Do patients with different craniofacial patterns have differences in upper airway volume? A systematic review with network meta-analysis.

BACKGROUND: Craniofacial skeletal discrepancies have been associated with upper airway dimensions. OBJECTIVE: To identify differences in upper airway volume across different sagittal and vertical skeletal patterns. SEARCH METHODS: Unrestricted literature searches in eight databases/registers for human studies until May 2023. SELECTION CRITERIA: Cross-sectional studies measuring upper airway volumes using three-dimensional imaging in healthy patients of different sagittal (Class I, Class II, and Class III) or vertical (normodivergent, hypodivergent, and hyperdivergent) craniofacial morphology. DATA COLLECTION AND ANALYSIS: Duplicate independent study selection, data extraction, and risk of bias assessment. Random-effects frequentist network meta-analysis was performed followed by subgroup-analyses and assessment of the quality of clinical recommendations (confidence in effect estimates) with the CINeMA (Confidence in Network Meta-Analysis) approach. RESULTS: Seventy publications pertaining to 66 unique studies were included with 56 studies (5734 patients) contributing to meta-analyses. Statistically significant differences were found for total  pharyngeal airway volume, with Class II having decreased airway volume (-2256.06 mm3; 95% Confidence Interval [CI] -3201.61 to -1310.51 mm3) and Class III increased airway volume (1098.93 mm3; 95% CI 25.41 to 2172.45 mm3) compared to Class I. Significant airway volume reductions for Class II were localized mostly at the oropharynx, followed by the palatopharynx, and the glossopharynx. Significant airway volume increases for Class III were localized mostly at the oropharynx, followed by the intraoral cavity, and hypopharynx. Statistically significant differences according to vertical skeletal configuration were seen only for the oropharynx, where hyperdivergent patients had reduced volumes compared to normodivergent patients (-1716.77 mm3; 95% CI -3296.42 to -137.12 mm3). Airway differences for Class II and Class III configurations (compared to Class I) were more pronounced in adults than in children and the confidence for all estimates was very low according to CINeMA. CONCLUSIONS: Considerable differences in upper airway volume were found between sagittal and vertical skeletal configurations. However, results should be interpreted with caution due to the high risk of bias, owing to the retrospective study design, inconsistencies in anatomic compartment boundaries used, samples of mixed children-adult patients, and incomplete reporting. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD42022366928).

Pain profile during orthodontic levelling and alignment with fixed appliances reported in randomized trials: a systematic review with meta-analyses.

OBJECTIVE: To assess the pain profile of patients in the levelling/alignment phase of orthodontic treatment, as reported from randomized clinical trials. MATERIALS AND METHODS: Five databases were searched in September 2022 for randomized clinical trials assessing pain during levelling/alignment with a visual analogue scale (VAS). After duplicate study selection, data extraction, and risk-of-bias assessment, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression, and certainty analyses. RESULTS: A total of 37 randomized trials including 2277 patients (40.3% male; mean age 17.5 years) were identified. Data indicated quick pain initiation after insertion of orthodontic appliances (n = 6; average = 12.4 mm VAS), a quick increase to a peak at day 1 (n = 29; average = 42.4 mm), and gradually daily decrease the first week until its end (n = 23; average = 9.0 mm). Every second patient reported analgesic use at least once this week (n = 8; 54.5%), with peak analgesic use at 6 h post-insertion (n = 2; 62.3%). Patients reported reduced pain in the evening compared to morning (n = 3; MD = - 3.0 mm; 95%CI = - 5.3, - 0.6; P = 0.01) and increased pain during chewing (n = 2; MD = 19.2 mm; 95% CI = 7.9, 30.4; P < 0.001) or occlusion of the back teeth (n = 2; MD = 12.4 mm; 95% CI = 1.4, 23.4; P = 0.3), while non-consistent effects were seen for patient age, sex, irregularity, or analgesic use. Subgroup analyses indicated increased pain among extraction cases and during treatment of the lower (rather than the upper) arch, while certainty around estimates was moderate to high. CONCLUSIONS: Evidence indicated a specific pain profile during orthodontic levelling/alignment, without signs of consistent patient-related influencing factors.

