Health-related quality of life, jaw function and sleep-disordered breathing among patients with dentofacial deformity.

BACKGROUND AND OBJECTIVES: Patients with dentofacial deformity (DFD) requiring orthognathic treatment have poor aesthetics, jaw function and psychological well-being, which potentially affect the quality of life. This study aimed to investigate the health-related general, oral and orthognathic quality of life, jaw function and sleep-disordered breathing at different stages of orthognathic surgical treatment. METHODS: A total of 120 consecutive patients with DFD were recruited and grouped as pre-orthodontic treatment (group 1), pre-surgery (group 2), 4 months post-surgery (group 3), 24 months post-surgery (group 4) and in addition 30 controls without DFD (group 0). Outcomes were assessed using general health Short Form Survey (SF-36), Oral Health Impact (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ), STOP-Bang and Jaw Function Limitation Scale (JFLS) questionnaires. In addition, presence or absence of pain was recorded. Data were tested with analysis of variance, Kruskal-Wallis test, Tukey post hoc test and structural equation modelling (SEM). RESULTS: Results revealed SF-36 (p = .814) and STOP-Bang (p = .143) total scores did not differ between control and treatment groups. In contrast, OHIP-14, OQLQ and JFLS total scores differed between groups (p = .001). Higher scores were observed in groups 1 (p = .001), 2 (p = .001) and 3 (p = .041) compared to group 0, indicating poor oral health in patients with DFD. Importantly, in group 4, oral health-related quality of life was better, and OHIP-14 (p = .936) and JFLS (p = .572) scores did not differ from controls. OQLQ scores of group 4 were significantly lower than group 1 (p = .001) but higher than group 0 (p = .013). SEM results revealed a significant negative associations of pain with JFLS and OQLQ; OHIP-14 with OQLQ; OHIP-14 with SF-36; and finally STOP-Bang with SF-36. Positive associations were observed between JFLS and OHIP-14; OHIP-14 and OQLQ. CONCLUSION: Oral health-related quality of life and jaw function appears to be improved 24 months after orthognathic surgery. Pain and limitation in jaw function had a negative association with health-related quality of life.

Stability, survival, patient satisfaction, and cost-minimization of CAD/CAM versus conventional multistranded fixed retainers in orthodontic patients: a 2-year follow-up of a two-centre randomized controlled trial.

BACKGROUND: CAD/CAM (computer-aided design/computer-aided manufacturing) fixed retainers (FRs) as an alternative to multistranded FRs to maintain orthodontic treatment outcome. OBJECTIVES: The primary aim was to compare CAD/CAM versus conventional multistranded FRs in terms of stability until 2 years. Secondary outcomes were failure rates, patient satisfaction, and cost-minimization. TRIAL DESIGN: 2-arm parallel, two-centre randomized controlled trial. METHODS: Patients were randomized to CAD/CAM or conventional FRs in both arches, in a 1:1 ratio and blocks of four. Allocation concealment was secured by using sequentially numbered envelopes. Patients were blinded. FRs were bonded at the end of treatment, and patients were recalled after 12 and 24 months. First-time retainer failures were recorded and digital impressions were taken. Arch widths and lengths, as well as Little's Irregularity Index (LII), were measured. Additionally, patients answered satisfaction questionnaires. Linear mixed models were applied for measurements and patient satisfaction. Survival analyses were estimated with Kaplan-Meier curves, along with Cox-regression modelling. Cost-minimization analysis was undertaken. RESULTS: One hundred and eighty-one patients were randomized (98 in Centre 1, and 83 in Centre 2): 90 in CAD/CAM and 91 in conventional group. One hundred and fifty three patients attended T24 follow-up. There were no significant differences in LII and arch dimensions between groups for failure-free patients. Within 24 months, 34% maxillary CAD/CAM FRs and 38% maxillary conventional FRs failed, along with 42% mandibular CAD/CAM FRs and 40% mandibular conventional FRs, with no significant difference in survival between groups (hazard ratios conventional to CAD/CAM: maxillary arch: 1.20 [P = 0.46], mandibular arch: 0.98 [P = 0.94]). There were no significant differences in patient satisfaction between groups. No harms were observed. Cost-minimization analysis showed that CAD/CAM FRs were slightly cheaper than conventional FRs. CONCLUSIONS: There were no clinically significant differences in LII, arch widths, and lengths between CAD/CAM and conventional FRs after 24 months. There were no differences in failures and patient satisfaction between groups. CAD/CAM FRs were slightly cheaper than conventional FRs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04389879.

