European journal of orthodontics最新文献

Background: The infrazygomatic miniscrew implants (IZC-MSI) serve as innovative temporary anchorage devices placed parallel to the roots of molars in the infrazygomatic crest region, leveraging their extra-radicular location to support the en masse distalization and intrusion of the maxillary dentition. The efficacy and stability of these screws are crucial for their application in contemporary orthodontic practices.

Objectives: This systematic review aimed to estimate the success rate and factors affecting the stability of IZC-MSI.

Search methods: An electronic search was conducted on 7 February 2024 across the following databases: PubMed, Scopus, EMBASE, and Cochrane databases without any restriction on language and time of publication.

Selection criteria: The review included clinical trials (both randomized and non-randomized) and retrospective cohort studies that utilized infrazygomatic miniscrew anchorage for orthodontic tooth movement in human participants.

Data collection and analysis: The proportion of success rate was calculated and factors affecting stability (patient and implant-related factors) such as age, sex, implant position, and loading characteristics were subjected to subgroup analysis and meta-regression. The quality assessment of studies was done using the Cochrane risk-of-bias tools for randomized (RoB 2.0) and non-randomized trials (ROBINS-I).

Results: Fourteen studies (n = 1683 IZC-MSI) were included in the meta-analysis revealing a 92% success rate of IZC-MSI (C.I. 87%-95%; prediction interval: 66%-99%; I2 = 80%). Studies with sample size > 100 presented a 94% success rate (C.I. 91%-96%; I2 = 63%) and moderate heterogeneity. Meta-regression analysis revealed no significant relation between age and success rate. Significant heterogeneity was observed in the subgroup analysis of host-, implant- and other related risk factors affecting stability and limited correlation was found. The risk-of-bias assessment revealed high risk in five, moderate in five, and low in four studies.

Conclusions: IZC-MSI have shown a good success rate for their clinical application. Although some factors appear to influence IZC-MSI stability, the majority of them necessitate additional investigation due to the low quality of evidence. Furthermore, high-quality studies are needed to confirm the results of this meta-analysis and address other important factors such as operator's experience, insertion torque, and sinus penetration that could not be analysed due to limited data.

Registration: CRD42024469048.

Objective: This retrospective study aimed to compare the three-dimensional (3D) outcomes of the novel miniscrew-anchored maxillary protraction (MAMP) therapy and the bone-anchored maxillary protraction (BAMP) therapy.

Methods: The sample comprised growing patients with skeletal Class III malocclusion treated with two skeletal anchored maxillary protraction protocols. The MAMP group comprised 22 patients (9 female, 13 male; 10.9 ± 0.9 years of age at baseline) treated with Class III elastics anchored on a hybrid hyrax expander in the maxilla and two mandibular miniscrews distally to the permanent canines. The BAMP group comprised 24 patients (14 female, 10 male; 11.6 ± 1.1 years of age at baseline) treated with Class III elastic anchored in two titanium miniplates in the infra-zygomatic crest and two miniplates in the mesial of the mandibular permanent canines. Three-dimensional displacements were measured in the pre- and post-treatment cone-beam computed tomography scans superimposed on the cranial base using the Slicer Automated Dental Tools module of 3D Slicer software (www.slicer.org). Mean differences (MD) between groups and 95% confidence interval (CI) were obtained for all variables. Intergroup comparison was performed using the Analysis of Covariance (P < .05).

Results: Both groups showed improvements after treatment. The MAMP group showed a smaller anterior (MD: -1.09 mm; 95% CI, -2.07 to -0.56) and 3D (MD: -1.27 mm; 95% CI, -2.16 to -0.74) displacements of the maxilla after treatment when compared with BAMP. Both groups showed negligible and similar anteroposterior changes in the mandible (MD: 0.33 mm; 95% CI, -2.15 to 1.34). A greater increase in the nasal cavity width (MD of 2.36; 95% CI, 1.97-3.05) was observed in the MAMP group when compared with BAMP.

Limitations: The absence of an untreated control group to assess the possible growth impact in these findings is a limitation of this study.

