Evidence-based potential of generative artificial intelligence large language models in orthodontics: a comparative study of ChatGPT, Google Bard, and Microsoft Bing

BACKGROUND

The increasing utilization of large language models (LLMs) in Generative Artificial Intelligence across various medical and dental fields, and specifically orthodontics, raises questions about their accuracy.

OBJECTIVE

This study aimed to assess and compare the answers offered by four LLMs: Google's Bard, OpenAI's ChatGPT-3.5, and ChatGPT-4, and Microsoft's Bing, in response to clinically relevant questions within the field of orthodontics.

MATERIALS AND METHODS

Ten open-type clinical orthodontics-related questions were posed to the LLMs. The responses provided by the LLMs were assessed on a scale ranging from 0 (minimum) to 10 (maximum) points, benchmarked against robust scientific evidence, including consensus statements and systematic reviews, using a predefined rubric. After a 4-week interval from the initial evaluation, the answers were reevaluated to gauge intra-evaluator reliability. Statistical comparisons were conducted on the scores using Friedman's and Wilcoxon's tests to identify the model providing the answers with the most comprehensiveness, scientific accuracy, clarity, and relevance.

RESULTS

Overall, no statistically significant differences between the scores given by the two evaluators, on both scoring occasions, were detected, so an average score for every LLM was computed. The LLM answers scoring the highest, were those of Microsoft Bing Chat (average score = 7.1), followed by ChatGPT 4 (average score = 4.7), Google Bard (average score = 4.6), and finally ChatGPT 3.5 (average score 3.8). While Microsoft Bing Chat statistically outperformed ChatGPT-3.5 (P-value = 0.017) and Google Bard (P-value = 0.029), as well, and Chat GPT-4 outperformed Chat GPT-3.5 (P-value = 0.011), all models occasionally produced answers with a lack of comprehensiveness, scientific accuracy, clarity, and relevance.

LIMITATIONS

The questions asked were indicative and did not cover the entire field of orthodontics.

CONCLUSIONS

Language models (LLMs) show great potential in supporting evidence-based orthodontics. However, their current limitations pose a potential risk of making incorrect healthcare decisions if utilized without careful consideration. Consequently, these tools cannot serve as a substitute for the orthodontist's essential critical thinking and comprehensive subject knowledge. For effective integration into practice, further research, clinical validation, and enhancements to the models are essential. Clinicians must be mindful of the limitations of LLMs, as their imprudent utilization could have adverse effects on patient care.

The Prevalence of Congenitally Missing Permanent Teeth in a Sample of Orthodontic and Non-Orthodontic Caucasian Patients

BACKGROUND

Hypodontia represents a notable clinical and public health concern.

OBJECTIVE

To assess the prevalence of congenitally missing permanent teeth in a sample of orthodontic/dental patients of Caucasian origin originating from the Greek island of Lesvos.

MATERIALS AND METHODS

Panoramic X-rays from 621 children and adolescents, aged 9 to 16 years (average age 12.5 years), 521 seeking orthodontic care (orthodontic group) and 100 seeking dental care (non-orthodontic group) were examined to identify congenitally missing permanent teeth.

RESULTS

The orthodontic group exhibited a 5.5% prevalence of congenitally missing permanent teeth (2.8% females; 2.7% males), while the non-orthodontic group showed a prevalence of 4% (3% females; 1% males). The descending order of prevalence for missing tooth types was as follows: lower second premolars, upper laterals, lower central incisors, lower canines, upper second premolars, and lower second molars. Among orthodontic patients with missing teeth, 62% presented with an Angle's Class II malocclusion. Hypodontia was most frequently observed in the mandible. No statistically significant differences were observed between the orthodontic and non-orthodontic groups in terms of the percentage of children and types of congenitally missing teeth.

CONCLUSIONS

Congenitally missing teeth were observed in about 4-5% of the studied population with a female predilection. The lower second premolar was the most commonly absent tooth, followed by the maxillary lateral incisors. An Angle's Class II malocclusion was present in the majority of orthodontic patients with hypodontia, mostly in the mandible.

Evaluation of ChatGPT's Real-Life Implementation in Undergraduate Dental Education: Mixed Methods Study

BACKGROUND

The recent artificial intelligence tool ChatGPT seems to offer a range of benefits in academic education while also raising concerns. Relevant literature encompasses issues of plagiarism and academic dishonesty, as well as pedagogy and educational affordances; yet, no real-life implementation of ChatGPT in the educational process has been reported to our knowledge so far.

OBJECTIVE

This mixed methods study aimed to evaluate the implementation of ChatGPT in the educational process, both quantitatively and qualitatively.

METHODS

In March 2023, a total of 77 second-year dental students of the European University Cyprus were divided into 2 groups and asked to compose a learning assignment on "Radiation Biology and Radiation Protection in the Dental Office," working collaboratively in small subgroups, as part of the educational semester program of the Dentomaxillofacial Radiology module. Careful planning ensured a seamless integration of ChatGPT, addressing potential challenges. One group searched the internet for scientific resources to perform the task and the other group used ChatGPT for this purpose. Both groups developed a PowerPoint (Microsoft Corp) presentation based on their research and presented it in class. The ChatGPT group students additionally registered all interactions with the language model during the prompting process and evaluated the final outcome; they also answered an open-ended evaluation questionnaire, including questions on their learning experience. Finally, all students undertook a knowledge examination on the topic, and the grades between the 2 groups were compared statistically, whereas the free-text comments of the questionnaires were thematically analyzed.

RESULTS

Out of the 77 students, 39 were assigned to the ChatGPT group and 38 to the literature research group. Seventy students undertook the multiple choice question knowledge examination, and examination grades ranged from 5 to 10 on the 0-10 grading scale. The Mann-Whitney U test showed that students of the ChatGPT group performed significantly better (P=.045) than students of the literature research group. The evaluation questionnaires revealed the benefits (human-like interface, immediate response, and wide knowledge base), the limitations (need for rephrasing the prompts to get a relevant answer, general content, false citations, and incapability to provide images or videos), and the prospects (in education, clinical practice, continuing education, and research) of ChatGPT.

CONCLUSIONS

Students using ChatGPT for their learning assignments performed significantly better in the knowledge examination than their fellow students who used the literature research methodology. Students adapted quickly to the technological environment of the language model, recognized its opportunities and limitations, and used it creatively and efficiently. Implications for practice: the study underscores the adaptability of students to technological innovations including ChatGPT and its potential to enhance educational outcomes. Educators should consider integrating ChatGPT into curriculum design; awareness programs are warranted to educate both students and educators about the limitations of ChatGPT, encouraging critical engagement and responsible use.

Evaluation of the Performance of Generative AI Large Language Models ChatGPT, Google Bard, and Microsoft Bing Chat in Supporting Evidence-Based Dentistry: Comparative Mixed Methods Study

BACKGROUND

The increasing application of generative artificial intelligence large language models (LLMs) in various fields, including dentistry, raises questions about their accuracy.

OBJECTIVE

This study aims to comparatively evaluate the answers provided by 4 LLMs, namely Bard (Google LLC), ChatGPT-3.5 and ChatGPT-4 (OpenAI), and Bing Chat (Microsoft Corp), to clinically relevant questions from the field of dentistry.

METHODS

The LLMs were queried with 20 open-type, clinical dentistry-related questions from different disciplines, developed by the respective faculty of the School of Dentistry, European University Cyprus. The LLMs' answers were graded 0 (minimum) to 10 (maximum) points against strong, traditionally collected scientific evidence, such as guidelines and consensus statements, using a rubric, as if they were examination questions posed to students, by 2 experienced faculty members. The scores were statistically compared to identify the best-performing model using the Friedman and Wilcoxon tests. Moreover, the evaluators were asked to provide a qualitative evaluation of the comprehensiveness, scientific accuracy, clarity, and relevance of the LLMs' answers.

RESULTS

Overall, no statistically significant difference was detected between the scores given by the 2 evaluators; therefore, an average score was computed for every LLM. Although ChatGPT-4 statistically outperformed ChatGPT-3.5 (P=.008), Bing Chat (P=.049), and Bard (P=.045), all models occasionally exhibited inaccuracies, generality, outdated content, and a lack of source references. The evaluators noted instances where the LLMs delivered irrelevant information, vague answers, or information that was not fully accurate.

