Blinding endophthalmitis from orthodontic headgear

Which anchorage device is the best during retraction of anterior teeth? An overview of systematic reviews

Objective

To evaluate the available evidence regarding the clinical effectiveness of different types of anchorage devices.

Methods

A comprehensive literature search of different electronic databases was conducted for systematic reviews investigating different anchorage methods published up to April 15, 2021. Any ongoing systematic reviews were searched using PROSPERO, and a grey literature search was undertaken using Google Scholar and OpenGrey. No language restriction was applied. Screening, quality assessment, and data extraction were performed independently by two authors. Information was categorized and narratively synthesized for the key findings from moderate- and high-quality reviews.

Results

Fourteen systematic reviews were included (11 were of moderate/high quality). Skeletal anchorage with miniscrews was associated with less anchorage loss (and sometimes with anchorage gain). Similarly, skeletal anchorage was more effective in retracting anterior teeth and intruding incisors and molars, resulting in minor vertical skeletal changes and improvements in the soft tissue profile. However, insufficient evidence was obtained for the preference of any anchorage method in terms of the duration of treatment, number of appointments, quality of treatment, patient perception, or adverse effects. The effectiveness of skeletal anchorage can be enhanced when directly loaded, used in the mandible rather than the maxilla, used buccally rather than palatally, using dual rather than single miniscrews, used for en-masse retraction, and in adults.

Conclusions

The level of evidence regarding anchorage effectiveness is moderate. Nevertheless, compared to conventional anchorage, skeletal anchorage can be used with more anchorage preservation. Further high-quality randomized clinical trials are required to confirm these findings.

Effectiveness of orthodontic miniscrew implants in anchorage reinforcement during en-masse retraction: A systematic review and meta-analysis

INTRODUCTION

The aim of this systematic review was to compare the effectiveness of orthodontic miniscrew implants-temporary intraoral skeletal anchorage devices (TISADs)-in anchorage reinforcement during en-masse retraction in relation to conventional methods of anchorage.

METHODS

A search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was performed. The keywords were orthodontic, mini-implants, miniscrews, miniplates, and temporary anchorage device. Relevant articles were assessed for quality according to Cochrane guidelines and the data extracted for statistical analysis. A meta-analysis of raw mean differences concerning anchorage loss, tipping of molars, retraction of incisors, tipping of incisors, and treatment duration was carried out.

RESULTS

Initially, we retrieved 10,038 articles. The selection process finally resulted in 14 articles including 616 patients (451 female, 165 male) for detailed analysis. Quality of the included studies was assessed as moderate. Meta-analysis showed that use of TISADs facilitates better anchorage reinforcement compared with conventional methods. On average, TISADs enabled 1.86 mm more anchorage preservation than did conventional methods (P <0.001).

CONCLUSIONS

The results of the meta-analysis showed that TISADs are more effective than conventional methods of anchorage reinforcement. The average difference of 2 mm seems not only statistically but also clinically significant. However, the results should be interpreted with caution because of the moderate quality of the included studies. More high-quality studies on this issue are necessary to enable drawing more reliable conclusions.

Group A streptococcal endophthalmitis complicating a sore throat in a 2-year-old child

A previously well 2-year-old presented to her general practitioner after 5 days of fever, lethargy, sore throat and a slightly red eye. A viral infection was diagnosed. Two days later, she re-presented with a swollen right eyelid and a moderately red eye. Oral amoxicillin and chloramphenicol eye drops were prescribed. The next day, marked periorbital swelling developed. She was admitted to hospital and parenteral ceftriaxone was started. Examination under anaesthetic showed injected globe diffuse corneal clouding and peripheral corneal opacities; ultrasound and CT suggested endophthalmitis. On transfer to a tertiary centre, intraocular vancomycin and subconjunctival cefuroxime were given. Aqueous fluid samples were positive for group A Streptococcus (GAS) by PCR, so parenteral clindamycin was added. GAS endophthalmitis was confirmed 1 day later from the positive intraocular fluid culture results. Visual evoked potentials revealed complete loss of vision. The eye was removed to limit potential spread. She made a good recovery postoperatively and was discharged on oral antibiotics.