White spot enamel lesions - is treatment or prevention the answer to this 'no win scenario'?

DESIGN: Prospective, randomized, double-blind, multicenter clinical trial. CASE SELECTION: Participants between 12 and 25 years old, who were generally healthy, with 2 or more white spot lesions on the labial surface of anterior dentition. DATA ANALYSIS: 79 patients who developed white spot lesions (WSL) on the labial surface of anterior teeth following orthodontic treatment were randomly assigned to 4 intervention groups. Group 1 received 5% sodium fluoride varnish every 6 months, the second group received CPP-ACP every 6 months, the third group was treated with resin infiltration at the initial visit followed by placebo every 6 months, and the final group which was the control group was coated with 1400 ppm fluoride toothpaste every 6 months. All the candidates were instructed to brush twice daily using a specific toothbrush and 1400 ppm fluoride toothpaste. The study lasted for 12 months, and photographs of the teeth with WSL were taken before and after completion of the intervention. Photographs were analyzed using ImageJ software to compare the changes in the percentage of WSL area to total tooth surface area among the four study groups. The distribution differences among groups were compared using nonparametric tests and differences between baseline and 1-year follow-up parameters were analyzed using paired chi-square tests. RESULTS: Reduction in the area of WSL were noted in all groups, with different levels of significance. The percentage reduction was 46.62% in the resin infiltration group and it was significantly higher than the remaining interventions. Fluoride varnish group had 26.57% reduction, the CPP-ACP group had 28.64% reduction and the control group had 29.75% reduction in the WSL area. Plaque index was noted to have significant correlation with the change in WSL area with higher plaque index scores demonstrating lesser reduction in WSL. CONCLUSIONS: The study found that resin infiltration significantly reduced the WSL area after 1-year follow-up. Fluoride toothpaste with or without CPP-ACP and fluoride varnish produced some therapeutic effects.

Reinventing serial extraction with a fresh perspective: does it inspire a change in current practice?

OBJECTIVE: To analyze the skeletal and dental effects of serial extraction with and without expansion on severe crowding. DATA SOURCE AND STUDY DESIGN: A retrospective controlled study using lateral cephalograms of 78 children of age 8.5 + /- 1.4 years. STUDY DESIGN: The study sample involved 52 orthodontic patients treated for severe crowding and 26 age matched controls who did not undergo orthodontic treatment. The treated cases were sorted into serial extraction (EX) only group and serial extraction and expansion (EX-EXP) group. Vertical and anteroposterior skeletal and dental cephalometric measurements of these subjects were analyzed at baseline time point and following eruption of posterior permanent dentition. RESULTS: The study found significant changes in vertical skeletal dimensions with a decrease in mandibular and occlusal plane angles in the experimental groups at the follow up. The facial height index was noted to be increased. The upper gonial angle decreased significantly in the groups that had extractions. There was no significant change in the inter-incisal angle among the groups, yet at follow-up the inter-incisal angle of the control group was significantly smaller than the intervention groups. CONCLUSIONS: The article concludes that serial extraction alone or in combination with expansion treatment performed prior to pubertal growth phase have comparable skeletal cephalometric findings primarily affecting the vertical dimension.

Association between orthodontic treatment and the occurrence of temporomandibular disorders: smoke and mirrors in the form of a systematic review?

QUESTION: To investigate the association between orthodontic treatment and incidence of temporomandibular joint disorders (TMD) as a revision to the existing literature. DATA SOURCES: Electronic searches were performed in the following databases: PubMed/Medline, Scopus, Scielo, Google Scholar and Web of Science. Hand search of the references of the included studies was also conducted. STUDY SELECTION: Two authors performed database search independently using the keywords to include case control and cohort studies in English or Spanish language. Systematic reviews and Randomized controlled trials (RCTs) were excluded. DATA EXTRACTION AND SYNTHESIS: From the studies that met the inclusion criteria, investigators extracted the following data: authors, year, study title, number of patients, male/female ratio, mean age (range), follow up time, groups, number of patients per group, country and results. The Newcastle Ottawa scale was used for risk of bias assessment. All disagreements were resolved by consulting with a third reviewer. RESULTS: A total of 686 articles were found in the search and 28 duplicates were removed. After title and abstract screening, 648 articles remained. Ten articles were analyzed for full text and four studies were excluded in the process, leaving six articles that met all inclusion and exclusion criteria. Out of six studies, four were case control, one cohort and one prospective cohort. Authors found good quality on all categories of risk of bias assessment in the selected studies. For the meta-analysis, they considered Odds Ratio (OR) because of its presence in every included study. An association between orthodontic treatment and the occurrence of TMD was demonstrated with an odds ratio of 1.84. CONCLUSIONS: The review authors conclude that the results of their systematic review indicate association between the orthodontic treatment and incidence of TMJ disorders.

Diagnostic accuracy of AI in orthodontic extraction decisions: "Are we ready to let Mr. Data run our Enterprise?" A commentary on a systematic review.