CONCLUSIONS

This study demonstrates that although LLMs hold promising potential as an aid in the implementation of evidence-based dentistry, their current limitations can lead to potentially harmful health care decisions if not used judiciously. Therefore, these tools should not replace the dentist's critical thinking and in-depth understanding of the subject matter. Further research, clinical validation, and model improvements are necessary for these tools to be fully integrated into dental practice. Dental practitioners must be aware of the limitations of LLMs, as their imprudent use could potentially impact patient care. Regulatory measures should be established to oversee the use of these evolving technologies.

Awareness of Forensic Odontology among Dental Students and Faculty in Cyprus: A Survey-Based Study

This study aimed to evaluate the awareness, comprehension, and practices concerning forensic odontology among dental students and faculty at a Dental School in Cyprus. An online, cross-sectional, descriptive survey, employing an adapted, self-administered questionnaire, was disseminated to all dental students and faculty at the School of Dentistry, European University Cyprus, in November 2022. The survey assessed participants' demographic information and explored their awareness with questions alluding to knowledge, attitudes and practices in forensic dentistry. Of those surveyed, 47 faculty members and 304 students responded, yielding response rates of 66.2% and 80%, respectively. Statistical analysis, including Kendall's tau test and χ2 test were employed to examine correlations and associations, with Cramer's V used to measure the strength of significant associations. The predetermined significance level was α = 0.05. Awareness levels were assessed through participants' responses to specific questions in the survey. It was revealed that 87% of faculty and 65% of students were familiar with forensic odontology. A noteworthy 94% of faculty and 85% of students recognized teeth as DNA repositories. A high percentage, 98% of faculty and 89% of students, acknowledged the role of forensic odontology in the identification of criminals and deceased individuals. Awareness of age estimation through dental eruption patterns was evident in 85% of faculty and 81.6% of students. A substantial proportion (80% of faculty) maintained dental records, while 78% of students recognized the importance of dental record-keeping in ensuring quality care. Interestingly, 57% of students and 64% of faculty were aware of the possibility of dentists testifying as expert witnesses. The majority, 95.7% of faculty and 85% of students, concurred that physical harm, scars, and behavioral alterations predominantly indicate child abuse. The findings, revealing robust awareness among respondents, underscore the importance of enhancing faculty engagement in relevant seminars to further strengthen their knowledge. Additionally, emphasizing improved record-keeping practices for potential forensic applications emerges as a crucial aspect. These insights have implications for refining dental education in Cyprus and enhancing forensic practices by promoting ongoing professional development and emphasizing meticulous record-keeping within the dental community.

Dental students' and faculty perception of online exams with e-invigilation in Cyprus

INTRODUCTION

During the recent pandemic, e-learning and e-assessment methods have been implemented worldwide, providing opportunities for further implementation in the dental curriculum. This study aims to research the dental students' and dental faculty's perceptions of online exams with e-invigilation.

MATERIALS AND METHODS

Online questionnaires were developed and delivered, after three semesters of online exams, to all students and faculty. Descriptive statistics were performed, and answers were grouped into Principal Components (PC) using Principal Component Analysis (PCA). Statistical significance was set at p < .05.

RESULTS

Two-hundred and sixty dental students (83.7%) and 24 dental faculty members (63.1%) answered the online questionnaires. PCA of students' responses revealed 4 PC, 'University support to students', 'Comparison between online and face-to-face exams', 'Preparation for the online exams' and 'Attitudes towards the technology used for the online exams'. PCA of faculty responses revealed 5 PC: 'Comparison between online and face-to-face exams', 'University support to faculty', 'Faculty attitudes towards the exam procedures', 'Human factors associated with the exam procedures' and 'Exam invigilation'. The overall satisfaction was high for both staff and students (higher for students and female staff). Students with previous experience in online exams scored more positively than first-year students. University support, process-related stress and e-invigilation were highlighted.

CONCLUSIONS

The overall satisfaction with the e-exams was high, despite the technical problems, time-consuming processes and related stress. University support (training, IT support and resources) and mock exams emerged as important elements of online exams, as was the e-invigilation, which students perceived as efficient and non-intrusive.

Molecular insights into the role of electronic cigarettes in oral carcinogenesis

Electronic cigarette (EC) usage or vaping has seen a significant rise in recent years across various parts of the world. They have been publicized as a safe alternative to smoking; however, this is not supported strongly by robust research evidence. Toxicological analysis of EC liquid and aerosol has revealed presence of several toxicants with known carcinogenicity. Oral cavity is the primary site of exposure of both cigarette smoke and EC aerosol. Role of EC in oral cancer is not as well-researched as that of traditional smoking. However, several recent studies have shown that it can lead to a wide range of potentially carcinogenic molecular events in oral cells. This review delineates the oral carcinogenesis potential of ECs at the molecular level, providing a summary of the effects of EC usage on cancer therapy resistance, cancer stem cells (CSCs), immune evasion, and microbiome dysbiosis, all of which may lead to increased tumor malignancy and poorer patient prognosis. This review of literature indicates that ECs may not be as safe as they are perceived to be, however further research is needed to definitively determine their oncogenic potential.

Oral Health-Related Quality of Life throughout Treatment with Clear Aligners in Comparison to Conventional Metal Fixed Orthodontic Appliances: A Systematic Review

BACKGROUND

Orthodontic clear aligners constitute an alternative and increasingly used orthodontic treatment modality, offering enhanced esthetics with potential consequences regarding patients' oral health-related quality of life (OHRQoL).

OBJECTIVE

Summarize and systematically evaluate existing evidence on the OHRQoL of patients treated with orthodontic clear aligners compared to treatment with conventional metal, fixed appliances.

SEARCH METHODS

We searched without limitations six databases and searched manually the reference lists of relevant studies up to the end of October 2022.

SELECTION CRITERIA

We looked for data from prospective studies that compared OHRQoL, using instruments that had undergone full psychometric validation, between orthodontic patients with clear aligners and labial, fixed, metal orthodontic appliances.

DATA COLLECTION AND ANALYSIS

We extracted the data from the located studies, and we assessed the risk of bias with the Cochrane Collaboration suggested tools. The quality of available evidence was based on the GRADE approach.

RESULTS

Three studies were identified. OHRQoL was impacted less by clear aligners compared to treatment with conventional labially placed, fixed, metal appliances. The exploratory meta-regression, with the time point of assessment as predictor, did not reveal any statistically significant effect. The quality of the available evidence ranged from very low to low.

CONCLUSIONS

According to the exploratory synthesis of the limited available dataset, treatment with clear aligners could be associated with better OHRQoL ratings compared to treatment with conventional labially placed, metal, fixed appliances. However, the quality of the presented evidence renders further high-quality studies warranted to be able to reach safer conclusions.

Do the various interceptive treatment modalities improve the position of palatally displaced permanent canines? A meta-analysis

BACKGROUND

Removal of maxillary primary canines and other interceptive treatment modalities in the mixed dentition have been suggested as methods used to increase the rate of normal eruption of palatally displaced permanent canines (PDCs). However, the information on the overall effect on PDCs' position has been inconclusive.

OBJECTIVE

To assess whether this practice improves the position of PDCs and to investigate the quality of the evidence.

SEARCH METHODS

Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to June 2022 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ClinicalTrials.gov, ProQuest Dissertations, and Theses Global).

SELECTION CRITERIA

We looked for data on the positional changes of PDCs (mesial inclination, vertical position, canine crown cusp tip to midline) from randomized controlled trials assessing the various interceptive treatment modalities.

DATA COLLECTION AND ANALYSIS

Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis and meta-regression were conducted using the random effects model and the overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach.

RESULTS

Five studies (3 at low risk of bias) were identified, involving 238 individuals, followed for up to 18 months post-intervention with OPG (orthopantomogram) or CBCT (cone-beam computed tomography). Exploratory data synthesis showed that PDCs' position improved more in the extraction sites compared to non-extraction. Analysis of the studies at low risk confirmed the above observations (6- and 12-month). Improvements were observed in patients using headgear after extraction of primary canines compared to extraction alone, but not in patients with double extraction of primary canines and first molars. The quality of available evidence was rated at best as moderate.

CONCLUSIONS

Interceptive treatment modalities in the mixed dentition may improve the position of PDCs. However, more studies are necessary in order to determine the clinical significance of the changes.

REGISTRATION

PROSPERO (CRD42015029130).

