Barriers and facilitators to the implementation of orthodontic mini-implants in clinical practice: a protocol for a systematic review and meta-analysis

BACKGROUND

Most orthodontic treatment plans need some form of anchorage to control the reciprocal forces of tooth movement. Orthodontic mini implants (OMIs) have been hailed for having revolutionized orthodontics, because they provide anchorage without depending on the collaboration of patients, they have a favorable effectiveness compared with conventional anchorage devices, and they can be used for a wide scale of treatment objectives. However, surveys have shown that many orthodontists never or rarely use them. To understand the rationale behind this knowledge-to-action gap, we will conduct a systematic review that will identify and quantify potential barriers and facilitators to the implementation of OMIs in clinical practice for all potential stakeholders, i.e., patients, family members, clinicians, office staff, clinic owners, policy makers, etc. The prevalence of clinicians that do not use OMIs will be our secondary outcome.

METHODS

The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 Statement was adopted as the framework for reporting this manuscript. We will apply broad-spectrum search strategies and will search MEDLINE and more than 40 other databases. We will conduct searches in the gray literature, screen reference lists, and hand-search 12 journals. All study designs, stakeholders, interventions, settings, and languages will be eligible. We will search studies that report on barriers or facilitators to the implementation of orthodontic mini implants (OMIs) in clinical practice. Implementation constructs and their prevalence among pertinent stakeholders will be our primary outcomes. All searching and data extraction procedures will be conducted by three experienced reviewers. We will also contact authors and investigators to obtain additional information on data items and unidentified studies. Risk of bias will be scored with tools designed for the specific study designs. We will assess heterogeneity, meta-biases, and the robustness of the overall evidence of outcomes. We will present findings in a systematic narrative synthesis and plan meta-analyses when pertinent criteria are met.

DISCUSSION

Knowledge creation on this research topic could identify and quantify both expected and unexpected implementation constructs and their stakeholders. Such knowledge can help develop strategies to address implementation issues and redirect future studies on OMIs towards knowledge translation. This could lead to improved patient-health experiences and a reduction in research waste.

Mixed dentition space analysis in a Sudanese population

OBJECTIVE

To test the applicability of the Tanaka and Johnston equation for prediction of the mesiodistal width of unerupted permanent teeth in a Sudanese population and to develop a new prediction equation for this specific population if necessary.

DESIGN

A descriptive, cross-sectional study.

SETTINGS

School-based study.

SUBJECTS AND METHODS

Two hundred and fifty subjects (118 males and 132 females) age 13 - 19 years were randomly selected from two public secondary high schools in Khartoum State. Mesiodistal widths of the upper and lower permanent canines, first and second premolars (CPM) as well as the mandibular permanent incisors (MPI) were measured manually on the dental casts using a digital caliper. The predicted values of the mesiodistal widths were statistically compared with the respective actual sum of the canine and premolars of the same quadrant.

RESULTS

Moderate correlation coefficients were found between the sum of the mesiodistal width of the MPI and the sum of the CPM in males (0.618 for mandibular arch and 0.626 for maxillary arch) and females (0.726 for mandibular arch and 0.680 for maxillary arch). A low coefficient of determination was recorded (0.45 and 0.48) in both jaws for combined genders.

CONCLUSIONS

The Tanaka and Johnston equations overestimated the actual mesiodistal width of CPM in both arches for males and females. New prediction equations with more accurate regression parameters were proposed for the Sudanese population.

Nickel titanium T-loop wire dimensions for en masse retraction

OBJECTIVE

To compare the force system produced by nickel-titanium T-loop springs made with wires of different dimensions.

MATERIAL AND METHODS

Thirty compound T-loop springs were divided into three groups according to the dimensions of the nickel-titanium wire used for its design: 0.016" × 0.022", 0.017" × 0.025", and 0.018" × 0.025". The loops were tested on the Orthodontic Force Tester machine at an interbracket distance of 23 mm and activated 9 mm. The force in the y-axis and the moment in the x-axis were registered while the calculated moment to force ratio was recorded at each .5 mm of deactivation. The data were analyzed by three analyses of variance of repeated measures to detect differences and interactions between deactivation and wire size on force, moment, and moment-force ratios (M/F).

