European journal of orthodontics最新文献

Background: The facial landmark annotation of 3D facial images is crucial in clinical orthodontics and orthognathic surgeries for accurate diagnosis and treatment planning. While manual landmarking has traditionally been the gold standard, it is labour-intensive and prone to variability.

Objective: This study presents a framework for automated landmark detection in 3D facial images within a clinical context, using convolutional neural networks (CNNs), and it assesses its accuracy in comparison to that of ground-truth data.

Material and methods: Initially, an in-house dataset of 408 3D facial images, each annotated with 37 landmarks by an expert, was constructed. Subsequently, a 2.5D patch-based CNN architecture was trained using this dataset to detect the same set of landmarks automatically.

Results: The developed CNN model demonstrated high accuracy, with an overall mean localization error of 0.83 ± 0.49 mm. The majority of the landmarks had low localization errors, with 95% exhibiting a mean error of less than 1 mm across all axes. Moreover, the method achieved a high success detection rate, with 88% of detections having an error below 1.5 mm and 94% below 2 mm.

Conclusion: The automated method used in this study demonstrated accuracy comparable to that achieved with manual annotations within clinical settings. In addition, the proposed framework for automatic landmark localization exhibited improved accuracy over existing models in the literature. Despite these advancements, it is important to acknowledge the limitations of this research, such as that it was based on a single-centre study and a single annotator. Future work should address computational time challenges to achieve further enhancements. This approach has significant potential to improve the efficiency and accuracy of orthodontic and orthognathic procedures.

Background: Several appliances or treatment protocols are marketed to either patients or orthodontists as being associated with improved orthodontic outcomes. However, clinical decision-making should be based on robust scientific evidence and not marketing claims or anecdotal evidence.

Objective: To identify appliances/protocols being associated with improved outcomes of fixed appliance treatment.

Search methods: Unrestricted literature searches in seven databases/registers for human studies until March 2024.

Selection criteria: Randomized or quasi-randomized clinical trials on human patients of any age, sex, or ethnicity receiving comprehensive orthodontic treatment with fixed appliances and assessing occlusal outcome with either the Peer Assessment Rating (PAR) or the American Board of Orthodontics-Objective Grading System (ABO-OGS) index.

Data collection and analysis: Duplicate/independent study selection, data extraction, and risk of bias assessment with the Cochrane RoB 2 tool. Random-effects meta-analyses of averages or mean differences with their 95% Confidence Intervals (CI), followed by meta-regression/subgroup/sensitivity analyses and assessment of the quality of clinical recommendations with the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results: Data from 20 small- to moderately-sized trials covering 1470 patients indicated that orthodontic treatment with fixed appliances is effective and results on average in a final PAR score of 6.0 points (95% CI 3.9-8.2 points), an absolute PAR reduction of 23.0 points (95% CI 15.6-30.4 points), a % PAR reduction of 82.6% (95% CI 70.8%-94.4%), and an absolute ABO-OGS score of 18.9 points (95% CI 11.7-26.2 points). However, very high between-study heterogeneity (I2 > 75%) was seen for both PAR and ABO-OGS. Extraction treatment was associated with significantly better occlusal outcome than non-extraction treatment with ABO-OGS (12.9 versus 16.6 points; P = .02). There was no statistically significant difference in occlusal outcome with (i) 0.018″-slot or 0.022″-slot brackets; (ii) customized or prefabricated brackets; (iii) anchorage reinforcement with temporary anchorage devices; (iv) use of vibrational adjuncts; and (v) aligners or fixed appliances (P > .05 in all instances), while small benefits were seen with indirectly bonded brackets.

Conclusions: Considerable between-study heterogeneity exists in the reported occlusal outcome of fixed appliance treatment, and different appliances or adjuncts have little effect on this. Standardization and/or automatization of the scoring procedures for PAR and ABO-OGS might help to improve consistency and reliability of outcome measurement in orthodontic trials.

Registration: PROSPERO (CRD42024525088).

Background: The clinical protocol and effectiveness of dental expansion with Clear Aligner Therapy (CAT), especially among adults is still unclear. There is a need to map and explore knowledge gaps of dental expansion with CAT among children and adults.

Objective: This scoping review explores the extent and depth of the available literature regarding the effectiveness and predictability of CAT in performing orthodontic expansion in both children and adults.

Methods: The following databases were consulted as sources of information: PubMed, MEDLINE, Embase, Web of Science, Scopus, LILACS, COCHRANE Library, and ProQuest Dissertations & Thesis, in which the search was limited to studies on children or adults requiring transverse arch expansion and using clear orthodontic aligners. Two independent reviewers assessed the citations and extracted data, which was then synthesized in a narrative format.

Results: Over all, 698 citations were retrieved, and 33 were included. Among these, 3 were systematic reviews, 4 were cohort studies, 2 were case-control studies, and 24 were case series. Eighty-five percent of the included studies were published in the last 5 years. Despite different protocols and measurement methods, aligners were effective for arch expansion in adults and children, and the expansion predictability was greater for the lower arch than for the upper arch. The evidence suggests that arch width increment is more predictable in the premolar region and less predictable in the canine and second molar areas, with high variability across studies.