Are asthma and allergy associated with increased root resorption following orthodontic treatment? A meta-analysis

OBJECTIVE

The aim of this study is to systematically investigate the available evidence from human studies regarding the association of asthma and/or allergy with EARR.

MATERIALS AND METHODS

Unrestricted searches in 6 databases and manual searching were performed up to May 2022. We looked for data on EARR after orthodontic treatment in patients with/without asthma or allergy. Relevant data were extracted, and the risk of bias was assessed. An exploratory synthesis was carried out using the random effects model, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation.

RESULTS

From the initially retrieved records, nine studies met the inclusion criteria (three cohort and six case-control). Overall, increased EARR was observed in the individuals with allergies in their medical history (Standardised Mean Difference [SMD]: 0.42, 95% Confidence Interval [CI]: 0.19 to 0.64). No difference in EARR development was observed among individuals with or without a medical history of asthma (SMD: 0.20, 95% CI: -0.06 to 0.46). The quality of available evidence, excluding studies at high risk, was rated as moderate for the exposure to allergy, and low for the exposure to asthma.

CONCLUSION

Increased EARR was noted in individuals with allergies compared to the control group, while no difference was observed for individuals with asthma. Until more data become available, good practice would suggest that it is important to identify patients with asthma or allergy and consider the possible implications.

May alcoholic and non-alcoholic drinks affect the rate of orthodontic tooth movement? A systematic review of animal studies

BACKGROUND

Humans may consume various beverages in everyday life. Previous research has shown that the administration of different substances (medicinal or not) may affect bone turnover and, thus, orthodontic tooth movement. It would be anticipated that the substances contained in beverages could have an impact on tooth movement, as well.

OBJECTIVE

To investigate in a systematic way and appraise the quality of the available evidence from animal studies regarding the impact of various drinks or the main ingredients included in beverages on the rate of orthodontic tooth movement.

SEARCH METHODS

Search without restriction in six databases (including grey literature) and hand searching were performed until March 2022.

SELECTION CRITERIA

We looked for controlled animal studies investigating the effect of drinks, or the main ingredients included in beverages, on the rate of orthodontic tooth movement.

DATA COLLECTION AND ANALYSIS

After study retrieval and selection, relevant data was extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. The quality of available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation.

RESULTS

The initially identified records were finally reduced to nine studies conducted on animals. Carbonated soft drinks were shown to decrease the rate of tooth movement, but alcohol consumption did not have an impact. Exploratory meta-analysis showed that caffeine exhibited an acceleratory effect after 3 weeks of force application. Exploratory meta-regression results indicated that high dosages of caffeine reduced the rate of tooth movement.

CONCLUSIONS

The located animal experiments reported that caffeine accelerates, carbonated drinks decelerate, while alcohol does not affect the rate of orthodontic tooth movement. However, due to various limitations it remains unclear whether caffeine, alcohol, or carbonated drinks finally influence tooth movement in animal studies.

REGISTRATION

Open Science Framework (https://osf.io/jyhbd/).

Antimicrobial Activity of Phytic Acid: An Emerging Agent in Endodontics

Background

Phytic acid (IP6) is a promising and emerging agent, and because of its unique structure and distinctive properties, it lends itself to several applications in dentistry. Recently, IP6 was proposed as a potential chelating agent in endodontics. However, there is limited knowledge regarding its antimicrobial and antibiofilm effectiveness. The aims of this study, were therefore to evaluate the antimicrobial and antibiofilm activities of IP6 against a range of microbial species and compare these with ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl). The contact time required for IP6 to exert its bactericidal effect on Enterococcus faecalis was also determined.

Methods

The inhibitory and biocidal activities of IP6, EDTA and NaOCl were assessed using a broth microdilution assay against 11 clinical and reference strains of bacteria and a reference strain of Candida albicans. The contact time required for various IP6 concentrations to eliminate planktonic cultures of E. faecalis was determined using a membrane filtration method according to BS-EN-1040:2005. IP6 bactericidal activity was also evaluated using fluorescent microscopy, and the antibiofilm activity of the test agents was also determined.

Results

IP6 was biocidal against all tested microorganisms. At concentrations of 0.5%, 1% and 2%, IP6 required 5 min to exert a bactericidal effect on E. faecalis, while 5% IP6 was bactericidal after 30 s. IP6 also eradicated biofilms of the tested microorganisms. In conclusion, IP6 had notable antimicrobial effects on planktonic and biofilm cultures and exhibited rapid bactericidal effects on E. faecalis. This research highlighted, for the first time the antimicrobial and antibiofilm properties of IP6, which could be exploited, not only in dental applications, but also other fields where novel strategies to counter antimicrobial resistance are required.

Does the rate of orthodontic tooth movement change during the estrus cycle? A systematic review based on animal studies

BACKGROUND

As the fluctuation of sex hormone levels in menstruating women results in periodical effects in bone metabolism, understanding the implications for tooth movement could be of benefit to the orthodontist. This type of research presents practical and ethical problems in humans, but animal models could provide useful information. Our objective was to systematically investigate the available evidence on the question whether the rate of orthodontic tooth movement varies between the different stages of the estrus cycle in animals.

METHODS

Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to February 2021 (Medline [PubMed], CENTRAL [Cochrane Library; includes records from Embase, CINAHL, ClinicalTrials.gov, WHO's ICTRP, KoreaMed, Cochrane Review Groups' Specialized Registers, and records identified by handsearching], Cochrane Database of Systematic Reviews [Cochrane Library], Scopus, Web of Knowledge [including Web of Science Core Collection, KCI Korean Journal Database, Russian Science Citation Index, SciELO Citation Index and Zoological Record], Arab World Research Source [EBSCO] and ProQuest Dissertation and Theses [ProQuest]). Our search focused on prospective controlled animal studies, whose samples included female subjects of any species that were quantitatively comparing the amount of tooth movement in the different stages of the estrus cycle. Following study retrieval and selection, relevant data was extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool.

RESULTS

From the finally assessed records, 3 studies met the inclusion criteria. Two of the studies experimented on Wistar rats, whereas the other on cats. Tooth movement was induced by expansion or coil springs. The rate of orthodontic tooth movement was increased during the stages of the estrus cycle when oestrogen and/or progesterone levels were lower. The risk of bias in the retrieved studies was assessed to be unclear.

CONCLUSION

Hormonal changes during the estrus cycle may affect the rate of orthodontic tooth movement. Although these animal experiment results should be approached cautiously regarding their translational potential, it could be useful to consider the possible impact of these physiological changes in the clinical setting until more information becomes available. Registration: PROSPERO (CRD42021158069).

"Maternal diabetes mellitus and its impact on the risk of delivering a child with congenital heart disease: a systematic review and meta-analysis"

AIM

Maternal pregestational diabetes mellitus (PGDM), type 1 or type 2, has been established as a potential risk factor for congenital heart disease (CHD). At the same time, the correlation between gestational diabetes mellitus (GDM) and increased risk of CHD has not been yet fully elucidated. The objective of this systematic review and meta-analysis (PROSPERO number: CRD42020182390) was to analyze the existing evidence on PGDM and to attempt to fill, to the best of our ability, the remaining knowledge gap in the association of GDM with CHD.

MATERIALS AND METHODS

Two authors have independently searched the Pubmed/Medline, Scopus, Cochrane, Web of Science, and Theses Global databases with keywords and Boolean operators. The search yielded 9333 relevant articles, which were later screened for eligibility. Original peer-reviewed (case-control or cohort) studies were included if they were published in English between 1997 and 2020. Thirteen studies on mothers with PGDM and seven studies on mothers with GDM were finally included in our meta-analysis to investigate the association of maternal diabetes with the risk of delivering a child with CHD. The selected studies were all assessed for their methodological quality using the Newcastle-Ottawa scale. Associations with p < .05 were considered statistically significant.

RESULTS

Our meta-analysis (I² > 75%, total population: n = 12,461,586) of 79,476 women with PGDM and 160,893 with GDM produced an odds ratio of 3.48 (2.36-4.61) and 1.55 (1.48-1.61), respectively. Additionally, we did not find any noticeable difference in the risk for CHD among diabetic women living in the USA and Europe. Nevertheless, it still needs to be clarified, whether or not the gestational diabetic population includes undiagnosed women with preexisting diabetes, which might account for the increased risk of delivering a child with CHD in women classified as suffering from GDM.

