Compliance with removable orthodontic appliances and adjuncts: A systematic review and meta-analysis

Orthodontic retainers: are they all the same?

INTRODUCTION

It is known that the stability of the results obtained with orthodontic treatment depends, in addition to the functional and aesthetic aspects, also on the adequate planning of the retention devices, the patient's compliance with this new phase, and the physiological changes that the human body experiences over the years, throughout the craniofacial aging process.

OBJECTIVE

This article discusses the importance of the orthodontic retention phase and the influence of diagnosis, planning and execution of corrective treatment of malocclusions, in order to achieve the expected success.

METHODS

Throughout the text, different types of retainers and approaches during this phase will be presented, with the aim of ensuring the stability of the results obtained after correcting problems in the vertical, transverse and anteroposterior directions.

RESULTS

Orthodontic retainers are not all the same. The retention protocol must be performed in an individualized and planned manner, taking the initial dental positions as a reference.

CONCLUSIONS

The orthodontist must inform the patient and parents about important aspects of how to maintain the occlusion achieved with orthodontic treatment. The retainers installed after the end of corrective treatment are not everlasting, they can suffer damage with use and must be replaced. Therefore, the patient must be aware of the importance of using retainers as prescribed by the orthodontist, and of returning for scheduled review appointments.

Forward-backward translation, content validity, face validity, construct validity, criterion validity, test-retest reliability, and internal consistency of a questionnaire on patient acceptance of orthodontic retainer

This study aimed to assess the validity and reliability of a questionnaire on patient acceptance of orthodontic retainers. The original questionnaire was forward- and backward-translated, followed by four validity tests (content validity, face validity, construct validity, criterion validity) and two reliability tests (test-retest reliability, internal consistency). Content validity was assessed by nine orthodontists who appraised the questionnaire's representativeness, relevance, clarity, and necessity. Face validity was established through semi-structured in-depth interviews with 35 English-literate participants currently wearing orthodontic retainers. Construct validity was established through Exploratory Factor Analysis (EFA). For criterion validity, 107 participants concurrently answered the questionnaire and the Retainer-modified Malaysian Oral Health Impact Profile questionnaire. Test-retest reliability was verified by 34 subjects who responded to the questionnaire again after a two-week interval. Six revised items passed the threshold value of 0.78 for Item-Content Validity Index and Content Validity Ratio and were revised based on findings from the face validity test. Principal Component Analysis of EFA extracted information on only one component, and all items were positively correlated with the component matrix. Spearman's rho value (rs = 0.490 and rs = 0.416) indicated a moderate correlation between the two questionnaires for criterion validity. Intraclass Correlation Coefficient ranged from 0.687 to 0.913, indicating moderate to excellent test-retest reliability. Cronbach's alpha ranged from 0.687 to 0.913 indicating that none of the questionnaire items showed unacceptable or poor internal consistency. The questionnaire on patient acceptance of orthodontic retainers has been validated and can be used in both clinical and research settings.

The Effect of Personality Traits on Patient Compliance With Clear Aligners

INTRODUCTION

 Patient compliance is crucial for achieving optimal outcomes in clear aligner (CA) therapy. Compliance may be influenced by various factors, including demographics, level of education, doctor-patient interaction, and personality traits based on the Big Five Inventory (BFI), which assesses openness, conscientiousness, extraversion, agreeableness, and neuroticism. This study investigates the relationship between personality traits and compliance among CA patients.

METHODS

 A cross-sectional study was conducted with 67 participants aged 12-60 undergoing CA treatment in Jeddah, Saudi Arabia. Patients completed an online questionnaire that assessed compliance behavior and personality traits using the BFI-10 tool. Data were statistically analyzed using SPSS software, version 26 (IBM Corp., Armonk, NY), to examine correlations between personality traits, demographic factors, and adherence to CA therapy. Compliance was scored based on adherence to follow-up visits and aligner wear time.

RESULT

 The study revealed that 34 participants (50.75%) demonstrated high adherence to the prescribed regimen. Males showed significantly higher compliance than females (p ≤ 0.05). Participants aged 12-34 exhibited the highest adherence rates (p ≤ 0.05), and those undergoing treatment for one year or less were also more compliant (p ≤ 0.05). Notably, satisfaction with one's smile did not significantly correlate with adherence (p > 0.05), contradicting the assumption that dissatisfaction with appearance drives better compliance. Furthermore, no significant association was identified between personality traits across any BFI domain and adherence.

CONCLUSION

 Despite the hypothesis that personality traits influence patient compliance, this study did not find a significant correlation. These findings suggest that factors other than personality traits may be more critical to adhering to CA treatment. The results highlight the need for further research to explore additional variables that may impact patient compliance in orthodontic therapy.

Long-term effects of orthodontic interceptive expansion treatment : A retrospective study

PURPOSE

The aim of this retrospective cohort study was to evaluate the long-term effects of interceptive orthodontic treatment with a removable expansion plate, based on transversal, sagittal, and vertical parameters.

METHODS

A total of 90 patients needing interceptive treatment due to a crossbite or space deficiency were included. Records consisting of clinical photos, radiographs, and digital dental casts were collected for evaluation at two time points: the start of interceptive treatment (T0) and the start of comprehensive treatment (T1). Molar occlusion, overjet, overbite, presence and type of crossbite, mandibular shift, and transversal measurements were recorded for comparison.

RESULTS

After expansion with removable appliances, a significant increase in intermolar width was achieved and could be maintained over the observation period (p < 0.001). However, no significant changes regarding overjet, overbite, or molar sagittal occlusion were observed. Crossbite correction was successful in 86.9% of patients with unilateral crossbite and in 75.0% of patients with bilateral crossbite (p < 0.001).

CONCLUSION

Early expansion with a removable expansion plate is a successful method to correct crossbites and increase intermolar width in the early mixed dentition phase. Results remain stable until the start of comprehensive treatment in the permanent dentition.

The role of orthodontics in the management of tooth wear

Pathological tooth wear is a dental problem that affects all age groups and appears to be increasing in prevalence. A subset of these patients may benefit from a combination of orthodontic and restorative care which will be discussed in this article. Orthodontics can help to create the necessary vertical, anterior-posterior and mesio-distal space for restorative work, reducing the need for tooth reduction and lessening the biological costs of restorative care, helping to reposition the gingival margins where this impacts upon aesthetics, as well as correcting co-existing malocclusion.

Compliance with Headgear Evaluated by Force- and Temperature-Sensitive Monitoring Device: A Case-Control Study

The aim was to objectively assess compliance in patients prescribed headgear and evaluate the impact of monitoring awareness, treatment duration, gender, and age on compliance levels. A total of 22 patients with Class II malocclusion wore the headgear integrated with the force and temperature sensitive Smartgear monitoring system (Smartgear, Swissorthodontics AG, Cham, Switzerland). Patients were instructed to wear the headgear for 13 h daily over a 3-month period. Randomly, 11 patients were informed that they monitored and 11 were not informed. Data were organized using Microsoft Excel and analyzed using R for statistical estimates, graphs, and hypothesis testing. Smartgear recorded an average daily compliance of 6.7 h. No statistically significant differences were found in cooperation between study group and control group over the 3 months of treatment, regardless of gender and age. However, there was slight greater cooperation in the first month than in the other months, and patients ≤10 years of age had almost 2 h more cooperation than their older counterparts. Moreover, the informed group exhibited an average of 1.1 more hours of cooperation per day than the uninformed group, which may carry clinical significance. This cooperation primarily occurred at night and was found to be statistically significant. Compliance among young patients typically remained lower than the prescribed level, regardless of their gender and psychological maturity. Although an awareness of monitoring does not seem to improve compliance, implementing such systems could still offer dentists a valuable means of obtaining objective information about their patients' adherence.

Patient adherence in orthodontics: a protocol for a scoping review

BACKGROUND

Patient adherence is a key factor in achieving orthodontic success. While in recent years there have been changes in orthodontic healthcare, no recent comprehensive reviews regarding adherence in orthodontics are available. Therefore, the aim of this planned scoping review is to systematically map the available literature regarding patient adherence in orthodontics to identify factors associated with patient adherence and to investigate if there are knowledge gaps in the available literature.

METHODS/DESIGN

This protocol was drafted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) statement and the PRISMA extension for Scoping Reviews (PRISMA-ScR). For the methods Arksey and O'Malley's framework and the Reviewer's Manual of the Joanna Briggs Institute for conducting scoping reviews were consulted. The inclusion criteria for this scoping review are studies of all designs assessing any form of adherence in orthodontics, published in English from 2006 onwards. The exclusion criteria are studies investigating adherence in the following patients: those with an intellectual or physical disability that could affect their ability to coincide with their therapist's recommendations and advice, those with oral cleft and craniofacial conditions, and those solely treated for obstructive sleep apnoea. Case reports and studies published in non peer reviewed journals will also be excluded. The following electronic databases will be searched: Embase, PubMed, and Web of Science Core Collection. The following key terms will be used in the search strategies: 'treatment adherence and compliance', and 'orthodontics'. Multiple reviewers will independently screen the results and perform the data charting process. A narrative description will be provided for the analysis of the included studies. The results will be categorized into multiple topics based on recommendations by previous studies into patient adherence. Identified knowledge gaps will be reported and recommendations for future research will be suggested.