Conclusions: Orthodontic aligners have demonstrated effectiveness in expanding arches in both adults and children. However, the literature suggests a decrease in arch width toward the posterior region, and there is no evidence of skeletal gains. To provide more conclusive evidence, randomized controlled clinical studies are warranted.

Registration: This review was registered in the Open Science Framework database (DOI: https://doi.org/10.17605/OSF.IO/6EG8F).

Objective: The objective was to compare the colourimetric increment (L*, a*, and b*) of three types of aligners after subjecting them to two stains and to evaluate the initial colourimetric characteristics.

Methods: A total of 120 aligners (40 Invisalign®, 40 Spark®, and 40 QuickSmile®) were immersed in two different agents (distilled water and coffee). Measurements were taken using a spectrophotometer before immersion (T0), after 12 hours (T1), and after 7 days (T2). Colour changes (ΔE*) were evaluated based on the International Commission of L'Eclairage, and subsequently converted to National Bureau of Standards units. The measurement was repeated three times. The intraclass correlation coefficient, one-way ANOVA, Tukey's post hoc test, and the independent t test were used (P ≤ .05).

Results: At T0, significant differences were observed for a*: Invisalign® and Spark® tended towards redder tones, whereas Quicksmile® leaned towards greener shades. Regarding b*, all aligners tended towards yellow, with Invisalign® exhibiting the least tendency. No differences were found in water between T1 and T0. In the intervals, T2-T1 and T2-T0, Spark® showed more noticeable changes, whereas for Invisalign® and Quicksmile®, the change was only slight. In coffee, a shift to another colour was detected in T1-T0, T2-T1, and T2-T0 for Invisalign®, whereas for other brands, it was barely noticeable except for T2-T0 in Spark®, where the change was appreciable. In coffee, Invisalign® tended towards darker values (L*), turning redder (a*), and more yellow (b*) in T2-T1 and T2-T0.

Conclusions: Invisalign® aligners initially presented a more reddish and less yellowish colour. In water, after 7 days, a noticeable colour change was found for Spark®. In coffee, a greater loss in brightness and a change to red and yellow were observed after 12 hours and 7 days for Invisalign®. This study highlights the importance of considering the impact of coffee on the colouring of aligners, especially with Invisalign®, which shows more noticeable changes.

Background/rationale: Systematic reviews on the effects of pacifiers on occlusion have highlighted the need for quality RCTs.

Trial design: Single region, three parallel-armed, prospective, randomized controlled trial.

Objectives: To investigate the correlations between early childhood non-nutritive sucking habits and malocclusion. Specifically to test whether the use of a study pacifier has differing effects compared to other pacifiers and control, and whether the duration of pacifier use or digit sucking influence the occlusion.

Participants: The subjects were firstborn children, born in 2008 in Vantaa, Finland.

Intervention: One-third of participants were offered study pacifiers, free of charge, from birth up to 2 years of age. The history of the subjects' sucking habits, including pacifier use was screened in a questionnaire at the age of 2 years, and clinical examinations were performed at the age of 7 years. In addition, the subjects were divided into groups that were equally matched regarding their mother's level of education.

Outcomes: Posterior crossbite, anterior crossbite, overjet, deep bite, open bite, and crowding.

Randomization method: Three districts were randomly allocated to three study groups by drawing lots.

Blinding: It was not possible to blind the clinicians or parents from the intervention. Blinding during data analysis was performed.

Results: From the original cohort of 2715 children born in the town of Vantaa, 1911 were excluded and 353 were lost to follow-up. The remaining 451 children were divided into three groups according to the use of pacifiers. The prevalence of posterior crossbite at the age of 7 years was higher if a non-study pacifier had been used (P = .005) even when matched for the mother's level of education (P = .029). The prevalence of posterior crossbite was higher if the pacifier habit had continued for 12 months or more compared to 11 months or less, 7% and 1%, respectively, (P = .003). Digit sucking for 12 months or more was associated with crowding (P = .016). The prevalence of crossbite in the study pacifier group was less than in control pacifiers.

Harms: No adverse harms were reported other than effects on the dentition.

Conclusion: The use of pacifiers is associated with the posterior crossbite, especially if their use continues for a year or more. Parents/guardians should be advised to stop the use or reduce the use of pacifiers to a minimum after their child's first birthday.

Trial registration: ClinicalTrials.gov NCT01854502.

Background: Systematic reviews (SR) are regularly updated to reflect new evidence. However, updates are time-consuming and costly, and therefore should ideally be informed by new high-quality research. The purpose of this study is to assess trends in the quantity, quality, and recency of evidence intervening updates of orthodontic SR.