Associations between temporomandibular disorders, pain, jaw and masticatory function in dentofacial deformity patients: A cross-sectional study.

BACKGROUND AND OBJECTIVE: Patients with dentofacial deformity often present with impaired masticatory function, orofacial pain and temporomandibular disorders (TMD). This study investigates the relationship between TMD, pain, jaw and masticatory function at different stages of orthognathic surgical (OS) treatment. METHODS: A total of 120 OS patients were prospectively recruited and grouped as pre-orthodontic (group 1), pre-surgery (group 2), 4-month post-surgery (group 3), 24-month post-surgery (group 4), in addition to 30 controls (group 0). Outcomes were assessed using: Jaw Function Limitation Scale (JFLS), McGill pain questionnaire, DC/TMD instrument, voluntary maximum bite force (MVBF), and masticatory efficiency (ME) using two-coloured chewing gum. Data were analysed using structural equation modelling. RESULTS: The prevalence of non-painful TMD did not differ between groups (p = .827). However, the prevalence of painful TMD differed between groups (p = .001). Among the painful TMDs, the highest prevalence was observed for masseter myalgia in group 2 (p = .031), and importantly group 4 did not differ from group 0 (p = .948). The MPQ score was significantly higher in group 1 (p = .001) compared to group 0, and the JFLS score was significantly higher in groups 1, 2 and 3 compared to group 0. Notably, MPQ (p = .756) and JFLS (p = .572) scores in group 4 were not different from group 0. However, MVBF (p = .996) and ME (p = .991) did not differ between groups 1 and 4. The association of self-reported pain and jaw function with the masticatory function was observed in OS patients. CONCLUSION: OS was not associated with a negative impact on TMD. Jaw function and pain levels were similar to controls at the 24-month follow-up. The masticatory function was further affected by the surgery and seems to require a longer recovery time. Moreover, it was confirmed that pain and TMD were associated with limitations in jaw function and impacts on masticatory function.

Functional outcome of total knee arthroplasty following tibial plateau fractures: a systematic review.

BACKGROUND: Posttraumatic osteoarthritis (PTOA) following a tibial plateau fracture (TPF) is a debilitating disease which often affects a young and active patient population for whom good knee function is essential. Frequently, total knee arthroplasty (TKA) is the only surgical option. The aim of this systematic review was to evaluate functional outcome for TKA in PTOA patients, together with several secondary outcome parameters. METHODS: A systematic review according to the PRISMA guidelines was conducted. Studies were included that reported on patient-reported outcome measures, range of motion or objective functional analysis after TKA because of PTOA following TPF. RESULTS: After analyzing 105 studies, 5 were included for the final review. In total, 162 patients with a TKA for PTOA were included of whom 125 (77%) were managed operatively for their TPF. All studies reported improvements in functional outcome after TKA, with two studies showing no significant differences between PTOA patients and a matched cohort of primary OA patients. Reported complication and re-intervention rates were higher for TKA patients with PTOA. CONCLUSION: The results of this review indicate the TKA for PTOA after a TPF provides satisfactory functional outcome, with results similar to those of matched primary OA patients. TKA should, therefore, be considered a viable treatment option to improve function, but both patients and orthopedic surgeons should be aware of the higher complication rates in this patient population.

Stability, survival, and patient satisfaction with CAD/CAM versus conventional multistranded fixed retainers in orthodontic patients: a 6-month follow-up of a two-centre randomized controlled clinical trial.