Physical properties of root cementum: Part 29. The effects of LED-mediated photobiomodulation on orthodontically induced root resorption and pain: a pilot split-mouth randomized controlled trial.

OBJECTIVES: To examine the effects of light-emitting diode (LED)-mediated photobiomodulation (PBM) on orthodontic root resorption and pain. METHODS: Twenty patients (3 males, 17 females, mean age 15 years 6 months) needing bilateral maxillary first premolar extractions for orthodontic treatment were included in this single-centre, split-mouth randomized controlled trial. Both premolars received 150 g of buccal tipping force for 28 days. One side was randomly assigned to receive intraoral 850 nm wavelength, 60 mW/cm2 power, continuous LED illumination via OrthoPulse device (Biolux Research Ltd, Vancouver, British Columbia, Canada) for 5 minutes/day. The other side served as control. After 28 days, both premolars were extracted and scanned with micro-computed tomography for primary outcome assessment of root resorption crater volume measurements. For secondary outcome assessment, visual analogue scale pain questionnaires were used for both sides at 24 hours, 48 hours, 72 hours, and 7 days. Randomization was generated using www.randomization.com and allocation was concealed in sequentially numbered, opaque, sealed envelopes. Blinding was not possible during the experiment due to the use of tape to block light on control side of the devices. Assessors were blinded during outcome assessments. RESULTS: All 40 premolars from 20 patients were included. There was no significant difference in the mean total root resorption between the LED PBM and control sides (mean 0.216 versus 0.284 mm3, respectively, P = 0.306). The LED side was associated with less pain at 24 hours (P = 0.023) and marginally more pain at subsequent time points, which was not statistically significant. No harms were observed. LIMITATIONS: Short study duration and the inability to blind patients and clinician during clinical part of study. CONCLUSION: This 28-day randomized split-mouth controlled trial showed that daily, LED-mediated PBM application, when applied for 5 minute/day, does not influence orthodontic root resorption. It is associated with significantly less pain 24 hours after the application of orthodontic force, but no difference thereafter. These results should be tested on patients undergoing a full course of orthodontic treatment. TRIAL REGISTRATION: Clinical Trials Registry ACTRN12616000652471.

Gender disparity in speakers of the European Orthodontic Society conferences held between 2015 and 2020: a cross-sectional report.

OBJECTIVES: To assess the representation of female scientists as speakers of blindly selected oral presentations or invited speakers in the latest European Orthodontic Society (EOS) conferences between 2015 and 2020. To examine the association with a number of study- and author-related characteristics. MATERIALS AND METHODS: Abstract books and programmes of the EOS conferences held between 2015 and 2020, were electronically searched to identify the gender of all speakers. The following predictor variables were assessed: year, continent of authorship, number of centres, number of authors involved, study design, study topic, and presentation as a WJB Houston Award nominee. RESULTS: A total of 312 oral presentations were recorded with almost even distribution of female/male gender. In the majority of oral presentations, a European-origin speaker affiliation was confirmed (208/312; 66.7%), with a relatively equal representation of women (P = 0.05). Seniority in authorship of oral presentations belonged to male scientists (209/312; 67%). Furthermore, a total of 84 invited speakers were identified, of which only 15 (17.9%) were female, indicating a substantial gender gap. No more than four women were invited to lecture annually, compared to a minimum of 10 male scientists. Overall, a significant difference was recorded for the odds of a female scientist to be invited as a speaker in the EOS conference (range of odds across years: 0.20-0.36), compared to the odds for conducting an oral presentation in the same context and timescale (range of odds across years: 0.75-1.45) (Mantel-Haenszel test for homogeneity, P-value < 0.001). LIMITATIONS: Findings were based solely on the annual orthodontic conference of the EOS, without further insights on national conferences, or identification of wide-range timescale effects. CONCLUSIONS AND IMPLICATIONS: Gender disparity related to invited speakers at the EOS 2015-20 annual conferences was unequivocally confirmed. Nevertheless, gender differences were not identified in oral presentations. Firm efforts to ensure female scientist's voice is equally represented are needed including a move from theory to practice.

