European journal of orthodontics最新文献

Objective: To assess in a prospective controlled study whether orthodontic treatment with fixed appliances results in development of gingival recession (GR), compared with an untreated group of participants.

Materials & methods: The sample consisted of 40 consecutive adult orthodontic patients (Intervention group) and 40 untreated adult volunteers, that satisfied the inclusion and exclusion criteria and were selected from the same background population, as the control group. GR was measured as part of a full periodontal assessment: before treatment (T0) and 12 months after removal of the fixed appliances (T1) in the intervention group, i.e. at about 30 months from T0, and at baseline (T0) and 30 months after (T1) in the control group. A count data model was fit using the sum of recessions at T1 and as predictors: treatment, periodontal phenotype (thin/thick), side (buccal/lingual), sex, age, and number of recessions at baseline, with robust standard errors to account for the multiple within patient observations.

Results: Nineteen females and 21 males in each group [mean age in years (range): intervention group 23.1 (16.8 - 43.3); control: 21.85 (18.2 - 43.9)] were analyzed. During the whole study period, the control group exhibited a modest increase in the number of recessions over time. Several patients in the intervention group exhibited a larger increase in the number of recessions than the controls. However, this was partly counteracted by a considerable amount of reduction in the number of recessions in several patients receiving treatment. The adjusted incidence for recession was 67% higher for the intervention group versus the control group (IRR = 1.67, 95% CIs: 1.05, 2.67, P = 0.03). Most recessions, though, were up to 1mm. The most affected teeth were the canines and the first premolars.

Conclusions: Compared to untreated individuals, patients undergoing orthodontic treatment with fixed appliances showed a higher incidence rate of gingival recession at 1-year posttreatment, adjusted for age, periodontal phenotype, side, gender and number of recessions at baseline. However, the severity of gingival recessions was of limited extent.

Objective: To evaluate the amount of bisphenol-A (BPA) released from different orthodontic appliances into saliva and plasma and to compare BPA levels between orthodontic appliance groups.

Methods: This non-randomized clinical trial included 78 patients, and they were divided into four groups: fixed appliance, temporary anchorage devices (TADs), removable appliance, and functional appliance groups. Saliva and plasma samples were collected before treatment/appliance wear (T0) and one day (T1), one week (T2), and one month (T3) after treatment/appliance wear. Saliva and plasma BPA levels were analysed using Ultra-performance Liquid Chromatography-Mass Spectrometry (UPLC-MS/MS). Data was analysed using analysis of variance (ANOVA) and Tukey HSD multiple comparison tests with Bonferroni correction. Correlations between saliva and plasma BPA levels at different time points were evaluated using Pearson correlation analysis.

Results: BPA levels ranged from 0.07-7.28 ng/ml in saliva samples and from 0.17-12.51 ng/ml in plasma samples in all groups. Within-group comparisons showed no significant changes over time (p > 0.0125) in each group. Between-group comparisons showed significantly higher saliva BPA levels in the fixed appliance group compared to the other groups (p < 0.017), with no significant differences in plasma BPA levels between groups (p < 0.0175). Positive correlations were observed between saliva BPA measurements, whereas positive correlation was observed only between T0 and T3 plasma PBA levels.

Conclusion: This research obviously demonstrated that the orthodontic appliances we investigated release BPA into the saliva. However, the BPA levels detected in both saliva and plasma are consistently within the acceptable safety limits. However, precautions should be taken to minimize BPA release during orthodontic treatment.

Introduction: Clear aligner therapy (CAT) is an aesthetic alternative to fixed appliance therapy (FAT). An understanding of patient experiences with CAT can enable clinicians to educate patients, manage expectations, and identify potential barriers to effective treatment. A scoping review was undertaken to map and synthesise the available evidence on patient experiences with CAT.

Methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed (MEDLINE), Embase, Scopus, Web of Science and Dentistry & Oral Sciences Source databases and grey literature were searched. Data collation and synthesis was presented in descriptive and tabular formats.

Results: The initial search yielded 541 articles following removal of duplicate studies. 37 studies met the selection criteria and were scoped in the present review. The studies identified included cross-sectional, longitudinal, prospective, and randomised clinical trials reporting on patient experiences with CAT associated with Oral Health-Related Quality of Life (OHRQOL) and satisfaction. The impacts of CAT on OHRQOL with relevance to pain was the most frequently evaluated aspect, followed by speech, satisfaction, eating, anxiety, and sleep.

Conclusions: CAT patients report satisfaction with the aesthetics of the appliance however can expect transient negative effects on OHRQOL, pain, anxiety, and speech after commencing treatment. Further longitudinal research using validated qualitative tools focussing on CAT is required.