OBJECTIVES: The primary aim of this two-arm parallel two-centre randomized controlled trial was to compare computer-aided design and computer-aided manufacturing (CAD/CAM) versus conventional multistranded fixed retainers (FRs) in terms of stability over 6 months. Secondary outcomes were failure rates and patient satisfaction. METHODS: Patients were randomized to CAD/CAM or conventional FRs in both arches, in 1:1 ratio and blocks of four. Allocation concealment was secured by using sequentially numbered envelopes. Patients were blinded. Retainers were bonded at the end of orthodontic treatment (T0), and patients were recalled after 1 (T1), 3 (T3), and 6 (T6) months. First-time retainer failures were recorded and digital impressions were taken. Arch widths and lengths, as well as Little's Irregularity Index (LII), were measured. Additionally, patients answered satisfaction questionnaires. Linear mixed models were applied for measurements and patient satisfaction. Survival analyses were estimated with Kaplan-Meier curves, along with Cox-regression modelling. RESULTS: One hundred and eighty-one patients were randomized (98 in Centre 1, and 83 in Centre 2): Ninety in the CAD/CAM group and 91 in the conventional group. Three subjects dropped out at baseline, as they did not attend any of the follow-up appointments.168 patients attended the T6 visit. There were no significant differences in arch dimensions between T0 and T6, whilst the LII was different only in the CAD/CAM group (mean difference: 0.2 mm; 95% confidence interval: 0.1 to 0.4; P < 0.001). Within 6 months, 39 upper retainers (19 out of 88 CAD/CAM and 20 out of 90 conventional retainers) and 52 lower retainers failed (26 out of 88 CAD/CAM and 26 out of 90 conventional retainers), with no significant difference between the survival of both types of retainers (hazard ratios conventional to CAD/CAM: upper arch: 0.99 [P =0.99], lower arch: 0.93 [P = 0.80]). There were no significant changes in patient satisfaction between the groups. No harms were observed. CONCLUSIONS: There were no clinically significant differences in LII, arch widths and lengths between CAD/CAM and conventional retainers after 6 months. There was no difference in failures and in patient satisfaction between both types of FRs. REGISTRATION: ClinicalTrials.gov NCT04389879.

How efficient is customized lingual orthodontics? An assessment of treatment outcome.

OBJECTIVE: To assess the efficacy of lingual orthodontics by comparing setups and post-treatment casts. SETTING AND SAMPLE POPULATION: Thirty-two consecutive patients treated with a customized lingual orthodontic appliance were included in this retrospective study. MATERIALS AND METHODS: Initial casts, post-treatment casts and setups were scanned, and the digital models produced were analysed in terms of overjet; overbite; molar and canine relationships; intercanine, interpremolar and intermolar distances; upper and lower arch lengths; midline deviation; bucco-lingual angulation of all teeth and mesio-distal angulation of anterior teeth. Comparisons between setups and post-treatment casts were performed via paired t tests. Relationships between the planned and actual correction were studied using regression analysis. RESULTS: Statistically significant differences in bucco-lingual torque between setups and post-treatment casts were found for all upper teeth, except for central incisors. In the lower jaw, statistically significant differences in bucco-lingual torque were found between setups and post-treatment casts for the lower incisors and molars. No statistically significant differences in mesio-distal angulation of anterior teeth were found between setups and post-treatment casts. Upper and lower arch widths did not vary significantly between setups and final casts, except upper inter-second premolar and intermolar distances. CONCLUSION: Customized lingual appliances offer efficient control of mesio-distal angulation of all anterior teeth. Significant differences in torque between setups and post-treatment casts were observed for upper lateral incisors, canines, premolars and molars, as well as lower incisors and molars. However, the torque difference was clinically significant (over three degrees) for upper second premolars and molars only.

Does quality of orthodontic treatment outcome influence post-treatment stability? A retrospective study investigating short-term stability 2 years after orthodontic treatment with fixed appliances and in the presence of fixed retainers.

OBJECTIVE: The present study aimed to evaluate stability 2 years after orthodontic treatment and to investigate the influence of various pre-treatment and post-treatment prognostic factors on stability. SETTING AND SAMPLE POPULATION: Consecutive patients treated with full fixed appliance and retained with fixed retainers were retrospectively assessed for eligibility. MATERIALS AND METHODS: Digital models were analysed at treatment start (T0), end of treatment (T1) and 2 years post-treatment (T2). The Peer Assessment Rating (PAR) index, Little's Irregularity Index (LII), arch width and length, overjet, overbite and presence of unexpected post-treatment changes were assessed. Multiple regression analyses were conducted to model the relationship of all outcomes with several prognostics simultaneously. RESULTS: The sample consisted of 287 subjects (mean treatment time: 25.1 months, standard deviation [SD] 7.5; mean post-treatment follow-up: 27.5 months, SD 6.1) with a mean weighted PAR score of 29.5 (SD 8.6) at T0, 1.8 (SD 2.9) at T1 and 3.2 (SD 3.6) at T2. At T1, 95% of the subjects had a perfect LII versus 86% at T2. An increased LII at T1 correlated with increased LII and PAR changes from T1 to T2. PAR at T1 as well as overjet at T0 was a significant prognostic factor for PAR at T2. At T2, five cases (1.7%) showed unexpected post-treatment changes related to fixed retainers. CONCLUSION: Short-term post-treatment stability with fixed retainers was very good. Prognostic factors for stability included LII and PAR at T1, suggesting that high-quality treatment outcome in the presence of fixed retainers may ensure post-treatment stability.