A comparative assessment of the dentoskeletal effects of clear aligners vs miniplate-supported posterior intrusion with fixed appliances in adult patients with anterior open bite. A multicenter, retrospective cohort study.

INTRODUCTION: This study aimed to retrospectively evaluate the dentoskeletal effects of clear aligners (Invisalign) vs miniplate-supported posterior intrusion (MSPI) and identify factors associated with posttreatment overbite in adults with anterior open bite. METHODS: Twenty-nine patients treated with Invisalign and 24 with MSPI combined with full-fixed orthodontic appliances were included from 5 orthodontic practices. Pretreatment and posttreatment lateral cephalometric measurements were included as outcomes. Comparisons across groups and identification of final overbite predictors were assessed with regression modeling and machine learning techniques. RESULTS: MSPI induced significantly greater maxillary molar intrusion (1.5 mm; 95% confidence interval [CI], 0.83-2.17; P <0.001), with subsequent reduction of anterior face height (ANS-Me) (-2.77 mm; 95% CI, -3.64 to -1.91; P <0.001), Mp-SN° (-1.95°; 95% CI, -2.77 to -1.12; P <0.001), and ANB° (-1.69°; 95% CI, -2.44 to -0.94; P <0.001) compared with Invisalign. MSPI resulted in a significantly larger increase in SNB° (0.94°; 95% CI, 0.23-1.65; P = 0.01) and point-Pog projection (2.45 mm; 95% CI, 1.12-3.77; P = 0.001). Compared with MSPI, Invisalign had a significantly greater increase in the distance of maxillary (1.05 mm; 95% CI, 0.38-1.72; P = 0.003) and mandibular (0.9 mm; 95% CI, 0.19-1.60; P = 0.01) incisal edges relative to their apical bases, with borderline greater lingual tipping of only the maxillary incisors (2.82°; 95% CI, -0.44 to 6.09; P = 0.09). Appliance type and initial overbite were significant final overbite predictors across all models. However, this difference was only evident in male patients (males [1.65; 95% CI, 0.99-2.32; P <0.001]; female [-0.04; 95% CI, -0.52 to 0.44; P = 0.87]). CONCLUSIONS: Both appliances effectively improve overbite. MSPI applied the correction via molar intrusion and counterclockwise mandibular autorotation, whereas Invisalign via maxillary and mandibular incisor extrusion.

The effect of micro-osteoperforations on orthodontic space closure investigated over 12 weeks: a split-mouth, randomized controlled clinical trial.

OBJECTIVES: To evaluate the effects of minimally invasive micro-osteoperforations (MOPs) on orthodontic tooth movement and pain. DESIGN: Prospective, split-mouth, randomized controlled trial. SETTING: Single-centre, university hospital. METHODS: Twenty subjects requiring maxillary first premolar extractions were included. Right and left sides of the maxilla were randomly allocated into experimental and controls. Space closure was initiated following alignment on 0.20″ stainless steel archwires, using 150 g force, applied by coil springs on power arms. Nance-TPA was used for anchorage. On the experimental side, two 5 mm deep MOPs in vertical alignment on distal aspect of the maxillary canine mid-root region were performed prior to space closure. OUTCOMES: The primary outcome was the amount of tooth movement during space closure, measured every 4 weeks for 12 weeks (T1, T2, and T3). Secondary outcome was the pain levels related to MOP, measured using Visual Analogue Scale (VAS) questionnaires. Significance was set at P < 0.01. RANDOMIZATION: Randomization was generated using a randomization table, and allocation was concealed in sequentially numbered, opaque, sealed envelopes. BLINDING: Blinding was not possible during the experiment but assessor was blinded during outcome assessment. RESULTS: All subjects completed the study, with tooth movement measurements available for all 20 patients for T0-T2. In three patients, space was closed on one side at T2. The average tooth movement between sides at three intervals (T0-T1, T1-T2, and T2-T3) were not significantly different. Overall difference following 12 weeks (T0-T3) was 0.69 mm higher on the experimental side (P < 0.001). No harms were observed. LIMITATIONS: Short-term study, cast measurements done with digital callipers. CONCLUSION: This 12-week randomized split-mouth controlled clinical trial showed two MOPs that are 5 mm deep, applied once prior to space closure, did not create clinically significant increase in maxillary premolar space closure. PROTOCOL: The protocol was not published before trial commencement. REGISTRATION: Trial was not registered. FUNDING: The Australian Society of Orthodontists Foundation for Research and Education.