Registration: This review was registered in the Open Science Framework database (DOI: xx).

Background/objectives: The inclusion of a participant flow diagram in randomized clinical trials (RCTs) is a requirement of the CONSORT guidelines. The aim of this study was to assess the reporting quality of flow diagrams of RCTs published in orthodontic journals in relation to the CONSORT Flow Diagram for Parallel Group RCTs.

Materials/methods: RCTs published between January 2011 and December 2023 in five orthodontic journals were identified and trial characteristics were extracted. The reporting of the flow diagram (if included) was assessed for completeness in relation to the CONSORT flow diagram template. Descriptive statistics and cross tabulations between RCT characteristics and presence/no presence of a flow diagram were performed. On an exploratory basis, univariable associations between RCT characteristics and presence/no presence of a flow diagram were performed and univariable logistic regression to examine the effect of publication year on flow diagram reporting.

Results: Three hundred and thirty-four RCTs met the inclusion criteria. The majority were published in 2021 (n = 39, 11.7%), and had 2 arms (n = 279, 83.5%). Three-hundred and seven (92.0%) RCTs were published in journals endorsing the CONSORT guidelines. Two hundred and thirty-three (69.8%) RCTs included a flow diagram and from these, 48.1% (n = 112) were fully compliant with flow diagram reporting. 121 (51.9%) omitted at least one item of the CONSORT reporting template. Significant associations between journal type, CONSORT endorsement by authors, ethical approval status, presence of a published protocol, significance of the primary outcome, involvement of a statistician, presence of conflict of interest, center type, type of analysis undertaken and the presence/ no presence of a flow diagram were present. Across the study timeframe, the odds of inclusion of RCT flow diagram increased per additional year (OR:1.47; 95%CI:1.34,1.61; p < .001).

Limitations: Only five orthodontic journals.

Conclusions/implications: Despite improvements over time, the inclusion and reporting of CONSORT flow diagram for parallel group RCTs in trials published in orthodontic journals requires improvement. To mitigate potential biased interpretation of trial results, journal editors should ensure a complete CONSORT flow diagram is submitted by researchers.

Background: Dental crowding is a primary concern in orthodontic treatment and significantly impacts therapy choices. Accurate quantification of crowding requires time-intensive cast- or scan-based measurements. The aim was to develop an automated deep-learning model capable of assessing anterior crowding and calculating the Little Irregularity Index using single occlusal intra-oral photographs.

Methods: A dataset of 125 untreated individuals (100 from Zurich, Switzerland, and 25 from Nijmegen, the Netherlands) comprised of annotated intra-oral scans and corresponding intra-oral photographs were used to train a dedicated convolutional neural network (CNN). The CNN was modeled to detect teeth boundaries, contact points and contact point displacements on photographs. The model's performance to determine anterior crowding and the Little Irregularity Index score was compared to consensus measurements based on intra-oral scans in terms of intra-class correlation (ICC) and mean absolute difference (MAD).

Results: The model correlated well with the consensus measurement, and proved to be reliable (ICC = 0.900) and accurate (MAD = 0.36 mm) for anterior crowding assessment and Little Irregularity Index alike (ICC = 0.930; MAD = 0.74 mm).

Limitation: The model was not trained on cases with interdental spacing, and its reliability for cases with crowding severity outside the tested sample has not been established.

Conclusion: The presented CNN-based model was able to quantify the crowding in the anterior segment of the lower dental arch and score the Little Irregularity Index from a single intra-oral photograph with a satisfactory reliability and accuracy. Application of this model may lead to more efficient and convenient orthodontic diagnostics.

Background: Orofacial myofunctional disorders (OMDs) are conditions or behaviors that negatively affect oral postures and functions. These behaviors can interfere with normal orofacial growth and development and related functions.

Objectives: Map the available evidence regarding the effectiveness of Orofacial Myofunctional Therapy (OMT) in treating or managing OMDs associated with specific malocclusion traits or orthognathic surgery outcomes.

Search methods: An experienced librarian developed a comprehensive search strategy for six databases and gray literature. The reference lists of included studies were reviewed.

Selection criteria: Randomized controlled trials and non-randomized studies of intervention were included in which individuals with OMDs were treated with OMT, regardless of the healthcare setting or the professional delivering the treatment.

Data collection and analysis: Two independent reviewers screened the retrieved records in two phases based on predefined eligibility criteria and extracted data. The evidence level was assessed using the Oxford Levels of Evidence.

