Research In Orthodontics

Minimally and Non-Invasive Approaches to Accelerate Tooth Movement:
Micro-osteoperforations. Patients are always attracted to decreasing the time it takes to complete orthodontic treatment. Recent advances in the understating of bone biology have been applied to a number of adjunctive techniques that in certain situations may reduce the time for certain tooth movements. In this new chapter, Ignacio Blasi looks at the use of micro-osteoperforations and the ability of these perforations to increase bone turnover rates, providing for increased speed of tooth movement. Studies have been done that demonstrate a localized positive effect on the speed of tooth movement.
Mechanical Vibration. Dubravko Pavlin presents information on the influence of low level mechanical vibration on orthodontic treatment, a technique borrowed from orthopedic colleagues. Some of the animal and human studies have reported increased rates of tooth movement and an ability to reduce pain perception when low level vibration therapy is used. Still other studies report no clinical effectiveness. While the jury is still out on this technique, clinical and basic science research into adjuncts that can influence biologic factors, are likely to bear fruit in the future.

Background: Although orthodontic white spot lesions (WSLs) are one of the most often and most evident adverse effects of comprehensive fixed appliance treatment, the efficacy of interventions for WSLs has not yet been adequately assessed in an evidence-based manner. Objective: Aim of this systematic review was to assess the therapeutic and adverse effects of interventions to treat post-orthodontic WSLs from randomized trials in human patients. Search methods: An unrestricted electronic search of eight databases from inception to May 2016. Selection criteria: Randomized controlled trials assessing any interventions for post-orthodontic WSLs on human patients. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results: A total of 20 unique studies and a total of 942 (42 per cent male and 58% per cent female) patients were included, with an average age of 16.2 years and a mean number of 8.2 WSLs (range 2.2 to 45.4) per patient. These were allocated to adjunct treatment with casein phosphopeptide-stabilized amorphous calcium phosphate creams, external tooth bleaching, low-or high-concentration fluoride films, gels, mouthrinses or varnishes, resin infiltration, miswak chewing sticks, bioactive glass toothpastse, or to no adjunct treatment (i.e. conventional oral hygiene). The monthly use of fluoride varnish was the best supplement to improve WSLs in terms of lesion area (1 trial; MD = −0.80 mm 2 ; 95% CI = −1.10, −0.50 mm 2 ; P < 0.05; high quality) and enamel fluorescence (3 trials; SMD = −0.92; 95% CI = −1.32, −0.52; P < 0.05; high quality), followed by the use of fluoride film. WSL treatment did not provide a considerable improvement in their clinical evaluation (3 trials; OR = 0.97; 95% CI = 0.60, 1.56; P > 0.05; moderate quality), with imprecision due to small sample size being the main limitation of existing evidence. Conclusions: Based on the existing trials, interventions for post-orthodontic WSLs, mainly fluoride varnish, seem to be effective, but further research is needed to elucidate their clinical relevance. Registration: PROSPERO (CRD42016037538)

Aim: The validity of meta-analysis is dependent upon the quality of included studies. Here, we investigated whether the design of untreated control groups (i.e. source and timing of data collection) influences the results of clinical trials in orthodontic research. Materials and methods: This meta-epidemiological study used unrestricted literature searching for meta-analyses in orthodontics including clinical trials with untreated control groups. Differences in standardized mean differences (ΔSMD) and their 95% confidence intervals (CIs) were calculated according to the untreated control group through multivariable random-effects meta-regression controlling for nature of the interventional group and study sample size. Effects were pooled with random-effects synthesis, followed by mixed-effect subgroup and sensitivity analyses. Results: Studies with historical control groups reported deflated treatment effects compared to studies with concurrent control groups (13 meta-analyses; ΔSMD = −0.31; 95% CI = −0.53, −0.10; P = 0.004). Significant differences were found according to the type of historical control group (based either on growth study or clinical archive; 11 meta-analyses; ΔSMD = 0.40; 95% CI = 0.21, 0.59; P < 0.001). Conclusions: The use of historical control groups in orthodontic clinical research was associated with deflation of treatment effects, which was independent from whether the interventional group was prospective or retrospective and from the study's sample size. Caution is warranted when interpreting clinical studies with historical untreated control groups or when interpreting systematic reviews that include such studies.

