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1.
Artigo em Inglês | MEDLINE | ID: mdl-34801348

RESUMO

INTRODUCTION: The primary aim was to analyze the effect of providing a mobile application (My Retainers) on adherence with removable retention. METHODS: Eighty-four participants planned for thermoplastic retainers were randomly allocated to 2 groups. The intervention group was given access to a bespoke mobile application, while the control group was not given access. Baseline data were obtained at the removal of orthodontic appliances with follow-up at 3 months, 6 months, 9 months, and 12 months. The primary outcome was objectively assessed retainer wear recorded using a TheraMon microelectronic sensor (MC Technology GmbH, Hargelsberg, Austria). Secondary outcomes were stability and periodontal implications. RESULTS: The objectively assessed wear time at 12 months was low in both groups, being marginally higher in the intervention (median, 3.09 h/d; interquartile range, 8.1) than the control group (median, 1.44 h/d; interquartile range, 9.22) with no between-group statistical difference (P = 0.30, 95% confidence interval [CI], -3.91 to 1.19). No statistically significant difference was identified between the groups in terms of stability and periodontal outcomes. Improvement in plaque scores (P <0.0001; 95% CI, -0.20 to 0.15) and bleeding on probing (P <0.0001, 95% CI, -0.23 to -0.12) was noted over time with no periodontal attachment loss detected over the study period. CONCLUSIONS: Provision of the mobile application did not lead to improved adherence with thermoplastic retainer wear. Similarly, no benefit in respect of either occlusal stability or periodontal health was observed over the 12-month study period. Further novel approaches to improve adherence with retainer wear and oral hygiene measures are required. REGISTRATION: NCT03224481. PROTOCOL: Not published. FUNDING: This work was supported by funding from the European Orthodontic Society.

2.
Br Dent J ; 231(9): 537-538, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34773009
3.
Artigo em Inglês | MEDLINE | ID: mdl-34736817

RESUMO

INTRODUCTION: The objective of this project was to systematically review the effectiveness of mobile applications and social media-based interventions in producing a behavioral change in orthodontic patients. METHODS: Electronic databases and reference lists of relevant studies were searched on March 1, 2021, with no language restrictions (PROSPERO: CRD42019157298). Randomized and nonrandomized controlled trials assessing the impact of mobile applications and social media-based interventions on orthodontic patients were identified. Primary outcomes included adherence to wear, appointment attendance, knowledge, oral health-related behaviors, oral hygiene levels, periodontal outcomes, and related iatrogenic effects. The quality of the included trials was assessed using the Cochrane risk of bias tools. A weighted treatment effect of interventions on periodontal outcomes was calculated. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: A total of 3617 articles were identified. Of these, 16 studies (14 randomized controlled trials and 2 nonrandomized controlled trials) were deemed eligible. Nine randomized controlled trials were judged to be of either low or unclear risk of bias. The intervention was favored in relation to gingival and plaque indexes, standardized mean difference: -0.81 (95% confidence intervals [CI], -1.35 to -0.28) and -0.91 (95% CI, -1.64 to -0.19), respectively. However, no significant effect was observed in bleeding on probing (standardized mean difference: -0.22; 95% CI, -0.5 to 0.05). The level of evidence was high in probing depth and bleeding on probing outcomes. CONCLUSIONS: A very low to moderate level of evidence supports the effects of mobile applications and social media-based interventions in producing positive behavioral changes in orthodontic patients. Further high-quality trials would assist in further elucidating the potential of these approaches to influence orthodontic treatment outcomes and experiences.

