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Owens D, Watkinson S, Harrison JE, Turner S, Worthington HV. Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database Syst Rev 2024; 4:CD003451. [PMID: 38597341 PMCID: PMC11005087 DOI: 10.1002/14651858.cd003451.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Prominent lower front teeth (Class III malocclusion) may be due to jaw or tooth position or both. The upper jaw (maxilla) can be too far back or the lower jaw (mandible) too far forward; the upper front teeth (incisors) may be tipped back or the lower front teeth tipped forwards. Orthodontic treatment uses different types of braces (appliances) fitted inside or outside the mouth (or both) and fixed to the teeth. A facemask is the most commonly reported non-surgical intervention used to correct Class III malocclusion. The facemask rests on the forehead and chin, and is connected to the upper teeth via an expansion appliance (known as 'rapid maxillary expansion' (RME)). Using elastic bands placed by the wearer, a force is applied to the top teeth and jaw to pull them forwards and downward. Some orthodontic interventions involve a surgical component; these go through the gum into the bone (e.g. miniplates). In severe cases, or if orthodontic treatment is unsuccessful, people may need jaw (orthognathic) surgery as adults. This review updates one published in 2013. OBJECTIVES To assess the effects of orthodontic treatment for prominent lower front teeth in children and adolescents. SEARCH METHODS An information specialist searched four bibliographic databases and two trial registries up to 16 January 2023. Review authors screened reference lists. SELECTION CRITERIA We looked for randomised controlled trials (RCTs) involving children and adolescents (16 years of age or under) randomised to receive orthodontic treatment to correct prominent lower front teeth (Class III malocclusion), or no (or delayed) treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcome was overjet (i.e. prominence of the lower front teeth); our secondary outcomes included ANB (A point, nasion, B point) angle (which measures the relative position of the maxilla to the mandible). MAIN RESULTS We identified 29 RCTs that randomised 1169 children (1102 analysed). The children were five to 13 years old at the start of treatment. Most studies measured outcomes directly after treatment; only one study provided long-term follow-up. All studies were at high risk of bias as participant and personnel blinding was not possible. Non-surgical orthodontic treatment versus untreated control We found moderate-certainty evidence that non-surgical orthodontic treatments provided a substantial improvement in overjet (mean difference (MD) 5.03 mm, 95% confidence interval (CI) 3.81 to 6.25; 4 studies, 184 participants) and ANB (MD 3.05°, 95% CI 2.40 to 3.71; 8 studies, 345 participants), compared to an untreated control group, when measured immediately after treatment. There was high heterogeneity in the analyses, but the effects were consistently in favour of the orthodontic treatment groups rather than the untreated control groups (studies tested facemask (with or without RME), chin cup, orthodontic removable traction appliance, tandem traction bow appliance, reverse Twin Block with lip pads and RME, Reverse Forsus and mandibular headgear). Longer-term outcomes were measured in only one study, which evaluated facemask. It presented low-certainty evidence that improvements in overjet and ANB were smaller at 3-year follow-up than just after treatment (overjet MD 2.5 mm, 95% CI 1.21 to 3.79; ANB MD 1.4°, 95% CI 0.43 to 2.37; 63 participants), and were not found at 6-year follow-up (overjet MD 1.30 mm, 95% CI -0.16 to 2.76; ANB MD 0.7°, 95% CI -0.74 to 2.14; 65 participants). In the same study, at the 6-year follow-up, clinicians made an assessment of whether surgical correction of participants' jaw position was likely to be needed in the future. A perceived need for surgical correction was observed more often in participants who had not received facemask treatment (odds ratio (OR) 3.34, 95% CI 1.21 to 9.24; 65 participants; low-certainty evidence). Surgical orthodontic treatment versus untreated control One study of 30 participants evaluated surgical miniplates, with facemask or Class III elastics, against no treatment, and found a substantial improvement in overjet (MD 7.96 mm, 95% CI 6.99 to 8.40) and ANB (MD 5.20°, 95% CI 4.48 to 5.92; 30 participants). However, the evidence was of low certainty, and there was no follow-up beyond the end of treatment. Facemask versus another