DISCUSSION

No systematic review has previously assessed this exact topic. Because of the broad-spectrum research questions and the expected widely scattered literature a scoping review approach was chosen over a systematic review approach. The Academic Centre for Dentistry Amsterdam (ACTA) has been conducting research in patient adherence in orthodontics up to 2006 and therefore only studies published from 2006 onwards will be researched in this review. Identifying knowledge gaps and summarizing and disseminating research findings on this topic is important for every dental professional performing orthodontic treatment. This protocol is registered in the Open Science Framework: https://osf.io/ec6qd.

Patient adherence in orthodontics: a scoping review

BACKGROUND

Patient adherence is a key factor in achieving orthodontic treatment success. Despite an evolution in orthodontic healthcare, no recent comprehensive reviews are available on patient adherence in orthodontics. This scoping review provides an evidence-based overview of the literature available on multiple aspects of patient adherence in orthodontics, during both active treatment as well as during the retention phase. Knowledge gaps identified in the literature are listed.

METHODS

The protocol for this scoping review was registered in the Open Science Framework ( https://doi.org/10.17605/OSF.IO/EC6QD ). Electronic databases and reference lists of relevant studies were searched up to 9 February 2023. The inclusion criteria were studies investigating any form of patient adherence in orthodontics published in English from 2006 onwards. The exclusion criteria were studies investigating adherence in the following patients: those with an intellectual or physical disability that could affect their ability to coincide with their therapist's recommendations and advice, those with oral cleft and craniofacial conditions, and those treated solely for obstructive sleep apnoea. Non-peer-reviewed studies and case reports were also excluded.

RESULTS

A total of 3284 articles were identified, 60 of which met the criteria for final inclusion.

CONCLUSIONS

There is no conclusive evidence on which factors have a significant impact on patient adherence and how patient adherence can be promoted. The degree of patient adherence is generally not compared to achieved treatment results or stability of treatment results, making it difficult to provide clear statements about the impact of the degree of adherence on desired treatment results or orthodontic stability.

The effect of text message reminders on compliance with Twin Block appliances: A randomised controlled trial

AIMS

The aim of this study was to evaluate whether text reminders influence patient compliance with Twin Block appliances. The null hypothesis was that there was no statistically significant differences in Twin Block compliance between those who receive text reminders and those that do not.

DESIGN

Single-blind parallel randomised controlled clinical trial.

SETTING

Health Service Executive (HSE) orthodontic outpatient clinic in Dublin, Ireland.

PARTICIPANTS

A total of 59 patients aged 11-15 years with a 5a Index of Orthodontic Treatment Need (IOTN grade) starting treatment with Twin Block appliances.

METHODS

A computer-generated unstratified allocation sequence was used to randomise the participants into the control group (CG) or the text group (TG). Both groups were asked to wear their appliances full-time. In addition to the same verbal and written instruction received by the CG, the TG received text message reminders, every 3 days, to wear their appliances. The primary outcome measure was wear time reported by Theramon® sensors embedded in the appliances. Data on wear time were uploaded from the Theramon® sensors onto cloud software. Participants in both groups were asked to fill out wear diaries and submit these at each visit. Treating clinicians and the primary investigator were blinded to the allocation group. Participants were followed up for 4 months. Participants were not blinded to their treatment group.

RESULTS

In total, 29 participants were allocated to the CG and 30 to the TG. The data for 53 participants were analysed, 24 from the CG and 29 from the TG. The median hours/day of wear recorded using the Theramon® sensors was 13.77 (interquartile range [IQR] = 10.19) for the CG and 17.72 (IQR = 5.62) for the TG. The difference in wear time recorded was not statistically significant (P = 0.16).

CONCLUSION

The study concluded that text message reminders had no statistically significant influence on patient compliance with Twin Block appliances.

Contemporary Twin Block appliance wear protocols: A survey of UK orthodontists

OBJECTIVE

This study was undertaken to determine contemporary trends in the use of the Twin Block appliance among UK orthodontists, including the wear time currently prescribed. In addition, the study explored if there had been any change in wear time prescribed, considering recent research evidence proposing part-time wear.

DESIGN

Cross-sectional, online survey.

PARTICIPANTS

Members of the British Orthodontic Society (BOS).

METHODS

The questionnaire was emailed to all BOS members in November 2021 and hosted on the QualtricsXM platform. The questionnaire was piloted for content validity and tested for reliability.

RESULTS

A response rate of 19% was attained. Nearly all (n = 244, 99%) participants used the Twin Block, and 90% (n = 218) prescribed full-time wear including/excluding eating. Although the majority (n = 168, 69%) had not made changes to their wear time prescriptions, nearly one-third (n = 75, 31%) had. Those who reported a change in their prescriptions currently prescribe less wear time than before, and commonly quoted 'research evidence' as the reason. A wide range in success rates (41%-100%) was reported, with patient compliance as the main reason for treatment discontinuation.

CONCLUSION

The Twin Block is a popular functional appliance among orthodontists in the UK, originally designed by Clark to be worn full time to maximise functional forces applied to the dentition. However, this wear regime may place considerable strain on patient compliance. Most participants prescribed full-time Twin Block wear excluding eating. Approximately one-third of orthodontists made changes to their wear time prescriptions during their practising career, and currently instruct less wear time than before.

Orthodontic treatment and biological limits: a retrospective clinical trial

BACKGROUND

The fundamental part of every successful orthodontic treatment is the detailed treatment planning including a precise determination of the virtual treatment objective (VTO) while considering the biological and anatomical limits. The aim of this study is to investigate and to compare the feasibility of the established reference values before and after orthodontic treatment and to determine the usefulness of this parameters as guidance for the sagittal anterior, sagittal posterior and transverse biological boundaries.

MATERIALS AND METHODS

Thirty-two patients aged 9 to 18 years (12 male and 20 female) with all permanent teeth present were randomly selected for orthodontic treatment with fixed multibracket appliance regardless of the potential malocclusion. The parameters 6-PTV, 1-NB [mm] and the WALA ridge were set for the identification of the transverse, sagittal anterior and sagittal posterior tooth position. The measurements were carried out at the beginning (T0) and at the end (T1) of the orthodontic treatment. They were set in relation with their individual threshold values (G). After the results of the measurements were conducted using the software OnyxCeph3TM (version 3.2.185 (505), Image Instruments GmbH, Chemnitz, DE), they were statistically calculated in the software RStudio (2022.12.0 Build 353 © 2009-2022 Posit Software PBC).

RESULTS

Among the 32 patients, the mean pre- and post-treatment changes measured through the three parameters in relation to the individual reference values were statistically significant (p < 0.01). The mean values for 6-PTV, 1-NB and the WALA ridge amounted 15.37 mm, 2.56 mm and 4.23 mm at the beginning of the treatment, while after the treatment the measured values amounted 20.31 mm, 2.4 mm and 5.55 mm. These measurements combined with the statistical analysis of the changes of WALA ridge (T0, T1) confirmed that the teeth have been successfully uprighted and aligned. Furthermore, the maxillary first molars have been moved slightly mesially, as proven by the changes in 6-PTV, without certainty as to whether bodily movement or mesial tipping took place. Additionally, the lower incisors have been protruded, slightly exceeding the individual threshold values.

CONCLUSION

The parameters investigated provide a suitable assessment tool for recording the limits of the sagittal posterior, the sagittal anterior and the transverse dimension.

Three-dimensional Evaluation of the Carriere Motion 3D Appliance in the treatment of Class II malocclusion

INTRODUCTION

This study aimed to quantify the outcomes of adolescent patients with Class II malocclusion treated with the Carriere Motion 3D Appliance (CMA) combined with full fixed appliances.

METHODS

Cone-beam computed tomography scans of 22 patients were available before orthodontic treatment (T1), at removal of the CMA (T2), and posttreatment (T3). The average age of the patients was 13.5 ± 1.6 years at T1, 14.1 ± 0.2 years at T2, and 15.6 ± 0.5 years at T3. The 3-dimensional image analysis procedures were performed using ITK-SNAP (version 3.6.0; www.itksnap.org, Hatfield, Pa) and SlicerCMF (version 4.11.0; http://www.slicer.org, Cambridge, Mass); skeletal and dentoalveolar changes relative to cranial base, maxillary, and mandibular regional superimpositions were evaluated.

RESULTS

Changes were analyzed with 1 sample t tests using the mean differences during the CMA phase (T1 to T2) and total treatment time (T1 to T3). Significant skeletal changes included a slight reduction of ANB from T1 to T3, mandibular growth (Co-Gn increment of 1.2 mm and 3.3 mm from T1 to T2 and T1 to T3, respectively), inferior displacement of point A, and anterior and inferior displacement of point B. The mandibular plane did not change significantly during treatment. During the CMA treatment, posterior tipping and distal rotation of the maxillary molars, tip back and inferior displacement of the maxillary canines, significant mesial rotation, and superior displacement of the mandibular molars were observed. These movements rebounded during the full fixed appliance phase except for the molar and canine vertical displacements. Clinically significant dental changes during treatment included a reduction in overjet and overbite, Class II correction of the molar and canine relationship, and proclination of the mandibular incisors.

