European journal of orthodontics最新文献

Objectives: The rapid advancement of Large Language Models (LLMs) has prompted an exploration of their efficacy in generating PICO-based (Patient, Intervention, Comparison, Outcome) queries, especially in the field of orthodontics. This study aimed to assess the usability of Large Language Models (LLMs), in aiding systematic review processes, with a specific focus on comparing the performance of ChatGPT 3.5 and ChatGPT 4 using a specialized prompt tailored for orthodontics.

Materials/methods: Five databases were perused to curate a sample of 77 systematic reviews and meta-analyses published between 2016 and 2021. Utilizing prompt engineering techniques, the LLMs were directed to formulate PICO questions, Boolean queries, and relevant keywords. The outputs were subsequently evaluated for accuracy and consistency by independent researchers using three-point and six-point Likert scales. Furthermore, the PICO records of 41 studies, which were compatible with the PROSPERO records, were compared with the responses provided by the models.

Results: ChatGPT 3.5 and 4 showcased a consistent ability to craft PICO-based queries. Statistically significant differences in accuracy were observed in specific categories, with GPT-4 often outperforming GPT-3.5.

Limitations: The study's test set might not encapsulate the full range of LLM application scenarios. Emphasis on specific question types may also not reflect the complete capabilities of the models.

Conclusions/implications: Both ChatGPT 3.5 and 4 can be pivotal tools for generating PICO-driven queries in orthodontics when optimally configured. However, the precision required in medical research necessitates a judicious and critical evaluation of LLM-generated outputs, advocating for a circumspect integration into scientific investigations.

Objective: Mouth breathing as a result of nasal obstruction affects craniofacial growth and development. This study aimed to investigate the effects of unilateral nasal obstruction and its recovery, along with the role of nitric oxide (NO) in masticatory muscle physiology.

Materials and methods: Forty-eight 4-week-old male rats were divided into control and experimental groups. The five experimental groups were subjected to left-sided nasal obstruction by suturing the external nostril, and the sutures were removed after 1, 3, 5, 7, or 9 weeks to allow for varying recovery periods. We assessed morphological changes in masseter, temporalis, and digastric muscle, by examining cross-sectional area (CSA) and myosin heavy chain (MHC) isoform composition of muscle fibers. Reverse transcription-quantitative real-time polymerase chain reaction to measure messenger RNA (mRNA) levels for tumor necrosis factor-α (TNF-α), glucose transporter 4 (GLUT4), and neuronal nitric oxide synthase (nNOS) were conducted.

Results: The SpO2, CSA, and fibers showing MHC-2b isoforms were significantly lower, while RT-PCR showed higher mRNA levels in TNF-α and nNOS, and a decrease in GLUT4 mRNA in the jaw-closing muscles in the long-term nasal obstruction groups than that in the control group.

Limitations: The study findings should be interpreted cautiously because of the functional differences between rodents and humans in terms of respiratory mechanisms.

Conclusions: Unilateral nasal obstruction affects the morphology and contractile characteristics of the rat masticatory muscles during development, with possible involvement of NO in muscle hypofunction. These changes may revert to baseline levels if the nasal obstruction is eliminated before puberty in rats.

Background: Craniofacial skeletal discrepancies have been associated with upper airway dimensions.

Objective: To identify differences in upper airway volume across different sagittal and vertical skeletal patterns.

Search methods: Unrestricted literature searches in eight databases/registers for human studies until May 2023.

Selection criteria: Cross-sectional studies measuring upper airway volumes using three-dimensional imaging in healthy patients of different sagittal (Class I, Class II, and Class III) or vertical (normodivergent, hypodivergent, and hyperdivergent) craniofacial morphology.

Data collection and analysis: Duplicate independent study selection, data extraction, and risk of bias assessment. Random-effects frequentist network meta-analysis was performed followed by subgroup-analyses and assessment of the quality of clinical recommendations (confidence in effect estimates) with the CINeMA (Confidence in Network Meta-Analysis) approach.