non-surgical orthodontic treatment Eight studies compared facemask or modified facemask (with or without RME) to another non-surgical orthodontic treatment. Meta-analysis did not suggest that other treatments were superior; however, there was high heterogeneity, with mixed, uncertain findings (very low-certainty evidence). Facemask versus surgically-anchored appliance There may be no advantage of adding surgical anchorage to facemasks for ANB (MD -0.35, 95% CI -0.78 to 0.07; 4 studies, 143 participants; low-certainty evidence). The evidence for overjet was of very low certainty (MD -0.40 mm, 95% CI -1.30 to 0.50; 1 study, 43 participants). Facemask variations Adding RME to facemask treatment may have no additional benefit for ANB (MD -0.15°, 95% CI -0.94 to 0.64; 2 studies, 60 participants; low-certainty evidence). The evidence for overjet was of low certainty (MD 1.86 mm, 95% CI 0.39 to 3.33; 1 study, 31 participants). There may be no benefit in terms of effect on ANB of alternating rapid maxillary expansion and constriction compared to using expansion alone (MD -0.46°, 95% CI -1.03 to 0.10; 4 studies, 131 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Moderate-certainty evidence showed that non-surgical orthodontic treatments (which included facemask, reverse Twin Block, orthodontic removable traction appliance, chin cup, tandem traction bow appliance and mandibular headgear) improved the bite and jaw relationship immediately post-treatment. Low-certainty evidence showed surgical orthodontic treatments were also effective. One study measured longer-term outcomes and found that the benefit from facemask was reduced three years after treatment, and appeared to be lost by six years. However, participants receiving facemask treatment were judged by clinicians to be less likely to need jaw surgery in adulthood. We have low confidence in these findings and more studies are required to reach reliable conclusions. Orthodontic treatment for Class III malocclusion can be invasive, expensive and time-consuming, so future trials should include measurement of adverse effects and patient satisfaction, and should last long enough to evaluate whether orthodontic treatment in childhood avoids the need for jaw surgery in adulthood.
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Affiliation(s)
- Darren Owens
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Simon Watkinson
- Orthodontic Department, East Lancashire Hospitals Trust, Blackburn, UK
| | - Jayne E Harrison
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Sarah Turner
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Hodecker LD, Kühle R, Weichel F, Roser CJ, Lux CJ, Bauer CAJ. Concept for the Treatment of Class III Anomalies with a Skeletally Anchored Appliance Fabricated in the CAD/CAM Process-The MIRA Appliance. Bioengineering (Basel) 2023; 10:616. [PMID: 37237686 PMCID: PMC10215846 DOI: 10.3390/bioengineering10050616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Intermaxillary elastics, anchored skeletally, represent a promising concept for treatment in adolescent patients with skeletal Class III anomalies. A challenge in existing concepts is the survival rate of the miniscrews in the mandible or the invasiveness of the bone anchors. A novel concept, the mandibular interradicular anchor (MIRA) appliance, for improving skeletal anchorage in the mandible, will be presented and discussed. CLINICAL CASE In a ten-year-old female patient with a moderate skeletal Class III, the novel MIRA concept, combined with maxillary protraction, was applied. This involved the use of a CAD/CAM-fabricated indirect skeletal anchorage appliance in the mandible, with interradicularly placed miniscrews distal to each canine (MIRA appliance), and a hybrid hyrax in the maxilla with paramedian placed miniscrews. The modified alt-RAMEC protocol involved an intermittent weekly activation for five weeks. Class III elastics were worn for a period of seven months. This was followed by alignment with a multi-bracket appliance. DISCUSSION The cephalometric analysis before and after therapy shows an improvement of the Wits value (+3.8 mm), SNA (+5°), and ANB (+3°). Dentally, a transversal postdevelopment in the maxilla (+4 mm) and a labial tip of the maxillary (+3.4°) and mandibular anterior teeth (+4.7°) with gap formation is observed. CONCLUSION The MIRA appliance represents a less invasive and esthetic alternative to the existing concepts, especially with two miniscrews in the mandible per side. In addition, MIRA can be selected for complex orthodontic tasks, such as molar uprighting and mesialization.