CONCLUSIONS

The CMA is an effective treatment modality for Class II correction in growing patients because of a combination of mesial movement of the mandibular molar, distal rotation of the maxillary molar, and anterior displacement of the mandible.

Assessment of the efficacy of various maxillary molar intrusion therapies: a systematic review

AIMS

To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of intrusion, subsequent vertical movement of mandibular molars, cost effectiveness, compliance, patient reported outcomes and adverse events.

METHODS

A pre-registered and comprehensive literature search of published and unpublished trials until March 22nd 2023 with no language restriction applied in PubMed/Medline, Embase, Scopus, DOSS, CENTRAL, CINAHL Plus with Full Text, Web of Science, Global Index Medicus, Dissertation and Theses Global, ClinicalTrials.gov, and Trip (PROSPERO: CRD42022310562). Randomized controlled trials involving a comparative assessment of treatment modalities used to intrude maxillary molars were included. Pre-piloted data extraction forms were used. The Cochrane Risk of Bias tool was used for risk of bias assessment, and The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for certainty of evidence appraisal.

RESULTS

A total of 3986 records were identified through the electronic data search, of which 24 reports were sought for retrieval. Of these, 7 trials were included. One trial was judged at high risk of bias, while the others had some concerns. Based on individual small sample studies, maxillary molar intrusion was achieved using temporary anchorage devices (TADs) and rapid molar intruder appliance (RMI). It was also observed to a lesser extent with the use of open bite bionator (OBB) and posterior bite blocks. The molar intruder appliance and the posterior bite blocks (spring-loaded or magnetic) also intruded the lower molars. Root resorption was reported in two studies involving TADs. None of the identified studies involved a comparison of conventional and TAD-based treatments for intrusion of molars. No studies reported outcomes concerning stability, cost-effectiveness, compliance and patient-reported outcomes. Insufficient homogeneity between the included trials precluded quantitative synthesis. The level of evidence was very low.

CONCLUSIONS

Maxillary molar intrusion can be attained with different appliances (removable and fixed) and with the use of temporary anchorage devices. Posterior bite blocks (spring-loaded or magnetic) and the RMI offer the additional advantage of intruding the mandibular molars. However, stability of the achieved maxillary molar intrusion long term is unclear. Further high-quality randomized controlled trials are needed.

The use of the Hanks Herbst vs Twin-block in Class II malocclusion: A randomized controlled trial

INTRODUCTION

This 2-arm parallel study aimed to compare and evaluate the efficiency of Hanks Herbst (HH) and Twin-block (TB) functional appliances in treating adolescents with Class II malocclusion.

METHODS

A parallel-group randomized controlled trial was undertaken in a single United Kingdom hospital. Eighty participants were recruited and randomized in a 1:1 ratio to receive either the HH or TB appliance. Eligibility criteria included children aged 10-14 years with an overjet of ≥7 mm without dental anomalies. The primary outcome was the time (in months) required to reduce overjet to normal limits (<4 mm). Secondary outcomes included treatment failure rates, complications and their impact on oral health-related quality of life (OHRQOL). Randomization was accomplished using electronic software with allocation concealed using sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for outcome assessment. Data were analyzed using descriptive statistics and regression analyses to detect between-group differences, including Cox regression for time to treatment success.

RESULTS

HH was significantly faster than TB in reducing the overjet to within normal limits (95% confidence interval [CI], -3.00 to -0.03; P = 0.046). Mean overjet reduction was more efficient with the HH than the TB appliance (ß = 1.3; 95% CI, 0.04-2.40; P = 0.04). Fifteen (37.5%) of the participants in the TB group and 7 (17.5%) in the HH group failed to complete the treatment (hazard ratio = 0.54; 95% CI, 0.32-0.91, P = 0.02). However, TB was associated with fewer routine (incidence rate ratio = 0.81; 95% CI, 0.7-0.9; P = 0.004) and emergency (incidence rate ratio = 0.1; 95% CI, 0.1-0.3; P = 0.001) visits. Chairside time was greater with the HH (ß = 2.7; 95% CI, 1.8-3.6, P = 0.001). Participants in both groups experienced complications with similar frequency. A greater deterioration in OHRQOL was found during treatment with the TB.

CONCLUSIONS

Treatment with HH resulted in more efficient and predictable overjet reduction than TB. More treatment discontinuation and greater deterioration in OHRQOL were observed with the TB. However, HH was associated with more routine and emergency visits.

REGISTRATION

ISRCTN11717011.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

No specific external or internal funding was provided. Treatment for participants was provided as part of routine orthodontic treatment in the hospital.

Cervical headgear therapy and sleep-related attributes

INTRODUCTION

The study aimed to assess (1) the effect of the treatment with cervical headgear on patients' sleep-related attributes and well-being and (2) whether these sleep-related parameters (ie, sleep quality and quantity) were associated with patients' compliance during the orthodontic treatment.

METHODS

The study protocol was based on a prospective longitudinal quasi-experimental design. Participants (n = 26; 9 males; mean age, 12.4 ± 1.68 years) were patients in the Postgraduate Orthodontic Clinic, National and Kapodistrian University of Athens. All patients received treatment with a cervical headgear having an embedded TheraMon microsensor. Sleep was assessed by wrist-worn actigraphy for 59 ± 19 days. The Epworth Sleepiness Scale was used to assess average daytime sleepiness, whereas we used the Athens Insomnia Scale for insomnia symptoms. Oral health-related quality of life (OHRQOL) was assessed by the Oral Health Impact Profile (OHIP-14).

RESULTS

Patients slept on average 7.35 ± 0.42 h/d. Compared with the lowest sleep duration recommended for their age group, patients had an average chronic sleep deficit of 1.40 ± 0.49 h/d. Patients wore the headgear 90.9% of the days for 10.40 ± 4.17 h/d. However, only 7 (28%) patients reached or exceeded the wear-time recommendation of 12 h/d. In contrast, 2 (8%) patients wore headgear <5 h/d, 11 (44%) 5-10 h/d, and 12 (48%) patients wore headgear >10 h/d. Aggregated by participants, the median Epworth Sleepiness Scale score during the study was 3.40 (interquartile range [IQR], 4.85; range, 0.2-13.6), the median Athens Insomnia Scale score was 3.00 (IQR, 4.25; range, 0-7), and the median Oral Health Impact Profile score was 1.40 (IQR, 4.17; range, 0.0-20.8). Compared with patients who wore the orthodontic appliance >7.8 h/d, patients who wore it <7.8 h/d had worse average daytime sleepiness (P = 0.050) and worse OHRQOL (P = 0.019).

CONCLUSIONS

Orthodontic treatment with cervical headgear has no substantive negative effect on sleep attributes (quantity and quality), average daytime sleepiness and OHRQOL. However, poor compliance with orthodontic treatment seems to be associated with higher levels of daytime sleepiness.

Microbial adherence on vacuum-formed retainers with different surface roughness as constructed from conventional stone models and 3D printed models: a randomized controlled clinical trial

OBJECTIVE

This single center parallel, randomized controlled trial aimed to determine the propensity of microbial adherence on vacuum-formed retainers (VFRs) with different surface roughness imprints.

MATERIALS AND METHODS

Thirty-six patients debonded from fixed appliances at a teaching institution were allocated by block randomization stratified for gender to three groups [VFRs fabricated on conventional, fused deposition modeling (FDM) or stereolithography apparatus (SLA) working models]. Participants wore the VFRs for three months full-time followed by three months part-time. VFRs were collected after each follow-up for Streptococcus and yeast counts. Surface roughness was measured indirectly on the working models using a 3D optical surface texture analyzer. Blinding was not feasible due to appliance appearance. The trial was registered [NCT03844425 ( ClinicalTrials.gov )] and funded by the Universiti Malaya Dental Postgraduate Research Grant (DPRG/14/19).

RESULTS

Thirty participants (eleven conventional, ten FDM, and nine SLA) were analyzed after six dropped out. No harms were reported. Microbial counts between the groups were not significantly different. There were more microbes in the lower VFRs than upper VFRs (total count: p<0.05; effect size, 0.5 during full-time wear and 0.4 during part-time wear). SLA had significantly (p<0.05) smoother surface than FDM (effect size, 0.3) and conventional models (effect size, 0.5). Microbial adherence was not associated with working model surface roughness.

CONCLUSION

Microbial adherence on VFRs was not influenced by degree of surface roughness imprints from working models.

CLINICAL RELEVANCE

3D printed models can be used to make VFRs. Lower VFRs tended to accumulate oral microbes, potentially increasing the oral health risk in the lower arch.

Orthodontic treatment with miniscrew anchorage: Analysis of quality of information on YouTube

INTRODUCTION

The evaluation of the quality of information (QOI) and clarity of information (COI) among oral health-related videos on the video-streaming Web site YouTube is scarce. This study evaluated QOI and COI regarding temporary anchorage devices contained within videos uploaded by dental professionals (DPs) on YouTube.

METHODS

YouTube videos were systematically acquired with 4 search terms. The top 50 videos per search term by the number of views were stored in a YouTube account. A set of inclusion/exclusion criteria were applied, videos were assessed for viewing characteristics, a 4-point scoring system (0-3) was applied to evaluate QOI in 10 predetermined domains, and a 3-point scoring system (0-2) was applied to evaluate COI. Descriptive statistical analyses and intrarater and interrater reliability tests were performed.