Malocclusion and oral health-related quality of life among young Danish adults. Is there a difference between subjects who received orthodontic treatment during adolescence and subjects without treatment need? A cross-sectional study.

OBJECTIVES: To evaluate and compare malocclusion traits and oral health-related quality of life (OHRQoL) between untreated young adults assessed to have no orthodontic treatment need during childhood, and young adults treated orthodontically during childhood. In addition, to investigate the relationship between malocclusion and OHRQoL. MATERIALS AND METHODS: One hundred undergraduate students were screened for eligibility. Subjects had intraoral scans and completed OHIP-14 questionnaires. Angle molar relationship, overjet, overbite, arch length and width, Little's Irregularity Index (LII), Peer Assessment Rating (PAR) index and Dental Aesthetic Index (DAI) scores were assessed. Unpaired t-tests were used to compare outcomes between treated and untreated subjects. Multiple regression analyses were conducted to model the relationship between OHIP-14 and several prognostics simultaneously. RESULTS: Ninety-six subjects were included (mean age ± SD = 23.7 ± 1.8 years): 41 treated and 55 untreated. The untreated subjects had significantly higher LII (p = .02), PAR (p = .01), DAI (p < .01) and overbite (p = .03). The treated subjects had significantly larger inter-canine and inter-premolar distances. No relationship was found between OHIP-14 and LII, PAR, DAI, age, gender and presence/absence of previous orthodontic treatment. However, the DAI score was significantly correlated with the OHIP-14 functional limitation domain. CONCLUSIONS: Untreated subjects had significantly higher LII, PAR and DAI scores than the treated subjects. DAI score was significantly correlated with the OHIP-14 functional limitation domain.

Translation and cross-cultural adaptation of the sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire into Danish language.

OBJECTIVE/BACKGROUND: Sleep-disordered breathing (SDB) is common but often underestimated in children. The gold standard for assessing SDB is polysomnography, but it is expensive and time-consuming. The Paediatric Sleep Questionnaire (PSQ/SRDB) is a validated screening tool for SDB, which represents an efficient and alternative tool for screening SDB among children. However, a translated and validated Danish version of the PSQ/SRDB is not available yet. Our aim was to cross-culturally translate the PSQ/SRDB into Danish language for use in clinical and research settings. PATIENTS/METHODS: The translation was carried out through forward-backward translation techniques performed by a panel of experts, and the cross-cultural adaptation was achieved by pretesting of the pre-final version. Internal consistency of the Danish PSQ/SRDB version was measured by Cronbach's alpha coefficients, while Cohen's kappa was used to evaluate test-retest reliability. Construct validity was assessed by factor analysis of the principal components. RESULTS: The Danish PSQ/SRDB was administered to the caregivers of 348 children. An overall Cronbach's alpha of 0.72 was found, confirming the survey's consistency, with the results for the domains ranging 0.52-0.70. The Danish PSQ/SRDB showed moderate to perfect reliability for all items, except for one question (C14). Factor analysis performed on the Danish PSQ/SRDB showed that the predetermined four factors were similar with the original version of the PSQ/SRDB. CONCLUSIONS: The Danish version of the PSQ/SRDB has been successfully translated and cross-culturally adapted, suggesting that it can be used as an appropriate paediatric screening tool for SDB in Denmark.

Indirect vs direct bonding of mandibular fixed retainers in orthodontic patients: Comparison of retainer failures and posttreatment stability. A 5-year follow-up of a single-center randomized controlled trial.

