Quantification of wear-time adherence of removable appliances in young orthodontic patients in relation to their BMI: a preliminary study

The Impact of Orthodontic Treatment on Body Weight Due to Change in Dietary Habits

Background Orthodontic treatment, while primarily focusing on correcting dental alignment and occlusion, has been increasingly validated for its potential impact on broader aspects of oral health and general well-being: its potential influence on body weight. While the mechanical effects of orthodontic appliances are well documented in the literature, their potential behavioral impact on weight loss remains underexplored. Beyond its primary role in correcting dental alignment, our study has unveiled a lesser-known benefit: its potential to aid in weight reduction among individuals who have already struggled through conventional methods. Orthodontic treatment is a surprising yet successful intervention in the field of weight management. Often known only for its use in correcting dental malalignments, our research has revealed an additional benefit: it can help people who have struggled to do so with other conventional methods lose weight. Orthodontic treatment accomplishes the same goals more quickly and with few side effects. In addition to highlighting the aesthetic and functional benefits of orthodontics, this growing body of knowledge also presents orthodontics as a novel solution for individuals struggling with weight issues. In exploring the mutually beneficial relationship between orthodontic care and weight loss, we looked at a way to achieve both improved overall health and fitness along with dental alignment. Since obesity is associated with a notably higher risk of negative health outcomes, losing weight not only helps you feel better about yourself but also improves your general health and wellness. This study explores the relationship between orthodontic treatment and reduction in weight among patients undergoing treatment at Sardar Begum Dental College. Its primary objective is to assess and compare changes in body weight among the said patients. Methodology This observational prospective study was carried out at the Department of Orthodontics and Dentofacial Orthopaedics, Sardar Begum Dental College, Peshawar. Every patient gave their informed consent and expressed their willingness for participation in the study. An online sample size calculator (OpenEpi) was used. The confidence level was set to 95% with a margin of error of ±5%, and the sample size calculated was 150. The patients were chosen using a convenient sampling technique. The patients' weights were recorded on the days of bonding (T0) and one month (T1), two months (T2), and three months (T3) following bonding. Data was processed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States). Since the data was not normally distributed, the Wilcoxon signed-rank test was applied. Results The Wilcoxon signed-rank test revealed that body weight was significantly reduced one month, two months, and three months after bonding. The body weight on the day of bonding (median=48.200; n=150) was compared to the body weight after one month (median=47.800; n=150), resulting in a statistically significant decrease (z=-9.480; p=0.000) with a large effect size (r=-0.547). The analysis shows a significant decrease in body weight after one month of orthodontic bonding, with a large effect size indicating a substantial impact of the orthodontic treatment on body weight. Conclusion Fixed orthodontic treatment appears to have an impact on body weight, i.e., weight is reduced after the first, second, and third months of bonding.

Weight changes during the initial phase of orthodontic treatment with clear aligners versus fixed appliances: a pilot prospective cohort study

OBJECTIVE

The aim was to assess adult patients' weight changes during the initial phase of orthodontic treatment (OT) with clear aligner therapy (CAT) versus fixed bracket systems (FBS).

METHODS

This pilot prospective cohort study included systemically-healthy adults who were treated with CAT or FBS. Participants with eating disorders and/or undergoing dietary programs were excluded. Weight was assessed using a calibrated digital scale at the start of OT (T1), 6-8 weeks (T2), and 12-16 weeks (T3) after starting OT. A questionnaire was used to record demographic variables, diet and exercise habits, self-reported compliance and discomfort during OT, and use of analgesics. Repeated measures analysis of variance was used to assess the association between treatment type (FBS versus CT) and time-period (T1, T2, T3) on participants' weight while adjusting for baseline covariates such as age, gender, height, and weight.

RESULTS

Forty-two participants (CAT group: 22 and FBS group: 20) were analysed. In the CAT group, there was a slight initial mean weight gain of 0.2 Kg (~ 0.4 pounds) (T2-T1), and 0.8 Kg (~ 1.7 pounds) overall mean weight loss between T1 and T3. For the FBS group, there was a slight initial weight loss of 0.3 Kg (~ 0.7 pounds) (T2-T1) and no overall change between T1 and T3. Treatment type (CAT versus FBS) was not significantly associated with weight changes during the initial phase of OT.

CONCLUSIONS

There were no significant differences in the weight changes during the initial phase of OT with CAT compared with FBS.

CLINICAL RELEVANCE

Clear aligner therapy should not be advertised as a weight loss strategy.

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.