RESULTS

Strong intrarater and interrater reliability scores were observed. Sixty-three videos from the top 58 most-viewed DPs were viewed 1,395,471 times (range, 414-124,939). Most DPs originated from the United States (20%), and orthodontists (62%) uploaded most of the videos. The mean number of reported domains was 2.03 ± 2.40 (out of 10). The mean overall QOI score per domain was 0.36 ± 0.79 (out of 3). The "Placement of miniscrews" domain scored highest (1.23 ± 0.75). The "Cost of miniscrews placement" domain scored the lowest (0.03 ± 0.25). The mean overall QOI score per DP was 3.59 ± 5.64 (out of 30). The COI in 32 videos was immeasurable, and only 2 avoided using technical words.

CONCLUSIONS

The QOI related to temporary anchorage devices contained within videos provided by DPs through the YouTube Web site is deficient, particularly in the cost of placement. Orthodontists should be aware of the importance of YouTube as an information resource and ensure that videos related to temporary anchorage devices contain comprehensive and evidence-based information.

Fixed and removable orthodontic retainers, effects on periodontal health compared: A systematic review

The aim of this systematic review is to analyze the properties of the different types of orthodontic retainers, identify their differences and define which type of device is most effective and less harmful to periodontal health.

Methods

A literature search was carried out by a reviewer by consulting PubMed, Lilacs, Embase, Medline full text, Scopus, Web of Science, Cochrane library, and Science Direct electronic databases for biomedical and health literature as well as the grey literature and setting up the search from December 2010 without any restriction about articles languages.

Results

The results showed that patients who wear retainers for a long period have significant differences in clinical parameters compared to patients without retainers. The type of retainer chosen also significantly influences the overall periodontal health of patients. Fixed retainers, both glass-fibre reinforced and steel wire retainers, proved to be the retainer type with the highest plaque and calculus accumulation values compared to removable retainers. In addition, among fixed retainers, glass-fibre reinforced retainers proved to be those that mostly promote the plaque and calculus accumulation in the application site.

Conclusion

Fixed retainers are the best devices to maintain the alignment of mandibular anterior teeth in the long term. Among these devices, stainless steel lingual retainers, plain or braided, should remain the first choice. Although they are also susceptible to periodontal complications, their effect on periodontal health can be considered statistically insignificant if compared to glass-fibre reinforced retainers which, showing worse periodontal complications, should not be used.

The effectiveness of adjuncts or alternatives to the use of orthodontic retainers in preserving posttreatment outcomes: A systematic review

INTRODUCTION

The objective of this study was to systematically evaluate the efficacy of adjuncts or alternatives to mechanical retention in preserving postorthodontic treatment outcomes.

METHODS

Electronic databases, unpublished literature, and ongoing trials were searched until July 22, 2022 (PROSPERO CRD42021291165). Randomized and nonrandomized controlled trials investigating the efficacy of adjuncts and alternatives to conventional orthodontic retainers were included. Stability, periodontal effects, cost-effectiveness, and patient-reported outcomes were to be evaluated. The Cochrane Risk of Bias Tool and Risk of Bias In Nonrandomized Studies of Interventions (ROBINS-I) were used for risk of bias assessment. The certainty of the evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation system. Exploratory sensitivity analysis was undertaken to calculate the weighted treatment effects of the intervention.

RESULTS

A total of 5128 records were screened. Seven trials fulfilled the inclusion criteria, of which 5 were randomized controlled trials. Five trials were judged to be at high risk of bias, with 2 studies of unclear risk of bias. Heterogeneity between the limited number of included studies precluded the conduct of meta-analysis. Circumferential supracrestal fibrotomy resulted in less increase in the mandibular Little's Irregularity Index (mean difference, -2.30 mm; 95% confidence interval, -2.86 to -1.74). The overall level of evidence was of very low quality.

CONCLUSIONS

Adjuncts and alternatives to mechanical retention have promise, but based on the existing evidence, the reliance on mechanical retention cannot be reduced. There is weak evidence supporting circumferential supracrestal fibrotomy to improve stability outcomes. Further high-quality prospective research focusing on the predictability and acceptability of these approaches is needed.

The development of a novel Orthodontic Alignment Index and its use to evaluate the effect of residual overjet on the stability of the alignment of the maxillary anterior dentition

BACKGROUND

It is thought that achieving a normal overjet may help to stabilise the alignment of the maxillary anterior dentition. Little's Irregularity Index is limited in assessing discrete post-orthodontic changes, fails to account for reciprocal rotations and is not sensitive to dental changes in three planes. A more holistic tool for the assessment of post-treatment change is therefore required.

AIM

To compare the post-treatment stability of maxillary anterior dental alignment in subjects treated either to a Class I incisor relationship or an increased overjet (> 4 mm) following fixed appliance-based orthodontics using a novel measurement tool.

MATERIALS AND METHODS

The Orthodontic Alignment Index (OAI) was developed and validated using a panel of 63 raters. The new index accounts for a range of weighted features including contact point displacement, spacing, reciprocal rotations, inclination, angulation and vertical discrepancy. A retrospective cohort study was undertaken at the Institute of Dentistry, Queen Mary University of London. Recruitment took place over a 4-year period. All participants had removable retainers in the maxillary arch only. The stability of maxillary anterior teeth was assessed using Little's Irregularity Index (LII) and the OAI. Subjects were recruited at least 12 months following completion of dual-arch fixed appliance-based treatment.

RESULTS

Eighty-two participants were included with a positive correlation observed between LII and OAI at the 12-month post-treatment review with a 1-mm increase in LII associated with a 2-point increase in the OAI (P < 0.001). Limited relapse was observed in both groups: normal overjet group (OAI = 1.28; LII = 0.52); residual overjet group (OAI = 0.88; LII = 0.47). Median regression analysis failed to identify a significant association between an increased overjet at debond and the alignment of the maxillary anterior segment when assessed with OAI (P = 0.389) and LII (P = 0.577). Furthermore, age, gender, extraction protocols and retention regime were not predictive of post-treatment change.

CONCLUSIONS

Using a novel index (OAI) and LII, there was limited post-treatment relapse in alignment of the maxillary anterior dentition over a 12-month period. Based on this retrospective evaluation, achieving a normal overjet at the end of treatment may have little bearing on the post-treatment stability of maxillary anterior alignment at 12 months.

Effect of electronic reminders on patients' compliance during clear aligner treatment: an interrupted time series study

Patient compliance is relevant to achieving therapeutic goals during clear aligner therapy (CAT). The aim of this study was to evaluate the efficacy of remote electronic (e-)reminders and e-feedback on compliance during CAT using an interrupted time series (ITS) analysis. We used routinely collected mobile application data from a German healthtech company (PlusDental, Berlin). Our primary outcome was self-reported compliance (aligner wear time min. 22 h on 75% of their aligners were classified as fully compliant, min. 22 h on 50-74.9% of their aligners: fairly compliant; min. 22 h on < 50% of their aligners: poorly compliant). E-reminders and e-feedback were introduced in the 1st quarter of 2020. Compliance was assessed at semi-monthly intervals from June-December 2019 (n = 1899) and June-December 2020 (n = 5486), resulting in a pre- and post-intervention group. ITS and segmented regression modelling were used to estimate the effect on the change in levels and trends of poor compliance. Pre-intervention, poor compliance was at 24.47% (95% CI: 22.59% to 26.46%). After the introduction of e-reminders and e-feedback (i.e., post-intervention), the percentage of poorly compliant patients decreased substantially, levelling off at 9.32% (95% CI: 8.31% to 10.45%). E-reminders and e-feedback were effective for increasing compliance in CAT patients.Clinical Significance: Orthodontists and dentists may consider digital monitoring and e-reminders to improve compliance and increase treatment success.

Orthodontic Compliance Assessment: A Systematic Review

OBJECTIVES

The aim of this review was to determine whether the type of removable appliance, as well as the age and sex of the patient, may affect the extension or reduction of wear time by assessing the correlation between the mean actual and orthodontist-recommended wear times.

METHODS

Randomised case control trials, cohort studies, case series, observational studies, reviews, and retrospective analyses were identified. The quality of the studies was assessed using the Cochrane Collaboration Tool and modified Newcastle-Ottawa Scale. The electronic databases Embase, PubMed, Scopus, and Web of Science were reviewed, and 542 articles were obtained, of which 31 were qualified for qualitative synthesis. The data from 1674 participants were collected and a weighted average was determined for the mean wear time of each appliance.

RESULTS

Regardless of the type of extra- or intraoral appliances, mean wear time was shorter than recommended, although patients using intraoral appliances cooperated more. The best compliance was noted for Schwarz appliances (73.70%) and plate retainers (85%). There was no evidence of an influence of patients' age and sex on compliance during treatment.

CONCLUSIONS

The considerable inconsistency and imprecision of articles could affect the reliability of the results. Previous studies analysing the effectiveness of treatment with removable appliances based on an arbitrarily assumed average wear time need to be revised in order to verify the actual wear time with the use of microsensors.

