European journal of orthodontics最新文献

Background: Adolescents undergoing orthodontic fixed appliance treatment face an increased risk of dental caries and developing white spot lesions (WSLs) due to challenges in maintaining effective oral hygiene. Preventive measures, including adherence to clinical guidelines, are important to reduce these risks.

Objective: To analyse adherence to clinical practice guidelines (CPGs) amongst patients undergoing orthodontic treatment with buccal fixed appliances in the northeast of the Netherlands.

Methods: A survey was presented to 539 adolescents aged 12-17 undergoing buccal fixed appliance treatment. Participants were recruited from ten orthodontic practices. The survey assessed adherence to the six recommendations of the Dutch CPGs. An adherence sum score (range 0 to 6) was calculated. Descriptive statistics and linear regression analyses (1000 bootstrap samples) were performed to analyse the relationships between participants' characteristics and adherence sum scores.

Results: In total, 485 adolescents started the survey, of whom 393 (72.9%) could be included (57% female; 48.9% aged 13 or 14). The median adherence sum score was 5 (IQR 4, 5), and 22.6% (n = 89) had an adherence sum score of 6. Males had a lower adherence sum score than females (-0.442, 95% CI: -0.979, -0.234). Older participants had a lower adherence sum score than younger participants (-0.066, 95%CI: -0.136, 0.002) per year of age. Higher educated participants had a lower adherence sum score than participants with lower education (-0.534, 95%CI: -0.953, -0.096).

Limitations: Self-reported data may introduce information bias as participants may give socially desirable answers.

Conclusions: Adherence to the CPGs amongst adolescents with buccal fixed orthodontic appliances is suboptimal, particularly in boys and older adolescents. Tailored educational interventions may address these gaps.

Background: Functional appliances, such as Twin Block and Herbst, produce dental and skeletal effects to correct Class II division 1 malocclusion. Although widely studied, there are no prospective randomized studies in the literature evaluating the effects of these appliances on the condyle (CO) and glenoid fossa (GF).

Objective: To evaluate the differences in the CO and GF after treatment using Twin Block (TB) and Herbst (HB) functional appliances for skeletal Class II malocclusions.

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

Materials and methods: The sample consisted of 24 patients (12 in the TB group, 11.9 ± 1 year; 12 in the HB group, 12.5 ± 1.8 years) with Class II division 1 malocclusion. Cone beam computed tomography (CBCT) scans were recorded before (T0) and after (T1) treatment (12 months). Superimpositions were performed on Dolphin Imaging software, and partial 3D models of CO and GF were segmented in ITK-SNAP software. A coordinate system (X, Y, and Z axes) was created using Geomagic Qualify software in each 3D T0 model. CO and GF models were aligned in the 3D T0 and T1 models. A 3D centroid point was generated between T0 and T1 in each CO and GF.

Results: The TB group showed posterior growth in the right CO (1.3 mm), left CO (1.3 mm), right GF (0.8 mm), and left GF (0.4 mm). The HB group showed posterior growth in the right CO (1.4 mm), left CO (1.7 mm), right GF (0.1 mm), and left GF (0.1 mm).

Limitations: As the operator and patients were aware of the type of functional appliance, blinding could be performed only to assess and measure the CBCT exams.

Conclusions: In both groups, CO and GF grew posteriorly; CO grew vertically in the superior direction, and GF in the inferior direction. The effects on CO and GF were similar when using TB or HB.

Trial registration: ClinicalTrials.gov (ID: NCT02411812). It was registered before commencement.

Background: Although cervical headgear (CH) is a widely studied method for the correction of Class II malocclusion, there is a lack of evidence regarding the effects of early versus later treatment timing on permanent upper canines and molars.

Objectives: To evaluate the differences between early versus later cervical headgear treatment to the eruption time and inclination of maxillary permanent canines and second molars, inclination of the first molars, and the overlapping between second and third molars.

Trial design: Randomized, parallel-group, prospective controlled trial on timepoints T0-T2, follow-up study on T2-T4.

Methods: The material consisted of 67 seven-year-old children, with a Class II malocclusion, randomized into two equal-sized groups using opaque sealed-envelope randomization. In the early group (EG, n = 33), CH treatment was started at the age of 7.8 (T0) and in the later group (LG, n = 34) at the age of 9.5 (T1). Children received active CH treatment until Class I molar occlusion was achieved, after which individualized orthodontic treatment was provided at timepoints T2-T4. Dental panoramic tomographs (DPTs) were taken at five timepoints: T0-T4 (T0 = mean age 7.3 years, T1 = 9.6 years, T2 = 11.5 years, T3 = 15.3 years, and T4 = 17.8 years). The comparisons between the groups in DPT measurements were made at different timepoints using t-test and Mann-Whitney U-test and by combining the results using a linear mixed model. Due to the nature of the trial, the clinicians and children could not be blinded during the study; therefore, blinding was applied during data assessment.