Evaluation of Pain, Dietary Intake, Body Mass Index, and Periodontal Status in Patients Undergoing Fixed Orthodontic Treatment With Bite Raiser

Background The aim of this study is to evaluate the effect of bite raisers on patients' body mass index (BMI), nutrient intake, periodontal status, and pain experienced during orthodontic treatment. Material and Methods This cohort study included 44 patients aged 18 to 35 years old; undergoing fixed orthodontic treatment. Patients of the intervention group received a composite resin bite raiser (3M Espe, St. Paul, USA) over their first mandibular molars along with fixed orthodontic appliances (slot 0.022 × 0.030", 3M Unitek, Monrovia, Calif), while the control group only received a fixed orthodontic appliance. Pain levels using the visual analog scale (VAS), dietary intake (calories, proteins, carbohydrate, and fat intake), body mass index (BMI), tooth mobility, bleeding on probing (BOP), and pocket depth (PD) were assessed for all patients in the first three months after fixed orthodontic appliance placement. The data were analyzed using SPSS software version 22.0 (IBM Corp, Armonk, NY, USA) at a significance level of 0.05. Results The pain had an increasing and then decreasing significant trend during the study for all patients (P<0.001). Calory intake also had an increasing and then decreasing significant trend for all participants (P=0.007). The consumption of carbohydrates and BMI significantly decreased during the study in both groups of patients (P<0.01) and tooth mobility, BOP, and PD significantly increased for all participants (P<0.001). No significant differences were observed between the intervention and control groups in terms of the above-mentioned variables. Conclusion The application of bite raiser does not influence patients' pain, dietary intake, BMI, and periodontal status. However, fixed orthodontic appliances affect patients' calorie and carbohydrate intake, patients' BMI, and periodontal indexes including tooth mobility, BOP, and PD.

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.

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.

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.

Effectiveness of removable appliances with temperature sensors in orthodontic patients: a systematic review and meta-analysis

BACKGROUND/OBJECTIVE

Patient compliance during orthodontic treatment is one of the factors that most affects success in the final result. The use of removable appliances is frequent at an early age and the monitoring of its use is essential to assess the collaboration of the patient. The aim of this study was to establish the effectiveness of microsensors included in removable appliances during orthodontic treatment or in the retention phase to enable a reliable and individualized follow-up of the patient.

SEARCH METHODS

The article search was carried out in various electronic databases and journals without any language restrictions.

SELECTION CRITERIA

Studies using microsensors into removable appliances were selected with the key selection criterion of a minimum follow-up of 4 weeks.

DATA COLLECTION AND ANALYSIS

The quality of the studies included was evaluated using the Cochrane scale for the randomized controlled trials and the Newcastle Ottawa Scale for control-case, cohort, and transversal studies. The mean of the differences with a 95% confidence interval was expressed for the continuous data.

RESULTS

Twenty-nine full-text articles were analysed and included in the qualitative synthesis. In general, the mean daily wear time of removable appliances measured objectively was less than the time that the professional had predetermined.

CONCLUSIONS

The use of microsensors as an objective measurement method enhances communication and boosts confidence in the orthodontist-patient relationship. More random clinical studies with temperature sensors are needed to establish to what extent they influence the orthodontic outcome.

REGISTRATION

PROSPERO (CRD42019120525).

Intake of Fibre-Associated Foods and Texture Preferences in Relation to Weight Status Among 9-12 Years Old Children in 6 European Countries

Plant foods, rich in fibre, can offer textures that children find difficult to orally manipulate, resulting in low preferences but are important for a healthy diet and prevention of overweight in children. Our aim was to investigate preferences for food texture, intake of fibre-associated foods and the relation to BMI. Three hundred thirty European children (9-12 years, 54% female) indicated their texture preferences using the Child-Food-Texture-Preference- Questionnaire (CFTPQ), and their parents responded on fibre-associated food consumption and anthropometric information. BMI was significantly lower for children with higher intake of wholegrain alternatives of common foods; in addition to being significantly influenced by country and the wearing of a dental brace. Overall BMI-for-age-percentiles (BMI_pct) were negatively associated with the consumption of wholegrain cereals, white pasta and wholemeal products and positively associated with the intake of legumes and white biscuits. In males, BMI_pct were negatively associated with wholegrain products and dried fruits, and in females, positively with legume consumption. A few country-related associations were found for BMI_pct and wholegrain biscuits, seeds and nuts and refined products. No overall correlation was found between BMI_pct and the texture preference of soft/hard foods by CFTPQ, except in Austria. We conclude that this study revealed evidence of a connection between fibre-associated foods and children's BMI at a cross-cultural level and that sex is an important determinant of fibre-associated food intake and the development of overweight in childhood.

Influence of increased body mass index on orthodontic tooth movement and related parameters in children and adolescents: A systematic review of longitudinal controlled clinical studies

Objectives:

To assess the impact of increased body mass index (BMI) on orthodontic tooth movement (OTM) and related parameters in children and adolescents.

Search sources:

A search of six electronic databases and manual searching were performed up to June 2019 without language and time restrictions.

Data selection:

Eligibility criteria were as follows: (1) longitudinal controlled clinical studies; (2) children and adolescents undergoing orthodontic therapy (OT); (3) no systemic diseases; (4) experimental group: patients with increased BMI; and (5) control group: patients with normal BMI.

Data extraction:

Screening, study selection and data extraction were performed; bias within studies was assessed using the Risk of Bias In Non-randomised Studies (ROBINS-I) tool.