4.
Trials ; 22(1): 699, 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645490

RESUMO

BACKGROUND: Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder characterised by the repeated episodic collapse of the upper airway during sleep, resulting in sleep deprivation, giving rise to apnoeas and hypopnoeas. Based on the severity of OSA, there are two primary treatment modalities, continuous positive airway pressure (CPAP) and mandibular advancement appliances (MAA); both are adherence-dependent. MAA is offered to those with mild to moderate OSA and is prescribed as an alternative to patients intolerable to CPAP. However, adherence to MAA treatment is variable and declines over time. Hence, the current study aims to assess the effectiveness of the stage-matched intervention, the Health Action Process Approach (HAPA), on adherence to MAA in patients with OSA. METHODS: A single-centre randomised clinical trial will be undertaken at Bart's Health NHS Trust. Fifty-six participants with newly diagnosed OSA are planned to be enrolled in the study and randomised to intervention care (IC) and standardised care (SC) groups. Participants in the SC group will receive routine care whilst participants in the IC group will receive the stage-matched intervention, developed using the HAPA model. Data indicating MAA adherence will be collected both objectively and subjectively, from micro-sensors embedded in the MAA design and sleep diaries, respectively at 3, 6, 18 and 36 months. In addition, a range of questionnaires designed to assess risk perception, outcome expectancy, and self-efficacy (SEMSA) and quality of sleep (PSQI and ESS) and life (EQ-5DL), socio-economic and social support scales will be used. DISCUSSION: The currently available treatments for obstructive sleep apnoea depend entirely on the patient's acceptance and use. There are several factors that affect cooperation and wear for example patients' awareness of their condition, social support and psychological behaviour. In addition, mood, such as anxiety, stress, and depression, may affect wear. At the same time, we know that interventions involving more education and behaviour approaches can help patients adapt more easily to some treatments. As a result, the present trial aims to explore the potential role of these factors to maximise treatment success and minimise side effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT04092660 . Registered on September 6, 2019.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Inquéritos e Questionários , Resultado do Tratamento
5.
Br Dent J ; 231(8): 503-511, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34686818

RESUMO

Introduction The Royal College of Surgeons of England (RCSEng) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG) offer the bi-collegiate Membership in Orthodontics (MOrth) examination, a summative assessment of specialist knowledge, skill and behaviour in orthodontics. The COVID-19 pandemic has had a profound global effect on almost every facet of normal life, including the conduct of face-to-face examinations. We highlight development, implementation and feedback for the bi-collegiate MOrth Part 2 examination delivered remotely to a cohort of candidates in September 2020 by RCSEng/RCPSG.Methods Two anonymised online surveys (Google Forms) were distributed via electronic mail following completion of the examination diet. Forty-two candidates were sent a survey covering four domains and comprising a total of 31 questions. The 20 examiners were sent a survey containing eight questions. In both surveys, free-text responses were also collected. A rating system was used to categorise responses. All survey responses were summarised in an online data collection sheet.Results The response rate was 78.5% (33/42) and 75% (15/20) for candidates and examiners, respectively. Overall, favourable responses in relation to all sections of the assessment were elicited from candidates with the majority (mean 79.8%; 75.8-81.9%) reporting that the online examination format worked well. Equally, favourable responses were reported by examiners. Notably, 80% of examiners felt that the online exam style did not affect the mark a candidate would receive, and 100% were confident that the marks the candidates received were a reflection of their ability and were not affected by the online delivery of the assessment.Conclusions The feedback from both candidates and examiners relating to an online remote assessment of the bi-collegiate MOrth Part 2 was generally positive. Based on the survey responses, this format of a high-stakes examination was acceptable to all stakeholders, and demonstrated a high level of perceived validity and reliability in terms of content.


Assuntos
COVID-19 , Ortodontia , Avaliação Educacional , Retroalimentação , Humanos , Pandemias , Reprodutibilidade dos Testes , SARS-CoV-2
6.
J Orthod ; : 14653125211046269, 2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34553620

RESUMO

OBJECTIVE: The primary aim was to evaluate the degree of root development of permanent canines at the time of alveolar eruption. We also aimed to assess whether differences in the degree of root development at alveolar eruption exist between permanent canines and premolars and between maxilla and mandible. DESIGN: A cross-sectional study. SETTING: Barts and The London School of Medicine and Dentistry, Queen Mary University of London. PARTICIPANTS: Two hundred dental panoramic radiographs taken as part of routine dental care. METHODS: Radiographs were assessed for canine and premolar root development stage and eruption level with calibration and repeat measurements undertaken. RESULTS: Two hundred and sixty teeth were identified as being at the level of alveolar eruption. The majority of maxillary canines reached alveolar eruption when root formation was complete. Most premolars and mandibular canines reached alveolar eruption when roots were three-quarters developed. At alveolar eruption, canines were statistically more mature than premolars (p<0.001) and maxillary teeth were more mature than mandibular teeth (p<0.05). CONCLUSIONS: Root development appears to be particularly advanced for maxillary permanent canines, being essentially root-complete at alveolar eruption, while premolars and mandibular permanent canines appear to have three-quarters root development at this stage. This information may be used to inform whether and when to extract primary teeth for orthodontic reasons.