Results: In the LG, the right canine erupted earlier in T1 and in T2 and in combined results both canines erupted earlier. In the LG canines were more vertically inclined in T2. The second molars in the EG were more distally tipped in T1 and on the left side in combined results. The eruption stage of the second molars was earlier in the LG than in the EG. In the EG, more overlapping of the right and left third molars with the second molars was observed in T1. All P-values were < 0.05. No harms were encountered.

Conclusion: A later treatment timing seems more beneficial, with earlier eruption and more vertically oriented canines, less distal tipping, and earlier eruption of second molars and less overlapping between second and third molars.

Trial registration: Clinical Trials ID: NCT02010346.

Background: Throughout a trial report, clear and accurate reporting is essential. The aim of this study was to assess the reporting quality of RCT abstracts presented at the European Orthodontic Society (EOS) Congress between 2015-2024. Associations between reporting quality and abstract characteristics were explored.

Material and methods: All EOS Congress scientific abstracts published between 2015-2024 (2020 excluded) were included. Descriptive statistics and frequency distributions were calculated. Mean values for adequate reporting per CONSORT item and sum score were calculated. On an exploratory basis, univariable linear regression between summary score and abstract characteristics was undertaken.

Results: 139 RCT congress abstracts were analysed. The most frequent years of RCT abstract presentation were 2018 (14.4%) and 2023 (19.4%). RCT abstracts were more likely to be poster types (62.6%), with corresponding authors based in Europe (77.7%), single centre (64.7%) and reporting a non-significant result for the primary outcome (54.0%). The mean overall total quality reporting score was 17.6 (SD 5.6, min 15 and max 22.8) out of a maximum score of 50. Items that tended not to be reported include authors contact details, participant (settings), randomization procedures and trial registration. Posters achieved lower scores compared to oral abstracts (-2.96; 95% CI -4.86, -1.07; P < 0.01). Additionally, an abstract word count greater than 251 words was associated with higher total score (3.28; 95% CI 0.74, 5.82; P = 0.012). A weak association (0.29, 95% CI: -0.03-0.62, p = 0.07) between year of abstract publication and an improvement in overall reporting score over time was evident.

Limitations: Only one society congress were assessed which may impact the generalisability of the results.

Conclusions: In relation to the CONSORT reporting Randomized Controlled Trials in Journal and Conference Abstracts checklist, RCT abstracts presented at EOS congress between 2015-2024 remain sub-optimal with reporting of key items lacking. However, reporting quality scores have shown an association with type of presentation (oral or poster), abstract word count and some evidence of improvement over time. Measures to encourage clear and consistent RCT abstract reporting are required.

Background/objectives: Molar-Incisor Hypomineralisation (MIH) affects 14% of the global population, often leading to compromised first permanent molars (FPM). Early extraction of severely affected FPMs may temporarily affect proper eruption and alignment of second permanent molars (SPM) and second premolars (SP). This study aimed to evaluate the eruption patterns of SPMs and SPs, and the overeruption of opposing FPMs, after early FPM extraction using panoramic radiographs in 11-year-old patients. A secondary aim was to assess radiographic quality for these evaluations.

Subjects and methods: This split-mouth trial included patients aged 6-9 with severe MIH requiring FPM extraction. Panoramic radiographs were taken pre-extraction (T0) and at age 11 (T1) to measure eruption length and angulation of SPMs and SPs. Radiographs were analysed using Facad software, and imaging errors were recorded. Paired t-tests compared extraction and non-extraction sides.

Results: Among 47 patients, 31 had maxillary and 25 mandibular FPM extractions. At T0, eruption length and angulation of SPMs and SPs were similar between sides. At T1, maxillary SPMs erupted faster (13.5mm vs. 10.8mm, p < 0.001) and more upright (72.9° vs. 62.1°, p < 0.001) on the extraction side, while SPs showed increased mesial angulation (82.5° vs. 89.3°, p < 0.05). Mandibular SPMs and SPs showed no differences. No overeruption of opposing FPMs was observed. Measurement reliability was excellent (ICC: 0.997-0.999), despite 75 of 94 radiographic contained errors.

Limitations: The three-year follow-up limits long-term insights, and radiographic distortions may affect reliability.