Results:

Seven studies were included. One study showed that an increased BMI is associated with less wear-time of removable orthodontic appliances and one study found no significant association. One study showed that an increased BMI is associated with less cooperation during OT; however, not with the treatment results. One study reported higher pain experience during OT in adolescents with than without increased BMI. Two studies showed that increased BMI in adolescents is related to OTM, one with increased and one with decreased rates of OTM, respectively. One study reported an association between increased BMI and incidence of white spot lesions and gingivitis during OT. The ROBINS-I tool showed low to moderate risk of bias within studies.

Conclusions:

The influence of BMI on OTM and related parameters in children and adolescents remains debatable.

Evaluation of body weight, body mass index, and body fat percentage changes in early stages of fixed orthodontic therapy

Aim:

The aim of this study was to evaluate and compare the changes in body weight, body mass index (BMI), and body fat percentage (BFP) during the initial stages of fixed orthodontic treatment.

Materials and Methods:

The sample for this observational prospective study included 68 individuals with fixed orthodontic appliance in the age group of 18–25 years of both the sexes (25 males and 43 females). The control group consisted of 60 individuals (24 males and 36 females). The weight, BMI, and BFP were measured using a Body Composition Monitor at three points of time “T1” initial; “T2” after 1 month; and “T2” after 3 months. The results were tabulated and analyzed with the Statistical Package for the Social Sciences software. The mean changes between different parameters in both the study and control groups and between males and females in the study group was compared by using two-tailed unpaired student's t-test. The statistical significance is set atP ≤ 0.05.

Results:

There was an overall decrease in the body weight, BMI, and BFP after 1 month in the study cohort, which was statistically significant compared to the control group (P < 0.0001). This was followed by an increase in the parameters after the end of the 3^rd month. Comparison of the parameters between the study and control group at the start of the treatment and at the end of the 3^rd month had no statistical significance. There was a marked variation in the changes of these parameters between males and females of the study group, which is statistically significant (<0.0001).

Conclusion:

There is a definite reduction in the weight, BMP, and BMI at the end of the first month followed by a gain of weight, but not at the initial point by the end of the 3^rd month.

Assessment of Factors Affecting Adolescent Patients' Compliance with Hawley and Vacuum Formed Retainers

INTRODUCTION

Success of orthodontic retention with removable retainers almost entirely depends on patients' compliance.

AIM

This study was carried out to investigate the relationship between adolescent orthodontic patients' compliance and various clinical and social factors.

MATERIALS AND METHODS

The data were collected from 77 orthodontic patients aged 7-11 years old who had finished the full fixed appliance therapy. Hawley's retainers were used in 34 patients and 43 patients used Vacuum Formed Retainers (VFRs). The subjects completed a questionnaire including several identifiers allowing the respondents to be classified into subgroups. They were also asked to indicate how long they wore their retainers during the day, by writing the number of hours in the report-card for the next three months. Comparison of the results was performed by one-way ANOVA and independent sample-t tests.

RESULTS

No significant differences were found between males and females. Type of the retainer, patients' grade of study, mothers' occupation, clinicians' and parents' attitudes and filling the report cards had significant effect on mean wear hours per day. When compliance of the patients was assessed according to treatment location, Living place, parents' educational degrees and ethnicity, no significant differences could be found.

CONCLUSION

The adolescent patients' compliance was greater with VFRs than with Hawley's retainers. Parental attitude and doctor-patient relationship had a great impact on adolescent patients' compliance.

A feasible method to improve adherence of Hawley retainer in adolescent orthodontic patients: a randomized controlled trial

BACKGROUND

Retention is an important component of orthodontic treatment; however, poor compliance with retainer use is often encountered, especially in adolescents. The purpose of this study was to prove the hypothesis that verbal instructions combined with images showing the severe consequences of poor compliance can increase retainer use.

METHODS

This study was a randomized controlled trial. The sample was recruited from Wenzhou, People's Republic of China, between February 2013 and May 2014, and 326 participants were randomized into three groups. Patients and parents in Group A (n=106) were given routine retainer wear instructions only; in Group B (n=111), images illustrating the severe consequences of poor compliance with Hawley retainer use were shown to patients, combined with routine instructions; and in Group C (n=109), images illustrating the severe consequences of poor compliance with Hawley retainer use were shown to patients and parents, combined with routine instructions. Three months after debonding, questionnaires were used to investigate daily wear time and the reasons for poor compliance. Differences in means between the groups were tested by one-way analysis of variance.

RESULTS

The mean daily wear time in Group C (15.09±4.13 hours) was significantly greater than in Group A (12.37±4.58 hours, P<0.01) or Group B (13.50±4.22 hours, P<0.05); the mean daily wear time in Group B was greater than in Group A, but was not significant (P=0.67). Reasons for nonusage were forgetting to wear the retainer (51%) and finding the retainer bothersome to frequently insert and remove (42%).

CONCLUSION

Verbal instructions combined with images showing the severe consequences of poor compliance can increase retainer use. Parents play an important role in compliance with retainer use in adolescent patients.