Three-dimensional nasolabial changes after maxillary advancement osteotomy in class III individuals: a systematic review and meta-analysis.

Background Class III malocclusions with maxillary retrognathia are commonly treated with single jaw Le Fort I maxillary advancement. The three-dimensional (3D) effects of surgery on the nasolabial region varies among the clinical studies. Quantifying these changes is of great importance for surgical planning and obtaining valid consent. Objectives To investigate the 3D relationship between soft tissue and skeletal changes secondary to Le Fort I maxillary advancement surgery in skeletal class III patients.Search methods Comprehensive search of multiple electronic databases supplemented by a manual and grey literature search were undertaken from inception to 9 June 2020.Selection criteria Studies that evaluated the 3D soft tissue changes of patients before and after maxillary advancement surgery alone.Data collection and analysis Study selection, data extraction and risk of bias assessment were performed independently by two reviewers, with disputes resolved by a third reviewer. A quantitative synthesis of the data was pre-planned for pooling similar outcome measures.Results Four studies were included in the final review and meta-analysis, with a total of 105 patients (mean age 16.7 + 33.9 years). The mean maxillary advancement of the included studies was 5.58 mm (95% CI 5.20-5.96). The sagittal effects of surgery on nose tip projection and prominence were insignificant (P >0.05, two studies); however, subnasal projection (MD 1.7 mm, two studies) and upper lip projection (MD 2.90 mm, four studies) increased significantly in a forward direction after surgery (P <0.05). Le Fort I osteotomy widens the upper philtrum width (MD 0.84 mm, two studies) (P <0.05). Inconsistencies among the included studies were identified; therefore, the results should be interpreted with caution.Conclusions There is weak evidence based on quantitative assessments that Le Fort I maxillary advancement significantly affects the nasolabial soft tissue envelope mainly in a sagittal dimension. These changes are concentrated around the central zone of the nasolabial region. Future prospective studies on maxillary advancement osteotomy with a standardised method of assessment, taking into consideration the confounding factors, are required.

Commonly used terminology in oral surgery and oral medicine: the patient's perspective.

Introduction Dentistry is progressing into person-centred care and away from a paternal approach. Effective verbal and written communication are crucial to allow this collaboration; however, misunderstanding of terminology can lead to confusion, poor decision-making and poor health outcomes.Methods A voluntary questionnaire with multiple-choice and short-answer questions was given to patients attending the NHS Lothian Oral Surgery and Oral Medicine Department over two weeks; 137 were completed. Eighteen terms were assessed, including: ulcer, local anaesthetic, impacted tooth, radiograph, sedation, biopsy, mucosa and benign. Exclusion criteria were non-English speakers who required a translator.Results The multiple-choice questions revealed that terms such as 'blister' and 'local anaesthetic' are relatively well understood. Other terms, such as mucosa, were poorly understood. Over a third of patients confused 'sedation' with general anaesthetic. Short-answer questions revealed a wide range of answers. 'Biopsy' and 'radiograph' were generally better understood compared to other terms. Demographics, educational background and English as a first language appeared to have an influence on understanding.Conclusion Patients had a varied understanding of terminology. Incorrect interpretation of words may lead to ill-informed decision-making or unnecessary concern. It is essential that challenging terminology is identified and explained at an understandable level.

Are developmentally missing teeth a predictive risk marker of malignant diseases in non-syndromic individuals? A systematic review.

BACKGROUND: Different genes and loci that are associated with non-syndromic developmental tooth agenesis (TA) have the same causation pathway in the development of tumours including breast cancer (BC), epithelial ovarian cancer (EOC), colorectal cancer (CRC) and lung cancer (LC). OBJECTIVES: To assess the link between TA and the development of cancer. SEARCH SOURCES: This registered review included a comprehensive search of electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], LILACS, Scopus, Web of Science and Medline via Ovid) until 1 April 2020, supplemented by manual, grey literature and reference lists search. There was no restriction in term of date of publication, gender, race or type of hypodontia. DATA SELECTION: The primary outcome was the relationship between TA and cancer. The secondary outcome was to identify the genetic correlation between TA and cancer. DATA EXTRACTION: Study selection, data extraction and risk of bias assessment were performed independently and induplicate by two reviewers, with disputes resolved by a third reviewer. RESULTS: Eight studies with a moderate-high risk of bias were included in the final review, with a total of 5821 participants. Due to the heterogeneity among the included studies, the data were presented narratively. Limited studies reported a high prevalence of EOC (19.2%-20%) and CRC (82%-100%) in individuals with TA (depending on the study) compared to those without TA (3% for EOC and 0% for CRC). While others reported a weak correlation between EOC and CRC and TA (P > 0.05). Weak evidence suggested a strong correlation between breast, cervical uterine and prostate cancers and TA (P < 0.05). CONCLUSIONS: Though low-quality evidence suggests a link between TA and cancer, it was not possible to verify that TA can hold a predictive value as a marker for cancers. Further research is needed to confirm the association. REGISTRATION: PROSPERO (CRD42020139751).