Conclusions: Early FPM extraction impacts maxillary but not mandibular SPM and SP eruption patterns without causing overeruption of opposing FPMs by age 11. Radiographic techniques are essential to minimize incorrect patient positioning, as such factors may impact measurement reliability.

Objectives: The aim of the systematic review and meta-analysis is to compare the efficacy of 4 different bone-anchored maxillary protraction techniques: 1) bone-anchored maxillary elastics (BAMP), 2) maxillary bone anchors combined with facemask (BAFM), 3) hybrid hyrax combined with facemask (HHFM) and 4) hybrid hyrax combined with mandibular bone anchors (HH-BAMP).

Search methods: The search was performed in four electronic databases: Pubmed, Embase, Scopus and Web of Science. In addition, the reference lists of eligible articles have been hand-searched.

Selection criteria: Study designs included: randomized controlled trials, non-randomized controlled trials, case-control studies including more than 4 patients.

Data collection and analysis: Qualitative and quantitative information were extracted for each study including author, year of publication, study type, sample size, chronological age of patient group pretreatment (years), skeletal maturity stage, gender (female/male), treatment duration (months), treatment type, type of skeletal anchorage, force magnitude (grams), duration of protraction (hours), RME or Alt-RAMEC and cephalometric measurements.Statistical heterogeneity was assessed by a stratified analysis for mean difference (MD) and a graphical display of the estimated treatment effects. A meta-analysis comparing treatment effects for the four groups were only made if two or more outcomes were reported.

Results: 653 articles were initially screened, 25 full-text articles satisfied the inclusion criteria including 6 randomized controlled trials. Comparing the four maxillary protraction protocols, SNA improved significantly more in group 4 compared to the other groups including group 1 (mean difference 1.9, 95% confidence interval [CI] 1.6-2.1; p < 0.001).Treatment with facemask (group 2) seemed to increase the lingual inclination of the lower incisors (IMPA) while in the other groups, proclination of the lower incisors were evident.

Conclusions: The level of evidence in the selected articles ranged from low to moderate. The current evidence suggests that skeletally anchored rapid maxillary expansion combined with maxillary protraction with mandibular bone anchors yields the greatest maxillary advancement in cl.III patients.

Registration: The study has been registered at PROSPERO with registration number CRD42023380964.

Background: Obesity and overweight represent significant public health concerns affecting children and adolescents. Besides their association with accelerated pubertal growth, the high body mass index (BMI) has been implicated in craniofacial dimension alterations and malocclusion development within this age group.

Objective: This study aimed to evaluate the impact of high BMI on sagittal and vertical craniofacial dimensions and malocclusions in children and adolescents. Search methods: We conducted unrestricted electronic searches across nine databases until November 2024. Selection criteria: Inclusion criteria were cross-sectional, case-control, and cohort studies involving participants aged 5 to 19 years that established a relationship between BMI, dimensional changes in craniofacial structures, and the presence of malocclusion. The research question applied the PECO framework. Data collection and analysis: After removing duplicates, extracting the data, and assessing the risk of bias with the JBI Critical Appraisal Tools for observational studies, we performed random-effects meta-analyzes of mean differences (MD) with 95% confidence intervals (CI). Subsequently, we assessed the quality of evidence.

Results: The study included 21 articles (19 cross-sectional, one cohort, one case-control) with low-to-moderate risk of bias. Eight studies focused on craniofacial dimensions, and 13 on malocclusion. The meta-analysis revealed significantly larger sagittal dimensions in patients with obesity or overweight, including extended cranial base length (S-N, MD = 0.8452 [0.5531-1.1373]), mandibular length (Cd-Gn, MD = 0.5770 [0.0639-1.0902]), maxillary length (Cd-A, MD = 0.8021 [0.4251-1.1790]), and bimaxillary protrusion (SNA, MD = 0.6008 [0.1099-1.0916]; SNB, MD = 0.6712 [0.1328-1.2096]; SNPg, MD = 0.5921 [0.0666-1.1175]). Concurrent gains in posterior facial height (S-Go, MD = 0.6619 [0.2385; 1.0853]) in the vertical dimension usually did not alter the overall facial plane, tending towards more horizontal growth. These gains were higher for girls with high BMI. Regarding malocclusions, only two of the 13 studies identified statistically significant associations between dental crowding and high BMI. While seven studies exhibited a low risk of bias, the included articles commonly demonstrated limited control over potential confounders.

Conclusion: Based on limited evidence, children and adolescents with high BMI presented enhanced bimaxillary prognathism and enlarged sagittal and vertical craniofacial dimensions. The BMI did not consistently impact malocclusions, although a few studies linked dental crowding to overweight. Orthodontic planning for this population should consider the patient's BMI.