Conclusion: Both BAMP and MAMP therapies showed adequate 3D outcomes after treatment. However, BAMP therapy produced a greater maxillary advancement with treatment, while MAMP therapy showed greater transversal increases in the nasal cavity.

Objectives: The purpose of this retrospective study was to compare the dento-skeletal changes observed in growing Class III patients treated with the Face Mask Protocol (FMP) with and without Bite Block (BB).

Materials: Thirty subjects (12 f, 18 m) who underwent FM/BB therapy were compared to a matched group (FM) of 29 patients (15 f, 14 m) treated without BB. All patients were evaluated before treatment (T0), at the end of active treatment (T1), and at a post-pubertal follow-up observation (T2). A control group (CG) of 20 subjects (10 f, 10 m) with untreated Class III disharmony was used for the comparison of post-pubertal changes. Intergroup statistical comparisons were performed with the independent samples t-test (P < .05).

Results: The comparison between treated samples showed a significant improvement of SN^GoGn (FM/BB vs FM, -2.1°), Overbite (FM/BB vs FM, +1.2 mm), and vertical position of lower molars FM/BB vs FM, -3 mm). When compared with the controls, both treated groups revealed a significant improvement of SNA (FM/BB, +1.8°; FM +2.1°), ANB (FM/BB +1.6°, FM +2.4°), gonial angle (FM/BB -4.9°; FM -4°), incisor inclination (Upper, FM/BB +1.7°, FM +2.3°; Lower, FM/BB -2.5°, FM -2.7°), and Overjet (FM/BB +3.2 mm; FM +4 mm). Improvement of SN^GoGn (-2.1°), Overbite (+1.8 mm), and vertical position of lower molars (-3.8 mm) were observed when FM/BB was compared with CG.

Limitations: Limitations are related to the difficulty to recruit a larger contemporary long-term control group due to ethical reasons.

Conclusion: Both FM protocols induced favorable changes in the treatment of Class III malocclusion with a good post-pubertal stability. The BB allows a more efficient control of the vertical skeletal relationship.

Objectives: This study aimed to quantitatively investigate the intractable 'roller coaster effect' (RCE) that occurs in premolar extraction cases treated with clear aligner therapy (CAT) or straight-wire appliance (SWA).

Methods: Protrusion cases treated with extraction of bilateral first premolars were included. Pre- and post-treatment cephalograms were obtained to measure the bending angle of occlusal plane (BAOP), namely the occlusal intersection angle between the anterior occlusal plane (AOP) and posterior occlusal plane (POP). BAOP is proposed as the indicator for quantifying RCE in this study.

Results: In the maxillary dentition, BAOP significantly decreased from 177.50 ± 5.57° to 171.10 ± 3.32° in the SWA group (n = 30), and from 178.00 ± 4.66° to 168.10 ± 5.63° in the CAT group (n = 36). In the mandibular dentition, BAOP had no significant change (from 164.90 ± 5.00° to 164.30 ± 6.40°) in the SWA group (n = 29), while significantly decreased from 163.40 ± 6.36° to 155.90 ± 7.48° in the CAT group (n = 37). In the both dentitions, the post-treatment BAOP was significantly smaller in the CAT compared to SWA group. Decrease of BAOP in the CAT group resulted from bending of the AOP rather than POP. Multiple linear regression analysis revealed that the mandibular canine crown length had a positive correlation with the mandibular post-treatment BAOP.

Limitations: Only two-dimensional cephalometric measurements were conducted.

Conclusions: In premolar extraction cases, CAT undergoes more severe RCE at completion of its first-phase treatment compared to SWA at the end of treatment. Longer mandibular canine crown may mitigate mandibular RCE in CAT.

Background: Orthodontic treatment is one of the longest and most common medical interventions in adolescence. There are certain inequalities in care leading to risk factors associated with higher rates of untreated tooth malocclusion, resulting in a significant burden on oral health. Little is known about that certain psychosocial and personal risk factors influence the uptake of orthodontic treatment. Therefore, the aim was to explore factors that might influence orthodontic treatment and psychosocial and personal factors in a representative sample in Germany.