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Affiliation(s)
- Lutz D. Hodecker
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Reinald Kühle
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (R.K.); (F.W.)
| | - Frederic Weichel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (R.K.); (F.W.)
| | - Christoph J. Roser
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Christopher J. Lux
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Carolien A. J. Bauer
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
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Zheng B, Al-Somairi MAA, Li Z, Zhao Y, Liu Y. Effect of filament types and loops number on the force degradation of elastomeric chains used for orthodontic treatment: an in-vitro study. BMC Oral Health 2023; 23:113. [PMID: 36803455 PMCID: PMC9940345 DOI: 10.1186/s12903-023-02812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/13/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In orthodontic treatment, closing spaces, specifically the extraction and scattered spaces of the anterior teeth, requires some auxiliary bias, such as an elastomeric chain. Many factors affect the mechanical properties of elastic chains. In this study, we investigated the relationship of the filament type, the number of loops, and the force degradation of elastomeric chains under thermal cycling conditions. METHODS The orthogonal design included three filament types (i.e., close, medium, and long). Four, five, and six loops of each elastomeric chain were stretched to have an initial force of 250 g in an artificial saliva environment at 37 °C and thermocycling between 5 and 55 °C three times a day. The remaining force of the elastomeric chains was recorded at different time points (4 h, 24 h, 7 days, 14 days, 21 days, and 28 days), and the percentage of the remaining force was calculated. RESULTS The force decreased significantly in the initial 4 h and degraded mostly within the first 24 h. In addition, the percentage of force degradation increased slightly between 1 and 28 days. CONCLUSIONS Under the same initial force, the longer the connecting body is, the fewer the number of loops and the greater the force degradation of the elastomeric chain are.
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Affiliation(s)
- Bowen Zheng
- grid.412449.e0000 0000 9678 1884Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, 110002 China
| | - Majedh Abdo Ali Al-Somairi
- grid.412449.e0000 0000 9678 1884Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, 110002 China ,grid.444909.4Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen
| | - Zhiyuan Li
- grid.412449.e0000 0000 9678 1884Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, 110002 China
| | - Yang Zhao
- grid.412449.e0000 0000 9678 1884Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, 110002 China
| | - Yi Liu
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, 110002, China.
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Parameswaran R, Ganapathi D, Rajkumar B, Parameswaran A. Surgical Camouflage as a Solution for Complete Decompensating Failures: An Interesting Experience With Class III Case Scenarios. Cureus 2022; 14:e25926. [PMID: 35844348 PMCID: PMC9281467 DOI: 10.7759/cureus.25926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 12/05/2022] Open
Abstract
Dental compensations are an integral part of skeletal malocclusions. Failure to achieve optimal decompensation may lead to compromised surgical movements, thereby resulting in sub-optimal occlusion and soft tissue profile. Hence the mandibular subapical osteotomy was chosen as a minimalistic surgical alternative to the traditional combination of Le Fort 1 and bilateral sagittal split osteotomy. The choice was made by prioritizing soft tissue considerations, which offered the probability of a better post-treatment outcome. This paper highlights two such challenging case scenarios where the surgical plan was modified in accordance with the soft tissue as the primary objective.
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Facio-Umaña JA, Chaurand J, Gonzalez-Luna PIV. Early class III treatment with maxillary protraction-miniscrew-assisted rapid palatal expansion (MARPE) and mandibular miniplates. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Hu S, An K, Peng Y. Comparative efficacy of the bone-anchored maxillary protraction protocols for orthopaedic treatment in skeletal Class III malocclusion: A Bayesian network meta-analysis. Orthod Craniofac Res 2021; 25:243-250. [PMID: 34468065 DOI: 10.1111/ocr.12532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/27/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the treatment effects of five bone-anchored maxillary protraction protocols (BAC3E, BAMP, BARME-FM, BARME-ME, SAFM) for skeletal Class III malocclusion. METHODS We conducted a systematic literature search through CENTRAL, EBSCO, PubMed and Web of Science and included the randomized controlled trials and clinical controlled trials, which met the criteria. A Bayesian network meta-analysis (NMA) for SNA, SNB, ANB, SN-MP and Wits appraisal was performed in R software using a random consistency model. The additional analyses included node-splitting analysis, statistical heterogeneity analysis, sensitivity analysis and ranking probability by SUCRA. RESULTS A total of 598 articles were initially obtained; 13 articles involving 482 individuals were eventually included. Among the five bone-anchored maxillary protraction protocols, the largest increment in SNA and Wits appraisal was observed in the BAMP group and BAC3E group, respectively; the SAFM, BAC3E and BAMP groups showed similar capability in terms of changes of ANB; least clockwise rotation of the mandible was found in the BARME-ME group, followed by the BAMP group; dental compensation appears to be most pronounced in the BAC3E group; and intermaxillary traction seems to reduce the lingual inclination of lower incisors and even cause labial inclination. CONCLUSIONS The SAFM, BAMP and BAC3E groups seem to be advantageous in the improvement of the maxillo-mandibular relationship, followed by the BARME-FM and BARME-ME groups. The findings of this study should be interpreted with caution as only short-term effects were compared and the quality of evidence ranged from very low to moderate. More RCTs with high-quality and long-term investigation are needed.