7.
Br Dent J ; 2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34446842

RESUMO

Aim To calculate fallow time (FT) required following dental aerosol generating procedures (AGPs) in both a dental hospital (mechanically ventilated) and primary care (non-mechanically ventilated). Secondary outcomes were to identify spread and persistence of aerosol in open clinics compared to closed surgeries (mechanically ventilated environment), and identify if extraoral scavenging (EOS) reduces FT and production of aerosol.Methods In vitro simulation of fast handpiece cavity preparations using a manikin was conducted in a mechanically and non-mechanically ventilated environment using Optical Particle Sizer and NanoScan at baseline, during the procedure and fallow period.Results AGPs carried out in the non-mechanically, non-ventilated environment failed to achieve baseline particle levels after one hour. In contrast, when windows were opened after AGPs, there was an immediate reduction in all particle sizes. In mechanically ventilated environments, the baseline levels of particles were very low and particle count returned to baseline within ten minutes following the AGP. There was no detectable difference between particles in mechanically ventilated open bays and closed surgeries. The effect of the EOS on reducing the particle count was greater in the non-mechanically ventilated environment; additionally, it also reduced the spikes in particle counts in mechanically ventilated environments.Conclusion High-efficiency particulate, air-filtered mechanical ventilation, along with mitigation (high-volume suction), resulted in reduction of fallow time (ten minutes). Non-ventilated rooms failed to reach baseline level even after one hour of fallow time. There was no difference in particle counts in open bays or closed surgeries in mechanically ventilated settings with an extraoral suction device reducing particulate spikes. This study confirms that AGPs are not recommended in dental surgeries where no ventilation is possible.

9.
Br Dent J ; 230(11): 709-716, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34117425

RESUMO

Bonded retainers may play an important role in reducing unwanted tooth movements following orthodontic treatment, with an open-ended perspective on retention now established. The importance of planning for bonded retention is emphasised, with key principles in minimising failure rates as well as wire and adhesive options discussed. Approaches to preparation of the wire and the teeth, the bonding process, as well as variations in retainer design, and means of preventing problems and undertaking repairs in order to achieve predictable fixed retention in the long term are also outlined.


Assuntos
Colagem Dentária , Contenções Ortodônticas , Desenho de Aparelho Ortodôntico , Aparelhos Ortodônticos Fixos
10.
Br Dent J ; 230(11): 717-721, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34117426

RESUMO

Careful orthodontic treatment planning should involve the delineation of clear treatment objectives within each dental arch. Treatment planning decisions are underpinned by aesthetic goals, dental health considerations and the prospect of stability, with these factors often competing. There is also a near-universal acceptance of the requirement for some form of retention. A novel hierarchy of orthodontic stability is proposed. As further evidence emerges and technical refinement continues, it is likely that this will undergo further adaptation. Ultimately, however, this knowledge will ensure that our understanding of the merits of orthodontic intervention, allied to the burden of retention, can be clearly presented to prospective orthodontic patients.


Assuntos
Assistência Odontológica , Estética Dentária , Humanos , Estudos Prospectivos
11.
Br Dent J ; 230(11): 731-738, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34117428

RESUMO

Retention may be particularly challenging after the correction of specific malocclusion features, such as tooth rotations, open bite and expansion, which are all inherently unstable. In this article, some indications for active retention are reviewed by highlighting a variety of clinical techniques and appliances. Active retention is discussed in relation to preservation of tooth alignment and in the three planes of space: sagittal, vertical and transverse. In some situations, an active retention regimen may be helpful to minimise or counteract relapse after orthodontic treatment and to improve patient satisfaction during the typically lengthy post-treatment period.


Assuntos
Má Oclusão , Mordida Aberta , Cefalometria , Humanos , Incisivo , Mandíbula , Técnicas de Movimentação Dentária
12.
Br Dent J ; 230(11): 765-769, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34117436

RESUMO

Patient adherence to removable retainer wear is integral to the long-term success of retention regimes. We discuss the factors influencing removable retainer wear, the methods of gauging wear levels, approaches to enhance adherence and the quality of online available information concerning retention. The potential value of patient involvement in approaches to retention within a shared decision-making framework and motivational interviewing are also highlighted.


