Is teledentistry effective to monitor the evolution of orthodontic treatment? A systematic review and meta-analysis.

INTRODUCTION: With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments. OBJECTIVE: To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment. MATERIAL AND METHODS: Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed. RESULTS: Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low. CONCLUSION: With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = -2.75[-3.95, -1.55]; I2=41%; p<0.00001) and the time for starting refinement (mean difference = -1.21[-2.35, -0.08]; I2=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.

Is teledentistry effective to monitor the evolution of orthodontic treatment? A systematic review and meta-analysis

ABSTRACT Introduction: With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments. Objective: To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment. Material and Methods: Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed. Results: Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low. Conclusion: With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = −2.75[−3.95, -1.55]; I2=41%; p<0.00001) and the time for starting refinement (mean difference = −1.21[−2.35, -0.08]; I2=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.

RESUMO Introdução: Com o advento da COVID-19, a teleodontologia e o monitoramento remoto tornaram-se uma realidade iminente, permitindo ao ortodontista acompanhar o tratamento ortodôntico por meio de checkups virtuais, que complementam as consultas presenciais. Objetivo: Avaliar a eficácia do uso da teleodontologia no acompanhamento da evolução do tratamento ortodôntico. Material e Métodos: Buscas foram realizadas em bases de dados on-line. A estratégia PECO focou na comparação de pacientes ortodônticos expostos e não expostos à teleodontologia. As buscas e a extração dos dados seguiram a metodologia PRISMA. A avaliação do risco de viés e da certeza da evidência foi realizada com as ferramentas ROBINS-I e GRADE, respectivamente. Uma metanálise também foi realizada. Resultados: Dos 1.178 estudos encontrados, 4 atenderam aos critérios e foram incluídos na análise qualitativa. O risco de viés para a avaliação do acompanhamento de tratamentos com alinhadores foi baixo a moderado; enquanto para o tratamento interceptativo, foi alto. Os estudos são favoráveis ao uso da teleodontologia. A meta-análise foi realizada apenas com estudos de alinhadores, devido à heterogeneidade. A certeza da evidência foi considerada muito baixa. Conclusão: Com muito baixo nível de certeza da evidência, a teleodontologia utilizando o software Dental Monitoring® é eficaz para auxiliar no acompanhamento da evolução do tratamento ortodôntico interceptativo (alto risco de viés) e, principalmente, do tratamento realizado com alinhadores (risco de viés baixo a moderado). A metanálise evidenciou redução no número de atendimentos presenciais (diferença média = −2,75[−3,95, -1,55]; I2=41%; p<0,00001) e no tempo para início do refinamento (diferença média = −1,21[−2,35, -0,08]; I2=49%; p=0,04). Estudos randomizados adicionais avaliando o tratamento ortodôntico corretivo com braquetes e fios são bem-vindos.

Como um cirurgião-dentista pode responder a uma dúvida clínica baseado na melhor evidência disponível? / How can a dentist answer a clinical question based on the best available evidence?

Introdução: a prática clínica baseada em evidência científica deve ser pautada, entre outros fatores, na busca prévia de conhecimento embasado pela ciência odontológica. Objetivo: o objetivo deste trabalho é apresentar uma proposta de protocolo de pesquisa, download e tradução de artigos científicos. Materiais e métodos: foi realizado um protocolo de pesquisa científica com o passo-a-passo detalhado em duas das principais bases de dados eletrônicas, ilustrado por meio de exemplos hipotéticos de três dúvidas clínicas. Resultados: o acesso e o desenvolvimento de habilidades de busca pela literatura científica devem chegar ao conhecimento dos profissionais da área odontológica com clareza e objetividade. Assim, a experiência clínica pode ser associada à evidência científica e à preferência do paciente na tomada de decisões. Conclusão: o aprimoramento da prática clínica deve oferecer e entregar qualidade nos resultados de tratamentos por meio da Odontologia baseada em evidências.