A retrospective long-term comparison of early RME-facemask versus late Hybrid-Hyrax, alt-RAMEC and miniscrew-supported intraoral elastics in growing Class III patients.

OBJECTIVE: To compare the long-term dentoskeletal effects of early treatment with banded or bonded RME (Rapid Maxillary Expansion)-Face Mask (RME-FM) versus late treatment with bonded Hybrid-Hyrax, alt-RAMEC (Alternate Rapid Maxillary Expansion and Contraction) and intraoral Class III elastics anchored to miniscrew-reinforced-Lower-lingual-Arch (alt-RAMEC-HH-LLA) in growing, maxillary retrognathic patients. MATERIALS AND METHODS: Two groups were matched at long-term follow-up retrospectively. Patients received either early RME-FM (n=16, 5 males, 11 females, age T1: 6.5±0.9 years, age T2: 15.8±2.5 years) or late alt-RAMEC-HH-LLA (n=15, 7 males, 8 females, age T1: 12.52±0.94 years, age T2: 16.8±0.9 years). Total follow-up was 9.2±2.3 years and 4.2±0.2 years respectively, including fixed appliances to compete treatment. RESULTS: Both treatments resulted in Class III correction except one unsuccessful case of alt-RAMEC-HH-LLA. Active maxillary protraction was 1.6±0.5years with RME-FM and 0.5 years with alt-RAMEC-HH-LLA being significantly shorter (P<0.001). Values at T2 estimation with multivariate linear regression for correlated multiple outcomes, conditional on baseline estimates, age and sex showed alt-RAMEC-HH-LLA inducing significantly more retroclined lower incisors (mean: -6.11°; 95%CI: -10.66, -1.57; P=0.01), less overbite (mean: -1.28mm; 95%CI: -1.79, -0.761; P<0.001), less maxillo (Co-A)- (mean: -4.54mm; 95%CI: -7.91, -1.16; P=0.01) mandibular (Co-Gn) (mean: -10.5mm; 95%CI: -17.45, -3.55; P=0.003) projections/size, more open gonial angle (mean: 4.93°; 95%CI: 2.27, 7.59; P<0.001), and less S-N length (mean: -5.04mm; 95%CI: -6.57, -3.51; P<0.001). CONCLUSIONS: Patients treated with either early RME-FM or late Alt-RAMEC-HH-LLA had comparable overall post-pubertal skeletal and overjet corrections. However, the late Alt-RAMEC-HH-LLA showed less correction of dentoalveolar compensations and in particular of the mandibular incisors. The overbite, maxillary and mandibular projection and size were lower and the gonial angle was more open.

The effect of piezocision vs no piezocision on maxillary extraction space closure: A split-mouth, randomized controlled clinical trial.

INTRODUCTION: The aim of this 2-arm-parallel, split-mouth trial was to investigate the effects of piezocision compared with no piezocision on maxillary canine distalization and to evaluate patient perceptions on the surgical procedure. METHODS: Twenty-two participants requiring extractions of maxillary first premolars were recruited from the Department of Orthodontics (Sydney Dental Hospital) waiting list. After leveling and alignment, a minimum of 3 mm space was required for canine retraction. Piezocision cuts distal to the canines were 4 mm long and 3 mm deep into the buccal cortical plate. The canine retraction was initiated on both sides immediately after surgery, with coil springs delivering 150 g of force per side. Random assignment of piezocision or control intervention on the patient's right side was performed (www.randomisation.com) for the random number generation, and allocation concealment was accomplished with opaque, sealed envelopes. Patients were assessed every 6 weeks for coil activation and alginate impressions over 18 weeks. The primary outcome was the amount of tooth movement in mm. Secondary outcomes were canine rotation, anchorage loss measured on scanned dental models, and patient pain levels and perception on piezocision using visual analog scale questionnaires. Blinding was feasible for the dental model measurements. RESULTS: Twenty patients completed the trial. The treatment × time interaction showed no statistically or clinically significant differences in maxillary extraction space closure (b = -0.02; 95% confidence interval [CI], -0.29 to 0.25; P = 0.89) canine rotation (b = -1.45; 95% CI, -4 to 1.09; P = 0.26) and anchorage loss (b = -0.02; 95% CI, -0.38 to 0.34; P = 0.92). All patients except for one had minimal pain associated with the piezocision surgery but found the procedure tolerable and would recommend it. No harm occurred during the trial. CONCLUSIONS: Piezocision-assisted maxillary canine distalization was similar to distalization with conventional orthodontics with patients tolerating the procedure.