CONCLUSION

While both GDM and PGDM seem to significantly increase the risk of CHD in comparison with the general population, PDGM appears to have a greater association with CHD, being correlated with a 3.5-fold increase in the risk of malformation. Preconceptional and gestational diabetes care are, therefore, essential to mitigate the adverse effect of hyperglycemia on fetal heart formation during pregnancy.

Effect of ovariectomy-induced osteoporosis on the amount of orthodontic tooth movement: a systematic review of animal studies

BACKGROUND

Understanding the impact of osteopenia and osteoporosis on orthodontic tooth movement could be of benefit to the orthodontist, but research in humans presents practical and ethical problems. The ovariectomized animal model could provide useful information on osteoporosis.

OBJECTIVE

To compare the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects.

SEARCH METHODS

Unrestricted searches in seven databases and manual searching of the reference lists in relevant studies were performed up to February 2021 (PubMed, Central, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Arab World Research Source, ProQuest Dissertations, and Theses Global).

SELECTION CRITERIA

We searched for studies quantitatively comparing the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects.

DATA COLLECTION AND ANALYSIS

Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model.

RESULTS

Thirteen studies were finally selected and no specific concerns regarding bias were identified. During the active period, ovariectomy was associated with a statistically significant acceleratory effect on the rate of orthodontic tooth movement compared to non-treated rats (3 weeks; 4 studies, 0.15 mm more movement in the ovariectomized rats; 95 per cent confidence interval: 0.10-0.19; P = 0.000). Exploratory meta-regression showed that this difference could increase over time. Following force discontinuation, no statistically significant differences were observed [3 weeks; 1 study (median ± SE), Ovariectomy group: 0.30 ± 0.04 mm; Sham operation group: 0.18 ± 0.03; P = 0.1558].

CONCLUSIONS

Ovariectomy-induced osteoporosis may affect the rate of orthodontic tooth movement. Although animal studies should be approached with caution regarding their translational potential, the safe practice would suggest that one should consider potential implications.

REGISTRATION

PROSPERO (CRD42018118003).

Effect of nicotine exposure on the rate of orthodontic tooth movement: A meta-analysis based on animal studies

Background

Nicotine exposure has been reported to modify bone cell function and the osseous metabolism with potential effects on the rate of orthodontic tooth movement.

Objectives

To systematically investigate and quantitively synthesize the most recent available evidence from animal studies regarding the effect of nicotine exposure on the rate of orthodontic tooth movement.

Search methods

Unrestricted searches in 7 databases and hand searching were performed until July 2020 (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ProQuest Dissertations and Theses Global).

Selection criteria

We searched for controlled studies on healthy animals investigating the effect of nicotine on the rate of orthodontic tooth movement.

Data collection and analysis

Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the SYRCLE’s Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model.

Results

From the initially identified records, 5 articles meeting the inclusion criteria were selected and no specific concerns regarding bias were identified. Quantitative data synthesis showed that the rate of orthodontic tooth movement in the nicotine exposed rats was higher than in the control group animals (2 weeks of force application; 0.317 mm more movement in nicotine exposed rats; 95% Confidence Interval: 0.179–0.454; p = 0.000). No effect of the concentration or the duration force application was demonstrated following exploratory meta-regression.

Conclusion

Rats administered with nicotine showed accelerated rates of orthodontic tooth movement. Although, information from animal studies cannot be fully translated to human clinical scenarios, safe practice would suggest that the orthodontist should be able to identify patients exposed to nicotine and consider the possible implications for everyday clinical practice.

Microbial Metabolic Genes Crucial for S. aureus Biofilms: An Insight From Re-analysis of Publicly Available Microarray Datasets

Bacterial biofilms are microbial lifestyles found in all environments. Up to 80% of human infections and 60–70% of hospital-acquired infections have a biofilm origin, with Staphylococcus aureus one of the leading causes of these infections. Microorganisms in biofilms exhibit significant antimicrobial resistance which poses important treatment challenges, hence the urgent need to identify novel antibiofilm strategies. Microbes form biofilms in response to various factors, and once these 3-dimentional structures form they are highly recalcitrant to removal. The switch from planktonic lifestyle to the biofilm protected mode of growth results in a phenotypic shift in the behavior of the microorganisms in terms of growth rate and gene expression. Given these changes, investigation of microbial gene expression and their modulation at different stages of biofilm maturation is needed to provide vital insight into the behavior of biofilm cells. In this study, we analyzed publicly available transcriptomic dataset of S. aureus biofilms at different stages of maturation to identify consistently upregulated genes irrespective of the biofilm maturation stage. Our reanalysis identified a total of 6 differentially expressed genes upregulated in both 48 and 144-h old S. aureus biofilms. Functional analysis revealed that these genes encode for proteins which play a role in key microbial metabolic pathways. However, these genes, as yet, are unrelated or fully studied in the context of biofilm. Moreover, the findings of this in silico work, suggest that these genes may represent potential novel targets for the development of more effective antibiofilm strategies against S. aureus biofilm-associated infections.

Bisphosphonates as Supplement to Dental Treatment: A Network Meta-Analysis

The objective of this study was to assess clinical measurements related to the effectiveness of bisphosphonate (BP) administration as a supplement to conventional dental treatment in patients free of bone-related diseases using a network meta-analysis. Only randomized controlled trials (RCTs) were included that provided dental clinical measurements on human patients treated with BPs with or without similar untreated controls or treated with placebo. Information sources included a systematic search of 17 electronic databases up to August 2020, complemented by manual searches. Risk of bias assessment was performed with the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Extracted measurements were pooled according to time of evaluation. The random-effects model by DerSimonian and Laird was used to calculate mean differences (MDs) and the respective 95% confidence intervals (CIs). Seven RCTs were included in the network meta-analysis, assessing 391 subjects reporting on periodontal treatment effects after 2 to 12 mo of BP administration. BP treatment was associated with significant improvement of most clinical measurements, compared with BP-naive controls. According to the network ranking, alendronate was more efficient in improvement of probing depth and clinical attachment gain when compared to zoledronate or alendronate/risedronate. Similarly, the local application of alendronate as a gel was more effective than the oral administration. A long-term analysis of the pharmaceutical effects was not possible due to insufficient data. The current review, performed according to existing guidelines, included only RCTs and, through appropriate statistical analyses, provided precise estimates for most assessed outcomes. However, no adverse effects or long-term treatment results were analyzed due to inadequate pertinent data. BP administration seems to be beneficial in the short term for the treatment of periodontal diseases, mainly through controlling periodontal inflammation.

Effects of systemic medication on root resorption associated with orthodontic tooth movement: a systematic review of animal studies

BACKGROUND

Theoretically, root resorption could be modulated by any medication taken that exhibits possible effects on the implicated molecular pathways.

OBJECTIVES

To systematically investigate and appraise the quality of the available evidence from animal studies, regarding the effect of commonly prescribed systemic medication on root resorption associated with orthodontic tooth movement.

SEARCH METHODS

Search without restrictions in eight databases (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ClinicalTrials.gov, ProQuest Dissertations and Theses Global) and hand searching until April 2018 took place. One author developed detailed search strategies for each database that were based on the PubMed strategy and adapted accordingly.

SELECTION CRITERIA

Controlled studies investigating the effect of systemic medications on root resorption associated with orthodontic tooth movement.

DATA COLLECTION AND ANALYSIS

Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool.

RESULTS

Twenty-one studies were finally identified, most of which at unclear risk of bias. Root resorption was shown to increase in Vitamin C treated animals in comparison with the control group, whereas a comparative decrease was noted after the administration of the alendronate, ibuprofen, growth hormone, low doses of meloxicam, simvastatin, lithium chloride and strontium ranelate. No difference was noted for acetaminophen, aspirin, fluoxetine, atorvastatin, misoprostol, zoledronic acid and zinc. Finally, inconsistent effects were observed after the administration of celecoxib, prednisolone and L-thyroxine. The quality of the available evidence was considered at best as low.

CONCLUSIONS

The pharmaceutical substances investigated were shown to exhibit variable effects on root resorption. Although the overall quality of evidence provides the clinician with a cautious perspective on the strength of the relevant recommendations, good practice would suggest that it is important to identify patients consuming medications and consider the possible implications.

REGISTRATION

PROSPERO (CRD42017078208).