OBJECTIVE: To collect evidence on the ability of artificial intelligence programs to accurately make extraction decisions in orthodontic treatment planning. DATA SOURCES: Authors electronically searched the following databases: PubMed/ MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, Computers & Applied Science, ACM Digital Library, and Compendex, Open Grey, Google Scholar, and ProQuest Dissertation and Thesis. STUDY SELECTION: Three independent reviewers collected the following data: number of cases of extraction and non-extraction, number of experts in orthodontics and their years of experience, number of variables used in the index model test, type of artificial intelligence and algorithms, accuracy outcomes, the three highest variable ranks weighted in the computational model, and the main conclusion. DATA EXTRACTION AND SYNTHESIS: Risk of bias was assessed using Quadas 2 checklist for AI, and certainty of evidence was evaluated by GRADE. RESULTS: After 2 phases of screening by 3 independent reviewers, 6 studies met the inclusion criteria for the final review. The AI programs used by the included studies were as follows: ensemble learning/random forest, artificial neural network/multilayer perceptron, machine learning/back propagation and machine learning/feature vectors. All studies showed an unclear risk of bias for patient selection. Two studies had high risk of bias in the index test, while two others presented an unclear risk of bias in the diagnostic test. Meta-analysis of the pooled data resulted in 0.87 accuracy value for all studies. CONCLUSIONS: The authors conclude that AI's ability to predict extractions is promising but should be interpreted with caution.

Is remote monitoring a reliable method to assess compliance in clear aligner orthodontic treatment?

Data source and study design Retrospective cohort study using the data obtained from PlusDental - a Berlin-based health-tech companyCohort selection and data analysis Patients who completed clear aligner therapy (CAT) in 2019 were selected for this study. A digital-based app was utilised for analysing compliance among patients who underwent non-extraction orthodontic treatment with clear aligners. The sample included 2,644 adult orthodontic patients, three-fourths of them being women and one-fourth men. The primary outcome involved patient compliance, which was evaluated using a questionnaire in the app, completed by the patient. The questionnaire required patients to enter details about the aligner change date, daily wear time and pressure exerted by each aligner. The effect of variables including age, sex, previous orthodontic treatment and satisfaction with one's smile on compliance, were also analysed. Statistical analysis was performed using two-sided chi-square tests.Results Only 36% of the patient sample were fully compliant and poor compliance was exhibited by 25%. Authors observed that women were less compliant than men and patients with no prior orthodontic treatment were better compliant towards CAT. Also, patients treated with removable appliances exhibited better compliance among those who had a history of previous orthodontic treatment.Conclusions The authors concluded that non-compliant patients can be identified early, using their results as a guideline. This will help in timely intervention of addressing compliance issues during clear aligner orthodontic treatment.

Gingival Enlargement in a Case of Variant Jones Syndrome: a Case Report.

Gingival enlargement can be caused by a variety of etiological factors like inflammation, drugs, and systemic diseases or can be presented as a part of a syndrome. One such syndrome is Jones Syndrome, which is associated with gingival enlargement and progressive hearing loss. We present here a case of fifteen-year-old boy with gingival enlargement, hearing loss, and generalized alveolar bone loss and diagnosed as Jones syndrome. The diagnosis was made based on history, clinical, radiographic, and histopathological findings. Gingival enlargement was surgically managed using gingivectomy and no recurrence was observed. The patient showed remarkable esthetical and functional improvement.

Prevalence of gingival overgrowth induced by antihypertensive drugs: A hospital-based study.

BACKGROUND: Gingival overgrowth (GO) is a known side-effect of calcium channel blockers. Although there have been several case reports, few studies have examined the prevalence of nifedipine, diltiazem, and amlodipine. This study was conducted to determine the prevalence and risk factors for GO in patients treated with calcium channel blockers. MATERIALS AND METHODS: A cross-sectional study was conducted in out patient Department of Medicine, Government Medical College, Calicut. 133 patients taking antihypertensives were examined for the presence of GO using two different indices: Vertical GO in 6 points around each tooth and horizontal Miranda-Brunet index in the interdental area. Gingival index (GI), plaque index, and probing depth were also evaluated. RESULTS: The frequency of GO was significantly higher in nifedipine-treated cases than other drug groups. Frequency of GO was 75% for nifedipine, 31.4% for amlodipine and 25% for amlodipine + metoprolol. Higher gingival, plaque and calculus were observed in patients taking calcium channel blockers. Among the possible risk factors, only the GI showed a significant correlation with GO. CONCLUSIONS: Patients taking antihypertensives had poor oral hygiene. Patients taking nifedipine showed a higher frequency of GO. Gingival inflammation acts as a predisposing factor.

Gingival enlargement in myelodysplastic syndrome.

The myelodysplastic syndrome (MDS) is characterized by peripheral blood cytopenias and increased risk of transformation to acute myeloid leukemia. This syndrome affects blood cell production and behavior. MDS is difficult to diagnose because of the absence of symptoms in the early stage of the disease. Often it is accidentally discovered during a routine physical exam/blood test. Till date, only a few cases of gingival enlargement associated with MDS are reported in the literature. Here is a remarkable case of gingival enlargement heralding the presence of MDS.