Effect of light-emitting diode-mediated photobiomodulation on extraction space closure in adolescents and young adults: A split-mouth, randomized controlled trial.

INTRODUCTION: This split-mouth trial aimed to examine the effects of light-emitting diode (LED)-mediated photobiomodulation compared with no photobiomodulation on maxillary canine distalization. METHODS: Twenty participants (10 males and 10 females; aged 11-20 years) requiring bilateral extraction of maxillary first premolars were included from the Sydney Dental Hospital waiting list. After premolar extractions, leveling, and alignment, canines were retracted on 0.020-in stainless steel wires with coil springs delivering 150 g of force to each side. Each patient's right side was randomly assigned to experimental or control using www.randomisation.com, and allocation concealment was performed with sequentially numbered, opaque, sealed envelopes. The experimental side received 850 nm wavelength, 60 mW/cm2 power, continuous LED with OrthoPulse device (Biolux Research Ltd, Vancouver, British Columbia, Canada) for 5 min/d. For the control side, the device was blocked with opaque black film. Patients were reviewed at 4-week intervals for force reactivation and intraoral scanning over 12 weeks. The primary outcome was the amount of tooth movement, and secondary outcomes were anchorage loss and canine rotation, all measured digitally. Blinding for study participants and the treating clinician was not possible; however, blinding was done for the measurements by deidentifying the digital scans. Linear mixed models were implemented for the data analysis. RESULTS: Nineteen participants concluded the study. Data analysis showed that the treatment × time interaction was not significant, suggesting no difference in space closure (unstandardized regression coefficient [b], 0.12; 95% confidence interval [CI], -0.05 to 0.29; P = 0.17), canine rotation (b, 0.21; 95% CI, -0.82 to 1.25; P = 0.69), and anchorage loss (b, -0.01, 95% CI, -0.28 to 0.26, P = 0.94). No harms were noted. CONCLUSIONS: Daily 5-minute application of LED did not result in clinically meaningful differences during extraction space closure compared with no LED application. REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12616000652471). PROTOCOL: The protocol was not published before trial commencement. FUNDING: This research was funded by the Australian Society of Orthodontists Foundation for Research and Education.

Nasal ventilation and rapid maxillary expansion (RME): a randomized trial.