Assuntos
Contenções Ortodônticas , Cooperação do Paciente , Humanos
13.
Br Dent J ; 230(11): 770-776, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34117437

RESUMO

In view of the diversity of orthodontic presentations, a single optimal retention protocol does not exist, with approaches tailored based on pre-treatment characteristics, treatment-induced changes and general patient characteristics. However, orthodontic practitioners should be responsive to the best available evidence to formulate optimal retention protocols in terms of appliance type, design and regimen, in particular. Based on a comprehensive search strategy, we discuss fundamental aspects concerning orthodontic retention of particular interest both to orthodontists and general dentists. These include stability and periodontal outcomes, cost-effectiveness, patient experiences, survival and failure rates of retainers, and the duration of retention.


Assuntos
Desenho de Aparelho Ortodôntico , Contenções Ortodônticas , Humanos , Ortodontistas
14.
Am J Orthod Dentofacial Orthop ; 160(1): 58-65, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33902978

RESUMO

INTRODUCTION: The relationship between malocclusion, orthodontic treatment, and oral health-related quality of life (OHRQOL) is complicated, with some traits, such as increased overjet, having a potentially greater adverse effect on an adolescent's OHRQOL. The aim of this study was to evaluate the impact of malocclusion and orthodontic treatment on OHRQOL in adolescents presenting with Class II Division 1 malocclusion and explore the relationship between OHRQOL using a condition-specific and generic instrument and occlusal outcome. METHODS: Two groups of adolescents were recruited from a United Kingdom university hospital: a pretreatment group of adolescents with Class II Division 1 malocclusion and a treated (posttreatment) group whose Class II Division 1 malocclusion had been corrected. Self-reported OHRQOL was assessed using the malocclusion impact questionnaire (MIQ) and the short form of Child Oral Health Impact Profile questionnaires. Occlusion severity and outcome were assessed using Peer Assessment Rating scores. RESULTS: A total of 241 participants (106 male; 135 female) were recruited. MIQ scores differed significantly between the pretreatment and posttreatment groups, with scores being 11.35 times lower posttreatment than pretreatment, after adjusting for age and sex (95% confidence interval, -17.28 to -5.42; P <0.001). Females had higher total MIQ scores by 2.6 (95% confidence interval, 0.38 to 4.82), which was statistically significant (P = 0.022). There was a moderate correlation between MIQ and Peer Assessment Rating scores, but this relationship strengthened when omitting the global MIQ questions (Spearman's correlation coefficient, 0.59). CONCLUSIONS: Increased overjet was associated with impaired OHRQOL using a condition-specific measure. A deeper understanding of associations between malocclusion, orthodontic treatment, and OHRQOL would benefit from longitudinal evaluation.


Assuntos
Má Oclusão , Qualidade de Vida , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Saúde Bucal , Inquéritos e Questionários , Reino Unido
15.
J Clin Sleep Med ; 17(7): 1485-1498, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33660611

RESUMO

STUDY OBJECTIVES: The review aimed to identify the factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea. METHODS: The protocol was initially registered with the International Register of Systematic Reviews (Prospero: CRD42019122615) prior to undertaking a comprehensive electronic search of databases and references without language and date restrictions. Quality assessment was undertaken using the Cochrane Collaboration's risk of bias tool and Quality in Prognosis Studies (QUIPS) tool. RESULTS: Studies exhibited low or unclear risk of bias for the domains assessed by the respective quality assessment tools. The influence of independent variables such as disease characteristics, patient characteristics, appliance features, and psychological and social factors on adherence levels was also assessed. There was a total of 31 included studies, which consisted of 8 randomized controlled trials, 2 controlled clinical trial, 7 prospective cohorts, 11 retrospective cohorts, and the remaining 3 studies were a case-series, case-control, and a mixed-methods. All 31 included studies were subject to qualitative analysis, with only 4 studies included in the quantitative analysis. Results of the meta-analysis demonstrated increased adherence with custom-made appliances, with a pooled mean difference of -1.34 (-2.02 to -0.66) and low levels of heterogeneity (I² = 0%). CONCLUSIONS: A weak relationship was observed between objective adherence and patient and disease characteristics, such as age, sex, obesity, apnea-hypopnea index, and daytime sleepiness, to oral appliance therapy. Nonadherent patients reported more side effects with oral appliance therapy than users and tended to discontinue the treatment within the first 3 months. Custom-made oral appliances were preferred and increased adherence reported in comparison to ready-made appliances. Further research is imperative to examine the relationship between psychosocial factors and adherence to oral appliance therapy.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Adulto , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
16.
Int Orthod ; 19(1): 88-95, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33531277