Does the rate of orthodontic tooth movement change during pregnancy and lactation? A systematic review of the evidence from animal studies

Background

The changes in bone homeostasis observed during pregnancy and lactation could result in alterations in the rate of orthodontic tooth movement, but research in human subjects presents significant ethical and practical limitations. Our aim was to compare the amount of orthodontic tooth movement between pregnant/lactating or not animals.

Methods

We searched without restrictions 8 databases and performed hand searching until July 2019 (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ClinicalTrials.gov, ProQuest Dissertations and Theses Global). We searched for studies comparing quantitatively the amount of orthodontic tooth movement between pregnant/lactating or not animals. Following retrieval and selection of studies, the collection of related data was performed and the risk of bias was assessed using the SYRCLE’s Risk of Bias Tool. Exploratory synthesis was carried out using the random effects model.

Results

Four studies were finally identified raising no specific concerns regarding bias. One study showed that lactation increased the rate of tooth movement by 50 % [p < 0.05]. Although an overall increase was noted in the pregnancy group as well, it did not reach statistical significance [3 studies, Weighted Mean Difference: 0.10; 95% Confidence Interval: − 0.04 - 0.24; p = 0.165].

Conclusions

The metabolic changes occurring during pregnancy and lactation may have an impact on the rate of tooth movement in animals. Although these animal experimental results should be approached cautiously, it could be safe practice to consider the impact of these physiological changes in the clinical setting.

Registration

PROSPERO (CRD42018118003).

Could medications and biologic factors affect post-orthodontic tooth movement changes? A systematic review of animal studies

Immediately after the removal of orthodontic appliances, the teeth might start to drift away from their corrected position in an attempt to reach a new equilibrium. Medications and biologic factors could potentially modulate these processes. The objective of the present systematic review is to systematically investigate and appraise the quality of the evidence regarding the effect of various medications and biologic factors on the rate of relapse following active tooth movement. Search without restrictions in eight databases and hand searching until April 2020 were conducted. Studies performed on animal models investigating the effects of medication and biologic factors on the rate of relapse following orthodontic tooth movement were considered. Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed. Seventeen studies were finally identified, mostly at either high or unclear risk of bias. Ketorolac did not show any significant effects on relapse, while the administration of tetracycline, atorvastatin, psoralen and raloxifene decreased it. Overall, the same result was observed with bisphosphonates with the exception of low dosage of risedronate, which did not have an effect. Osteoprotegerin and strontium resulted in reduced relapse, but not in the immediate post-administration period. Inconsistent or conflicting effects were noted after the use of simvastatin and relaxin. The quality of the available evidence was considered at best as low. It can be concluded that specific medications and biologic factors may have an effect on the rate of relapse following tooth movement. The orthodontist should be knowledgeable about the substances potentially affecting retention.

Orthodontic Procedures, With or Without Extracting Primary Canines, for the Interceptive Management of Palatally Displaced Permanent Canines: A Systematic Review

Purpose: Although rapid maxillary expansion (RME), transpalatal arch (TPA) and cervical-pull headgear (HG) have been suggested for the interception of palatally displaced permanent canines (PDCs), existing knowledge remains inconclusive. The purpose of this study was to assess these practices in an evidence-based manner.<br/> Methods: Randomized controlled trials (RCTs) investigating the prevalence of physiologic PDC eruption after using RME, TPA and HG, with or without the extraction of the primary canines, were searched, and the risk of bias was assessed.<br/> Results: Data from five RCTs were included. RME, TPA and HG, with or without extracting primary canines, can significantly increase the rate of normal eruption of PDCs compared to no intervention (risk ratio [RR] = 2.5 to 4.5). In comparison to extraction, no difference was observed, except for HG combined with primary canine extraction (RR = 1.413; 95 percent confidence interval = 1.062 to 1.880).<br/> Conclusion: RME, TPA and HG can significantly increase the rate of normal eruption of PDC compared to no intervention. However, when compared to extraction, no differences were noted, except for HG combined with primary canine extraction.

Child perceptions questionnaire: translation, cultural adaptation and initial validation in a Greek adolescent population with malocclusion

PURPOSE

Several studies have shown that orthodontic anomalies may affect young people's Oral Health-Related Quality of Life (OHRQoL). The purpose the present study was to translate in the Greek language, culturally adapt and initially validate the CPQ_11-14 ISF-16 for a Greek adolescent population with malocclusion.

METHODS

Following relevant methodological recommendations, after translation, the comprehensiveness of the Greek version of CPQ_11-14 ISF-16 (CPQ_11-14 ISF-16-GR) was verified in a pilot study of 20 Greek adolescents. The main study was undertaken in a sample of 200 adolescents that presented for an initial consultation at the Postgraduate Orthodontic Clinic. Cronbach's alpha was used to test internal consistency/reliability and Spearman's rho for criterion validity with the Oral Health Impact Profile (OHIP-14). Forty individuals completed the same questionnaires again after 3 weeks. Test-retest reliability was assessed using Intraclass Correlation Coefficient. Statistical tests were undertaken using SPSS (v. 24, IBM Corp., NY, USA).

RESULTS

The CPQ_11-14 ISF-16-GR presented high internal consistency (Cronbach's alpha = 0.848 > 0.70) and very satisfactory Discrimination Index (DI = 0.47 > 0.30). Moreover, the CPQ_11-14ISF-16 showed excellent criterion validity with OHIP-14 (rho = 0.719, p < 0.001). Test-retest reliability was at high levels as well (ICC = 0.719, p < 0.001).

CONCLUSION

The CPQ_11-14 ISF-16-GR exhibits satisfactory psychometric properties to continue the investigation of OHRQoL in Greek adolescents with malocclusion. Further testing of is required in a variety of environments to increase generalizability and investigate the particular characteristics of CPQ application in malocclusion cases.

Do probiotics promote oral health during orthodontic treatment with fixed appliances? A systematic review

BACKGROUND

Treatment with fixed orthodontic appliances has been associated with significant biofilm accumulation, thus putting patients at a higher risk of oral health deterioration. The use of probiotics has been proposed to be useful in the prevention or treatment of oral pathologies such as caries and diseases of periodontal tissues. Our aim was to investigate the effects of probiotic use on inflammation of the gingival tissues and the decalcification of the enamel in patients being treated with fixed orthodontic appliances.

METHODS

We searched without restrictions 8 databases and performed hand searching until September 2019. We searched for randomized controlled trials (RCTs) evaluating whether individuals with fixed orthodontic appliances benefit from probiotic treatment in terms of the inflammation of the gingivae and decalcification of the enamel. Following the selection of studies and the extraction of pertinent data, we appraised the risk of bias and the confidence in the observed effects based on established methodologies.

RESULTS

From the final qualifying studies, three did not show any statistically significant effect on gingival inflammation after probiotic administration of up to 1 month. Similarly, non-significant differences were noted in another study regarding white spot lesions development (mean administration for 17 months). No adverse effects were reported and the level of evidence was considered moderate.

CONCLUSIONS

Supplementation of orthodontic patients with probiotics did not affect the development of inflammation in the gingivae and decalcification in the enamel. Additional RCTs, with longer intervention and follow-up periods, and involving different combinations of probiotic strains are required.

TRIAL REGISTRATION

PROSPERO (CRD42018118008).

Tooth Wear in a Sample of Community-Dwelling Elderly Greeks

PURPOSE

Increased wear of teeth may constitute a major problem in the future for the elderly. The aim of the present study was to investigate tooth wear in a sample of elderly Greeks and explore the presence and extent of severe occlusal/incisal wear in relation to the parameters of age, gender and remaining teeth.

MATERIALS AND METHODS

A convenience sample of 70 dentate elderly (60-92 years old) was examined. Tooth wear was assessed using a modification of the tooth wear index. The presence of severe occlusal/incisal wear was explored using the multiple correspondence analysis (MCA) and x2 tests and the extent (% of surfaces) with analysis of variance (ANOVA).

RESULTS

Increased prevalence of severe wear was observed in the occlusal/incisal and, to a lesser extent, in the cervical surfaces of the examined teeth. Seventy per cent (70%) of the participants had at least one severely worn tooth surface. Advanced age seemed to be associated with severe occlusal/incisal wear (>70 years: 79.4%; 60-70 years: 52.8%; x2 test, p = 0.024). The mean (± SD) percentage of severely worn teeth and surfaces was 34.2 ± 32.6% and 9.6 ± 9.6%, respectively. ANOVA showed that males and those with less than 20 remaining teeth exhibited more severely worn occlusal/incisal surfaces (p = 0.031 and p = 0.000, respectively).

