbite, and upper and lower crowding, on the rate of bracket survival was also evaluated. RESULTS: There was a statistically significant difference between ABT and NABT in terms of bracket survival. The mean bracket survival with ABT was 176.21 ±77.89 days and with NABT it was 162.53 ±83.34 days. The novel technique showed a hazard ratio of bracket survival of 2.99 as compared to the conventional method. There was a statistically significant influence of overjet on the rate of bracket survival (p = 0.010). The posterior segment had a higher rate of bracket failure as compared to the anterior segment in NABT, which was statistically significant (p < 0.001). However, this difference was statistically non-significant in the case of ABT. CONCLUSIONS: There was an increased rate of bracket failure with NABT as compared to ABT. The rate of bracket breakages in the anterior quadrants was comparable for both bonding techniques.

Dental, skeletal, and soft-tissue changes in adult orthodontic patients treated with premolar extraction and nonextraction: A cross-sectional study.

INTRODUCTION: Various treatment modalities exist to improve and correct Class I malocclusion. This study evaluated the dental, skeletal, and soft-tissue changes in patients treated by premolar extraction (PME) and nonextraction. METHODS: A cross-sectional study was conducted, including subjects ideally planned for PME. Pretreatment and posttreatment lateral cephalograms were compared among the 2 groups. The American Board of Orthodontics Objective Grading System (ABO-OGS) was used to score the posttreatment casts, and soft-tissue profile silhouettes were judged by a panel of orthodontists to evaluate the improvement among the 2 groups. Comparisons between the 2 groups were performed using the Mann-Whitney U test. Spearman correlation was used to study the correlation between the assessment methodologies. RESULTS: Highly significant differences were observed between the 2 groups for ABO-OGS scores (P ≤0.001) and profile silhouette assessment (P ≤0.001). Compared with posttreatment cephalometric readings, highly significant differences were seen for the dental variables: SN-U1, IMPA, and interincisal angle (P ≤0.001). Statistically significant differences were seen for all soft-tissue cephalometric variables. Highly significant moderate to negative correlation (r = -0.410, P ≤0.001) was seen between profile silhouettes and ABO-OGS alignment scores. Highly significant strong negative correlation (r = -0.642, P ≤0.001) was seen between profile silhouettes and the lower lip. CONCLUSION: Dental and soft-tissue changes were highly significant and were found to be in the ideal range when treated with PME. However, PME and nonextraction treatment modalities did not significantly affect the skeletal parameters as seen on the lateral cephalogram.

Cephalometric predictors of optimal facial soft-tissue profile in adult Asian subjects with Class II malocclusion treated via maxillary premolar extraction: A cross-sectional study.

INTRODUCTION: Class II malocclusion is most commonly treated using maxillary premolar extractions. The objective of this study was to predict cephalometric parameters associated with favorable facial soft-tissue profiles in adult Asian subjects with Class II malocclusion treated via maxillary premolar extractions. METHODS: A cross-sectional study was performed with 46 patients equally divided into favorable (FG) and unfavorable groups. The sample was divided on the basis of subjective and objective criteria. Subjectively, pretreatment and posttreatment facial silhouettes were shown to the panel of orthodontists to rate via the visual analog scale. Objectively, posttreatment soft-tissue cephalometric variables were taken. The sample receiving 60% visual analog scale and ideal posttreatment soft-tissue measurements were included in FG. Paired t test and independent t test were applied to determine the significant changes within and between both groups. To predict the cephalometric and occlusal variables associated with FG outcome, the Cox regression analysis was applied. RESULTS: On the evaluation of pretreatment cephalometric variables, the independent t test showed statistically significant differences for UI-NA (P = 0.42), Wits appraisal plane (0.010), upper lip to E-line (0.047), and interincisal angle (P = 0.049). Evaluation of the pretreatment occlusal variables the independent t test and chi-square test showed overjet (P = 0.018) and molar relationship (P = 0.045) to be statistically significant. The Cox regression analysis showed no cephalometric or occlusal variables to be statistically significant to predict the soft-tissue outcomes. A statistically significant strong correlation was also observed between the subjective and objective evaluation methods. CONCLUSIONS: Cephalometric analysis may be more valuable as a diagnostic rather than a predictive tool for favorable soft-tissue outcomes.