RESULTS

All groups had significantly different forces (P < .001). The 0.016" × 0.022" wire produced 1.78N of force while the 0.017" × 0.025" and the 0.018" × 0.025" produced 2.81 N and 3.25 N, respectively. The 0.016" × 0.022" wire produced lower moments (11.6 Nmm) than the 0.017" × 0.025" and 0.018" × 0.025" wires, which produced similar moments (13.9 Nmm and 14.4Nmm, respectively). The M/F produced was different for all groups; 0.016" × 0.022" T-loops produced 6.7 mm while the 0.017" × 0.025" and 0.018" × 0.025" T-loops produced 5.0 mm and 4.5 mm, respectively. An interaction was detected for all variables between deactivation and groups.

CONCLUSION

The larger wires tested produced higher forces with slight increase on the moments, but the M/F produced by the 0.016" × 0.022" wire was the highest found.

Comparative evaluation and influence on shear bond strength of incorporating silver, zinc oxide, and titanium dioxide nanoparticles in orthodontic adhesive

OBJECTIVE

To investigate the influence of silver (Ag), zinc oxide (ZnO), and titanium dioxide (TiO₂) nanoparticles on shear bond strength (SBS).

MATERIALS AND METHODS

One hundred and twenty extracted premolars divided into four groups with thirty specimens in each group. Group 1 (control): brackets (American Orthodontics) were bonded with Transbond XT primer. Groups 2, 3, and 4: brackets (American Orthodontics) were bonded with adhesives incorporated with Ag, ZnO, and TiO₂ nanoparticles in the concentration of 1.0% nanoparticles of Ag, 1.0% TiO₂, and 1.0% ZnO weight/weight, respectively. An Instron universal testing machine AGS-10k NG (SHIMADZU) was used to measure the SBS. The data were analyzed by SPSS software and then, the normal distribution of the data was confirmed by Kolmogorov-Smirnov test. One-way ANOVA test and Tukey's multiple post hoc procedures were used to compare between groups. In all statistical tests, the significance level was set at 5% (P < 0.05).

RESULTS

A significant difference was observed between control (mean [standard deviation (SD)] 9.43 [3.03], confidence interval [CI]: 8.30-10.56), Ag (mean [SD]: 7.55 [1.29], CI: 7.07-8.03), ZnO (mean [SD]: 6.50 [1.15], CI: 6.07-6.93), and TiO₂ (mean [SD]: 6.33 [1.51], CI: 5.77-0.89) with SBS (F = 16.8453, P < 0.05) at 5% level of significance.

CONCLUSION

Incorporation of various nanoparticles into adhesive materials in minimal amounts may decrease SBS and may lead to the failure of bracket or adhesive. The limitation of this study is that it is an in vitro research and these results may not be comparable to what the expected bond strengths observed in vivo. Further clinical studies are needed to evaluate biological effects of adding such amounts of nanoparticles and approve such adhesives as clinically sustainable.

Can shielded brackets reduce mucosa alteration and increase comfort perception in orthodontic patients in the first 3 days of treatment? A single-blind randomized controlled trial

INTRODUCTION

Orthodontic patients can experience pain and discomfort on the oral mucosa from trauma caused by friction with the brackets and the wires. In this split-mouth design, single-blind randomized controlled trial, we aimed to investigate whether brackets with a self-snapping customized plastic shield would induce less mucosa alteration and discomfort than those without the shield.

METHODS

The overall sample comprised 42 patients (22 female, 20 male) from a government-funded orthodontic practice, with a mean age of 16.7 years. Eligibility criteria included, among others, no history of mouth ulcers or systemic diseases. Customized shields for the maxillary and mandibular brackets were fabricated and inserted on one side of the mouth. The null hypothesis was that bracket shielding would have no advantage. The primary outcomes were mucosal and discomfort assessments. As the secondary outcome, the numbers of spontaneous detachments of the shields were reported. Treatment allocation was mainly implemented using a random number table for selection of the intervention side. Only the raters in charge of assessing the oral mucosa were blinded to the side of the mouth where the shields had been placed. The mucosa was assessed by 3 calibrated raters at the following time points: immediately before bracket placement (baseline assessment, T0), 3 days after delivering the shields (direct assessment of intervention, T1), and 4 days after removal of the shields (indirect assessment of intervention, T2). The raters used a newly devised yardstick in which the higher the score, the more severe the alteration. Discomfort was assessed at T1 and T2 using a visual analog scale. The Mann-Whitney U test was performed at the 5% level of significance.