Introduction: A clinical practice based on scientific evidence should be performed, among other factors, on the prior search for knowledge supported by dental science. Objective: The objective of this study is to present a research protocol proposal, download and translation of scientific articles. Materials and methods: A step-by-step detailed scientific research protocol was carried out in two of the main electronic databases, illustrated by hypothetical examples of three clinical questions. Results: The access and the development of scientific literature search skills should reach the knowledge of dental professionals with clarity and objectivity. Thus, the clinical experience can be associated with scientific evidence and patient preference in decision-making. Conclusion: The improvement of clinical practice must offer and deliver quality in treatment outcomes through evidence-based dentistry.

Biostatistics: essential concepts for the clinician.

INTRODUCTION: The efficiency of clinical procedures is based on practical and theoretical knowledge. Countless daily information is available to the orthodontist, but it is up to this professional to know how to select what really has an impact on clinical practice. Evidence-based orthodontics ends up requiring the clinician to know the basics of biostatistics to understand the results of scientific publications. Such concepts are also important for researchers, for correct data planning and analysis. OBJECTIVE: This article aims to present, in a clear way, some essential concepts of biostatistics that assist the clinical orthodontist in understanding scientific research, for an evidence-based clinical practice. In addition, an updated version of the tutorial to assist in choosing the appropriate statistical test will be presented. This PowerPoint® tool can be used to assist the user in finding answers to common questions about biostatistics, such as the most appropriate statistical test for comparing groups, choosing graphs, performing correlations and regressions, analyzing casual, random or systematic errors. CONCLUSION: Researchers and clinicians must acquire or recall essential concepts to understand and apply an appropriate statistical analysis. It is important that journal readers and reviewers can identify when statistical analyzes are being inappropriately used.

Biostatistics: essential concepts for the clinician

ABSTRACT Introduction: The efficiency of clinical procedures is based on practical and theoretical knowledge. Countless daily information is available to the orthodontist, but it is up to this professional to know how to select what really has an impact on clinical practice. Evidence-based orthodontics ends up requiring the clinician to know the basics of biostatistics to understand the results of scientific publications. Such concepts are also important for researchers, for correct data planning and analysis. Objective: This article aims to present, in a clear way, some essential concepts of biostatistics that assist the clinical orthodontist in understanding scientific research, for an evidence-based clinical practice. In addition, an updated version of the tutorial to assist in choosing the appropriate statistical test will be presented. This PowerPoint® tool can be used to assist the user in finding answers to common questions about biostatistics, such as the most appropriate statistical test for comparing groups, choosing graphs, performing correlations and regressions, analyzing casual, random or systematic errors. Conclusion: Researchers and clinicians must acquire or recall essential concepts to understand and apply an appropriate statistical analysis. It is important that journal readers and reviewers can identify when statistical analyzes are being inappropriately used.

RESUMO Introdução: A eficiência dos procedimentos clínicos é baseada em conhecimentos práticos e teóricos. Inúmeras informações diárias estão ao alcance do ortodontista; porém cabe a esse profissional saber selecionar o que realmente tem impacto na prática clínica. A Ortodontia baseada em evidências acaba exigindo que o clínico conheça os fundamentos da bioestatística para compreender os resultados das publicações científicas. Tais conceitos também são importantes aos pesquisadores para um correto planejamento e análise dos dados. Objetivo: O presente artigo tem como objetivo apresentar, de forma clara, alguns conceitos essenciais da bioestatística que auxiliem o ortodontista clínico na compreensão da pesquisa científica para uma prática clínica baseada em evidências. Além disso, será apresentada uma versão atualizada do tutorial para auxílio na escolha do teste estatístico adequado. Essa ferramenta em PowerPoint® pode ser empregada para auxiliar o usuário a encontrar respostas para dúvidas comuns sobre bioestatística, como o teste estatístico mais adequado para comparar grupos, escolha de gráficos, realizar correlações e regressões, análises de sobrevivência e dos erros aleatório e sistemático. Conclusão: Pesquisadores e clínicos devem adquirir ou relembrar conceitos essenciais para compreender e aplicar uma análise estatística apropriada. É importante que os leitores e revisores de periódicos possam identificar quando análises estatísticas estão sendo utilizadas de forma inadequada.