RESUMO

OBJECTIVE: The aim of this study was to compare the stability of overjet reduction in adolescents treated with either orthodontic camouflage involving extraction of premolar units or functional appliance therapy. MATERIAL AND METHODS: A retrospective cohort study was undertaken with data collected at pre-treatment (T0), debond (T1) and 12 months post-treatment (T2). The primary outcome measure was stability of overjet reduction, and secondary outcome measures included Angle's molar relationship, and Little's Irregularity Index score. RESULTS: Forty-two Class II participants, 18 treated with a functional appliance and 24 with camouflage, were included with a mean pre-treatment age of 13.07 years (SD 1.72), with 23 (55%) being female. Mean overjet reduction during treatment in the functional appliance group was 6.99mm with relapse of just 0.62mm present at 12 months post-treatment. In the orthodontic camouflage group, there was a mean overjet reduction of 3.54mm with relapse of 0.27mm at 12 months post-treatment. Linear regression analysis confirmed no statistical difference (P=0.501) in overjet relapse between both treatment groups at 12 months post-treatment, adjusting for overjet at baseline. A further regression analysis revealed no significant association between overjet relapse and pre-treatment skeletal discrepancy, labial segment crowding, retention regime or compliance with the retention protocol. CONCLUSIONS: Both functional appliance and orthodontic camouflage therapies appear to have good antero-posterior occlusal stability, with minor degrees of overjet relapse occurring over a 12-month follow-up period. There was no significant difference between the treatments in relation to overjet relapse, buccal segment interdigitation or anterior irregularity.


Assuntos
Má Oclusão Classe II de Angle/terapia , Aparelhos Ortodônticos , Ortodontia Corretiva/instrumentação , Ortodontia Corretiva/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Má Oclusão , Má Oclusão Classe III de Angle/terapia , Sobremordida , Estudos Retrospectivos , Extração Dentária , Resultado do Tratamento
17.
Br Dent J ; 2020 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-33184480

RESUMO

Introduction Transmission of SARS-CoV-2 through aerosol has been suggested, particularly in the presence of highly concentrated aerosols in enclosed environments. It is accepted that aerosols are produced during a range of dental procedures, posing potential risks to both dental practitioners and patients. There has been little agreement concerning aerosol transmission associated with orthodontics and associated mitigation.Methods Orthodontic procedures were simulated in a closed side-surgery using a dental manikin on an acrylic model using composite-based adhesive. Adhesive removal representing debonding was undertaken using a 1:1 contra-angle handpiece (W&H Synea Vision WK-56 LT, Bürmoos, Austria) and fast handpiece with variation in air and water flow. The removal of acid etch was also simulated with the use of combined 3-in-1 air-water syringe. An optical particle sizer (OPS 3330, TSI Inc., Minnesota, USA) and a portable scanning mobility particle sizer (NanoScan SMPS Nanoparticle Sizer 3910, TSI Inc., Minnesota, USA) were both used to assess particulate matter ranging in dimension from 0.08 to 10 µm.Results Standard debonding procedure (involving air but no water) was associated with clear increase in the 'very small' and 'small' (0.26-0.9 µm) particles but only for a short period. Debonding procedures without supplementary air coolant appeared to produce similar levels of aerosol to standard debonding. Debonding in association with water tended to produce large increases in aerosol levels, producing particles of all sizes throughout the experiment. The use of water and a fast handpiece led to the most significant increase in particles. Combined use of the 3-in-1 air-water syringe did not result in any detectable increase in the aerosol levels.Conclusions Particulate matter was released during orthodontic debonding, although the concentration and volume was markedly less than that associated with the use of a fast handpiece. No increase in particulates was associated with prolonged use of a 3-in-1 air-water syringe. Particulate levels reduced to baseline levels over a short period (approximately five minutes). Further research within alternative, open environments and without air exchange systems is required.