Results: Twenty-four studies were included (18 primary studies and 6 reviews). Seven studies focused on OMDs associated with malocclusion sagittal characteristics (Class I, II, or III), ten examined open-bite-related OMDs, and seven explored OMDs following orthognathic surgery. Only four studies (22%) were randomized controlled trials (RCTs); most studies lacked proper randomization procedures, did not report allocation concealment, and three of the four RCTs were open-label. Among the six comparisons identified, five were deemed plausible (four with a level of evidence 3 and one with a level of evidence 2). No comparisons were rated at level 1 evidence. As a result, the effectiveness of OMT alone or in combination with orthodontic treatment for the conditions of interest could not be conclusively confirmed. Further well-designed RCTs are needed to confirm or refute this finding and to strengthen the overall evidence base.

Conclusion: Although no high-level evidence currently supports the effectiveness of OMT for managing OMDs associated with malocclusion traits, its potential effectiveness remains plausible. Level 2 evidence suggests that OMT may effectively manage OMDs following orthognathic surgery.

Registration: Open Science Framework (DOI 10.17605/OSF.IO/M6HNS).

Background: Issues regarding research transparency have been highlighted in the literature. The aim of this investigation was to assess the trend of adhering to the reporting of key transparency practices (data sharing, code sharing, COI disclosure, funding disclosure, and protocol registration) by articles published in three leading orthodontic journals.

Material and methods: A Scopus database search was undertaken to identify articles published in 2013, 2018 and 2023 in three orthodontic journals. Independent data extraction was performed. Frequency distributions and cross tabulations (COI not disclosed vs COI disclosed) were calculated. Univariable logistic regression was undertaken to detect associations between COI disclosure and publication characteristics, journal type and reporting of transparency practices.

Results: 1498 articles were analysed. No data sharing statement (60.7%) was commonly cited. The intention to share data was stated in approx. 15% articles. No article stated a code sharing statement. Almost 70% articles had not registered a protocol. A third of articles disclosed the funder or sponsor (32.7.%), while approximately an equal number of articles disclosed (49.1%) or did not disclose (50.9%) any conflict of interest. Articles published in the EJO had higher odds of reporting protocol registration (OR 7.42; 95% CI: 4.55, 12.10; P < .01) and funding disclosure (OR 3.44; 95% CI: 2.52, 4.69; P < .01) compared to AO and AJODO. A COI disclosure statement was more likely to be in articles published in AJODO. The odds of reporting a data sharing statement were higher in articles published in EJO (OR 8.72; 95% CI: 5.72, 13.29; P < .001). Apart from code sharing, improvements over the 5-year intervals in reporting of transparency indicators were evident.

Limitations: Only three journals were assessed which may impact the generalisability of the results.

Conclusions: Despite improvements over the 5-year intervals, the reporting of research transparency indicators requires improvement in articles published in orthodontic journals. To encourage transparent research conduct and open science practices, journals and their editors should promote reporting of research transparency indicators.

Background: Orthognathic surgery enhances both oral function and aesthetic outcomes for patients with dentofacial disharmony (DFD). However, the influencing factors on oral health-related quality of life (OHRQoL) in patients with varying characteristics remain unclear.

Objective: This systematic review aims to comprehensively investigate the factors that influence quality of life (QoL) in patients undergoing orthognathic surgery, and address the gaps of subgroup comparisons in existing reviews, specifically focusing on country development level, type of DFD, type of surgical procedure, and sex.

Search methods: PubMed, Embase, Web of Science, CENTRAL, SIGLE, CNKI, CSTJ, and WANFANG Database were searched from 2000 to 2025.

Selection criteria: This systematic review included cohort studies that evaluated the impact of orthognathic surgery on QoL and its various influencing factors as measured by Orthognathic Quality of Life Questionnaire-22 (OQLQ-22) or the Oral Health Impact Profile-14 (OHIP-14).

Data collection and analysis: The Newcastle-Ottawa Scale (NOS) for Cohort Study was employed to evaluate the quality of included studies. RevMan software was used to perform the meta-analyses.

Results: The review included 22 articles with 1482 participants, of which 20 were included in the meta-analyses. Using OQLQ-22, an improvement was noted in the four dimensions of QoL at five months postoperatively compared to the preoperative period. Subgroup analysis indicated that patients undergoing double jaw surgery (MD 22.55, 95% CI [17.00, 28.10]), with skeletal Class III malocclusion (MD 21.91, 95% CI [16.38, 27.45]) and female patients (MD 23.72, 95% CI [11.05, 36.40]) experienced a more significant degree of improvement, suggesting a higher likelihood of achieving greater surgical satisfaction. Notably, the overall QoL improvement was more pronounced in developing countries (MD 21.63, 95% CI [13.82, 29.45]) overall compared with developed countries (MD 18.22, 95% CI [14.22, 22.22]). Similar results were observed in the use of OHIP-14.