Comparison of treatment outcomes as assessed by 3 indexes in subjects with Class I malocclusion treated by 3 different methods: A cross-sectional study.

INTRODUCTION: Various treatment modalities exist to improve and correct Class I malocclusion. This study was conducted to evaluate the outcomes of nonextraction (NE), premolar extraction (PME), and mandibular incisor extraction (MIE) treatment modalities in subjects presenting with Class I malocclusion. METHODS: A cross-sectional study was conducted at a tertiary care hospital using pretreatment and posttreatment dental casts along with intraoral photographs of 90 orthodontic subjects. These subjects were divided equally into NE, PME, and MIE groups and scored using the Index of Orthodontic Treatment Need, Index of Complexity, Outcome, and Need (ICON), and peer assessment rating (PAR) indexes. Nonparametric tests were run to compare pretreatment and posttreatment scores and to evaluate the percentage and categorical changes for the treatment modalities. Pairwise comparisons were performed using the Mann-Whitney U test. RESULTS: Statistically significant differences (P ≤0.001) were seen between the pretreatment and posttreatment scores for all modalities. Statistically significant improvements were seen between the 3 treatment modalities for the PAR (P = 0.010) and ICON (P = 0.003) indexes. Significant categorical improvements were found for the Aesthetic Component (AC) (P = 0.012) among the 3 groups. Pairwise comparison revealed significant differences between the NE and MIE groups (ICON, P = 0.001; AC, P = 0.018) and PME and MIE groups (PAR, P = 0.002; ICON, P = 0.007; AC, P = 0.007). CONCLUSIONS: Posttreatment scores of all indexes were reduced, with significant differences found among the treatment modalities for all except the Dental Health Component index. The pairwise comparison revealed suboptimal occlusal results with the MIE group. Good occlusal and esthetic treatment outcomes were achieved with the PME and NE groups.

Influence of incisor inclination and anterior vertical facial height on facial attractiveness in an adult Asian male.

INTRODUCTION: Balanced facial proportions and hard tissue relationships are important factors in facial attractiveness. The objective of this study was to determine the most pleasing maxillary incisal inclination (MII) on the lateral profile and the impact of various lower anterior facial height (LAFH) ratios (at rest and with a smile) on facial attractiveness. METHODS: This cross-sectional study was performed with 66 raters equally divided into 3 panels: general dentists (GD), orthodontic residents (OR), and laypersons (LP). Lateral profile view photographs of an Asian man were modified using Photoshop software (Adobe Systems, San Jose, Calif) to show altered MII and LAFH ratios at rest and when smiling. Subjective evaluations of facial attractiveness were performed by raters using a visual analog scale. Kruskal-Wallis test was used to compare esthetic scores among raters, and the Mann-Whitney U test was applied to compare ES between groups. RESULTS: Kruskal-Wallis test showed significant differences in esthetic scores among raters for -10° (P = 0.028) and -15° MII (P = 0.030). Similarly, significant differences were found in ES for 8% LAFH ratio (P = 0.022), and 4% LAFH ratio (P = 0.035) at rest. Mann-Whitney U test showed significant differences between raters for -10° and -15° MII and between 8% and 4% LAFH ratio at rest. CONCLUSIONS: All groups rated -5° inclinations to be most attractive. General dentists and orthodontic residents found normal LAFH to be the most attractive, whereas long facial height was less attractive with smile. In addition, smile had a camouflaging effect on LAFH.

Predicting the sagittal skeletal pattern using dental cast and facial profile photographs in children aged 9 to 14 years.