3D effects of a bone-anchored intra-oral protraction in treating class III growing patient: a pilot study.

OBJECTIVES: The aim of this prospective case series study is to assess the three-dimensional (3D) skeletal and soft tissue effects of the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol in conjunction with a miniscrew-supported class III elastic wear in class III growing patients. MATERIALS AND METHODS: Fourteen consecutive participants (mean age 12.05 ± 1.09 years), who displayed class III malocclusions with retrognathic maxillae, were recruited. A cone beam computed tomography (CBCT) scan was acquired before commencing treatment (T1). All participants were treated with a tooth-bone-borne rapid maxillary expansion (hybrid MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. This was followed by full-time class III elastics, delivering 400 g/side, to protract the maxilla. When a positive overjet was achieved, protraction was ceased and a post-treatment CBCT scan (T2) was taken. The 3D analysis of pre- and post-treatment CBCT scans was blinded. The scans were registered on the anterior cranial base. The Euclidean distance between the two extracted surface models of the pre- and post-treatment scans was displayed as a color surface map. RESULTS: All participants completed the intervention successfully. The majority of the participants showed protraction of the anterior maxillary region (71.4%) and in the zygomatic processes (64.2%). The maxilla significantly protracted (SNA 1.87° ± 1.06°; Vert.T-A 3.29 ± 1.54 mm), while the mandibular base significantly redirected posteriorly (SNB - 2.03° ± 0.85°, Vert.T-B - 3.43 ± 4.47 mm) and that was reflected on the ANB and Wits measurements. No adverse effects were observed. CONCLUSION: Class III elastics combined with the Alt-RAMEC activation protocol of the hybrid MARME appliance is an effective treatment method for mild/moderate class III malocclusions. A long-term follow-up and comparisons with other treatment modalities are required.

Effectiveness of different debonding techniques and adjunctive methods on pain and discomfort perception during debonding fixed orthodontic appliances: a systematic review.

BACKGROUND: Pain is an unpleasant side-effect that can be experienced during orthodontic procedures including debonding of fixed appliances. Pain experience can vary depending on the appliance, debonding technique, as well as adjunctive measures used. OBJECTIVES: The primary objective of this systematic review was to assess the effectiveness of different debonding techniques and adjunctive methods on pain/discomfort perception during debonding procedure (PDP) of fixed orthodontic appliances. The secondary objective was to assess the effects of anatomic location and gender on PDP of fixed orthodontic appliances. SEARCH METHODS: Multiple electronic databases were searched from inception to August 2018. Reference lists of the included articles were manually screened. SELECTION CRITERIA: Randomized clinical trials (RCTs) and controlled clinical trials were included. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers according to Cochrane guidelines, with disputes resolved by a third reviewer. Clinical heterogeneity in study design and methodology prevented quantitative synthesis of the data. RESULTS: The search yielded 198 articles after the removal of duplicates. Seven studies were included in the final review with a total of 307 participants aged 12-60 years. Of the four studies comparing different debonding instruments of labial fixed appliances, two studies showed that the lift-off debonding instrument (LODI) produced lower PDP levels than ligature cutting pliers. Three studies compared adjunctive measures to reduce PDP of labial fixed appliances. Finger pressure and bite wafers significantly reduced PDP levels. Analgesics administration (ibuprofen + paracetamol tablets) 1 hour prior to debonding also reduced PDP. PDP was significantly higher in anterior segments and in females. LIMITATIONS: The authors acknowledge that there was clinical heterogeneity among the included studies and that the potential effect of diurnal variation on pain during debonding was not considered in any of the included trials. CONCLUSIONS AND IMPLICATIONS: There is weak evidence indicating that using the LODI may reduce PDP of labial fixed appliances. Adjunctive measures such as an intrusive force with finger pressure, bite wafers, and preoperative analgesia may further aid PDP control. Further well-designed parallel-group RCTs taking into consideration the diurnal variation in pain are required. REGISTRATION: PROSPERO (CRD42017084474). FUNDING: None. CONFLICT OF INTEREST: The authors declare that there is no conflict of interest.

Reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis.

BACKGROUND: Reminders are implemented in healthcare services to increase compliance with treatment and to decrease the rate of failed appointments. Their effects in the provision of orthodontic care are not yet fully understood. OBJECTIVES: The main objectives of this review were to assess the effectiveness of reminder systems in improving oral hygiene (OH) and adherence to appointments in orthodontic patients. SEARCH METHODS: An unrestricted search was conducted in six electronic databases and was supplemented by an extensive manual search up to January 2018. SELECTION CRITERIA: Only randomized controlled trials (RCTs) evaluating the effectiveness of reminders in orthodontics were included. DATA COLLECTION AND ANALYSIS: Two authors were independently involved in study selection, data extraction, and bias assessment. A random-effects model with its corresponding 95% confidence interval (CI) was generated for comparable outcomes. Periodontal parameters were evaluated in the short term (1-3 months) and in the long term (>3 months). Cochrane risk of bias tool was utilized for bias assessment and the quality of the resultant evidence was graded. Additional subgroup and sensitivity analyses were implemented. RESULTS: Fourteen RCTs involving 2078 participants met the inclusion criteria; five studies were excluded from the quantitative synthesis due to high risk of bias. Small but statistically significant standardized mean differences in the plaque index scores were recorded favoring patients receiving reminders in the short-term (-0.38; 95% CI: -0.65 to -0.10) and in the long-term (-1.51; 95% CI: -2.72 to -0.30). Patients receiving reminders were less likely to miss their appointments with a relative risk of (0.39; 95% CI: 0.22 to 0.70) and less likely to develop white spot lesions (0.45; 95% CI: 0.31 to 0.65). CONCLUSIONS: There is moderate-to-high quality of evidence that reminders have a positive effect on OH and adherence to appointments in orthodontic patients. These effects were demonstrated in the short- and long-term. Future high-quality RCTs should be designed with longer follow-up periods. REGISTRATION: PROSPERO (CRD42017084479). CONFLICT OF INTEREST: None.

Reproducibility of the index of orthognathic functional treatment need scores derived from plaster study casts and their three-dimensional digital equivalents: a pilot study.

OBJECTIVE: To determine the reproducibility of Index of Orthognathic Functional Treatment Need (IOFTN) scores derived from plaster casts and their three-dimensional (3D) digital equivalents. DESIGN: Pilot study, prospective analytical. SETTING: UK hospital orthodontic department. PARTICIPANTS: Thirty casts and their digital equivalents, representing the pre-treatment malocclusions of patients requiring orthodontic-orthognathic surgical treatment, were scored by four clinicians using IOFTN. METHODS: Casts were scanned using a 3Shape digital scanner and 3D models produced using OrthoAnalyzerTM (3Shape Ltd, Copenhagen, Denmark). Examiners independently determined the IOFTN scores for the casts and digital models, to test their inter- and intra-operator reliability using weighted Kappa scores. RESULTS: Intra-operator agreement with IOFTN major categories (1-5: treatment need) was very good for plaster casts (0.83-0.98) and good-very good for digital models (0.78-0.83). Inter-operator agreement was moderate-very good for casts (0.58-0.82) and good-very good for digital models (0.65-0.92). Intra-operator agreement with IOFTN sub-categories (1-14: feature of malocclusion) was good-very good for casts (0.70-0.97) and digital models (0.80-0.94). Inter-operator agreement was moderate-good for casts (0.53-0.77); and moderate-very good for the digital models (0.58-0.90). CONCLUSIONS: Digital models are an acceptable alternative to plaster casts for examining the malocclusion of patients requiring combined orthodontic-orthognathic surgical treatment and determining treatment need.

Alignment efficiency and esthetic performance of 4 coated nickel-titanium archwires in orthodontic patients over 8 weeks: A multicenter randomized clinical trial.