RESULTS

Of 60 patients, 42 were eligible, and 35 were randomly selected to have one side of the mouth receive the intervention. Two patients discontinued the intervention at T1, and 5 stopped at T2. Seven additional patients were recruited and completed all time points. Thus, 42 patients participated at T0, 40 at T1, and 35 at T2. Thirty-five patients participated at all time points. At T1, no statistically significant difference in terms of mucosa alteration was observed between the 2 sides (median of all differences [MD], 0.0; 95% CI, 0.0-1.0; P = 0.11). The same occurred at T2 (MD, 0.0; 95% CI, 0.0-0.0; P = 1.00). The comfort level was statistically higher at T1 on the shielded side (MD, 14.0; 95% CI, 1.0-36.0; P = 0.04), whereas no difference was observed at T2 (MD, 0.0; 95% CI, 0.0-1.0, P = 0.81). No serious harm was observed.

CONCLUSIONS

The customized bracket shields were effective in reducing discomfort during the first 3 days of orthodontic treatment despite no significant difference in terms of visible mucosa alteration.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

Expenses for the fabrication of the shields were covered by the main author (L.P.B.P.). Orthodontic materials were from the Center for Dental Specialties in Cajazeiras, Brazil.

[Impacted teeth and the six incarnations of resorption]

There are six distinct types of resorption of dental hard tissue that occur in association with unerupted and impacted permanent teeth. These pathologic entities differ markedly from one another in terms of their aetiology, their treatment and their prognosis. In several of them, the continued existence of the affected tooth may be in danger while in others, conservative treatment may halt the resorption process and provide for a successful outcome. The treatment approach is specific for each type and is entirely dependant on the diagnosis. This presentation will discuss prevalence, aetiology, presenting symptoms and clinical signs, radiographic features, histopathology, differential diagnosis, treatment and prognosis in relation to each of the conditions.

Changes in the oropharyngeal airway of Class II patients treated with the mandibular anterior repositioning appliance

OBJECTIVE

 To evaluate the effects of functional appliance treatment on the oropharyngeal airway volume, airway dimensions, and anteroposterior hyoid bone position of growing Class II patients.

MATERIALS AND METHODS

 Twenty Class II white patients (mean age, 11.7 ± 1.75 years) treated with the MARA followed by fixed appliances were matched to an untreated control sample by cervical vertebrae maturation stage at pretreatment (T1) and posttreatment (T2) time points. Cone beam computed tomography scans were taken at T1 and T2. Dolphin3D imaging software was used to determine oropharyngeal airway volume, dimensions, and anteroposterior hyoid bone position.

RESULTS

 Multivariate ANOVA was used to evaluate changes between T1 and T2. Oropharyngeal airway volume, airway dimensions, and A-P position of the hyoid bone increased significantly with functional appliance treatment. SNA and ANB decreased significantly in the experimental group (P ≤ .05). Changes in SNB and Sn-GoGn failed to reach statistical significance.

CONCLUSIONS

 Functional appliance therapy increases oropharyngeal airway volume, airway dimensions, and anteroposterior hyoid bone position in growing patients.

Three-dimensional analysis of enamel surface alteration resulting from orthodontic clean-up -comparison of three different tools

Background

The present study aimed at 3D analysis of adhesive remnants and enamel loss following the debonding of orthodontic molar tubes and orthodontic clean-up to assess the effectiveness and safety of One-Step Finisher and Polisher and Adhesive Residue Remover in comparison to tungsten carbide bur.