Methods: The data are based on the KiGGS Survey Wave 2, a representative cross-sectional study of children and adolescents in Germany. Sociodemographic data, uptake of orthodontic treatment, parental socioeconomic status, social support, self-efficacy, and perceived health status were collected through a self-reported questionnaire.

Results: A total of 6599 children and adolescents between 11 and 17 years were included in the analysis. Girls, non-immigrants, children, and adolescents with higher levels of social support, and children and adolescents who have visited a dentist or orthodontist more often in the past 12 months are more likely to have received orthodontic treatment. Among 14- to 17-year-olds, the likelihood of seeking orthodontic treatment is also associated with an increasing parental socioeconomic status (odds ratio 1.07 [95% CI 1.02; 1.14] P = .013).

Conclusions: Certain protective and risk factors as well as personal and psychosocial factors are associated with orthodontic treatment. This knowledge can be used to determine which individuals should be targeted for need-based care to ensure that health care is provided without over- or undertreatment.

Background: Recent advancements in computer-aided design and computer-aided manufacturing (CAD/CAM) technology have led to the development of customized brackets for personalized treatment.

Objective: Comparing customized CAD/CAM brackets for their efficacy and effectiveness in orthodontic patients using systematic review and meta-analysis of the literature.

Search methods: A comprehensive search was conducted in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to June 2024, with no language or date restrictions.

Selection criteria: Studies that complied with PICO (population, intervention, comparison, outcome) questions were included, and the Cochrane Risk of Bias 2.0 and Newcastle-Ottawa Scale tools were used to assess the risk of bias in the included studies.

Data collection and analysis: Using custom piloted forms, relevant data was retrieved from the included studies. Then a random-effects inverse variance meta-analysis was used to pool the results. The primary outcome was the effectiveness of orthodontic treatment measured by the American Board of Orthodontics cast-radiographic examination (ABO-CRE). Secondary outcomes were overall treatment time and mean number of appointments for CAD/CAM and conventional brackets.

Results: Six studies were included in our final review and meta-analysis. Based on the results of meta-analysis, no significant differences between CAD/CAM and conventional brackets for ABO-CRE score (Mean Difference (MD) = -0.49, Confidence Interval (CI)95% = -4.67, 3.68; P = .82) or number of appointments (MD = -1.88, CI95% = -5.91, 2.16; P = .36) could be found. However, significantly shorter overall treatment time for CAD/CAM brackets were reported (MD = -4.07, CI95% = -7.16, -0.99; P = .010).

Conclusions: The findings of our meta-analysis indicate that both bracket types perform comparably in terms of treatment results and the number of clinical appointments required during treatment. Nevertheless, a distinct advantage of CAD/CAM brackets emerged concerning overall treatment duration. Notably, patients using CAD/CAM brackets experienced an average treatment period reduction of approximately 4 months, a clinically significant result.

Registration: The protocol for this systematic review was registered at PROSPERO with the ID CRD42024605257.

Background: Maxillary lateral incisor agenesis is often managed with orthodontic space closure and canine substitution. Anatomic gingival margin heights associated with the maxillary anterior teeth are considered important for achieving aesthetic excellence with space closure, but evidence relating to the perceptions of lay people is poor.

Objectives: This study investigated the influence of gingival margin height variation in the maxillary anterior teeth following orthodontic space closure and canine substitution in the absence of maxillary lateral incisor teeth on perceived aesthetics judged by a lay population.

Material and methods: Images of a case treated with space closure and bilateral canine substitution were digitally modified to create gingival margin height variation for the substituted lateral incisors and canines. Six variations were created, including one conforming to accepted norms for anatomic gingival margin heights. Lay people represented by parents of orthodontic patients ranked the images based on aesthetics, with data analysed statistically using linear models at 5%.