Results: Seventy publications pertaining to 66 unique studies were included with 56 studies (5734 patients) contributing to meta-analyses. Statistically significant differences were found for total  pharyngeal airway volume, with Class II having decreased airway volume (-2256.06 mm3; 95% Confidence Interval [CI] -3201.61 to -1310.51 mm3) and Class III increased airway volume (1098.93 mm3; 95% CI 25.41 to 2172.45 mm3) compared to Class I. Significant airway volume reductions for Class II were localized mostly at the oropharynx, followed by the palatopharynx, and the glossopharynx. Significant airway volume increases for Class III were localized mostly at the oropharynx, followed by the intraoral cavity, and hypopharynx. Statistically significant differences according to vertical skeletal configuration were seen only for the oropharynx, where hyperdivergent patients had reduced volumes compared to normodivergent patients (-1716.77 mm3; 95% CI -3296.42 to -137.12 mm3). Airway differences for Class II and Class III configurations (compared to Class I) were more pronounced in adults than in children and the confidence for all estimates was very low according to CINeMA.

Conclusions: Considerable differences in upper airway volume were found between sagittal and vertical skeletal configurations. However, results should be interpreted with caution due to the high risk of bias, owing to the retrospective study design, inconsistencies in anatomic compartment boundaries used, samples of mixed children-adult patients, and incomplete reporting.

Clinical trial registration: PROSPERO (CRD42022366928).

Background: Several methods have been proposed to assess outcome of bone-grafted alveolar clefts on cone beam computed tomography (CBCT), but so far these methods have not been compared and clinically validated.

Objectives: To validate and compare methods for outcome assessment of bone-grafted clefts with CBCT and provide recommendations for follow-up.

Methods: In this observational follow-up study, two grading scales (Suomalainen; Liu) and the volumetric bone fill (BF) were used to assess the outcome of 23 autogenous bone-grafted unilateral alveolar clefts. The mean age at bone grafting was 9 years. The volumetric BF was assessed in five vertical sections. The bone-grafted cleft outcome was based on a binary coding (success or regraft) on a clinical multidisciplinary expert consensus meeting. Grading scales and volumetric assessment were compared in relation to the bone-grafted cleft outcome (success or regraft). Reliability for the different outcome variables was analyzed with intra-class correlation and by calculating kappa values.

Limitations: The study had a limited sample size. Clinical CBCT acquisitions had a varying tube current and exposure time.

Results: Volumetric 3D measurements allowed for outcome assessment of bone-grafted alveolar clefts with high reliability and validity. The two grading scales showed highly reliable outcomes, yet the validity was high for the Suomalainen grading scale but low for the Liu grading scale.

Conclusions: Volumetric 3D measurement as well as the Suomalainen grading can be recommended for outcome assessment of the bone-grafted cleft. Yet, one must always make a patient-specific assessment if there is a need to regraft.

Background: Given the importance that swallowing pattern and tongue posture might have in the aetiology of malocclusion, it appears important to be aware of the physiological changes of tongue function and its posture.

Objectives: The study aimed to assess changes of the swallowing pattern and tongue posture during the transition from the deciduous to mixed dentition and the association between them.

Materials and methods: The study included 57 subjects aged 5.87 ± 0.5 with normal occlusion, orofacial functions, no history of trauma, or orthodontic treatment. Ultrasonography was used for the assessment of tongue posture and swallowing pattern, where the spontaneous act of swallowing was recorded. To evaluate the possible effect of incisors' eruption, the swallowing pattern and tongue posture ultrasonograms were compared at the deciduous (DD), early mixed (EMD), and intermediate mixed (IMD) timepoints.

Results: A significant association between the swallowing pattern and tongue posture at the DD and IMD timepoint was found. Moreover, the visceral swallowing pattern decreases with age (odds ratio [OR] = 0.777), as well as with a prolonged phase IIa (OR = 0.071), while it increases when the tongue is postured on the mouth floor (OR = 5.020).