CONCLUSIONS

The presence and the extent of severe wear in the sample of the examined elderly is high compared to elderly populations in other countries. Severe wear was more prevalent with advanced age and more extensive in the occlusal/incisal surfaces in males and those having less than 20 remaining teeth.

Effects of systematic bisphosphonate use in patients under orthodontic treatment: a systematic review

BACKGROUND

Bisphosphonates are a class of drugs prescribed for several osseous related disorders owing to their ability to regulate bone turnover, which could in turn affect orthodontic treatment outcomes.

OBJECTIVE

To examine the effect of bisphosphonate (BP) use on orthodontic patients through clinical and radiographic measurements.

SEARCH METHODS

Systematic and unrestricted search of 17 databases complemented with additional hand-searches were performed up to March 2019.

SELECTION CRITERIA

Articles reporting on human patients with a history of BPs administration that received orthodontic treatment were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Data regarding the medical profile of the patients, the specific type of malocclusion and the performed treatment plan, as well as the clinical and radiographic outcomes were extracted. Quality assessment was performed by the ROBINS-I tool for the cohort studies and by a slightly modified checklist from the original one proposed by Agbabiaka et al. for the case reports.

RESULTS

7 articles (1 retrospective cohort study and 6 case reports) were eventually included in the present review including 122 subjects (29 patients and 93 controls) reporting on the clinical and radiographic changes following orthodontic treatment of patients during or after BPs use. BPs seem to have a controversial effect on the clinical and patient-reported variables, even though the majority of the included patients presented with compromised treatment results and a rather slow rate of tooth movement. Most radiographic findings revealed mild root resorption, widened periodontal ligament spaces and sclerotic changes on the surrounding alveolar bone. However, these results should be interpreted with caution, due to the limited number of the eligible articles and their limitations.

LIMITATIONS

The included studies were of rather low quality due to study design and incomplete reporting.

CONCLUSIONS AND IMPLICATIONS

BP administration seems to be associated with compromised clinical outcomes, prolonged treatment time, and moderate changes on the roots and surrounding tissues of orthodontic patients.

REGISTRATION

Non-registered.

FUNDING

None.

Molecular Characterization of Staphylococcus aureus Isolates Associated with Nasal Colonization and Environmental Contamination in Academic Dental Clinics

Aim: To determine the genetic makeup of methicillin-sensitive/methicillin-resistant Staphylococcus aureus (MSSA/MRSA) from nasal colonization and environmental contamination in dental clinics. Materials and Methods: Nasal swabs from students and health care workers and environmental swabs were obtained at two academic dental clinics in the United Arab Emirates. The StaphyType DNA microarray-based assay was used for molecular characterization. Results: Forty-eight S. aureus isolates were identified phenotypically (nasal: n = 43; environmental: n = 5), but 6 of these were assigned to S. argenteus by genotyping. These were CC_(argenteus)2596, CC_(arg)2250-MSSA, CC_(arg)2250-MSSA-(Panton Valentine leukocidin [PVL]+) (n = 2), and CC_(arg)2198-MSSA (n = 2). MRSA nasal colonization rate was 5.4% (n/N = 8/146) with the following strain affiliations: CC5-MRSA-[IV+fus+ccrAB], "Maltese Clone"; CC6-MRSA-IV, "WA MRSA-51"; CC22-MRSA-IV (PVL+/tst+); CC22-MRSA-[IV+fus+ccrAA/(C)]; and two each of CC5-MRSA-[VI+fus] and CC97-MRSA-[V/VT+fus]. The SCC-borne fusidic acid resistance (fusC) gene was detected in MRSA (n = 5) and MSSA (n = 1). Some MSSA strains, CC1-MSSA-[fus+ccrAB1] and ST1278-MSSA-[ccrA1], harbored recombinase genes. A CC30-MSSA harbored ACME locus/arc-genes, while ST1278-MSSA-[ccrA1] had an ACME-III element. Enterotoxin genes were commonly carried, but tst-1 gene was found in only CC22, CC30, and CC34 strains, while pvl genes were identified in CC_(arg)2250 and CC22-MRSA-IV. Of the 51 noncoagulase staphylococci (CoNS) identified, 18 were mecA positive. Conclusion: The findings demonstrate the first report of rare strains (ST1278 MSSA, CC_(arg)2198, CC_(arg)2596, and PVL+CC_(arg)2250) in our region. Detection of MSSA with recombinase genes and ACME loci alongside mecA-positive CoNS is of clinical significance as this could provide a milieu for acquisition and transfer of SCC-elements, either with different ACME types, with fusC or the mecA gene resulting in conversion of MSSA into MRSA.

Do orthodontic patients develop more gingival recession in anterior teeth compared to untreated individuals? A systematic review of controlled studies

OBJECTIVE

To investigate, in an evidence-based manner, the contemporary available information regarding the development of gingival recession in the anterior teeth of orthodontically treated and age-matched untreated individuals.

MATERIAL AND METHODS

Eight databases were searched without restrictions from the date of coverage initiation to June 30th, 2019 (registration in PROSPERO: CRD42018080948). Studies evaluating gingival recession development following comprehensive orthodontic treatment were reviewed. Following study selection, data extraction and risk of bias assessment, the random effects model was employed for exploratory data synthesis. The confidence in the retrieved estimates was appraised using current guidelines.

RESULTS

Finally, three studies, with a follow-up of 6 years maximum, were identified. Overall, the amount of gingival recession did not increase significantly immediately after treatment with normal occlusion. However, for some of the comparisons considered, the risk for orthodontic patients to present with labial gingival recession seemed to increase, especially during retention [mandibular incisors 6 years post-treatment: Odds Ratio: 8.81, 95% Confidence Interval: 1.93-40.07, p=0.005].

CONCLUSION

Although the amount of recession does not differ, some increase in the risk for gingival recession development in the anterior teeth may be encountered in orthodontically-treated individuals compared to untreated subjects with normal occlusion. However, these findings should be viewed cautiously until more studies of high quality become available. Good practice would suggest that it is important to identify patients at potential risk and consider the possible implications for orthodontic treatment.

A single-centre investigator-blinded randomised parallel group clinical trial to investigate the effect of probiotic strains Streptococcus salivarius M18 and Lactobacillus acidophilus on gingival health of paediatric patients undergoing treatment with fixed orthodontic appliances: study protocol

BACKGROUND

There is limited data on the beneficial effects of probiotics on the gingival health of patients undergoing treatment with fixed orthodontic appliances. This study aims to compare the effect of probiotic tablets combined with regular oral hygiene versus regular oral hygiene alone on gingival status in these patients. The effect of probiotic intake on plaque formation and salivary microbiome composition will be also assessed.

METHODS AND ANALYSIS

This is a 3 month single-centre, single blind (clinical and laboratory examiners), parallel group randomised controlled two arm superiority trial. Fifty paediatric patients attending the Postgraduate Orthodontic Clinic at the Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates, who meet the eligibility criteria will be recruited. Block randomisation with 1:1 allocation and concealment of allocation will be carried out. The treatment group will receive probiotic tablets containing Streptococcus salivarius M18 and Lactobacillus acidophilus together with regular oral hygiene versus the control group on regular oral hygiene alone. Clinical examination and collection of saliva for microbiome assay will be carried out at baseline and end of study. Self-reporting by patients will be used to document acceptability and adverse effects. Statistically significant decrease in gingival bleeding on probing in the treatment group will be classified as primary outcome of treatment success. Statistically significant reduction in Plaque Index, Gingival Index and shift in the composition of the oral microbiome in favour of beneficial bacteria are secondary outcomes indicative of efficacy of probiotic intake.

ETHICS AND DISSEMINATION

Ethical approval for the study has been granted by the HBMCDM, MBRU, Institutional Review Board (Reference #: MBRU-IRB-2018-015). Study findings will be disseminated via publication in peer-reviewed journal.

TRIAL REGISTRATION NUMBER

ISRCTN95085398.

Does medication administration affect the rate of orthodontic tooth movement and root resorption development in humans? A systematic review

Background

Recently, the potential impact of different medications on the rate of orthodontic tooth movement and the associated root resorption has been systematically reviewed in animal studies and various effects have been shown. However, animal data cannot be extrapolated to human clinical situations directly.