OBJECTIVE: To assess three rapid maxillary expansion (RME) appliances in nasal ventilation. TRIAL DESIGN: Three-arm parallel randomized clinical trial. METHODS: Sixty-six growing subjects (10-16 years old) needing RME as part of their orthodontic treatment were randomly allocated (1:1:1 ratio) to three groups of 22 patients receiving Hyrax (H), Hybrid-Hyrax (HH), or Keles keyless expander (K). The primary outcome of nasal ventilation (pressure and velocity) and secondary outcomes (skeletal, dental, soft tissue, and nasal obstruction changes) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone-beam computed tomography (CBCT) data by applying computational fluid dynamics (CFD) method. Differences across groups were assessed with crude and adjusted for baseline values and confounders (gender, age, skeletal maturation, expansion amount, mucosal/adenoid hypertrophy, nasal septum deviation) regression models with alpha = 5%. RESULTS: Fifty-four patients were analysed (19H, 21HH, 14K). RME reduced both nasal pressure (H: -45.8%, HH: -75.5%, K: -63.2%) and velocity (H: -30%, HH: -58.5%, K: -35%) accompanied with nasal obstruction resolution (H: 26%, HH: 62%, K: 50%). Regressions accounting for baseline severity indicated HH expander performing better in terms of post-expansion maximum velocity (P = 0.03) and nasal obstruction resolution (P = 0.04), which was robust to confounders. Mucosal/adenoid hypertrophy and nasal septum deviation changes were variable, minimal, and similar across groups. The HH resulted in significantly greater increase in the nasal cross-sectional area (62.3%), anterior (14.6%), and posterior (10.5%) nasal widths. Nasal obstruction resolution was more probable among younger (P = 0.04), skeletally immature (P = 0.03), and male patients (P = 0.02) without pre-treatment mucosal hypertrophy (P = 0.04), while HH was associated with marginal greater probability for obstruction resolution. CONCLUSIONS: RME resulted in improvement of nasal skeletal parameters and simulated ventilation with the former being in favour of the HH and the latter not showing significant differences among the three appliances. LIMITATION: Attrition in the K group due to blocked activation rods possibly leading to limited sample to identify any existing group differences. HARMS: Replacement of blocked Keles expanders for finalizing treatment. PROTOCOL: The protocol was not published before the trial commencement. REGISTRATION: Australian and New Zealand Clinical Trial Registry; ACTRN12617001136392.

Australian Orthodontists Utilization and Attitude Toward a Government Funded Cleft Scheme.

OBJECTIVES: To (1) survey Australian orthodontists about their involvement with a government-funded scheme for patients with clefts, the Medicare Cleft Lip and Cleft Palate Scheme (MCLCPS) and (2) investigate their attitude toward treating patients with clefts and their training in this respect. DESIGN: A 13-question online survey was distributed to members of the Australian Society of Orthodontists. The survey gathered information regarding respondent demographics, the number of MCLCPS-eligible patients seen in the past 12 months and usual billing practices. RESULTS: A total of 96 complete responses were obtained. About 70% of respondents had treated MCLCPS-eligible patients in the past 12 months and 55% saw between 2 and 5 patients during this time. The likelihood of treating patients with clefts increased by a factor of 4.8 (95% CI: 1.2-18.9) if practicing outside of a capital city and 1.5 times for each decade increase in orthodontist's age (95% CI: 1.0-2.2). The MCLCPS was utilized by 81% of orthodontists with 26% of these respondents accepting rebate only. Most orthodontists felt their university training could have better prepared them to treat patients with clefts. A minority of orthodontists felt that a rebate increase would make them more likely to treat these patients. CONCLUSIONS: Australian orthodontists who treat patients with clefts tend to be older and work outside of capital cities. The decision to treat these patients tends to not be financially motived. Specialty orthodontic training programs could improve the preparedness of their graduates to treat patients with clefts.

The upper airway volume effects produced by Hyrax, Hybrid-Hyrax, and Keles keyless expanders: a single-centre randomized controlled trial.

OBJECTIVE: To assess upper airway volume changes after rapid maxillary expansion (RME) with three different expanders. TRIAL DESIGN: Three-arm parallel randomized clinical trial. METHODS: Sixty-six patients, 10-16 years old, in permanent dentition, with maxillary transverse deficiency were recruited and assigned with block randomization (1:1:1 ratio) and allocation concealment to three groups of 22 patients each (Hyrax, Hybrid-Hyrax, and Keles keyless expander). The primary outcome (overall upper airway volume change) and secondary outcomes (volume changes in the nasal cavity, nasopharynx, oropharynx, and hypopharynx) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone beam computed tomography. Differences across groups were assessed with crude or adjusted for confounders (gender, age, growth stage, skeletal pattern, baseline airway volume, and amount of expansion) linear regression models. RESULTS: Fifty-one patients were analysed (19, 19, and 13 in the Hyrax, Hybrid-Hyrax, and Keles groups). Maxillary expansion resulted in considerable increases in total airway volume in the Hybrid-Hyrax group (+5902.1 mm3) and less in the Hyrax group (+2537.9 mm3) or the Keles group (+3001.4 mm3). However, treatment-induced changes for the primary and all secondary outcomes were of small magnitude and no significant difference was seen among the three expanderes in the total airway volume in either crude or adjusted analyses (P > 0.05 in all instances). Finally, among pre-peak patients (CVM 1-3), the Hybrid-Hyrax expander was associated with significantly greater increases in total airway volume compared to the Hyrax expander (P = 0.02). CONCLUSIONS: RME resulted in relatively small increases in total upper airway volume and its separate compartments, with mostly no statistically significant differences across the Hyrax, Hybrid-Hyrax, and Keles groups. LIMITATIONS: Significantly greater attrition was found in the Keles group due to appliance failure. The current trial might possibly be under-powered to detect differences between groups, if such exist. HARMS: Keles expanders blocked during activations and required substitution for completion of treatment. PROTOCOL: The protocol was not published before trial commencement. REGISTRATION: Australian and New Zealand Clinical Trial Registry (ACTRN12617001136392).