INTRODUCTION: This 2-arm parallel trial aimed to assess the number of failures of mandibular fixed retainers bonded with direct and indirect bonding methods at a 5-year follow-up and investigate the stability of intercanine and interpremolar distances. METHODS: Consecutive patients from the clinic of the University of Geneva (Switzerland) were randomly allocated to either direct or indirect bonding of a mandibular fixed retainer at the end of orthodontic treatment. Inclusion criteria included the presence of all mandibular incisors and canines; and the absence of active caries, restorations, fractures, or periodontal disease of these teeth. The patients were randomized in blocks of 4 using an online randomization service, with allocation concealment secured by contacting the sequence generator for assignment. Two and 5 years (T5) after bonding the retainers, the patients were recalled, and impressions were taken. The primary outcome was the 5-year survival of the mandibular fixed retainer bonded with both bonding methods. The secondary outcomes were the intercanine and interpremolar distances and the assessment of unexpected posttreatment changes (ie, changes in torque and/or rotations of the mandibular incisors and canines). Blinding was applicable for outcome assessment only. Kaplan-Meier curves were generated, and a Cox proportional hazard regression model was fitted for bonding type, age, and treatment. Linear mixed models were fitted to intercanine and interpremolar distances: bonding type, time, age, and treatment were modeled as outcomes. RESULTS: Sixty-four patients were randomized in a 1:1 ratio. At T5, 6 patients without previous failure were lost to follow-up from each group. At T5, the fixed retainer was debonded in 14 patients (54%) for each group. The hazard ratio of indirect bonding to direct bonding was 1.09 (95% confidence interval, 0.26-4.60; P = 0.91); there was no statistically significant difference in survival between the groups. Regarding intercanine and interpremolar distances, none of the tested prognostic factors reached statistical significance. Unexpected posttreatment changes were observed in 6 failure-free patients, all bonded with the direct bonding method. Only 1 patient required debonding of the fixed retainer. No other serious harms were observed. CONCLUSIONS: The 5-year survival rate for both direct and indirect bonding methods was 46%, without a statistically significant difference between bonding methods. Bonded retainers were effective in maintaining intercanine and interpremolar distances. Unexpected posttreatment changes were only observed with retainers bonded with the direct bonding method. REGISTRATION: The trial was not registered. PROTOCOL: The protocol was not published before trial commencement. FUNDING: No funding or conflict of interest to be declared.

Orthodontic Tooth Movement Studied by Finite Element Analysis: an Update. What Can We Learn from These Simulations?

PURPOSE OF REVIEW: To produce an updated overview of the use of finite element (FE) analysis for analyzing orthodontic tooth movement (OTM). Different levels of simulation complexity, including material properties and level of morphological representation of the alveolar complex, will be presented and evaluated, and the limitations will be discussed. RECENT FINDINGS: Complex formulations of the PDL have been proposed, which might be able to correctly predict the behavior of the PDL both when chewing forces and orthodontic forces are simulated in FE models. The recent findings do not corroborate the simplified view of the classical OTM theories. The use of complex and biologically coherent FE models can help understanding the mechanisms leading to OTM as well as predicting the risk of root resorption related to specific force systems and magnitudes.

Three-dimensional soft tissue changes in orthodontic extraction and non-extraction patients: A prospective study.

OBJECTIVES: To assess the soft tissue changes in orthodontic extraction and non-extraction patients on 3D stereophotogrammetric images. SETTING AND SAMPLE: 23 extraction (22.2 ± 9.2 years) and 23 non-extraction (20.3 ± 11.1 years) consecutive patients were enrolled at the Sections of Orthodontics at Aarhus University and at University of Naples Federico II. METHODS: All patients had a first 3D image taken after bonding of brackets on the upper incisors (T0), and a second 3D image (T1) after space closure in the extraction group or at insertion of the first SS or TMA rectangular wire in the non-extraction group. The 3D images were captured with 3dMDFace System and analysed with 3dMDVultus Software. After placing 19 landmarks, 15 measurements were obtained. Intragroup changes were analysed with paired t-test and intergroup changes with unpaired t-test (P < .05). RESULTS: Superimpositions of the 3D images at T0 and T1 visualized with colour-coded maps showed that soft tissue changes primarily happened in the perioral area in both groups. The Nasolabial angle increased significantly in the extraction group (3°± 4.1, P = .002), while it decreased in the non-extraction group (-1.5°± 5.5°, P = .002). There was a significant difference between the two groups (4.4°, P = .004). CONCLUSIONS: 3D comparison of the soft tissues in the extraction and non-extraction groups showed statistically significant, but clinically limited differences in the perioral area. The Nasolabial angle was significantly larger at T1 in the extraction group compared with the non-extraction group.

Does rapid maxillary expansion enlarge the nasal cavity and pharyngeal airway? A three-dimensional assessment based on validated analyses.