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Affiliation(s)
- Shoushan Hu
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ke An
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yiran Peng
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan, China
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Zhao W, Chen Y, Kyung HM, Xu JS. Effectiveness of Tongue Crib Combination Treating Severe Skeletal Angle Class III Malocclusion in Mixed Dentition. Int J Clin Pediatr Dent 2021; 13:668-676. [PMID: 33976494 PMCID: PMC8060944 DOI: 10.5005/jp-journals-10005-1855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the treatment effects of tongue crib combination for treating severe skeletal Angle class III malocclusion in mixed dentition by X-ray cephalometric analysis. Materials and methods A sample of 22 patients with severe skeletal Angle class III malocclusion of deficiency maxilla and overgrown mandible in mixed dentition was prospectively collected and equally divided into two groups. The patients (males 6 and females 5; mean age 8.35 ± 1.6 years) in the study group were treated with tongue crib combination, and the untreated patients (females 5, males 6; mean age 8.12 ± 1.3 years) served as the control group. X-ray cephalometric films were measured before and after treatment for comparing the change of occlusion, maxilla, mandible, and soft tissue. A paired t-test was used by SPSS 21.0 statistical software. The intragroup data were compared by using the Wilcoxon test, and intergroup data were compared by using the Mann–Whitney U test (p < 0.05). Results In the study group, all patients got a favorable facial profile. Anterior and posterior teeth crossbite and upper and lower first molars relationships were improved. In cephalometric measurement, significant changes were noted in the maxillary skeletal component. The significant forward growth of the maxilla exhibited in a statistical increase of SNA, ANS-PNS, Wits appraisal, p < 0.05. The mandible revealed slightly posterior rotation by no significant decrease in SNB and no change Co-Gn. After 1-year of retention, the changes of the teeth showed self-correction and facial profile improved further. Regarding vertical changes, maintenance of growth was shown a small non-significant increase of FMA, N-Me, and ANS-Me. There is a significant difference from those in the control group (p < 0.05). Conclusion Tongue crib combination is an effective device for the patients in the growing period with skeletal Angle class III malocclusion by improving the maxillary growth and limiting the mandibular growth. How to cite this article Zhao W, Chen Y, Kyung H-M, et al. Effectiveness of Tongue Crib Combination Treating Severe Skeletal Angle Class III Malocclusion in Mixed Dentition. Int J Clin Pediatr Dent 2020;13(6):668–676.
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Affiliation(s)
- Wenting Zhao
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Yan Chen
- Department of Orthodontics, Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia, China
- Yan Chen, Department of Orthodontics, Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia, China, Phone: +86 0471 3451219, e-mail:
| | - Hee-Moon Kyung
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Jin-Shuai Xu
- Oral Department, General Hospital of Datong Coal Mine, Datong, Shanxi, China
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CBCT Analysis of Changes in Dental Occlusion and Temporomandibular Joints before and after MEAW Orthotherapy in Patients with Nonlow Angle of Skeletal Class III. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7238263. [PMID: 32149128 PMCID: PMC7053462 DOI: 10.1155/2020/7238263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/02/2020] [Indexed: 11/29/2022]
Abstract
This study focus on the changes of the position and morphology of jaw and condyle after MEAW (the multiloop edgewise arch wire) treatment in adults with a nonlow angle (mean angle or high angle SN − MP > 27°) of skeletal class III (mild to moderate skeletal classs III means −5° < ANB < 0°) malocclusions measured by CBCT (cone beam computed tomography). Twenty adult patients (aged 17-26) with a nonlow angle of skeletal class III malocclusions were selected in this study taken orthodontic treatment by MEAW. CBCT was taken before and after the treatment to analyze the changes of the jaw and condyle. After treatment, the angle of L7-MP decreased 12.2°, L6-MP decreased 10.5°, L1-MP decreased 8.8° (P < 0.001 for each) and U1-SN increased (P < 0.05). There was no significant changes between anterior and posterior APDI index and between anterior and posterior spaces of the TMJ (temporomandibular joint) (P > 0.05). The linear ratio of the TMJ was the LR > 12 before treatment, while it was −12 < LR < 12 after treatment; however, there was no statistically significant difference between them (P > 0.05). There was also no significant change in anterior and posterior position and morphology of the condyle within the joint fossa after the treatment by MEAW in this study. MEAW technology in correcting the class III with nonlow angle patients mainly relies on the compensation of distally and posterior mandibular teeth, rather than the mandible and condyle moving backward to establish a neutral occlusal. This study was approved by the institutional ethics committee of the Second Hospital of Tianjin Medical University (No. KYJJ2013002).