Orthodontic Procedures, With or Without Extracting Primary Canines, for the Interceptive Management of Palatally Displaced Permanent Canines: A Systematic Review.

Purpose: Although rapid maxillary expansion (RME), transpalatal arch (TPA) and cervical-pull headgear (HG) have been suggested for the interception of palatally displaced permanent canines (PDCs), existing knowledge remains inconclusive. The purpose of this study was to assess these practices in an evidence-based manner.
Methods: Randomized controlled trials (RCTs) investigating the prevalence of physiologic PDC eruption after using RME, TPA and HG, with or without the extraction of the primary canines, were searched, and the risk of bias was assessed.
Results: Data from five RCTs were included. RME, TPA and HG, with or without extracting primary canines, can significantly increase the rate of normal eruption of PDCs compared to no intervention (risk ratio [RR] = 2.5 to 4.5). In comparison to extraction, no difference was observed, except for HG combined with primary canine extraction (RR = 1.413; 95 percent confidence interval = 1.062 to 1.880).
Conclusion: RME, TPA and HG can significantly increase the rate of normal eruption of PDC compared to no intervention. However, when compared to extraction, no differences were noted, except for HG combined with primary canine extraction.

The effects of a clinically feasible application of low-level laser therapy on the rate of orthodontic tooth movement: A triple-blind, split-mouth, randomized controlled trial.

INTRODUCTION: This split-mouth trial aimed to investigate the effect of low-level laser therapy (LLLT) on the amount of maxillary canine distalization when applied every 4 weeks over 12 weeks. METHODS: Twenty-two adolescents and young adults (15 female, 7 male; aged 13-25 years; n = 22) requiring bilateral maxillary first premolar extractions were recruited. After extractions and leveling-alignment, canines were retracted using closed-coil nickel-titanium springs delivering 150 g of force. LLLT was applied to 8 intraoral points on the buccal and palatal sides around the canine root for 10 seconds per point, on day 0, 28, and 56 with the control side receiving sham application. Alginate impressions were taken every 4 weeks on day 0, 28, 56, and 84. The amount of tooth movement, anchorage loss, and canine rotation were measured digitally. Randomization was generated using www.randomisation.com and allocation concealment through sequentially numbered, opaque, sealed envelopes. Participants, operator, and statistic assessor were blinded. Linear regression modeling accounting for clustering within each patient was used to identify differences between LLLT and control sides. RESULTS: Twenty-one patients completed the study. The total amount of tooth movement was similar in the LLLT (2.55 ± 0.73 mm) and control group (2.30 ± 0.86 mm), whereas 0.25 mm (95% confidence interval, -0.21, 0.71 mm) of difference was insignificant (P = 0.27). No significant differences were found for anchorage loss (P = 0.22) or canine rotation (P = 0.25). No harms were reported. CONCLUSIONS: Application of LLLT every 4 weeks did not result in differences in the amount of tooth movement, anchorage loss, and canine rotation during extraction space closure.

Alveolar ridge alterations in the maxillary anterior region after tooth extraction through orthodontic forced eruption for implant site development: a clinical CBCT study.