Materials and methods

Thirty human molars were bonded with chemical-cure orthodontic adhesive (Unite, 3M, USA), stored 24 h in 0.9 % saline solution, debonded and cleaned using three methods (Three groups of ten): tungsten carbide bur (Dentaurum, Pforzheim, Germany), one-step finisher and polisher (One gloss, Shofu Dental, Kyoto, Japan) and Adhesive Residue Remover (Dentaurum, Pforzheim, Germany). Direct 3D scanning in blue-light technology to the nearest 2 μm was performed before etching and after adhesive removal. Adhesive remnant height and volume as well as enamel loss depth and volume were calculated.

An index of effectiveness and safety was proposed and calculated for every tool; adhesive remnant volume and duplicated enamel lost volume were divided by a sum of multiplicands. Comparisons using parametric ANOVA or nonparametric ANOVA rank Kruskal-Wallis tests were used to compare between tools for adhesive remnant height and volume, enamel loss depth and volume as well as for the proposed index.

Results

No statistically significant differences in the volume (p = 0.35) or mean height (p = 0.24) of adhesive remnants were found (ANOVA rank Kruskal-Wallis test) between the groups of teeth cleaned using different tools. Mean volume of enamel loss was 2.159 mm³ for tungsten carbide bur, 1.366 mm³ for Shofu One Gloss and 0.659 mm³ for Adhesive Residue Remover - (F = 2.816, p = 0.0078). A comparison of the proposed new index between tools revealed highly statistically significant differences (p = 0.0081), supporting the best value for Adhesive Residue Remover and the worst – for tungsten carbide bur.

Conclusions

The evaluated tools were all characterized by similar effectiveness. The most destructive tool with regards to enamel was the tungsten carbide bur, and the least was Adhesive Residue Removal.

Characterization of the salivary microbiome in patients with pancreatic cancer

Clinical manifestations of pancreatic cancer often do not occur until the cancer has undergone metastasis, resulting in a very low survival rate. In this study, we investigated whether salivary bacterial profiles might provide useful biomarkers for early detection of pancreatic cancer. Using high-throughput sequencing of bacterial small subunit ribosomal RNA (16S rRNA) gene, we characterized the salivary microbiota of patients with pancreatic cancer and compared them to healthy patients and patients with other diseases, including pancreatic disease, non-pancreatic digestive disease/cancer and non-digestive disease/cancer. A total of 146 patients were enrolled at the UCSD Moores Cancer Center where saliva and demographic data were collected from each patient. Of these, we analyzed the salivary microbiome of 108 patients: 8 had been diagnosed with pancreatic cancer, 78 with other diseases and 22 were classified as non-diseased (healthy) controls. Bacterial 16S rRNA sequences were amplified directly from salivary DNA extractions and subjected to high-throughput sequencing (HTS). Several bacterial genera differed in abundance in patients with pancreatic cancer. We found a significantly higher ratio of Leptotrichia to Porphyromonas in the saliva of patients with pancreatic cancer than in the saliva of healthy patients or those with other disease (Kruskal–Wallis Test; P < 0.001). Leptotrichia abundances were confirmed using real-time qPCR with Leptotrichia specific primers. Similar to previous studies, we found lower relative abundances of Neisseria and Aggregatibacter in the saliva of pancreatic cancer patients, though these results were not significant at the P < 0.05 level (K–W Test; P = 0.07 and P = 0.09 respectively). However, the relative abundances of other previously identified bacterial biomarkers, e.g., Streptococcus mitis and Granulicatella adiacens, were not significantly different in the saliva of pancreatic cancer patients. Overall, this study supports the hypothesis that bacteria abundance profiles in saliva are useful biomarkers for pancreatic cancer though much larger patient studies are needed to verify their predictive utility.

Effect of Saliva Contamination on Microleakage Beneath Bonded Brackets: A Comparison Between Two Moisture-Tolerant Bonding Systems

OBJECTIVES

This study aimed to evaluate the effects of saliva contamination on the metallic bracket microleakage bonded with two moisture-tolerant bonding systems.