Comparing Distal-Jet with Dental Anchorage to Distal-Jet with Skeletal Anchorage: A Prospective Parallel Cohort Study

The use of traditional intra-oral devices in maxillary molar distalization is not without undesirable consequences. The aim of the present study was to compare the miniscrew-supported distal-jet appliance to a traditional distal-jet appliance by evaluating the amount of upper first molar distalization and the dentoalveolar side effects. Data of 600 subjects visited at the orthodontic unit of Sapienza University of Rom were analyzed. Only 46 patients met the inclusion criteria and were selected and treated. Subjects were assigned randomly to receive treatment either with miniscrew-supported distal-jet appliance (Group A) or with a traditional distal-jet appliance (Group B). In Group A, miniscrews were inserted using a computer-guided surgical guide. The amount of upper first molar distalization and the dentoalveolar side effects were assessed both on the digital casts and on the lateral cephalometric radiograph at the end of the distalization phase. A descriptive statistical analysis that included the mean values and the standard deviation was conducted to evaluate the molar distalization and the dentoalveolar effects in two groups. Intergroup differences were determined using the Student’s t-test. The significance was set at p ≤ 0.05. In Group A, greater maxillary first molar distalization and a spontaneous distalization of the first premolars and a palatal inclination of central incisors were observed. By contrast, in Group B, the first premolars tipped mesially and a proclination of the maxillary central incisors was observed. In both groups, the transverse widths of the dental arch increased while a greater tendency of first premolar extrusion and of maxillary first molar rotation was observed in Group B. The skeletal anchorage device achieved greater first molar distalization and did not cause dento-alveolar side effects.

Association of Craniofacial Patterns with the Curve of Spee and the Time Required for Orthodontic Levelling

The curve of Spee (CoS) is an important parameter for an individualized treatment plan. The available information regarding a potential association of the depth of the curve of Spee with various skeletal craniofacial characteristics is conflicting and it is also unknown whether certain craniofacial parameters affect the duration of the levelling phase of orthodontic treatment. A prospective sample of 32 patients with mild to moderate crowding that underwent orthodontic treatment with full fixed appliances was used to study these topics. The craniofacial characteristics were captured on pre-treatment lateral cephalometric radiographs and measurements of the CoS were performed on the initial 3D digital dental models using the Viewbox 4 software. Non-parametric statistics and Spearman’s correlations were applied. Weak negative correlations were detected between the CoS depth and the SNA and SNB angles. There was no other association between the CoS and craniofacial parameters, including various anteroposterior measurements. Furthermore, there was no significant association of any craniofacial parameter with the duration of the levelling. Contrary to certain clinical beliefs, it can be argued that the craniofacial characteristics are not associated with the CoS and the time required for its levelling in subjects with moderate pre-treatment CoS depth.

Patient compliance with Twin Block appliance during treatment of Class II malocclusion: a randomized controlled trial on two check-up prescriptions

BACKGROUND

Compliance is crucial for the treatment outcome with removable appliances. Previous studies on treatment with the Twin Block appliance have focused on effectiveness in relation to other treatment methods or wear-time. Studies on different check-up intervals to improve compliance seem to be lacking.

OBJECTIVES

To compare the impact of two different check-up prescriptions on patient compliance and treatment outcome during treatment with Twin Block.

TRIAL DESIGN

Two-arm parallel group, single-centre, randomized controlled trial.

MATERIALS AND METHODS

Seventy-three patients, 38 boys, and 35 girls, mean age 11.2 years, were included and block-randomized into two groups treated with a Twin Block appliance. Group 1 was called for check-up visit every sixth week and group 2 every fourth week. Compliance was evaluated with a TheraMon® microsensor, moulded into the appliance, measuring wear-time. Overjet, overbite, and molar relationships were assessed on study casts before and after treatment. The treatment outcomes were analysed on an intention-to-treat basis.

RESULTS

In group 1, the reduction of overjet was 5.2 mm and the mean wear-time was 6.9 hours. In group 2, the reduction was 4.7 mm and the wear-time was 6.1 hours. Seventy-four per cent of the patients presented an overjet of 4 mm or less. Wear-time did not correlate to age, gender, or severity of malocclusion.

HARMS

No harm was observed in any patient. Lateral open bites were registered during treatment but were normalized at the end of the treatment.

LIMITATIONS

The trial was a single-centre study and long-term effects were not evaluated.

CONCLUSIONS

During treatment with the Twin Block appliance, a 4-week check-up interval did not improve treatment outcome or increase wear-time, compared to a 6-week check-up interval. The mean wear-time was 6.5 hours per day, even if the recommendation was 12 hours.

CLINICAL TRIAL REGISTRATION

NCT05155774.

Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review

This review aims to analyze the multiple factors affecting patients’ level of compliance (how much they wear removable devices/clear aligners) during orthodontic treatments and to investigate the available methods and devices to monitor the appliance wearing time and to improve it. A literature search was conducted on electronic databases (Pubmed, Scopus, and Google Scholar). The results of the present study suggest that compliance indicators may misestimate the intraoral wearing time. Compliance is affected by patient-related factors (age, personality traits, the importance of personal appearance, self-perception of malocclusion), appliance-related factors (visibility, pain/discomfort), and clinician-related factors (trust, clear and complete communication, motivation). The motivation of pre-pubertal patients is mostly external, while adolescents/young adults have intrinsic motivation for orthodontic treatment. Patients’ self-reports tend to overestimate the appliance wearing time. Even if there is a lack of evidence, teledentistry might improve patients’ awareness of being monitored, thus increasing the time for which orthodontic devices are worn. Compliance is a key factor for clear aligner treatments, but high-quality studies focusing on this aspect are missing. Further studies should focus on how to handle the lack of cooperation and how to increase compliance in order to maximize the treatment’s results.

Predicting patient experience of Invisalign treatment: An analysis using artificial neural network

Objective

Poor experience with Invisalign treatment affects patient compliance and, thus, treatment outcome. Knowing the potential discomfort level in advance can help orthodontists better prepare the patient to overcome the difficult stage. This study aimed to construct artificial neural networks (ANNs) to predict patient experience in the early stages of Invisalign treatment.

Methods

In total, 196 patients were enrolled. Data collection included questionnaires on pain, anxiety, and quality of life (QoL). A four-layer fully connected multilayer perception with three backpropagations was constructed to predict patient experience of the treatment. The input data comprised 17 clinical features. The partial derivative method was used to calculate the relative contributions of each input in the ANNs.

Results

The predictive success rates for pain, anxiety, and QoL were 87.7%, 93.4%, and 92.4%, respectively. ANNs for predicting pain, anxiety, and QoL yielded areas under the curve of 0.963, 0.992, and 0.982, respectively. The number of teeth with lingual attachments was the most important factor affecting the outcome of negative experience, followed by the number of lingual buttons and upper incisors with attachments.

Conclusions

The constructed ANNs in this preliminary study show good accuracy in predicting patient experience (i.e., pain, anxiety, and QoL) of Invisalign treatment. Artificial intelligence system developed for predicting patient comfort has potential for clinical application to enhance patient compliance.

Clear aligner treatment for a four-year-old patient with anterior cross-bite and facial asymmetry: A case report

BACKGROUND

Clear aligners have been widely used to treat malocclusions from crowding, extraction cases to orthodontic-orthognathic cases, and practitioners are exploring the border of it. For the first time, clear aligners were used to early intervene anterior cross-bite and facial asymmetry.

CASE SUMMARY

This case report described a four-year-old child presented with anterior cross-bite and facial asymmetry associated with functional mandibular shift, who had undergone a failed treatment with conventional appliances. The total treatment time was 18 weeks, and a stable outcome was obtained.

CONCLUSION

The increasing need in early treatment highlights the need for clinicians to thoroughly investigate for the patient regarding clinical manifestation as well as patient compliance. We hope that our case will be contemplated by clinicians when seeking for treatment alternatives.

Evaluation of the effectiveness of modified aligner appliance with nickel-titanium springs in treatment of mild crowding of lower incisors: A randomized controlled clinical trial

BACKGROUND

This study aimed to evaluate the effectiveness of modified aligner appliances with nickel-titanium springs (MAAs) in treating mild mandibular crowding and assess the overall alignment treatment duration, alignment improvement percentage, and mandibular incisor proclination.

METHODS

This two-armed, parallel-group randomized controlled trial included 36 patients (7 men, 29 women) with mild mandibular incisor crowding according to Little's Irregularity Index. Patients were randomly assigned to two groups: the MAA group (mean age = 22.56 ± 3.50 years) and the conventional fixed bracket group (control group; mean age = 20.89 ± 2.90 years). The duration of alignment treatment of the lower anterior teeth was calculated. The progress of alignment was evaluated every 2 weeks on the study casts, which were taken at fixed intervals: pretreatment (T0) and 2 (T1), 4 (T2), 6 (T3), and 8 (T4) weeks after beginning the treatment. Change of mandibular incisor proclination was evaluated by measuring and comparing pretreatment and postalignment lateral cephalograms.

RESULTS

No statistically significant difference was detected between the two groups in terms of alignment treatment duration (P = 0.097), whereas a significant difference was observed in the alignment improvement percentage at T1 (P = 0.000), T2 (P = 0.001), and T3 (P = 0.022). In addition, the MAA group had a lower change of mandibular incisor proclination than the control group (P = 0.000).