Objectives

To systematically investigate the most up to date available evidence from controlled human studies regarding the effect of medication administration on the rate of orthodontic tooth movement and associated root resorption development.

Search methods

We searched eight databases (covering also grey literature) without restrictions and we performed hand searching up until October 2018.

Selection criteria

Controlled studies in humans assessing the effect of various medications on the rate of orthodontic tooth movement and root resorption development.

Data collection and analysis

Study selection was followed by data extraction and risk of bias assessment using the ROBINS-I tool for non-randomized and the Cochrane Risk of Bias Tool for randomized studies.

Results

Eight studies, at various risk of bias, were finally identified. With regard to the rate of orthodontic tooth movement, local injections of prostaglandin E1 were found to exert an increasing effect, whereas systemic intake of nabumetone decreased it. Following tenoxicam administration, drinking water with fluoride or local injections of calcitriol (vitamin D metabolite), no significant effects were demonstrated. Concerning root resorption development, nabumetone administration was shown to reduce it, whereas fluoride, overall, was not observed to exert any effect. Only in individuals subjected to heavy orthodontic forces, did fluoride show a protective effect for the period of force application, but not in the longer term during retention.

Conclusions

The aforementioned substances may show varying effects on the rate of orthodontic tooth movement and root resorption development in human subjects. Despite the observed limitations, the orthodontist should be able to identify patients taking pharmaceuticals and consider any implications related to orthodontic treatment.

Registration

PROSPERO (CRD42017078208).

Do facial morphology, posture and function change following glossectomy? A systematic review

OBJECTIVES

To systematically investigate and critically appraise the quality of the currently available literature regarding the morphological, postural, and functional changes observed in individuals following glossectomy.

MATERIALS AND METHODS

A search without restrictions in eight databases (including grey literature) and hand searching from inception until March 2018 was performed. Data on morphological, postural, and functional changes after glossectomy were reviewed. Methodological quality was evaluated using the risk of bias in nonrandomized studies of intervention tool.

RESULTS

Out of 835 initially identified unique records, only three articles following patients for 1 year after glossectomy fulfilled the selection criteria. Overall, no significant morphological, postural, and functional changes were observed. Only the distance between the dorsum and the nasal line increased and the freeway space decreased significantly.

CONCLUSIONS

Overall, no significant differences were noted in the medium term, in terms of dentofacial structures adaptation and tongue function following glossectomy. Further research is warranted in order to elucidate the consequences of the altered oral environment.

Medication and orthodontic tooth movement

As any pharmaceutical substance may influence the events associated with orthodontic tooth movement, it is of importance for the clinician to be able to recognize any prospective patient's history and patterns of medicinal consumption. This review presents the effects of various commonly prescribed medications on the rate of orthodontic tooth movement. The article concludes that it remains, to a degree, unclear which types of medication may have a clinically significant effect in everyday clinical scenarios. However, since both prescription and over-the-counter medication use have recently increased significantly among all age groups, good practice suggests that it is important to identify patients consuming medications and consider the possible implications in orthodontic therapy.

Does common prescription medication affect the rate of orthodontic tooth movement? A systematic review

Background

As the taking of any medication may theoretically affect the complex pathways responsible for periodontal tissue homeostasis and the events leading to orthodontic tooth movement, it is considered important for the orthodontist to be able to identify prospective patients' history and patterns of pharmaceutical consumption.

Objective

To systematically investigate and appraise the quality of the available evidence regarding the effect of commonly prescribed medications on the rate of orthodontic tooth movement.

Search methods

Search without restrictions in eight databases and hand searching until June 2017.

Selection criteria

Controlled studies investigating the effect of commonly prescribed medications with emphasis on the rate of orthodontic tooth movement.

Data collection and analysis

Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool.

Results

Twenty-seven animal studies, involving various pharmacologic and orthodontic interventions, were finally identified. Most studies were assessed to be at unclear or high risk of bias. The rate of orthodontic tooth movement was shown to increase after the administration of diazepam, Vitamin C and pantoprazole, while simvastatin, atorvastatin, calcium compounds, strontium ranelate, propranolol, losartan, famotidine, cetirizine, and metformin decreased the rate of orthodontic tooth movement. No interference with the rate of orthodontic tooth movement was reported for phenytoin, phenobarbital and zinc compounds, whereas, inconsistent or conflicting effects were noted after the administration of L-thyroxine, lithium compounds, fluoxetine and insulin. The quality of the available evidence was considered at best as low.

Conclusions

Commonly prescribed medications may exhibit variable effects on the rate of orthodontic tooth movement. Although the quality of evidence was considered at best as low, raising reservations about the strength of the relevant recommendations, the clinician should be capable of identifying patients taking medications and should take into consideration the possible implications related to the proposed treatment.

Registration

PROSPERO (CRD42015029130).

Performance of Hawley-type retainers: a systematic review of randomized clinical trials

Background

Although post-treatment changes are almost inevitable, and retention has long been recognized as one of the most critical and routine problems faced by orthodontists, there remains a lack of certainty regarding the parameters of any definitive retention protocol following orthodontic treatment.

Objective

To investigate the performance of the Hawley-type retainers.

Search methods

Search without restrictions in 15 databases and hand searching until December 2016.

Selection criteria

Randomized clinical trials comparing the performance of Hawley-type retainers to other removable appliances or comparing different Hawley-type retainers' wearing schedules.

Data collection and analysis

Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Results

Finally, 10 studies were identified involving 854 individuals, followed for up to 1 year after debonding. Eight studies compared subjects using Hawley and clear thermoplastic retainers; another compared Hawley to positioner and, finally, one trial involved individuals allocated to different Hawley appliance wearing schedules. Three studies were considered as being of low, four of unclear, and three of high risk of bias. In general, few differences were observed between the Hawley and other removable retainers regarding outcomes relevant to maxillary and mandibular dental arch measurements, dental arch relationships and occlusal contacts, speech evaluation, patient reported outcomes, adverse effects, and problems related to the appliances, as well as economic evaluation related outcomes. Moreover, no differences were observed between the compared Hawley wearing schedules. Overall, the quality of the available evidence was considered low.

Conclusions

Given the overall quality of the available evidence and the multitude of parameters, which may have affected the results of the included trials, good practice would suggest further research in the respective field in order to increase both the quantity and quality of information available.

Registration

PROSPERO (CRD42015029279).

Funding

No funding was received for the present systematic review.

Does long-term use of pain relievers have an impact on the rate of orthodontic tooth movement? A systematic review of animal studies

Background

Pain relief drugs are used and misused widely and may theoretically affect the events leading to orthodontic tooth movement.

Objective

To systematically investigate and appraise the quality of the available evidence regarding the effect of pain relief medications on the rate of orthodontic tooth movement.

Search methods

Search without restrictions in eight databases (including grey literature) and hand searching until October 2018.

Selection criteria

Animal controlled studies investigating the effect of pain relievers on the rate of orthodontic tooth movement.

Data collection and analysis

Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed using the SYRCLE’s risk of bias tool.

Results

Fourteen studies were finally identified, most of which at unclear risk of bias. Ibuprofen and loxoprofen did not show any significant effects on the rate of orthodontic tooth movement, whereas indomethacin, ketorolac, morphine, and high doses of etoricoxib were found to decrease it. Inconsistent or conflicting effects were noted after the administration of acetaminophen, acetylsalicylic acid, celecoxib, meloxicam, and tramadol. The quality of the available evidence was considered at best as low.

Conclusions

Long-term consumption of pain relievers may affect the rate of orthodontic tooth movement. The orthodontist should be capable of identifying patients taking pain relievers independently of orthodontic treatment and consider the possible implications.

Trial registration

PROSPERO (CRD42017078208).

Toothbrushing-Should We Advise Mechanical or Power Brushes? Results of an International Delphi Conference

BACKGROUND AND AIM

To develop evidence-based answers to a series of questions in relation to toothbrushing using a modified Delphi consensus approach. Oral hygiene and especially toothbrushing have been a fundamental part of the efforts to prevent caries and gingivitis. The questions discussed involved the frequency and duration of brushing, the effectiveness and safety of powered brushes and the recommendations for children and orthodontic patients.