Effects of rapid maxillary expansion on temporomandibular joints.

OBJECTIVE: To evaluate the impact of rapid maxillary expansion (RME) on the condylar position, disc joint, joint space, and interarticular relationship in growing patients. MATERIALS AND METHODS: A systematic search was performed in nine databases. The clinical studies selected included those with pre- and post-magnetic resonance, conventional computed tomography or cone beam tomography in growing patients. Risk of bias assessment was performed using the Cochrane Collaboration tool for controlled clinical studies and National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment for Before-After Studies With No Control Group. RESULTS: Initially, 4303 records were identified. Only eight studies fulfilled the criteria and were included in the qualitative analysis. Of those, two were controlled clinical studies with a risk of uncertain to high bias. The remaining papers had a low to moderate risk of bias. Results showed that RME in children and adolescents promoted the following: remodeling in the head and or condylar branch, changes in condylar position and joint space, maintenance of improved symmetry between the condyles, and no ability to modify the position or shape of the articular disc. CONCLUSIONS: RME in growing patients is able, in the short term, to modify the condyle-fossa relationship but does not change the position or shape of the articular disc. The intercondylar symmetric relationship is maintained or improved. Although the NHLBI score shows low to moderate risk of bias, the clinical relevance of these review findings is limited by Cochrane and Grades of Recommendation, Assessment, Development and Evaluation scores.

Are cloth masks a substitute to medical masks in reducing transmission and contamination? A systematic review.

During the COVID-19 pandemic the use of cloth masks has increased dramatically due to the shortage of medical masks. However, the efficiency of this material is controversial. We aimed to investigate the efficiency of cloth masks in reducing transmission and contamination by droplets and aerosols for the general population and healthcare workers. Electronic databases were searched without year or language restrictions. Clinical and laboratorial studies were included. The risk of bias (RoB) was assessed using an adapted quality checklist for laboratory-based studies. ROBINS-I tool and Cochrane RoB 2.0 were used to evaluate non-randomized (n-RCT) and randomized clinical trials (RCT), respectively. The quality of the evidence was assessed through GRADE tool. From the eleven studies selected, eight were laboratory-based studies, one non-randomized and one RCT supported by laboratory data. Between the evaluated fabrics only three presented a filtration efficiency > 90%. Hybrid of cotton/chiffon (95%CI 95.2 to 98.8), hybrid of cotton/silk (95%CI 92.2 to 95.8) and cotton quilt (95%CI 94.2 to 97.8). However, cloth masks are not recommended for healthcare workers. A meta-analysis was not feasible due to a high methodological heterogeneity. The overall quality of evidence ranged from very low to moderate. Despite the lower efficiency compared to medical masks, laboratorial results may underestimate the efficiency of cloth masks in real life. Cloth mask efficiency is higher when made of hybrid fabrics (cotton/chiffon, cotton/silk) and cotton quilt, mainly with multiple layers.

Are cloth masks a substitute to medical masks in reducing transmission and contamination? A systematic review

Abstract: During the COVID-19 pandemic the use of cloth masks has increased dramatically due to the shortage of medical masks. However, the efficiency of this material is controversial. We aimed to investigate the efficiency of cloth masks in reducing transmission and contamination by droplets and aerosols for the general population and healthcare workers. Electronic databases were searched without year or language restrictions. Clinical and laboratorial studies were included. The risk of bias (RoB) was assessed using an adapted quality checklist for laboratory-based studies. ROBINS-I tool and Cochrane RoB 2.0 were used to evaluate non-randomized (n-RCT) and randomized clinical trials (RCT), respectively. The quality of the evidence was assessed through GRADE tool. From the eleven studies selected, eight were laboratory-based studies, one non-randomized and one RCT supported by laboratory data. Between the evaluated fabrics only three presented a filtration efficiency > 90%. Hybrid of cotton/chiffon (95%CI 95.2 to 98.8), hybrid of cotton/silk (95%CI 92.2 to 95.8) and cotton quilt (95%CI 94.2 to 97.8). However, cloth masks are not recommended for healthcare workers. A meta-analysis was not feasible due to a high methodological heterogeneity. The overall quality of evidence ranged from very low to moderate. Despite the lower efficiency compared to medical masks, laboratorial results may underestimate the efficiency of cloth masks in real life. Cloth mask efficiency is higher when made of hybrid fabrics (cotton/chiffon, cotton/silk) and cotton quilt, mainly with multiple layers.