Conclusions: This study highlights the factors influencing QoL in orthognathic patients, including country development level, type of DFD, surgical procedures, and sex in the QoL. The degree of improvement in patients' QoL varied according to these characteristics. Given the limited number of studies available, further comprehensive research is warranted.

Registration: PROSPERO (CRD42024582409).

Background/objectives: To assess Dutch dentists' experience, competence and opinions on various aspects of orthodontic retention with bonded retainers and identify any gaps that may exist in practice and communication.

Materials/methods: A web-based questionnaire was sent to 1000 randomly selected general dentists, covering their (i) experience, competence and opinion in bonded retainer monitoring and maintenance, (ii) knowledge of unintentional active bonded retainers, (iii) responsibility for bonded retainers, and (iv) orthodontic practitioners' communication.

Results: The response rate was 23.6% (n = 236). Orthodontic treatment was performed by 24% of dentists. Dentists were familiar with follow-up (98%), repairs (95%) and placement (77%) of bonded retainers. The more hours involved in treatment, the more competent they felt in repairing BRs (P = .025). However, over a quarter felt insufficiently competent in repairing (26%) and placement (33%) of bonded retainers. When patients requested their dentist to remove their bonded retainer, 89% informed them about possible consequences, and 41% referred them to their orthodontic practitioner. Awareness of torsional movements of anterior teeth due to unintentionally active bonded retainers was high (77%). Almost two thirds (64%) believed that dentists should check bonded retainers one year after placement. Respondents felt insufficiently informed by orthodontic practitioners regarding several aspects of the retention phase. One-third (34%) would appreciate additional training.

Limitations: The main limitations of this study are the low response rate, which could result in non-response bias, and the focus on bonded retainers only.

Conclusions/implications: Dutch dentists are well informed about the possibility of torsional movements due to unintentionally active bonded retainers. Clear communication between orthodontic practitioners and dentists is essential for effective long-term follow-up and shared responsibility. Knowledge and skills regarding monitoring and maintenance of bonded retainers should be integrated into dental curricula and postgraduate courses.

Background: Orthodontic treatment involving tooth extractions typically spans 25-35 months in adult patients. While various methods have been explored to accelerate this process, the outcomes remain inconsistent. This study focuses on evaluating the efficacy of these methods specifically in adult populations.

Objectives: This study aimed to evaluate the effects of flapless piezocision combined with low-level laser therapy (LLLT) on the rate of en-masse retraction, comparing it to piezocision alone and conventional.

Materials and methods: This single-center, three-arm, parallel-group randomized controlled trial involved adult patients with Class II Division 1 malocclusion who required upper premolar extractions. The study included healthy males and females aged 17-28. Participants were randomly assigned to one of three groups in a 1:1:1 ratio through seven blocks of nine participants each: (1) Piezocision-assisted en-masse retraction with low-level laser therapy (FC + LLLT), (2) Piezocision-assisted en-masse retraction (FC), and (3) Conventional en-masse retraction (CONV). After completing the leveling and alignment phase, piezocision procedures were performed using buccal and palatal vertical incisions made with a piezosurgery microsaw in FC and FC + LLLT groups. Six weeks later, in the FC + LLLT group, low-level laser therapy (LLLT) utilizing a GaAlAs diode laser was administered regularly until en-masse retraction. The primary outcome was the rate of en-masse retraction; secondary outcomes included changes in first molar positions and inter-molar and inter-canine widths.

Results: In this RCT of 80 patients, 63 (16 males and 47 females, mean age: 21.46 ± 3.16 years) were recruited. The FC + LLLT group had the greatest retraction rate at 1.32 ± 0.19 mm/month, significantly greater than the FC (1.09 ± 0.13 mm/month) and CONV groups (0.75 ± 0.06 mm/month). No significant differences were found in first molar distal movement or inter-molar width changes.

Conclusion: Combining LLLT with flapless piezocision significantly boosts upper anterior teeth retraction by 43.8%, compared to 31.8% with piezocision alone. This approach remains effective throughout the retraction period, while piezocision benefits were mainly seen in the initial two months. All methods cause slight distal movement of first molars and minor increases in inter-canine and intermolar widths, with no significant differences.

Harms: No harms were reported.

Trial registration number: This trial protocol was registered in the Clinical Trials database (NCT05655169).