CONCLUSIONS

The clinical application of MAAs may be effective in lower incisor decrowding, with a reduction in lower incisor inclination compared with conventional fixed brackets. This trial was registered at ClinicalTrials.gov (identifier: NCT04988373).

The Use of Microsensors to Assess the Daily Wear Time of Removable Orthodontic Appliances: A Prospective Cohort Study

Orthodontic treatment with removable appliances is still common in children and adolescents. However, their effectiveness depends primarily on the patients’ compliance. Currently, it is possible to check the daily wear time (DWT) of the removable appliances using special microsensors. The aim of this prospective cohort study was to assess the degree of patients’ compliance depending on the type of removable appliance used. In total, 167 patients (87 F, 80 M) were enrolled in the study and were treated with block appliances (Klammt, Twin-Block), Schwarz plates, and block appliances in combination with headgear. All patients were followed up for 6 months with the mean daily wear time checked at followup visits using TheraMon^® microsensors fitted in the appliances. It has been shown that the type of appliance influences the patients’ compliance. The DWT for the Twin Block was significantly longer compared to the DWT for the other appliances. Girls have been shown to wear removable appliances better than boys. It has been proven that the majority of patients do not follow the orthodontist’s recommendations, wearing removable appliances for just over half of the recommended time. Microsensors can be used for objective verification of patients’ compliance, which allows for a reliable assessment of the effectiveness of treatment with removable appliances.

Adolescents' perception of malocclusion, their motivations, and expectations concerning the orthodontic treatment. Is it all about attractiveness? A qualitative study

INTRODUCTION

In addition to essential clinical parameters, orthodontic treatment outcomes should also consider patients' opinions and perceptions, which could be comprehensively clarified with a qualitative scientific approach. Considering that the information on younger patients' views is scarce, the objective of this study was to investigate how adolescent orthodontic patients perceive malocclusion, and their motivations and expectations concerning orthodontic corrective treatment.

METHODS

In this descriptive qualitative study, 12 adolescents aged 12 to 14 years and of both genders, covering a heterogeneous collection of malocclusions, were recruited from the waiting list of an Orthodontics Graduate Course. They were individually interviewed before the appliance insertion by an experienced researcher using an interview guide and photographic records to stimulate patients' self-perception of their oral condition. The interviews proceeded simultaneously with transcription analyses until saturation. After the transcription evaluation, the framework analysis technique was performed.

RESULTS

Data derived from the transcription analyses were grouped into 3 major themes: perceptions concerning the concepts of normality and abnormality regarding oral health; self-perceptions regarding malocclusion and other discrepancies; and motivations for seeking orthodontic treatment and expectations related to the results.

CONCLUSIONS

Attractiveness was exceptionally relevant among adolescent patients. Most interviewees seemed to focus their attention on esthetically upsetting dentofacial traits, which they expected to be corrected by orthodontic treatment. In addition to self-oriented appearance-driven motivations, parents, other health professionals, friends, and peers also influenced adolescents' perception of their need for treatment. The achievement of a normal dentofacial status seems to be closely attached to social and individual aspirations.

Dentoskeletal effects of early class III treatment protocol based on timing of intervention in children

Background

To detect the optimal timing of intervention based on different cervical vertebral maturation stage (CS1-2 vs. CS3-4) for the treatment of Class III malocclusion with early Class III protocol.

Methods

A total sample of 43 patients (23 females, 20 males) ranging between 7 and 13 years of age with dentoskeletal Class III malocclusion treated with the modified SEC III (Splints, Elastic and Chincup) protocol divided into two groups based on the cervical vertebral maturation stages (CS1-2 and CS3-4) was included in this retrospective observational longitudinal study. Patient compliance was assessed using a 2-point Likert scale. Statistical comparisons between the two groups were performed with independent sample t tests.

Results

No statistically significant differences for any of the cephalometric variables describing the baseline dentoskeletal features were found between the two groups except for the mandibular unit length that was significantly greater in the pubertal group (P = 0.005). The modified SEC III protocol produced favorable sagittal outcomes in both groups, whereas no statistically significant T1-T2 changes were found between the CS1-2 and CS3-4 groups for any of the angular and linear measurements. No significant differences were found in the prevalence rates of the degree of collaboration between the two groups (P = 1.000).

Conclusions

No significant differences between prepubertal and pubertal patients were found in the sagittal and vertical dentoskeletal changes with the modified SEC III protocol. Thus, this early Class III treatment produced similar favorable effects in growing subjects regardless of the cervical vertebral maturation stages from CS1 to CS4.

Correlation of twin-block appliance efficacy and wear durationas assessed with a compliance indicator

BACKGROUND

The aim of this study was to investigate the association between objective wear time and treatment efficacy of a twin block (TB) appliance.

METHODS

A TB appliance incorporating a compliance indicator was delivered to 44 children in the age group of 11-14 years (25 boys and 19 girls). Participants were instructed to wear the appliance full time and were recalled at 3-4- week intervals. Cephalograms and study models were taken at baseline and after 6 months of appliance therapy.

RESULTS

Data from 41 of the 44 participants were analyzed. A wide variation in daily wear time among participants was observed. Based on wear time, they were divided into full time (FT >17 h/d) and part time (PT < 12 h/d) wear groups. Mean wear durations were 20.86 hours in the FT-wear group and 9.55 hours in the PT-wear group. In skeletal changes, the ANB (A point, nasion, B point) angle was reduced by 2.69° in the FT-wear group, and 1.33° in the PT-wear group, and statistically significant increases were seen for the mandibular base measurement (Pg/OLp) in the FT-wear group (2.22mm), compared with those in the PT-wear group (0.44mm). . In dental changes, overjet were reduced by 3.91 mm and 2.0 mm in the FT-wear and PT-wear group, respectively. This difference was statistically significant.

CONCLUSIONS

Skeletal effects were pronounced in the FT-wear group, and dentoalveolar changes were comparable in the 2 wear groups. The maximum skeletal treatment effect of a TB appliance was found to occur with FT wear over a 6-month treatment period.

ADOLESCENTS WITH REMOVABLE CLASS II CORRECTORS EXPRESS HIGHER DISSATISFACTION AND ARE MORE LIKELY TO DISCONTINUE TREATMENT

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Pacha MM, Fleming PS, Johal A. Complications, impacts, and success rates of different approaches to treatment of Class II malocclusion in adolescents: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2020;158:477-494.e7. doi: 10.1016/j.ajodo.2020.03.021. Epub 2020 Sep 2. PMID: 32888735.

SOURCE OF FUNDING

There is no information about funding.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

The effectiveness of a bespoke mobile application in improving adherence with removable orthodontic retention over 12 months: A randomized controlled trial

INTRODUCTION

The primary aim was to analyze the effect of providing a mobile application (My Retainers) on adherence with removable retention.

METHODS

Eighty-four participants planned for thermoplastic retainers were randomly allocated to 2 groups. The intervention group was given access to a bespoke mobile application, while the control group was not given access. Baseline data were obtained at the removal of orthodontic appliances with follow-up at 3 months, 6 months, 9 months, and 12 months. The primary outcome was objectively assessed retainer wear recorded using a TheraMon microelectronic sensor (MC Technology GmbH, Hargelsberg, Austria). Secondary outcomes were stability and periodontal implications.

RESULTS

The objectively assessed wear time at 12 months was low in both groups, being marginally higher in the intervention (median, 3.09 h/d; interquartile range, 8.1) than the control group (median, 1.44 h/d; interquartile range, 9.22) with no between-group statistical difference (P = 0.30, 95% confidence interval [CI], -3.91 to 1.19). No statistically significant difference was identified between the groups in terms of stability and periodontal outcomes. Improvement in plaque scores (P <0.0001; 95% CI, -0.20 to 0.15) and bleeding on probing (P <0.0001, 95% CI, -0.23 to -0.12) was noted over time with no periodontal attachment loss detected over the study period.

CONCLUSIONS

Provision of the mobile application did not lead to improved adherence with thermoplastic retainer wear. Similarly, no benefit in respect of either occlusal stability or periodontal health was observed over the 12-month study period. Further novel approaches to improve adherence with retainer wear and oral hygiene measures are required.

REGISTRATION

NCT03224481.

PROTOCOL

Not published.

FUNDING

This work was supported by funding from the European Orthodontic Society.

The influence of mobile applications and social media-based interventions in producing behavior change among orthodontic patients: A systematic review and meta-analysis

INTRODUCTION

The objective of this project was to systematically review the effectiveness of mobile applications and social media-based interventions in producing a behavioral change in orthodontic patients.

METHODS

Electronic databases and reference lists of relevant studies were searched on March 1, 2021, with no language restrictions (PROSPERO: CRD42019157298). Randomized and nonrandomized controlled trials assessing the impact of mobile applications and social media-based interventions on orthodontic patients were identified. Primary outcomes included adherence to wear, appointment attendance, knowledge, oral health-related behaviors, oral hygiene levels, periodontal outcomes, and related iatrogenic effects. The quality of the included trials was assessed using the Cochrane risk of bias tools. A weighted treatment effect of interventions on periodontal outcomes was calculated. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system.