Limitations: The young age of the investigated subjects, direct contact of the probe, and the determination of the rest phase of the tongue were considered limitations.

Conclusions: No statistically significant changes in swallowing pattern and tongue posture occurred during the transition period; however, a significant association between the swallowing pattern and tongue posture among subjects with normal occlusion, regardless of the dentition phase was detected.

Background: Retention has been always considered a major challenge in orthodontics. Recently computer-aided design/computer-aided manufacturing (CAD/CAM) fixed retainers (FRs) have been introduced as a marked development in retainer technology, offering potential advantages.

Objective: The objective of this study was to compare the differences in relapse and failure rates in patients treated with FRs using CAD/CAM technology, lab-based technique, and chairside method.

Trial design: A double-blinded, prospective, randomized controlled clinical trial was conducted over a 2-year period at a single centre.

Methods:

Interventions: These patients were divided into three groups: CAD/CAM group with multistranded Stainless Steel wires (CAD/CAM, n = 14), lab group with the same multistranded wires (lab, n = 15), and a chairside group with Stainless Steel Ortho-FlexTech wires (chairside, n = 14).

Outcomes: Inter-canine width (ICW) and Little's irregularity index were digitally measured from scans at the orthodontic debonding (T1), 6-month retention (T2), 1-year retention (T3), and 2-year retention (T4) visits. All forms of failure were documented and analyzed.

Randomization: Participants were randomly assigned to the three groups using online randomization software (randomization.com) by a statistician who was not involved in the study.

Blinding: Patients were blinded in terms of the FR group to which they were each randomly assigned. The principal investigator was blinded upon data analysis since patients' records were coded to minimize observer and measurement bias.

Results: Initially 81 patients were assessed for eligibility. Seventy-five patients were randomly allocated into the three study groups. After 2-year follow-up, 43 patients came back for the follow-up and were analyzed. The CAD/CAM group showed significantly less reduction in ICW compared to the chairside group at all time intervals (P < .05) and compared to the lab group at 6 months (P = .038). In terms of LII, the CAD/CAM group exhibited significantly less change than the chairside and lab groups at all time intervals (P < .05). The CAD/CAM group had the lowest failure rate (21.4%), followed by chairside group (28.6%) and then lab group (33.3%), however the differences were insignificant. No harms were observed in the current study.

Conclusion: Within 2 years of fixed retention, CAD/CAM FRs showed significantly less relapse than lab-based and chairside FRs. However, there was no significant difference in failure rates among the groups.

Trial registration: NCT05915273.

Objective: To assess if the dental follicle volume of palatally impacted canines (PICs) affects the relative root position of the adjacent lateral incisors (LIs) and first premolars (FPs).

Materials and methods: A retrospective cross-sectional study of 49 patients with unilaterally PICs with dental follicles who had CBCT imaging previously taken. Four orthodontic centers in different countries provided the sample. A mean difference of 5° between the angular measurements (mesiodistal tip, buccolingual inclination, or mesiodistal rotation) of the LI and FP adjacent to the PIC and the controls was considered clinically relevant. A value of 0.05 was set for significance level and a power of 80%. The minimum sample size was determined to be 26 patients. These patients were further assigned to an LI sample (n = 49) and an FP sample (n = 23), dependent on the direct contact of the dental follicle to that adjacent tooth. A manual segmentation technique was used to obtain the volumetric measurements of the dental follicle. Angular measurements of adjacent teeth were then compared to the contralateral nonimpacted side, which acted as the control. A multivariant regression analysis was performed using IBM SPSS software, and statistical significance was set at α = 0.05.

Results: Adequate intra-rater reliability was accomplished. The multivariant regression analysis implied that there is no difference in the mean change in the tip, torque, and rotation of the LI and FP between the impacted and control sides when dental follicle volumes are considered (P = .509 for the LI sample and P = .804 for the FP sample).