Registration: PROSPERO (CRD 42024511194).

Background: Applying a pharmacological substance to provide appropriate anchorage is a simple procedure that does not depend on the patient, does not irritate the soft tissue inside or outside the mouth, is accepted by the patient aesthetically, and has a lower cost than anchorage devices. Bisphosphonates (BPs) have been suggested in the orthodontic literature for anchorage, but there is little evidence regarding their effectiveness.

Objectives: This systematic review aimed to assess the quality of evidence from animal research that demonstrated how bisphosphonate, when administered locally and systemically, reduced the movement of teeth in orthodontics.

Search methods: We performed a broad electronic search to retrieve relevant studies from eight databases and hand-searching from 1990 up to June 2024 to identify the animal trials that met the inclusion criteria of this systematic review.

Selection criteria: The review included animal studies that evaluated the rate of tooth movement following localized injection of bisphosphonates with simulated orthodontic tooth movement.

Data collection and analysis: The Systematic Review Centre for Laboratory Animal Experimentation's tool (SYRCLE) was used to assess the risk of bias for the included papers.

Results: 690 titles were found using the search method. Following screening, 361 articles were excluded. The full texts of the remaining 65 papers were read entirely, and ten papers were included in this review. Two studies were judged as having a 'low risk of bias', whereas the other showed an 'unclear risk of bias'. When BPs treatment was used in comparison to the naive and saline groups, the results showed a decrease in OTM, osteoclast number, and alveolar bone loss, but there are conflicting findings about how BPs affect root resorption. In the periodontal ligament, the BPs groups showed decreased vascularization and increased necrotic zones without causing osteonecrosis.

Conclusions: Local or systemic application of bisphosphonate can alter the bone remodeling cycle, affecting osteoclast activity and, consequently, orthodontic tooth movement. So, they could be applied to give a high degree of anchorage to limit adverse movement. However, longer-term research is needed to evaluate potential side effects from bisphosphonate use during orthodontic treatment.

Registration: The systematic review protocol was registered on 23/8/2022 in the National Institute of Health Research's PROSPERO; the registration number is CRD42022348745.

Background: Root resorption (RR) is a critical concern in orthodontics. It is influenced by treatment duration and techniques. Minimally invasive surgically accelerated orthodontics (MISAO) aims to reduce treatment time but may impact RR, necessitating a systematic evaluation of its effects.

Objective: This review aims to evaluate the impact of MISAO techniques on RR across different types of orthodontic movements compared to conventional techniques.

Search methods: A systematic search of nine databases and a manual screening of journals were conducted following PRISMA guidelines, with no restrictions on language or publication date (up to June 2024).

Selection criteria: Studies evaluating RR before/after MISAO in humans, with ≥ 5 participants per group, were included. Animal studies, non-surgical interventions, and studies lacking RR data were excluded.

Data collection and analysis: Bias risk was assessed using the RoB 2.0 tool for RCTs and the ROBINS-I tool for CCTs. RR assessment quality was evaluated using the McHarm tool, and evidence certainty was determined using the GRADE approach.

Results: A review of 23 studies (585 participants, ≈ 2,420 teeth) showed varied MISAO effects on RR. MOPs and piezocision had no significant impact on RR during leveling, alignment, and canine retraction (P > 0.05), except for isolated cases where piezocision reduced RR (P < 0.05). IN En-masse retraction, piezocision reduced RR in central incisors and the right canine (P = 0.030, 0.046, 0.025), while MOPs had no effect (P = 0.175). Upper molar distalization with MOPs increased RR in mesiobuccal roots (P = 0.043) but decreased it in distobuccal roots (P < 0.001). Piezocision reduced RR during lower second molar protraction (P = 0.005), while MOPs and piezocision increased RR during buccal tipping (P = 0.029 and P = 0.001, respectively). Evidence quality ranged from 'very low' to 'moderate'.

Conclusions: This review indicates that while MISAO affects RR similarly to conventional methods during leveling and alignment, its impact varies for other orthodontic movement types. Minimizing surgical invasiveness is key to reducing RR risk while maximizing the benefits of accelerated treatment. Direct resorption occurs due to poorly planned procedures applied too close to the root, while indirect resorption is influenced by bone density and tooth movement. Further research is needed to standardize RR assessment methods and explore long-term outcomes to refine MISAO techniques for safer and more predictable results.

Registration: The protocol was registered in the PROSPERO database (ID: CRD42023393763).