RESULTS

A total of 3617 articles were identified. Of these, 16 studies (14 randomized controlled trials and 2 nonrandomized controlled trials) were deemed eligible. Nine randomized controlled trials were judged to be of either low or unclear risk of bias. The intervention was favored in relation to gingival and plaque indexes, standardized mean difference: -0.81 (95% confidence intervals [CI], -1.35 to -0.28) and -0.91 (95% CI, -1.64 to -0.19), respectively. However, no significant effect was observed in bleeding on probing (standardized mean difference: -0.22; 95% CI, -0.5 to 0.05). The level of evidence was high in probing depth and bleeding on probing outcomes.

CONCLUSIONS

A very low to moderate level of evidence supports the effects of mobile applications and social media-based interventions in producing positive behavioral changes in orthodontic patients. Further high-quality trials would assist in further elucidating the potential of these approaches to influence orthodontic treatment outcomes and experiences.

Rehearsal's effect on long-term recall and comprehension of orthodontic informed consent

INTRODUCTION

The purpose of this study was to determine if written rehearsal of informed consent improved 6-month recall and comprehension compared with the current best practices.

METHODS

A consultation was provided and subjects read the modified informed consent document. They were randomized to group A (received the core and up to 4 custom elements of treatment, wrote what each image displayed) or group B (presentation of the 18 elements with core elements chunked at the end followed by up to 4 custom elements). Interviews recording knowledge recall/comprehension occurred immediately and after months later.

RESULTS

Overall, no significant differences in baseline or 6-month follow-up scores were found between groups. Initially, group A outperformed group B in some core domains. There were no significant differences between groups in the change of scores from initial to follow-up. Follow-up scores were significantly lower than baseline scores (P <0.05). Higher initial scores were associated with larger drops at follow-up. A decrease in knowledge >20% was common.

CONCLUSIONS

Overall the methods are comparable at baseline and 6-months. Initial content retention was roughly 60+%, with 6%-9% deterioration. For areas of treatment methods, risk, discomfort, and resorption at 6-months, the current processes failed the patient and left the practitioner vulnerable to risk management issues. Results support the rehearsal method with immediate feedback for misunderstandings as the preferred method for informed consent.

Orthodontic emergencies and mental state of Chinese orthodontic patients during the COVID-19 pandemic

Background

The ongoing COVID-19 pandemic postponed routine follow-up visits of many orthodontic patients, which compromised their treatment process and mental states. This study was aimed to assess orthodontic emergency occurrence and psychological states of Chinese orthodontic patients during this pandemic.

Methods

Orthodontic patients in China were invited to answer an anonymous online questionnaire from February 20, 2020 to March 5, 2020, when routine dental care was suspended in China. The questionnaire included self-assessment of oral hygiene and compliance, orthodontic emergencies, perceptions and feelings about COVID-19 and anxiety self-rating scale, etc. Collected data was statistically analyzed with Chi-square, independent t test and univariable generalized estimating equations regression analysis.

Results

A total of 1078 respondents (292 male; 786 female) from 30 provinces of China were included in this study. About one-third (33.67%) of patients reported that they encountered orthodontic problems during the pandemic. Patients with clear aligners reported fewer orthodontic problems than those with fixed appliances or removable appliances. Female patients, elder patients and patients who encountered orthodontic emergencies were more anxious than other patients.

Conclusions

The compliance and occurrence of orthodontic emergencies differed in patients with different orthodontic appliances. Patients with orthodontic emergencies exhibited higher anxiety states.

Modified SEC III protocol: vertical control related to patients' compliance with the chincup

OBJECTIVES

To compare the short-term outcomes of modified SEC III protocol in growing patients in relation to their compliance with the chincup, matching them with an untreated Class III control group (CG).

MATERIALS AND METHODS

Thirty-four patients (mean age of 8.6 ± 1.2 years) with Class III dentoskeletal malocclusion treated with the modified SEC III protocol and divided into group 1 (G1, 18 subjects), reporting good compliance and group 2 (G2, 16 subjects) not compliant with the chincup. The records were analysed before treatment (T1) and after the orthopaedic phase (T2), with an interval period of about 1.3 ± 0.5 years. The CG consisted of 16 untreated subjects with Class III dentoskeletal malocclusion (mean age of 8.3 ± 1.4 years). The statistical comparisons among the three groups were performed with ANOVA with Tukey's post hoc tests.

RESULTS

Both G1 and G2, compared with CG, presented significant improvements in the sagittal skeletal relationships (ANB +2.5° and +2.5°, Wits +4.2° and +3.0°, respectively). G1 exhibited a significant more favourable control of vertical skeletal relationships when compared to G2 (Palatal Pl.-Mandibular Pl. -2.0°) that were associated with a statistically significant reduction of the gonial angle (ArGoMe -1.7°). Limitations of the study were its retrospective nature and the lack of evaluation of the long-term outcomes.

CONCLUSIONS

Both groups of treated patients showed favourable sagittal skeletal improvement compared with controls. The use of chincup in patients with good compliance produced significantly greater control of the skeletal vertical dimensions compared with patients not compliant with the chincup.

A pilot study to investigate the histomorphometric changes of murine maxillary bone around the site of mini-screw insertion in regenerated bone induced by anabolic reagents

OBJECTIVE

The objective of this study was to investigate the histomorphometric changes around the site of mini-screw insertion in the regenerated bone which was induced by an anabolic-injection method using both anabolic peptide and bone morphogenetic protein 2 (BMP-2).

METHODS

Twenty-seven eight-week-old C57BL/6J male mice were used. Some mice received submucosal co-injections of anabolic peptide and BMP-2 just in front of the maxillary first molar. Screw insertion was then performed 4 weeks after injection. All mice underwent a weekly in vivo micro-focal X-ray computed tomography (µCT) analysis before being sacrificed at week 8. The bone formation activity was evaluated using fluorescent labelling in the undecalcified sections. The analyses, including screw insertion, were performed in the frontal plane, in front of the site of screw insertion.

RESULTS

Reconstructed µCT images revealed that the co-injection of anabolic reagents could lead to a gradual increase in the bone mineral density (BMD) of the injection-induced thickened bone by week 8. Both radiological and histomorphometric analyses indicated that screw insertion did not have any deleterious effects on either the BMD or the bone formation activity of the induced bone. Furthermore, the injection of anabolic reagents also led to an increase in the BMD of the underlying maxillary bone at the injection site.

CONCLUSION

Our histomorphometric analyses suggest that performing such anabolic injection to thicken bone could stimulate bone formation in the basal bone as well as in the induced bone. Similar augmentation of bone formation could be obtained even after subsequent screw insertion at the site of the induced bone.

Comparison of objective wear time between monoblock and twin-block appliances measured by microsensor

OBJECTIVES

To assess the objective compliance levels in skeletal Class II patients with mandibular retrognathia wearing monoblock and twin-block appliances.

MATERIALS AND METHODS

A prospective clinical study was conducted with 30 patients between 10 and 15 years old who were equally divided into two study groups. Group 1 was treated with monoblock, and group 2 was treated with twin-block appliances. The patients were instructed to wear their appliance for 15 hours per day. Wear times were monitored by a microsensor. (TheraMon; MCTechnology, Hargelsberg, Austria) for an average of six appointments. Patients were also instructed to record their wear times on a chart, and this record was admitted as subjective wear time. Statistical analysis was performed with the data derived from both the patients' charts and the monitoring records.

RESULTS

The mean wear time by the patients was 10.67 ± 3.93 hours, which was less than the 15 hours prescribed by the orthodontist, with no difference between the two appliances (P > .05). The regular use rate, which included the days with a wear time of 8 hours or more per day, was 75%. Compliance levels decreased by 35% throughout the six control appointments. Patients declared that their wear time was more than their objective wear time by an average of 3.76 hours.

CONCLUSIONS

Despite their different designs, there was no significant difference between the monoblock and twin-block appliances in terms of compliance.

Predictors of patient compliance during Class II division 1 malocclusion functional orthodontic treatment

OBJECTIVES

To determine factors that could predict Class II/1 malocclusion patient compliance during functional treatment.

MATERIALS AND METHODS

The sample consisted of 77 subjects (aged 11-13 years; 47% girls) presenting with Class II/1 malocclusion. Inclusion criteria were distal molar relationship, overjet greater than 5 mm, and confirmed pubertal growth spurt. Removable functional appliances (62% Twin Block [TB], 38% Sander Bite Jumping [BJ]) with built-in maxillary expansion screws were used. Follow-up period was 1 year. Patients and parents independently filled out the Child Perception Questionnaire, Parental/Caregiver Perception Questionnaire, and Family Impact Scale to assess emotional and social well-being, oral symptoms, functional limitations, parental emotions, family activities, conflicts, and financial burden as possible predictors of compliance during treatment. Sex, overjet, and appliance type were also analyzed.

RESULTS

There were more noncompliant than compliant patients (55% vs 45%). Parental perception of altered emotional well-being of their children was the strongest predictor, increasing compliance odds 3.4 times (95% confidence interval [CI], 1.2-9.4; P = .017). Patients were 3.2 times (95% CI, 1.1-9.3; P = .033) more likely to cooperate with TB compared with BJ appliance. OJ ≥ 8 mm increased compliance odds 3.1 times (95% CI, 1.0-9.4; P = .044).

CONCLUSIONS

Parental perception of child's emotional well-being alteration, severity of malocclusion, and type of appliance are major predictors of compliance. Psychosocial issues and oral function limitations reported by children and family impact are of negligible influence.