OBJECTIVES: To evaluate the three-dimensional changes following rapid maxillary expansion (RME) of the nasal cavity (NC) and pharyngeal airway (PA) in growing patients, using innovative and validated evaluation methods and to investigate whether a correlation between skeletal expansion and increase in airway volume exists. SETTINGS AND SAMPLE POPULATION: Records of patients who had cone beam computed tomography taken before and after orthodontic treatment with or without RME were retrospectively collected and divided into two groups: (a) RME, 39 patients (mean age 10.40 ± 1.74 years); and (b) control, 29 patients, matched for age (mean age 11.07 ± 1.45 years) and follow-up period. MATERIAL AND METHODS: Total and partial volumes of the NC and the PA were calculated. The PA centerline was determined to assess the minimal cross-sectional area and hydraulic diameter. Paired and unpaired t test were applied to compare the difference between time points and between groups. One-way ANOVA and post hoc Tukey's tests were used to compare subgroups with respect to changes in palatal width and lacrimal ducts distance. RESULTS: All of the NC, PA and skeletal parameters were significantly enlarged after RME. The NC volume and inter-molar distance in the RME were significantly larger compared to the control group. The initially lower mean values of minimal cross-sectional area and hydraulic diameter in the RME group when compared to the control group normalized after RME treatment. CONCLUSIONS: Based on validated analyses, the NC volume increase was evident after RME in the long term after controlling for growth.

Computer-aided design and manufacturing of bone- and tooth-borne maxillary protraction with miniscrews and Class III elastics: Can we contemporize Class III treatments in growing patients?

The purpose of this clinical report is to illustrate an innovative treatment plan for a patient with Class III malocclusion. The plan combined the versatility of computer-aided design and manufacturing technology with miniscrews. Maxillary and mandibular fully customized metal framework anchored to 4 miniscrews was digitally designed and constructed for a growing patient with midface hypoplasia and a skeletal Class III malocclusion. The patient wore Class III elastics between hooks on the maxillary and mandibular frameworks full time for 10 months. Overcorrection was obtained with limited dental side effects, and a significant improvement of the profile was achieved. With the advantages of computer-aided design and manufacturing technology and less invasive insertion procedure compared with miniplate surgery, this patient-specific treatment approach was simple and effective.

Computer-aided indirect bonding versus traditional direct bonding of orthodontic brackets: bonding time, immediate bonding failures, and cost-minimization. A randomized controlled trial.

INTRODUCTION: The primary aim of this randomized controlled trial was to compare the time for bracket bonding using either direct or computer-aided indirect bonding; a secondary aim was to assess immediate bracket debondings and cost minimization. METHODS: Consecutive patients were randomly allocated to two groups (blocks of four, online-generated sequence) using a split-mouth design with a direct and a computer-aided indirect bonding method: group 1 (upper right and lower left quadrants: indirect bonding; upper left and lower right quadrants: direct bonding) or group 2 (opposite situation). The primary outcome was difference in time spent for bonding brackets. The secondary outcome was immediate bracket debondings (at the bonding appointment). Time for indirect bonding was recorded in two steps: digital bracket placement and clinical bonding procedure. Outcome assessment was blinded. Friedman's ANOVA test was used to assess differences in bonding time. Chi-square test was used to compare immediate debondings. A cost-minimization analysis was undertaken. RESULTS: Thirty-seven patients were randomized to group 1 or 2. Ten patients were excluded: 15 patients were analyzed in group 1 and 12 in group 2. Clinical chair time for bonding half a mouth was significantly shorter for computer-aided indirect bonding (12 minutes 52 seconds) than for direct bonding (16 minutes 47 seconds) (P < 0.001). When adding the time for digital bracket placement, the total bonding time (28 minutes 14 seconds) was longer for indirect bonding than for direct bonding (P < 0.001). There was no single immediate debonding with the direct bonding method, while 14 brackets were lost with the indirect bonding method (5.1 per cent) (P = 0.0001). Cost-minimization analysis showed that computer-aided indirect bonding was more expensive than direct bonding. CONCLUSIONS: The clinical chair time was significantly shorter for computer-aided indirect bonding than for direct bonding. However, the total bonding time for computer-aided indirect, including digital bracket placement, was longer than for direct bonding. There were significantly more immediate debondings with computer-aided indirect bonding than with direct bonding. Under these conditions, computer-aided indirect bonding was more expensive than direct bonding. REGISTRATION: This trial was retrospectively registered on ClinicalTrials.gov (University of Aarhus Protocol Record 10101). PROTOCOL: The protocol was not published before trial commencement.