Results: One hundred and twenty responders were included (median age 48.0 years), 50% male and 81.7% Caucasian, with 87% able to provide specific preferences. In absolute terms, the highest-ranking [image C] had substituted lateral incisor gingival margins below the central incisors (considered normal) but substituted canine margins symmetrically below the substituted lateral incisors (considered to be too low); followed by [image D] with symmetrically level gingival margins; and [image F] with asymmetric substituted lateral incisor margins and substituted canine margins symmetrically too low. The lowest-ranked [image E] had normal substituted lateral incisor margins but asymmetric substituted canine margins. Image C was most often ranked first (29.8% of responders) and image E last (22.1%). After adjusting for potential confounding effects, image E received the worse scores.

Conclusions: Anatomic norms for gingival margin height in absent maxillary lateral incisor-canine substitution do not correlate with the highest-ranking aesthetic choices of a lay population. Lateral incisor gingival margins symmetrically below the central incisors and substituted canine margins symmetrically below these ranked highest. Vertical asymmetry in the substituted canine position was considered the least aesthetic.

Background: Periodontal ligament cells (PDLCs) possess mechanotransduction capability, vital in orthodontic tooth movement (OTM) and maintaining periodontal homeostasis. The study aims to elucidate the expression profiles of mechanosensitive ion channel (MIC) families in PDLCs and how the inflammatory mediator alters their expression and function, advancing the understanding of the biological process of OTM.

Methods and methods: Human PDLCs were cultured and exposed to TNF-α. RNA sequencing was conducted to explore the mRNA transcriptome of both normal and TNF-α-treated PDLCs. Differentially expressed MICs were identified and analyzed. The functional expressions of TRPA1 and TRPM8 were further validated by RT-qPCR, Western blot, and calcium influx assays.

Results: All 10 identified MIC families or subfamilies were expressed in PDLCs, with the TRP family being the most abundant. KCNK2, PIEZO1, TMEM87A, and PKD2 were the most expressed ion channels in PDLCs. TNF-α altered the expression of the MIC families, resulting in increased expression of PIEZO, K2P, TRP, TMEM63, and TMEM87 families and decreased expression of ENaC/ASIC, TMC/TMHS/TMIE, TMEM150, TMEM120, and L/T/N-Type calcium channel families. Furthermore, 17 DEMICs were identified (false discovery rate < 0.05), with the top five (fold change ≥ 2), including upregulated TRPA1 and TRPM8. The functional expressions of TRPA1 and TRPM8 were verified, suggesting that TNF-α significantly increased their expression and sensitized their activities.

Conclusions: The study provides comprehensive expression profiles of the MICs in PDLCs and reveals how inflammation alters the expression and activities of the MICs. Treatments targeting these MICs may offer promising strategies for improving OTM and preventing complications in inflammatory environments, ultimately leading to more effective and safer orthodontic practices.

Objectives: To develop a reproducible, reliable clinical index of alveolar bone grafting (ABG) outcome based on the eruption position of the cleft canine tooth and determine the association between eruption position and radiographic outcome at 6 months post-grafting.

Methods: Children with complete, non-syndromic, unilateral/bilateral cleft lip and palate in the West of Scotland were identified. Post-ABG radiographic outcome (Kindelan index) and canine eruption position in children with a cleft of the alveolus who had undergone ABG were documented. A Kindelan score was assigned to the 6-month post-bone-graft radiograph. Following canine tooth eruption, four-point clinical index scale (CIS) scores were assigned to maxillary occlusal images taken prior to commencement of definitive orthodontics; 1-canine eruption in alveolar crest, 2-canine eruption buccal to alveolar crest, 3-canine eruption palatal to alveolar crest, and 4-canine impaction. Intra and inter-rater reliability was assessed using Cohen and Fleiss kappa's, respectively. Duration of orthodontics treatment, number of orthodontic clinic visits, and clinical management of the cleft site space were noted.

Results: Eighty-three patients representing 98 bone graft sites were identified. CIS scoring intra- and inter-rater reliability was 0.69-0.99 and 0.63-0.75, respectively. CIS score was associated with reduced visits (P = .015), months in orthodontics (P = .009), and likelihood of space closure (P = .006).

Limitations: This is a retrospective study with small numbers but is comparative to other similar studies in the literature.

Conclusions: The CIS presented appears to be a reliable index of ABG outcome. It also demonstrates an association with the burden of orthodontic care post-cleft alveolar bone graft.