18.
J Clin Epidemiol ; 126: 154-159, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32890636

RESUMO

OBJECTIVES: The objective of the study was to determine the change in quality of evidence in updates of Cochrane reviews that were initially published between January 1, 2013 and June 30, 2014. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to document evidence quality. STUDY DESIGN AND SETTING: We searched the Cochrane Database of Systematic Reviews on March 20, 2020 to identify which of the reviews from the initial (2013/14) sample had been updated. Using the same methods to determine the quality of evidence in the previous analysis, we assessed the quality of evidence for the first-listed primary outcomes in the updated reviews. RESULTS: Of the 608 reviews in the original sample, 154 had been updated with and 151 contained available data for both original and updated systematic reviews (24.8%). The updated reviews included: 15 (9.9%) with high-quality evidence, 56 (37.1%) with moderate-quality evidence, 47 (31.1%) with low-quality evidence, and 33 (21.9%) with very low-quality evidence. No change in the GRADE quality of evidence was found for most (103, 68.2%) of the updated reviews. The quality of evidence rating was downgraded in 28 reviews (58.3%) and upgraded in 20 (41.7%), although only six reviews were promoted to high quality. CONCLUSION: Updated systematic reviews continued to suggest that only a minority of outcomes for health care interventions are supported by high-quality evidence. The quality of the evidence did not consistently improve or worsen in updated reviews.


Assuntos
Gerenciamento de Dados/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Epidemiológicos , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Revisões Sistemáticas como Assunto
19.
Am J Orthod Dentofacial Orthop ; 158(4): 477-494.e7, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32888735

RESUMO

INTRODUCTION: We aimed to explore the prevalence and nature of complications associated with Class II correctors in adolescents and their impact on the quality of life (QOL), completion of treatment, and success rate. METHODS: The review was registered in PROSPERO, and a comprehensive electronic search was performed without language or date restrictions. Randomized and nonrandomized trials, prospective cohort and cross-sectional studies, case series, and qualitative research were included. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the quality of included studies. Data were grouped according to appliances design: removable functional, fixed functional, hybrid functional, headgear, and fixed maxillary molar distalization appliances. RESULTS: Data from 27 studies were included, of which 11 were deemed eligible for meta-analysis. Overall, 1676 adolescents were included related to fixed functional (n = 682), removable functional (n = 682), hybrid functional (n = 84), headgear (n = 186), and Carriere (n = 42) appliances. The mean number of emergencies was 0.8 (95% confidence interval [CI], 1.1-2.1) and 2 (95% CI, 0.9-3.0) for removable and fixed designs, respectively. However, the rate of discontinuation was 35% (95% CI, 0.28-0.42) and just 1% (95% CI, 0.01-0.1) for removable and fixed designs, respectively. Other QOL dimensions such as eating, sleep, speech, and emotional domains were significantly impaired during treatment with removable functional appliances. CONCLUSIONS: Removable Class II correctors were associated with a high rate of treatment discontinuation, most likely because of the negative impact on QOL and lack of compliance. More complications were observed with fixed designs, although this did not impact the overall success rates. Further prospective studies are needed to explore patient perceptions and cost-effectiveness to inform treatment decisions better.


Assuntos
Má Oclusão Classe II de Angle/terapia , Qualidade de Vida , Adolescente , Estudos Transversais , Humanos , Dente Molar , Estudos Prospectivos
20.
Am J Orthod Dentofacial Orthop ; 158(5): 650-660, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32950336

RESUMO

INTRODUCTION: A diverse range of outcomes is used in orthodontic research with a focus on measuring outcomes important to clinicians and little consistency in outcome selection and measurement. We aimed to develop a core outcome set for use in clinical trials of orthodontic treatment not involving cleft or orthognathic patient groups. METHODS: A list of outcomes measured in previous orthodontic research was identified through a scoping literature review. Additional outcomes of importance to patients were obtained using qualitative interviews and focus groups with adolescents aged 10-16 years. Rating of outcomes was carried out in a 2-round electronic Delphi process involving health care professionals and patients using a 9-point scale. A face-to-face meeting was subsequently held with stakeholders to discuss the results before refining the core outcome set. RESULTS: After triangulation, a final list of 34 outcomes grouped under 10 domains was obtained for rating in the e-Delphi surveys. Fifteen outcomes were voted "in" after the second Delphi round involving 274 participants with a further outcome being included after the consensus meeting. These were subsequently refined into a final set of 7 core outcomes, including the impact of self-perceived esthetics, alignment and/or occlusion, skeletal relationship, stability, patient-related adherence, breakages, and adverse effects on teeth or teeth-supporting structures. CONCLUSIONS: A bespoke orthodontic core outcome set encompassing both clinician- and patient-focused outcomes was developed. Incorporating this is the first step into providing a more holistic assessment of the impact of treatment while allowing for meaningful comparisons and synthesis of results from individual trials.


Assuntos
Ensaios Clínicos como Assunto , Estética Dentária , Ortodontia , Projetos de Pesquisa , Adolescente , Criança , Consenso , Técnica Delfos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Resultado do Tratamento
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