Treatment effect of bone-anchored maxillary protraction in growing patients compared to controls: a systematic review with meta-analysis.

OBJECTIVE: The aim of this systematic review was to determine which evidence level supports maxillary advancement after bone-anchored maxillary protraction (BAMP) in growing patients compared to controls. SEARCH METHODS: PubMed, Cochrane, Embase, Scopus, and Web-of-Science databases were searched with no restrictions on publication status or year. SELECTION CRITERIA: Prospective and retrospective human studies about BAMP, in at least three patients, were included. Authors were contacted when necessary, and reference lists of the included studies were screened. DATA COLLECTION AND ANALYSIS: Two authors undertook independent data extraction with conflict resolution by a third author. Risks of bias were assessed. A meta-analysis for estimates of changes for ANB angle, Wits appraisal, and incisor to mandibular plane angle (IMPA) angle of BAMP treatment compared to control groups was performed. RESULTS: A total of 449 articles were initially retrieved; 28 full-text articles met the inclusion criteria. Sample sizes ranged from 3 to 52 patients. There was heterogeneity in cephalometric outcomes reported, which prevented the comparison of certain outcomes. ANB angle improved more with BAMP in the maxilla combined with facemask (bone-anchored facemask, BAFM) compared to traditional facemask therapy: this was statistically but not clinically significant (0.2 degrees). No data are available for BAMP with skeletal anchorage in both jaws in combination with Class III elastics (bone-anchored Class III elastics, BAC3E). Likewise, no statistically significant differences in Wits appraisal were found (less than 1 mm). Lower incisor retroclination and facial height seemed to be better controlled with BAC3E compared to BAFM. CONCLUSIONS: The level of evidence available to support the maxillary advancement effect after BAMP was low. Publications reporting results based on identical samples tended to suggest overly positive results of BAMP. The differences in sagittal correction between BAMP and traditional facemask therapy were small and of questionable clinical significance. Long-term follow-up results are not available and, therefore, much needed. LIMITATIONS: Most articles had a low level of evidence and some included a historical control group. REGISTRATION: PROSPERO database number CRD42015023366.

Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: A systematic review and meta-analysis.

INTRODUCTION: The purpose of this systematic review was to evaluate the three-dimensional (3D) changes occurring at short- and long-term follow-up after rapid maxillary expansion (RME) in nasal cavity (NC) and upper airway (UA) in growing patients. METHODS: A literature search up to 1 July 2019 was performed. Randomized and non-randomized clinical trials and cohort studies comparing the effects of RME in a paediatric population using 3D analyses based on computed tomography (CT), cone-beam CT and MRI were included. The risks of bias of the included studies were assessed using the Cochrane Collaboration's risk of bias tool, the GRADE approach and a customized tool. The random-effects meta-analyses of the mean differences and 95% confidence intervals of NC and UA volume changes were carried out, followed by subgroup analyses. RESULTS: Twenty-seven studies were included, with 18 selected for quantitative synthesis. Immediately after expansion, the nasopharynx and oropharynx increased significantly. After 3 months of retention, only the NC and nasopharynx showed a significant volume increase. Two studies mentioned the use of a sleep-disordered breathing questionnaire, and one study reported the difference before and after RME. None of the 27 articles included assessed the correlation between the skeletal widening and NC or UA volume changes after RME. CONCLUSIONS: The existing evidence confirmed only the short-term positive effect of RME on expanding the volume of the NC and the upper part of the UA. However, long-term stability could not be sustained.

Interradicular sites and cortical bone thickness for miniscrew insertion: A systematic review with meta-analysis.