INTRODUCTION: The objective of this 4-arm parallel study was to evaluate the alignment efficiency and esthetic performance of 4 coated nickel-titanium archwires over an 8-week period. METHODS: Patients in the permanent dentition requiring maxillary and mandibular fixed orthodontic treatment with a preadjusted edgewise appliance were eligible for inclusion. Patients attending 4 hospital departments (United Kingdom and Italy) were randomly allocated to 1 of 4 treatment interventions: (1) BioCosmetic (Forestadent, Pforzheim, Germany), 0.017 in; (2) Titanol (Forestadent), 0.016 in; (3) TP Aesthetic (TP Orthodontics, La Porte, Ind), 0.014 in; and (4) Tooth Tone (Ortho Organizers, Calsbad, Calif) 0.016 in. Block randomization with block sizes of 4 and 8 was used to ensure an allocation ratio of 1:1:1:1. The primary outcome was alignment efficiency determined by the reduction in Little's irregularity index (mm). Secondary outcomes were color change using the Commission Internationale de L'Eclairage L*a*b* system and percentage of coating loss. Blinding was only applicable to outcome assessment of alignment efficiency. Regression models with Sidak's multiple comparison of means were used to analyze the data. RESULTS: One hundred fifty patients (300 dental arches) were allocated to the treatment interventions, including 61 male and 89 female subjects with a mean age of 16.60 years. The average duration of follow-up was 63.65 days. Baseline characteristics for the archwire groups were similar. One patient was lost to follow-up. Five percent (n = 15) of the archwires fractured: BioCosmetic, 5.3% (n = 4); Titanol, 6.8% (n = 5); TP Aesthetic, 5.3% (n = 4); and Tooth Tone, 2.7% (n = 2). We analyzed 283 dental arches for alignment efficiency. There was no statistically significant difference for mean reduction in irregularity between the archwire groups (P = 0.627): BioCosmetic (n = 71), 3.86 mm (95% CI, 3.31-4.41); Titanol (n = 69), 4.51 mm (95% CI, 4.00-5.02); TP Aesthetic (n = 71), 4.13 mm (95% CI, 3.49-4.78); and Tooth Tone (n = 72), 4.21 mm (95% CI, 3.89-4.46). There was a statistically significant difference between archwire groups for color change (P = 0.001) and percentage of coating loss (P = 0.001), with BioCosmetic performing best in both parameters. CONCLUSIONS: There was no difference between the archwires for alignment efficiency. BioCosmetic performed statistically significantly better than did the other groups for both color change and coating loss. REGISTRATION: This trial was registered with the East Midlands NHS Research Ethics Committee (12/EM/0190). PROTOCOL: The protocol was not published before trial commencement.

The application of the Index of Orthognathic Functional Treatment Need (IOFTN): service evaluation and impact.

OBJECTIVES: (1) To undertake a service evaluation of the Index of Orthognathic Functional Treatment Need (IOFTN). (2) To determine its suitability to replace the Index of Orthodontic Treatment Need (IOTN) in the assessment of patients with dentofacial deformity. DESIGN: Laboratory- and questionnaire-based study. SETTING: UK hospital-based orthodontic department. METHODS: Cohen's Kappa was used to assess inter- and intra-operator reliability for the IOTN and the IOFTN against 30 orthognathic patients' models scored to a 'gold standard'. Questionnaires gathered feedback on ease of use of the IOFTN. Change in treatment need status for a further 60 orthognathic patients was estimated utilising the IOTN, the IOFTN and a modified IOTN (mIOTN). RESULTS: Inter-operator agreement with the 'gold standard' for the IOTN and the IOFTN ranged from 0.64-0.90 and 0.61-0.91, respectively. Intra-operator agreement for the IOTN and the IOFTN ranged from 0.46-1.00 to 0.59-0.95, respectively. Mean feedback score was 9.08 out of a maximum score of 10. Overall, 88.9% of patients scored grades 4 or 5 on the IOFTN (IOTN = 87.8%; mIOTN = 77.8%). CONCLUSIONS: The IOFTN is simple and reliable to use. It is an appropriate aid in the prioritisation of surgical patients. Further recommendations are given.

The 'slingshot' technique to align palatally impacted canines with elastomeric chain.

Orthodontic alignment of palatally ectopic maxillary canines can be challenging. Treatment is usually prolonged and further complicated by the need for surgical exposure. Several methods are commonly used and have been described in the literature. This article presents two cases to describe a relatively unknown yet effective technique using the 'slingshot' method. This method is operator friendly and easily tolerated by patients.