REVIEW RESULTS

The Delphi panel agreed that twice daily brushing for 2 minutes and a systematic pattern is advised. Moreover, it was concluded that evidence suggests that power brushes are safe and more effective in the short and long-term compared to manual brushes in terms of plaque removal and gingivitis reduction. For children and orthodontic patients, the likelihood of enhancing compliance/convenience with use of a power brush was highlighted.

CONCLUSION

Toothbrushing constitutes a fundamental part of the efforts to prevent caries and gingivitis.

CLINICAL SIGNIFICANCE

Twice daily brushing for 2 minutes and a systematic pattern is advised. Power brushes are safe and could provide benefits, for adults, children and orthodontic patients.

Tooth wear during orthodontic treatment with fixed appliances: a systematic review

OBJECTIVES

Tooth wear, additional to the physiologic alterations of the dentition, may occur during orthodontic treatment. The objective of the present review was to investigate systematically the literature relevant to its progression in patients having undergone comprehensive orthodontic treatment.

DATA SOURCES

Search without restrictions in eight databases since inception and hand searching until October 2017 was performed.

DATA SELECTION

Studies evaluating tooth wear immediately before and after the completion of orthodontic treatment with fixed appliance were evaluated independently and in duplicate.

DATA EXTRACTION

Following study retrieval and selection, data on volumetric and surface tooth wear was extracted. Individual study risk of bias assessment was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.

DATA SYNTHESIS

All three finally included studies reported wear of teeth during the period of treatment but were at serious risk of bias. Two of them investigated tooth wear by 3D volumetric measurements and one used grading scales. The mean volume reduction was 1.02 mm³ per tooth for the incisor group [95% Confidence Interval (CI): 0.84-1.20], 1.62 mm³ for the canines [95% CI: 0.8-2.38; I²= 96%; random effects method] and 0.95 mm³ for premolars and molars [95% CI: 0.84-1.07]. The overall quality of evidence limited the confidence in the observed estimates.

CONCLUSIONS

Varying degrees of tooth wear were reported after comprehensive orthodontic treatment. Further studies are needed in order to elucidate how much is associated with orthodontic treatment and/or physiologic alterations of the dentition.

Soft Tissue Characteristics and Gender Dimorphism in Class III Malocclusion: a Cephalometric Study in Adult Greeks

Background/Aim: Class III malocclusion case are considered complex problems associated with unacceptable esthetics. The purpose of the present study was to assess the characteristics of the soft tissue profile and investigate the possible gender differences in adult Greeks with Class III malocclusion. Material and Methods: The material of the study comprised of 57 pretreatment lateral cephalograms of adult patients with Class III malocclusion aged 18 to 39 years. Eleven variables were assessed. The variables were measured and the mean, minimum and maximum and standard deviations were calculated. Parametric and non-parametric tests were used to compare males and females patients. Results: The total sample was characterized by concave skeletal profile. Male patients exhibited greater nose prominence and superior sulcus depth, longer distance from subnasale to the harmony line, more concave profile, thicker upper lip and larger upper lip strain. Conclusions: Many significant differences were noted in soft tissue characteristics between males and females with skeletal Class III malocclusion, suggesting possible gender dimorphism.

Erosive Tooth Wear and Related Risk Factors in 8- and 14-Year-Old Greek Children

The aim of the present study was to investigate the erosive tooth wear of primary and permanent teeth and its association with related risk factors. Two groups of Greek children aged 8 (n = 329) and 14 years (n = 263) were examined in the classroom using the Basic Erosive Wear Examination (BEWE) index. Data concerning risk factors were collected using questionnaires. Dental caries (DMFS/dmfs) was also recorded. The data were analyzed using the t test, one-way ANOVA, multiple regression analysis, Fisher's exact test, and the χ2 test. In the 8-year-olds, the primary teeth showed a predominantly medium level of wear and the permanent teeth no wear. A majority of the 14-year-olds exhibited low risk levels of wear. The most frequently affected dental surface in both age groups was the occlusal surface of the mandibular posterior teeth. In the 8-year-olds, BEWE scores and the prevalence of wear in the primary teeth was influenced by gender (p = 0.020). In their permanent teeth, soft drink consumption (p < 0.0001) and preference for lemon/vinegar (p = 0.041) significantly affected wear prevalence and BEWE scores, while habitually retaining soft drinks in the mouth influenced wear prevalence (p = 0.008), risk (p = 0.004), and BEWE scores (p = 0.022). In the 14-year-olds, wear prevalence was significantly affected by the consumption of lemon-flavored candies (p = 0.016) and soft drinks (p = 0.050). BEWE scores were significantly affected by gender (p = 0.022) and soft drink consumption (p = 0.030). Gender influenced tooth wear risk in both age groups (p = 0.010 and p = 0.021, respectively). The results of this study indicate that erosive tooth wear differed between primary and permanent teeth and was influenced by gender and dietary factors.

Performance of clear vacuum-formed thermoplastic retainers depending on retention protocol: a systematic review

We aimed at comparing the performance of vacuum-formed thermoplastic retainers (VFR) worn either full-time or part-time, in maintaining orthodontic treatment results in terms of tooth alignment, arch form and occlusion. We reviewed randomized and prospective controlled clinical trials comparing VFR wearing protocols and searched databases, without restrictions, for published and unpublished literature. The risk of bias was assessed using the Cochrane Risk of Bias tool and the overall level of certainty in the evidence following ADA methodology. 184 studies were initially identified and reduced to the 3 randomized controlled trials included in the systematic review by means of specific criteria. One study followed patients 1 year into retention, and the other two for 6 months. Little's Irregularity Index, intermolar and intercanine width, arch length, overjet and PAR score did not differ significantly between the patients wearing their retainers part time or full time. We observed a slight increase in the overbite in the part-time group in only one trial. With a moderate level of certainty, we found that during the observation period, full-time VFR wear is not superior to part-time, bearing in mind the potential implications for health burden, retainer longevity and cost-effectiveness, as well as patient satisfaction and compliance.

Alterations in diet consistency and variation in Hypoxia Inducible Factor-1α expression in condylar chondrocytes

OBJECTIVE

To investigate the expression of HIF-1α during the postnatal development of the mandibular condyle under normal and soft consistency diet conditions.

MATERIALS AND METHODS

Forty eight Wistar-Furth rats, aged 21 days, were divided into two groups, each being fed with either normal or soft consistency diet. Three animals from each group were sacrificed after 3, 7, 10 days (initial period), 14, 17 days (intermediate period), and 21, 24 and 28 days (final period) after the start of the experiment. Immediately after sacrifice, the mandible was excised surgically, fixed, demineralised and embedded in paraffin. Six µm thick sections were obtained, processed for conventional and immunohistochemical staining and observed in the optical microscope. HIF-1α expression was assessed semiquantitavely and graded separately for the nucleus stained cells and the cells stained exclusively in the cytoplasm. Differences in HIF-1α expression in the experimental groups were evaluated statistically.

RESULTS

HIF-1α expression was evident in the proliferative and chondroblast layers. No differences were observed between the anterior, the intermediate and the posterior parts of the condylar cartilage. In the normal consistency diet group, nuclear HIF-1α expression increased gradually until the end of the experiment. On the contrary, in the soft diet animals, nuclear HIF-1α expression increased only at the final period of the experiment. The normal diet fed animals exhibited more intense nuclear HIF-1α expression compared to cytoplasmic expression.

CONCLUSIONS

HIF-1α expression in condylar chondrocytes varies under altered conditions of diet consistency.

Prevalence of tooth transposition. A meta-analysis

OBJECTIVE

To synthesize currently existing data and investigate the prevalence of tooth transposition as well as its relation to gender, dental arch, and quadrant occurrence.

MATERIALS AND METHODS

Several electronic databases were searched in order to identify the potentially relevant studies. Initially, 591 papers were retrieved. After applying specific inclusion and exclusion criteria, nine studies were eligible for inclusion in this evaluation. Meta-analysis was performed by determining the event rate and the 95% confidence intervals estimated by the random effect model.

RESULTS

Analysis of the data of the primary studies revealed that tooth transposition has a mean prevalence of 0.33%. This prevalence seems to be the same between the two genders. However, tooth transposition appears more frequently in the maxilla than in the mandible and more unilaterally than bilaterally.

CONCLUSION

Tooth transposition is a rare phenomenon that affects various populations, including across genders, in a similar manner. Some maxillary predisposition exists, and its unilateral occurrence is higher than that of bilateral.