INTRODUCTION: Safe zone maps are useful for the clinician to plan miniscrew insertion and possibly reduce radiation exposure. This study aimed to investigate the available evidence regarding the presence of sufficient interradicular space and adequate cortical bone thickness in patients with a complete permanent dentition, in the vestibular and palatal or lingual interradicular sites, mesial to the second molar. METHODS: PubMed, Scopus, Web of Science, Cochrane Library, and OpenGrey databases were searched up to January 2019 for observational studies involving patients with fully erupted second molars that investigated the amount of interradicular space and/or the cortical thickness of the alveolar processes using 3-dimensional data sets. A custom tool was prepared and used to assess the risk of bias in individual studies. A meta-analysis was performed when at least 4 different studies evaluated 1 identical parameter homogeneously. Publication bias was assessed with the Egger linear regression test. RESULTS: Twenty-seven observational articles were included in the qualitative synthesis. Only 11 articles were at low risk of bias. Fifteen articles were included in the meta-analysis. The results were graphically reported in "safe-zone" maps. CONCLUSIONS: In the maxilla, the most suitable insertion sites are those from mesial to the first molar to distal to the first premolar, and between the canine and the lateral incisor, all at 6 mm from the cementoenamel junction. In those areas, the cortical bone has adequate thickness, not requiring predrilling. In the mandible, the preferable vestibular interradicular spaces are those between first and second molars and between first and second premolars, both at 5 mm from the cementoenamel junction, and predrilling is suggested in these areas. TRIAL REGISTRATION NUMBER: PROSPERO CRD42016042081.

A Danish version of the oral health impact profile-14 (OHIP-14): translation and cross-cultural adaptation.

BACKGROUND: The Oral Health Impact Profile-14 (OHIP-14) questionnaire assesses quality of life related to people's perception of oral disorders on their well-being. However, a translated and validated Danish version of OHIP-14 is not yet available. The purpose of this pilot study was to translate and cross-culturally adapt the English version of the OHIP-14 into Danish (OHIP-14-DK). In addition, to assess its content and face validity, internal consistency and test-retest reliability. METHODS: The English version of OHIP-14 was translated into Danish following a standard protocol of cross-cultural adaptation. Stages I-IV: translation phase to generate a pre-final version "OHIP-14-DK". Stage V: pre-testing phase. A random sample of 22 orthodontic patients (mean age 24.7 years, SD ±14.8; 14 females, 8 males) were selected at the Section of Orthodontics, Aarhus University, Denmark. All patients self-completed the OHIP-14-DK and were then interviewed to assess its content and face validity. Internal consistency was assessed with Cronbach's alpha coefficients. All patients completed the same questionnaire again at a one-week interval. Test-retest reliability was assessed using Spearman's correlation coefficient and intra-class correlation coefficient (ICC). RESULTS: The initial and back translations were very similar: the OHIP-14-DK proved to have a good level of equivalence with no translation errors or deviations. Furthermore, the OHIP-14-DK seemed well-adapted to Danish culture and was understood by individuals down to 12 years of age. Pre-testing demonstrated good face and content validity; interviews had a response rate of 100% and confirmed that each item was understandable without inducing reluctance or hesitation. Thus, responses were related to their corresponding item. Therefore, no final adjustments were required for the pre-tested version. Cronbach's alpha for the OHIP-14-DK subscales fell in the 0.75-0.84 range, indicating an adequate-to-good internal consistency. Spearman's correlation coefficient for the OHIP-14-DK total score was 0.77. The ICC for the OHIP-14-DK total score was 0.91. CONCLUSIONS: The OHIP-14-DK seems well adapted to Danish culture, proved to be face and content valid and also showed good internal consistency and excellent reliability. However, its psychometric properties still need to be tested. STUDY REGISTRATION: Not applicable.

Three-dimensional prediction of roots position through cone-beam computed tomography scans-digital model superimposition: A novel method.

OBJECTIVES: To introduce a new, fast, reliable, and free from software-related bias method to predict three-dimensionally the root position and angulation during and after orthodontic treatment. The final goal is to keep to a minimum the use of ionizing radiation by eliminating the necessity of multiple radiation exposure for checking root alignment. SETTING AND SAMPLE POPULATION: Pre- and post-treatment digital models and cone-beam computed tomographic (CBCT) scans from a patient were retrieved. MATERIAL AND METHODS: The post-treatment digital model (post-model) was set as the reference; pre- and post-treatment CBCT scans were pre-aligned to the post-model with a point set registration; iterative closest point algorithm was then employed for final adjustments. The accuracy of the proposed method was assessed by comparing the average distance between the expected root position setup with the true position of the roots, as from the post-treatment CBCT. RESULTS: After crown superimposition, 3D colour maps showed that the accuracy of the root prediction was below 0.1 mm. CONCLUSION: The proposed digital workflow allows to predict in an accurate and truly three-dimensional way the final position of roots, when an initial CBCT is available, without the need of an extra X-ray examination for the patient at the end of treatment. The limitation of the exposure to mid- and post-treatment X-rays is in accordance with the ALARA (As Low As Reasonably Achievable) principle and it is even more relevant in growing patients.