OBJECTIVE: To investigate the effects of orthodontic forced eruption (OFE) with the straight-wire appliance in the dimensions of the alveolar process when used for extracting compromised maxillary anterior teeth and implant site development. MATERIAL AND METHODS: Cone-beam computed tomography (CBCT) scans of 7 patients needing extraction of 17 maxillary anterior teeth were obtained before and immediately after OFE. Alveolar plate height and thickness measurements were performed on the buccal and palatal socket walls in CBCT sagittal cross sections. Statistical analysis included sample size calculation, paired t-test, and Wilcoxon test to evaluate alveolar plate dimensional changes and linear regression analysis to assess whether bone changes and the feasibility of implant insertion were associated to tooth type and root length, baseline alveolar plate thickness, and age. RESULTS: OFE caused statistically significant reduction of the buccal alveolar plate height (1.95 ± 1.83 mm) and significant increase of the palatal alveolar plate height (1.31 ± 2.41 mm) in the central tooth socket areas. Buccal reduction was associated positively to the baseline root length and negatively to the thickness of the corresponding plate in the apical level. A non-significant increase was noted in both buccal (0.23 ± 0.93 mm) and palatal (0.63 ± 1.59 mm) proximal bone. Inadequate buccal bone support hindered immediate implant placement in six sockets; however, all inserted implants showed adequate and gradually increasing stability from insertion to final restoration. CONCLUSIONS: OFE resulted in favourable increase in the heights of the palatal and proximal alveolar bone and significant reduction in the buccal plate height, which inhibited implant placement in 35% of the treated sockets.

Changes in Roughness and Mechanical Properties of Invisalign® Appliances after One- and Two-Weeks Use.

The aim of this study was to estimate the possible changes of surface roughness and the mechanical properties of Invisalign® appliances over one- and two-week of service. Forty appliances with attachments were retrieved after the end of orthodontic treatment from different patients. Half of them had been used for one week (1W), and the rest for two weeks (2W). Ten unused Invisalign® appliances were used as the control (CON). An equal number of teeth possessing attachments were cut of aligners deriving from all groups (1W, 2W, and CON), and the Sa, Sq, Sz, Sc, and Sv roughness parameters of the internal surface of the aligner attachment area and the opposite lingual side (which was in contact to enamel) were determined by optical profilometry. Then, ten first molars originating from all groups were embedded in acrylic resin, and were ground and polished. Instrumented indentation testing (IIT) was performed in order to determine the Martens hardness (HM), indentation modulus (EIT), and relaxation index (RIT), according to ISO 14577-2002. The produced data were statistically processed by one- or two-way analysis of variance (ANOVA) and multiple comparison post-hoc tests (a = 0.05). Both the surface roughness and mechanical properties of the retrieved groups (1W and 2W) showed statistically significant differences compared with CON, but without statistically significant differences between each other. The roughness variables of the as-received material were shown to be reduced after intraoral service demonstrating a wear effect. Ageing has a detrimental effect on the surface roughness and mechanical properties of Invisalign® appliances, although this effect is restricted to the first week of clinical usage.

A comparative histomorphological and micro computed tomography study of the primary stability and the osseointegration of The Sydney Mini Screw; a qualitative pilot animal study in New Zealand rabbits.

OBJECTIVE: The aim of this study was to assess the potential of improving orthodontic miniscrews' (MSs) primary stability in vivo by evaluating the dispersion capacity of an injectable bone graft substitute (iBGS) through a newly designed hollow MS [The Sydney Mini Screw (SMS)] and its integration with the cortical and trabecular bone by using the femur and tibia in a New Zealand rabbit animal model. METHODS: In total, 24 MSs were randomly placed in each proximal tibia and femur of 6 New Zealand rabbits with an open surgery process. Aarhus MSs were used as controls and the effect of injection of iBGS was studied by implanting SMSs with and without iBGS injection. The dispersion of iBGS and the integration of the SMS were studied by using micro Computed Tomography (µCT) and histochemical analysis at two time points, 0 day and 8 weeks post-implantation. RESULTS: iBGS was successfully injected through the SMS and hardened in situ. After 8 weeks, µCT results revealed that the iBGS particles were resorbed and bone tissue was formed around the SMS and within its lateral exit holes. CONCLUSIONS: This pilot animal study showed the high potential of the combined use of iBGS and SMS as a newly developed technique to promote the primary stability of MSs.