OBJECTIVE: To quantify prediction of sagittal skeletal pattern using anteroposterior dental relationships on dental casts and facial profile photograph. Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from December 2016 to July 2017, and comprised orthodontic patients of either gender aged 9-14 years who attended the outpatient dental clinic. The sagittal skeletal relationship assessed on cephalometric radiographs was compared with anteroposterior dental and facial measurements on their dental cast and facial profile photographs. A prediction model was developed using multiple linear regression. The applicability of the prediction model was checked on an independent sample. Data was analysed using STATA 12. RESULTS: Of the 76 patients, about two-third (n=47) were females. The overall median age was 12.3 years (inter-quartile range: 1.8), with majority (60.5%) aged 12-14 years. The proportion of Class I, II and III malocclusion was 25 (32.9%), 50 (65.8%) and 1 (1.3%) respectively. Highest percentage of variability 47.4% in ANB angle was determined by the soft tissue ANB angle. 54.9% of the variability in the ANB angle could be explained by overjet, soft tissue ANB' angle, lower lip to E-line distance, Class II incisor relationship, history of malocclusion and thumb sucking, interaction terms between Class II incisor relationship and history of malocclusion, and history of thumb sucking and soft tissue ANB' angle. CONCLUSIONS: Sagittal skeletal relationship in an individual can be predicted with moderate accuracy using the prediction equation incorporating dental and facial variables along with history of malocclusion and thumb-sucking without potentially harmful exposure to cephalometric radiographs.

Effect of Direct versus Indirect Bonding Technique on the Failure Rate of Mandibular Fixed Retainer-A Systematic Review and Meta-Analysis.

INTRODUCTION: Fixed retainer failure is a common cause of relapse and may require additional orthodontic treatment. The two main methods for bonding the mandibular fixed retainer include direct and indirect techniques. This topic has not been explored previously in a systematic review. Therefore, the objective of this systematic review was to evaluate the effect of direct versus indirect bonding technique on the failure rate of mandibular fixed retainer. METHODS: Online databases (PubMed, Dental and Oral Science, CINAHL, and Cochrane Central Register of Controlled Trials, Scopus) were systematically searched electronically for articles up until April 2021. Google Scholar and clinicaltrials.gov databases were utilized for hand searching. Randomized, non-randomized clinical trials and cohort studies on human subjects were considered regardless of language or year of publication. Orthodontic patients in their retention phase (mandibular 3×3 fixed retainer), in which the retainer was bonded using direct bonding technique as control and indirect as intervention were included. The outcome assessed was retainer failure rate. Two authors independently examined and extracted the data from the studies that satisfied the inclusion criteria. Risk of bias in clinical trials was assessed using the Cochrane Collaboration's tool, whereas risk of bias in cohort studies was assessed using the Newcastle-Ottawa Scale. The meta-analysis was conducted using the RevMan software V.5.3.5.22. The outcome was estimated using weighted average difference and 95% confidence intervals (CIs). The studies' heterogeneity was assessed using Cochrane's heterogeneity test (I2 Test). RESULTS: Four articles fulfilling the inclusion criteria were included in qualitative and quantitative synthesis. Retainer failure rates were analysed in a total number of 266 patients bonded with mandibular 3×3 retainers after orthodontic therapy. Direct bonding technique of fixed retainer on 131 patients was compared with indirect technique on 135 patients. There was no statistically significant difference in the rate of retainer failure between the two methods (95% CI, 0.67, 1.40). CONCLUSIONS: Within the limitations of insufficient evidence this systematic review and meta-analysis concluded that there is no difference in the failure rate of mandibular fixed retainers between direct and indirect bonding techniques. Due to the scarcity of available data, further studies are needed to establish definitively one's clinical benefit over the other.

WITHDRAWN: Cephalometric predictors of optimal soft tissue profile outcomes in growing Asian skeletal class II subjects treated with twin-block appliance: a retrospective study.

Ahead of Print article withdrawn by publisher.