Methods: SR relevant to orthodontics with at least two versions were identified from the Cochrane Database. The number, risk of bias, and year of publication of included trials were recorded for each update. Multivariate regression was conducted to assess factors affecting the risk of bias in trials, and the proportions within SR.

Results: Forty-five SR inclusive of updates were included. The median number of trials was three per review and this increased across subsequent versions. Seven reviews (15.6%) included no evidence, and 40.74% of updates included no new evidence. Most of the primary research was considered high risk of bias (57.3%), although this was reduced marginally across updates. The proportion of studies considered low risk did not improve significantly between updates. There was no impact of publication year of clinical trials on the risk of bias (P = 0.349). However, average age of trials included in a systematic review significantly affected the proportion of low risk-of-bias studies (P = 0.039).

Conclusions: SR are frequently updated without including new evidence. New evidence that is included is commonly deemed to be at high risk of bias. Targeted strategies to improve the efficient use of resources and improve research quality should be considered.

Background: Orchestration of tooth movement necessitates an equilibrium of bone synthesis and resorption. Vitamin D, through receptor-mediated actions, regulates the differentiation and maturation of osteoblasts and also induces osteoclastogenesis, maintaining this equilibrium.

Objective: To analyze the impact of vitamin D in orthodontic tooth movement (OTM).

Search method: A comprehensive exploration of the existing literature was conducted by systematic search through seven e-databases.

Selection criteria: The criteria for inclusion were established using the PICO format: Orthodontic patients treated with fixed appliance (P), administered with vitamin D3 (I), collated with appropriate control groups (C), with tooth movement as the primary outcome and root resorption, anchorage loss, gingival crevicular fluid (GCF) volume, pain perception, and alveolar bone density as the secondary outcome (O).

Data collection and analysis: After an extensive database search, 251 articles were obtained. Six articles were chosen following a stringent selection using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The critical appraisal of randomized control trials (RCTs) involved the meticulous application of the RoB 2 tool. The quantitative synthesis incorporated a subset of six articles only.

Results: In the meta-analysis investigating the influence of vitamin D on OTM, a notable disparity was evident between the vitamin D and control groups. Specifically, the standardized mean difference (SMD) stood at 1.43, accompanied by a 95% confidence interval (CI) ranging from 0.691 to 2.169 (P = .00154). For root resorption, the SMD was recorded at -0.51, with a 95% CI spanning from -3.051 to 2.031 (P = .11).

Conclusions: The rate of tooth movement was enhanced by systemic and local administration of vitamin D. However, the inadequacy of available data is a hindrance in determining conclusively the impact of vitamin D on the extent of root resorption. The resolution of this quandary needs future human studies devoted toward investigating the influence of vitamin D in the realms of OTM and associated root resorption, thereby providing a definitive elucidation.

Registration details: Prospero- CRD42023491783.

Background: Different types of retention appliances have been proposed over the years, but their effectiveness in maintaining arch dimensions and alignment after orthodontic treatment is still unclear.

Aim: To assess the efficacy of vacuum-formed retainers (VFRs) in preserving arch widths, arch length, and anterior alignment in maxillary and mandibular arches, compared to removable Hawley retainers (HRs) or fixed bonded retainers (FBRs). Search methods: unrestricted literature search of five major databases up to March 2024.

Selection criteria: randomized/non-randomized clinical studies comparing VFRs to removable HRs or FBRs.

Data collection and analysis: after duplicate study selection, data extraction, and risk of bias assessment, random effects meta-analyses of standardized mean differences and their 95% confidence intervals were performed, followed by meta-regressions, sensitivity analyses, and assessment of the quality of evidence with GRADE.

Results: Twenty-two prospective studies (4 non-randomized and 18 randomized controlled trials) involving 1797 patients (mean age 17.01 years, 38.3% males) were included. No significant differences were found in the intercanine width, intermolar width, and arch length between VFRs and HRs, in both arches (P > 0.05). However, VFRs were statistically more effective than HRs in terms of Little's irregularity scores (LII) in the maxilla (eight studies; SMD = -0.42; 95% CI: -1.03 to -0.09; P = 0.02; I2 = 73.4%) but not in the mandible (P = 0.12). No significant differences were reported for all considered outcomes between VFRs and FBRs in in both arches (P > 0.05), except for lower LII, where VFRs were significantly less efficient (eight studies; SMD = 1.49; 95% CI = 0.26-2.7; P = 0.02; I2 = 93%). Follow-up times, risk of bias, and wire type (of FBRs) did not show statistically significant effects on outcome variables. Sensitivity analyses showed robustness of the findings for including non-randomized and postretention studies. The certainty in these estimates was from moderate to low due to the risk of bias and inconsistency.

Conclusions: Low to moderate quality evidence indicates that VFRs are as effective as HRs in maintaining arch widths, length, and alignment. Low-quality evidence found similar efficacy between VFRs and FBRs, with FBRs being statistically more effective at maintaining lower arch alignment, but the difference was not clinically significant.

Registration: PROSPERO registration (CRD42024518433).