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Shi H, Ge HS, Chen LY, Li ZH. [Meta-analysis of the efficacy of bone anchorage and maxillary facemask protraction devices in treating skeletal class Ⅲ malocclusion in adolescents]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:69-74. [PMID: 32037769 PMCID: PMC7184303 DOI: 10.7518/hxkq.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/19/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the efficacy of bone anchorage and maxillary facemask protraction devices in treating skeletal class Ⅲ malocclusion in adolescents. METHODS Articles relating to the use of bone anchorage and maxillary facemask protraction devices for treating skeletal class Ⅲ malocclusion in adolescents were searched from the databases of Cochrane Library, PubMed, EmBase, CNKI, and Wanfang database. Several inclusion and exclusion criteria were developed for the article screening. The clinical data were extracted, and the quality of the selected articles was evaluated. A Meta-analysis of SNA, SNB, ANB, ANS-Me, Wits, and U1-PP change was performed by using RevMan 5.3. RESULTS Seven studies (264 patients) were included in the Meta-analysis. Among these studies, three were randomized controlled trials, and four were non-randomized controlled trials. Compared with the maxillary facemask protraction device group, the bone ancho-rage device group had higher SNA changes and lower ANS-Me, Wits, and U1-PP changes (P<0.05). No significant differences were observed in the SNB and ANB changes between these two groups. CONCLUSIONS Compared with the maxillary facemask protraction device, the bone anchorage device can increase the extent of protraction of the maxilla and has better controls for the labial inclination of the maxillary anterior teeth in treating skeletal class Ⅲ malocclusion among adolescents. However, additional high-quality randomized controlled trials must be performed to verify the results.
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Affiliation(s)
- Hui Shi
- Dept. of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Jiangxi Key Laboratory of Stomatology and Biomedicine, Nanchang 330006, China
| | - Hong-Shan Ge
- Dept. of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Jiangxi Key Laboratory of Stomatology and Biomedicine, Nanchang 330006, China
| | - Lu-Yi Chen
- Dept. of Oral Medicine, Shenzhen Stomatological Hospital, Shenzhen 518000, China
| | - Zhi-Hua Li
- Dept. of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Jiangxi Key Laboratory of Stomatology and Biomedicine, Nanchang 330006, China
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Becker K, Schwarz F, Rauch NJ, Khalaph S, Mihatovic I, Drescher D. Can implants move in bone? A longitudinal in vivo micro-CT analysis of implants under constant forces in rat vertebrae. Clin Oral Implants Res 2019; 30:1179-1189. [PMID: 31494964 DOI: 10.1111/clr.13531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/24/2019] [Accepted: 08/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Whereas stationary stability of implants has been postulated for decades, recent studies suggested a phenomenon termed implant migration. This describes a change in position of implants as a reaction to applied forces. The present study aims at employing image registration of in vivo micro-CT scans from different time points and to assess (a) if migration of continuously loaded implants is possible and (b) migration correlates with the force magnitude. MATERIAL AND METHODS Two customized machined implants were placed in the dorsal portion of caudal vertebrae in n = 61 rats and exposed to standardized forces (0.5 N, 1.0 N, and 1.5 N) applied through a flat nickel-titanium contraction spring, or no forces (control). Micro-CT scans were performed at 0, 1, 2, 4, 6, and 8 weeks after surgery. The baseline image was registered with the forthcoming scans. Implant migration was measured as the Euclidean distance between implant tips. Bone remodeling was assessed between the baseline and the forthcoming scans. RESULTS The findings confirmed a positional change of the implants at 2 and 8 weeks of healing, and a linear association between applied force and velocity of movement (anterior implant: χ2 = 12.12, df = 3, and p = .007 and posterior implant: χ2 = 20.35, df = 3, and p < .001). Bone apposition was observed around the implants and accompanied by formation of load-bearing trabeculae and a general cortical thickening close and also distant to the implants. CONCLUSION The present analysis confirmed that implants can migrate in bone. The applied forces seemed to stimulate bone thickening, which could explain why implants migrate without affecting stability.
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Affiliation(s)
- Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Nicole Jasmin Rauch
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Silava Khalaph
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ilja Mihatovic
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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