Limitations: CBCT imaging of dental follicle border delimitations, partial volume effect, and scattering are limitations. This is a convenience sample where the FP subsample is small.

Conclusion: The dental follicle volume of the PICs does not seem to influence the relative position of the adjacent LI and FP mesiodistal tip, buccolingual inclination, and mesiodistal rotation. Early intervention could have been suggested to avoid certain malocclusion traits if significant displacements were demonstrated.

Background: Blood-derived materials have been used recently to accelerate orthodontic tooth movement, but there are conflicting reports on their effectiveness.

Objective: To evaluate the potential effect of local injection of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) on the rate of orthodontic tooth movement.

Trial design: A single-center, three-arm, parallel-group randomized controlled trial.

Materials and methods: The sample consisted of 60 patients aged between 18 and 25 years (mean age: 21.1 ± 2.2 years) with Class II division 1 malocclusion requiring anterior retraction. Using a computer-generated list of random numbers, patients were assigned to three groups of canine retraction: (i) assisted with PRP injection (PRP group), (ii) assisted with i-PRF group, and (iii) conventional treatment with no injections (Cont. group). In the interventional groups, injections were done immediately and at 8 weeks after the onset of canine. Transpalatal arches (TPAs) were used to reinforce anchorage. The upper canines were distalized on 0.019 × 0.025-inch stainless archwires using coil springs with a force of 150 g. The primary outcome was the amount of canine retraction, whereas the secondary outcomes were canine rotation and anchoring loss. Assessment was done at five-time points: the beginning of tooth movement (T0) and at 4, 8, 12, and 16 weeks following T0 on three-dimensional superimposed digital models.

Results: Sixty patients were randomized and included in this study (20 patients in each group), there were no dropouts. The rate of canine retraction was faster in the experimental groups. The PRP group showed a significantly slower movement in the second and fourth months than the i-PRF group while in the first and third months, there were nonsignificant differences between the two experimental groups.

Limitations: Blinding was not possible during the clinical stage of this trial.

Conclusions: PRP and i-PRF were found to be effective in accelerating orthodontic tooth movement during canine retraction. However, the effect of i-PRF was longer than that of PRP.

Trial registration: ClinicalTrials.gov (ID: NCT05335824).

Objective: The objective of this study was to examine the impact of intraoral aging on the mechanical properties of directly printed aligners (DPA) compared to thermoformed aligners (TA).

Materials and methods: This prospective in vivo experiment included three types of aligners: DPAs (group DP) fabricated from Tera Harz TC-85 DAC resin (Graphy, Korea), TA (group INV) made from a polyurethane-based polymer (Align Technology, Inc., CA, USA), and TA (group DUR) made from polyethylene glycol terephthalate based polymer (Scheu-Dental, Germany). Each group was categorized into retrieved (Clin) and unused aligners (Ctr). Thirty patients (10 per group) wore the aligners for 7 days, thereby generating the retrieved samples. Thirty unused aligners were employed as control samples. The following mechanical properties were determined: Martens Hardness (HM), indentation modulus (EIT), elastic index (ηIT), and indentation relaxation (RIT). Intergroup comparisons were conducted using ANOVA/Kruskal-Wallis test. Comparisons between retrieved and control samples were done using Wilcoxon-Mann-Whitney-U/Student's t-test/Welch's test.

Results: Statistically significant differences between the groups were found for both control and used samples (P < .001). Pairwise comparisons also revealed significant differences between the samples. The mechanical properties did not differ significantly between unused and retrieved INV- and DUR-aligners, whereas for DP-aligners significant differences for ηIT and RIT were found following intraoral service (P-values .012 and .002, respectively).

Conclusions: Group DUR showed generally more favorable mechanical properties compared to DP and INV. The much higher RIT and EIT in DP aligners suggest their higher rigidity and force decay, which could compromise their clinical efficacy.