Terapia endodôntica em dentes decíduos por odontopediatras / Endodontic Therapy in Primary Teeth by Pediatric Dentists

Objetivo: Verificar a conduta de odontopediatras quanto à escolha da terapia endodôntica em dentes decíduos, assim como os fatores que influenciam essa eleição e os materiais nela utilizados. Método: Estudo transversal com 30 odontopediatras atuantes no Estado do Pará, Região Amazônica do Brasil, a partir de um questionário elaborado contendo informações pessoais e questões de caráter específico sobre possíveis técnicas de terapias endodônticas em dentes decíduos. Os dados foram apurados utilizando o softwareMicrosoft Excel 2010, onde foi elaborada a estatística descritiva.Resultados: Em caso de molar decíduo com cárie profunda sem exposição pulpar, 86,7% dos odontopediatras realizariam a proteção pulpar indireta (PPI). No caso de pequena exposição acidental da polpa, 50% fariam proteção pulpar direta (PPD) e 46,7%, a pulpotomia. Já em grande exposição pulpar com inflamação suave, 56,7% fariam a pulpotomia e 43,3% a PPD. Em polpa exposta, a pulpectomia foi o tratamento mais relatado em dentes com 1/3 de reabsorção radicular, presença de pólipo pulpar e presença de fístula. Nos casos de extensa lesão radicular e fístula, a maioria (93,3%) faria exodontia. Como medicação intracanal indicada, 36,7% escolheria a pasta Guedes Pinto em casos de pulpectomia. Em caso de pulpotomia, Hidróxido de cálcio (36,7%) e formocresol (33,3%) foram os materiais mais indicados. A pasta de hidróxido de cálcio é o material de escolha na PPD e na PPI para, respectivamente, 83,3% e 86,7% dos profissionais. Conclusão: Não foi observada uniformidade nas respostas da maioria das situações, especialmente nos casos de exposição da polpa e na escolha do material para a técnica. Estes dados confirmam a necessidade de um protocolo clínico para o tratamento pulpar em dentes decíduos baseado em comprovada evidência científica.

Objective: To evaluate the pediatric dentist?s approach with regards to choice of the endodontic therapy in primary teeth and the factors that account to the election of treatment and the materials.Method: This research was a cross-sectional study involving 30 pediatric dentists from the Pará State in the northern Brazil, based on the answers to a questionnaire containing personal information and specific questions addressing the possible endodontic therapies for primary teeth. The collected data were analyzed using Microsoft Excel 2010 software, in which a descriptive statistics was carried out.Results: In primary molars with deep caries without pulp exposure, 86.7% of the pediatric dentists would choose indirect pulp capping (IPC). In case of a small accidental pulp exposure, 50% would perform direct pulp capping (DPC) and 46.7% would perform pulpotomy. In case of a large pulp exposure with mild inflammation, 56.7% of the interviewers would do pulpotomy and 43.3% DPC. Pulpectomy was the most reported treatment for teeth with pulp exposure, 1/3 of root resorption, pulpal polypus and fistula. In case of extensive root lesion and fistula, most participants (93.3%) would perform exodontia. For intracanal dressing in cases of pulpectomy, 36.7% would choose the Guedes Pinto paste. For pulpotomy, calcium hydroxide (36.7%) and formocresol (33.3%) were the most frequently indicated. Calcium hydroxide paste was the material of choice for IPC and DPC for 83.3% and 86.7% of the professionals, respectively.Conclusion: There were no uniformity in the answers for most situations, especially for choosing the treatment and material for cases of pulp exposure. The results emphasize the need for establishing a research-based clinical protocol for pulpal therapy in primary teeth.