Short term effects of interceptive expansion treatment: a prospective study

OBJECTIVES

This prospective cohort study investigated the short term effects of interceptive orthodontic treatment with a removable expansion plate, evaluating the changes in occlusion in all its dimensions: transversal, sagittal and vertical.

SUBJECTS AND METHODS

A total of 226 patients treated with a removable expansion plate (slow maxillary expansion, SME) by orthodontic residents at the Department of Orthodontics, University Hospitals Leuven, Belgium were included. The patients had a mean age of 8.5 years at the start of the treatment. The mean treatment time was 6.9 months. Transversal measurements (intercanine and intermolar width) and occlusal characteristics (molar occlusion, overjet, overbite and functional shift) were collected before (T0) and after active treatment (T1). Statistical analysis was performed using the Wilcoxon signed rank test, Sign test and McNemar test for assessing changes between T0 and T1. Linear models were used to assess the associations between patient factors and the amount of expansion.

RESULTS

A significant increase in transversal width at different occlusal landmarks was found. Correction of unilateral, bilateral and frontal crossbites was successful in 99.0%, 95.2% and 93.6% of the cases respectively. Changes in sagittal molar occlusion were significant: 64.9% (right side) and 62.6% (left side) remained stable, 28.4% (right) and 29.3% (left) improved and 6.7% (right) and 8.1% (left) deteriorated. Overbite changes were found to be statistically significant, though clinically irrelevant. Overjet changes were non-significant.

CONCLUSIONS

A removable expansion plate is successful in improving the transversal dental dimensions of the maxilla. Statistically significant sagittal effects on molar occlusion were found. Long-term follow-up is needed to evaluate the long-term stability of this treatment.

Vacuum-formed retainers and bonded retainers for dental stabilization-a randomized controlled trial. Part II: patients' perceptions 6 and 18 months after orthodontic treatment

OBJECTIVE

To compare removable vacuum-formed Essix C retainers with bonded cuspid-to-cuspid retainers (CTCs) regarding patients' perceptions after debonding and 6 and 18 months of retention.

TRIAL DESIGN

A single-centre two-arm parallel-group randomized controlled trial.

METHODS

This trial included 104 adolescent patients, computer-generated randomized, with sequentially numbered, opaque and sealed envelopes, into two groups and stratified by gender. They were treated with fixed appliances with and without tooth extractions in both jaws and were ready for debond. Patients in the intervention arm received a vacuum-formed retainer (VFR) in the mandible (n = 52), and patients in the active comparator arm received a CTC (n = 52). Both groups had a VFR in the maxilla. Treatment outcome satisfaction, quality of care and attention, side-effects during the retention phase, and retainer acceptance and compliance were assessed with questionnaires at baseline (T1, 2 weeks after debond) and after 6 (T2) and 18 months (T3) of retention. Operator was blinded to group assignment during measurements.

RESULTS

Ninety-five patients completed the questionnaires at all three time points. Patients were overall satisfied with treatment outcome, quality of care and attention, and how their retainers worked at all three time points, with no differences between groups. At T1 and T3, the VFR group reported significantly more pain and discomfort (T1: P = 0.005, T3: P < 0.0001) and soreness (T1: P = 0.001, T3: P = 0.011) in the mandible compared to the CTC group. The CTC group found it easier to get used to their retainers. After 18 months, 70.5 per cent in the VFR group and 73.9 per cent in the CTC group reported the recommended wear-time of the VFRs. Decreased wear-time was correlated to perceived pain and discomfort (rs = -0.421, P < 0.0001).

LIMITATIONS

The results were limited by our retainer design and recommended wear regimen.

CONCLUSIONS

Both groups reported high treatment outcome satisfaction and low levels of side-effects during the retention phase. Nevertheless, the VFR group reported more pain and discomfort at T1 and at T3. Self-reported compliance was the same in both groups. The VFR group was more concerned about relapse.

TRIAL REGISTRATION

NCT03070444 (https://clinicaltrials.gov).

Attitude towards Telemonitoring in Orthodontists and Orthodontic Patients

The purpose of this study was to analyze the attitude of dentists and patients towards the use of Dental Monitoring^TM (DM), an orthodontic telemonitoring software. Thus, two different specially prepared specific questionnaires were administered to 80 dentists (40 were general dentists and 40 orthodontists) and 80 orthodontic patients. All dentists judged positively telemonitoring, as 96.25% of them considered telemonitoring indicative of high tech and high-quality treatment; 100% considered it a way to reduce the number of in-office visits; 17.5% agreed on a weekly telemonitoring frequency, 40% on a biweekly, and 42.5% on a lower frequency. Further, 97.5% of patients judged positively telemonitoring; 81.25% of them considered telemonitoring indicative of high-tech treatment; 81.25% declared to be interested in reducing the number of in-office visits through telemonitoring; 27.5% agreed on taking self-picture every week, 57.5% every two weeks, and 15% on a lower frequency. Both patients and dentists positively judged telemonitoring, considering it a technologically advanced tool increasing the perception of quality and accuracy of the treatment. Both groups were interested in reducing the number of in-office visits, although not all of them revealed to be ready to invest more money and time in it.

A national survey of orthodontists in Malaysia and their use of functional appliances for Class II malocclusions

Objectives

The aim of this study was to evaluate the use of functional appliances by the currently practising orthodontists in Malaysia. The objectives were to identify the different types of functional appliances used by Malaysian orthodontists and to investigate the variation in treatment protocols when attempting growth modification.

Methods

An online questionnaire consisting of 24 open-ended and multiple-choice questions was emailed to members of the Malaysian Association of Orthodontists (MAO) (n = 183). The survey was based on a previous study conducted by members of the British Orthodontic Society and was modified to suit the Malaysian population. The data were analysed using SPSS to generate frequency tables and descriptive statistics.

Results

Seventy-two responses were received from current Malaysian orthodontists. Of the respondents, 71% practised in a government setting and 29% were in private practice. The Clark Twin Block was the most frequently used functional appliance by 90% of Malaysian orthodontists. Many of the respondents (57%) prescribed full-time wear of removable functional appliances for 6–9 months (except during mealtimes) (51%). Following active removable functional appliance therapy, 91% prescribed a period of retention which involved a reduction in the duration of wear. The retention phase extended for 2 to 3 months (41%) or for 4 to 6 months (39%) for the majority of the respondents.

Conclusions

The Clark Twin Block is the most frequently-used functional appliance for the management of a Class II malocclusion by orthodontists currently practising in Malaysia.

Modified Arnold expander: an alternative for mandibular arch expansion

Introduction:

Due to the anatomical constraints of the mandible, mandibular dental arch usually serves as a guideline to determine the required changes in the maxillary transverse dimension. The Schwarz appliance and the Lip Bumper are the traditional orthodontic appliances for mandibular arch expansion in patients with borderline amounts of crowding, and/or transverse discrepancy. However, they often require patient cooperation, which may be a concern for orthodontists in daily practice.

Objectives:

This article illustrates a simple fixed orthodontic device as an alternative to achieve mandibular arch expansion in patients with moderate tooth-size/arch-length discrepancy. The four reported cases refer to 8 to 10-year-old patients in the mixed dentition, with an Angle Class I or Class II malocclusion, transverse deficiency in both arches, moderate crowding and/or posterior crossbite, combined with compromised smile aesthetics. The patients were treated with rapid maxillary expansion (RME) using Hass expander appliance and the modified Arnold expander (MAE).

Conclusion:

This low-cost compliance-free orthodontic appliance provided dentoalveolar decompensation by means of uprighting the posterior teeth, with minimal or no adjustments during treatment. The final results were achieved in only three to four months, and fulfilled all treatment objectives, such as an increase in the arch perimeter and width, and a better teeth alignment.

Effect of Photobiomodulation on Relapse in an Experimental Rapid Maxillary Expansion Model in Rat

Rapid maxillary expansion (RME) is performed on transversely deficient maxilla. As all orthodontic treatments, retention is important in maintaining therapeutic outcomes. Fixed /removable retainers are used post-RME causing hygiene and compliance problems. Given photobiomodulation's positive effects on the quantity and quality of bone regeneration, its effect on post-RME relapse was studied. Thirty Sprague Dawley rats were randomly divided into group R, non-irradiated RME-treated (n = 12), group P, irradiated RME-treated (n = 12) and group C, non-RME non-irradiated (n = 6). A 1.5 mm metal ring inserted between maxillary incisors at days 0 and 15 was expanded until 1.5 mm space was obtained at day 30. In group P, Ga-Al-As diode laser (810 nm, 100 mW, 4J/cm² , 30 secs) was applied on days 0, 2, 4, 6, 8, 10, 12 and 14 as predictor variable. The relapse was measured as the space lost between incisors for 30 days after appliance removal (primary outcome variable) and compared with t-test. In week 2, space loss in group P was significantly lower (P < 0.05) than all other groups. The relapse during weeks 2 and 3 was significantly lower in group P than group R. However, no significant difference in relapse amount was found between groups during first and fourth week. There was a significant difference (P < 0.05) between groups in relapse rates (secondary outcome variable) but not in total relapse after 4 weeks. Photobiomodulation proved beneficial in resisting relapse in our study, and it is suggested to be continued until the end of expansion.