Objectives: The purpose of this paper is to provide a useful critical review relating to the effects of malocclusion on the physical, social, and psychological aspects of the Quality of Life (QoL) of patients. Methods: The information presented in previous articles was reviewed. They include reviews, meta analyses, cross-sectional studies, retrospective and prospective longitudinal studies, and randomized controlled trials. These full-text English-language papers were studied to determine the effects of malocclusion on QoL. Results: Recent studies have found that malocclusion is associated with higher levels of dissatisfaction with appearance, and have the potential to negatively impact Oral Health Related Quality of Life (OHRQoL). However, due to the differences in study designs, population demographics studied, and methods of assessment of physical, social, and psychological health, the evidence needs more analysis. Conclusion: In recent years, attention to patient-centered assessment has greatly increased. The orthodontist’s point of view has expanded from dentofacial esthetics to the patient’s overall OHRQoL. This leads to increase in dental practitioners comprehensively and rigorously, thus assessing the effects of malocclusion on QoL. The demand on standardized, valid, and reliable data collection instruments will increase as practices treats malocclusion issues to elevate patient’s overall OHRQoL.

PURPOSE: Review of the current literature to investigate the relationship between orthodontic treatment and the use of bisphosphonates. METHOD: Original articles and reviews on this issue have been sought in the bibliographic databases PubMed, Medline, Cochrane, Embase, and Scopus up until December 2015.
RESULTS: The findings on the effect of bisphosphonates on orthodontic treatment vary and involve a reduced degree of orthodontic tooth movement, incomplete extraction space closure, reduced relapse following treatment, reduced loss of anchorage, reduced root resorption, and the possible increased effectiveness of distraction osteogenesis in orthodontics.
CONCLUSIONS: The effect of bisphosphonate treatment on orthodontic treatment seems significant; however, further documentation is necessary.

Introduction: The effect of the maxillary expander on the inferior third of the face may be conditioned by the type of expander when done with an occlusally bonded acrilic covering or on conventional bands.
Objective: The purpose of this retrospective study was to compare the effects of expander design on the vertical plane using a) a banded Haas expander and, b) a Haas expander with acrilic covering, in the Steiner mandibular plane.
Materials and Methods: Initial (before treatment) and final (months after expander removal) lateral cephalometric x-rays of 20 patients with disjunction were retrospectively compared: ten patients with Haas expanders bonded with acrilic covering and ten patients with banded Haas expanders. The reference plane employed was S-Na. The mandibular plane was Go-Gn anatomic.
Results: Significant differences existed between both groups before initiating treatment. It was observed in the group with banded Haas expanders that the mandibular plane of 5 subjects remained unchanged while increasing in the other 5 subjects. The mean initial mandibular plane was 34.7º, while the final mean was 35.55º. No significant differences existed.
With respect to the group with Haas expanders with acrilic covering, the mandibular plane did not change in four subjects, while decreasing 5 others and increasing by 4º in one individual. Average initial mandibular plane was 39.25º; The final average was 38.85º. There were, similarly no significant differences present in this group.
Conclusions: Rapid Palatal Expansions (RPE) conducted with banded Haas expanders remains unchanged or increase lightly the mandibular plane. On the contrary, those conducted with acrilic covered expanders tend to either maintain or decrease the mandibular plane angle. The acrilic covered expander appears to provide some control over vertical dimension, thus indicating its more appropriate use in patients with increased vertical dimension such as dolichofacial patterns. Conclusions from this study are based on results obtained from a retrospective study in which samples were not randomly chosen. We think that further prospective research studies on the effect of maxilliary expansion on facial pattern should be done.