MATERIALS AND METHODS

Ninety freshly extracted premolar teeth were randomly divided into six groups of 15 with the following treatments: G1 (control): After acid etching, Assure primer and Assure adhesive were applied to non-contaminated enamel surfaces. G2 (contaminated after etching): The etched enamel surface was exposed to saliva, then Assure primer and Assure adhesive were applied. G3 (contaminated after priming): Saliva contamination was done after application of Assure primer. The exact same procedures were applied to groups G4 to G6 except that TIMP primer and Transbond Plus adhesive system were used. To measure the microleakage score, the teeth were stained with 2% methylene blue for 24 hours, sectioned and examined under a stereomicroscope at ×16 magnification. Data analysis was performed using Fisher's exact test.

RESULTS

In dry conditions, Assure and TMIP were not significantly different in terms of microleakage scores. All contaminated groups exhibited higher microleakage score at the enamel/adhesive interface compared to the bracket/adhesive interface (P< 0.01). In wet conditions, Assure groups showed higher microleakage at the enamel-adhesive interface compared to the TMIP groups (P<0.05). At the bracket-adhesive interface, the microleakage scores were not significantly different in saliva contaminated groups compared to the controls.

CONCLUSION

Saliva contamination caused greater microleakage at the enamel-adhesive interface compared to the adhesive-bracket interface.

A secondary analysis to determine variations of dental arch measurements with age and gender among Ugandans

BACKGROUND

Dental arch dimensions are useful in dental practice and in forensic odontology. Local data is essential because ethnic differences exist in dental arch dimensions. In the Ugandan population no studies had been done on dental arch dimensions. The objective of the current study was to determine the variations in dental arch dimensions with age and gender in a sample of dental casts from the Ugandan population.

METHOD

This was a secondary analysis of dental casts previously prepared using mandibular and maxillary arch impressions of 220 children (85 boys and 135 girls) aged 12-17 years recruited from schools in Kampala, Uganda. Dental arch dimensions for the maxilla and mandibular casts were taken using a digital vernier calliper. The data was analysed using the means based independent samples t test to obtain the descriptive statistics with regression analysis being used to obtain the regression coefficients and constants using STATA 12.

RESULTS

The overall maxillary dimensions were significantly smaller in females than males by 1.50 mm (95% CI -2.91 to -0.09, P = 0.04), controlling for age group. The overall dimensions of the mandible were also smaller in younger participants, though this was not statistically significant.

CONCLUSION

From this study we observed significant differences in arch dimensions between males and females that are of forensic value for this population. There is need for more study of the differences in arch dimensions with age using a larger and more age diverse study population.

Orthodontics as a prospective career choice among undergraduate dental students: A prospective study

Objectives:

The purposes of this study were to investigate the factors influencing the career choice of dental students and to identify the future life plans of the students at Prince Sattam Bin Abdulaziz University Dental College who had chosen orthodontics as their future specialty.

Materials and Methods:

An epidemiological descriptive survey was conducted using a set of questionnaire among the second year to fourth year students at Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia. Data were categorized by demographic variables and were analyzed with statistical methods using descriptive statistical analysis.

Results:

The most important factor influencing the decision to pursue specialty in orthodontics was considering that “orthodontics is intellectually challenging” (23%), followed by “previous positive experience” (15%). The decision to become an orthodontist was made by 3.7% of the respondents in the first year of their course, 44.4% in the second year of their study, 11.1% during the third year of their study, 25.9% during the fourth year of their study, while none of them had made their decision during the final year of their dental school studies. Only one student (3.7) said he planned to work in a private college in an academic setting, five students (18.5%) had plans to do private practice, two students indicated that they would work for the Ministry of Health, while most students (40.7%) reported that they were planning to try a combination of all of the above. Six students (22.2%) remained undecided.

Conclusions:

Majority of the students who had chosen orthodontics as their future specialty of choice at Sattam Bin Abdulaziz University Dental College, Saudi Arabia had taken up this specialty as they felt that orthodontics was intellectually challenging.

Differences in dentofacial characteristics of Class I malocclusion between Saudi and Japanese adult females

OBJECTIVES

The objective was to compare dentofacial characteristics of Class I malocclusion in Saudi and Japanese adult females.

MATERIALS AND METHODS

Lateral cephalograms of 50 Saudi adult female and 50 Japanese adult female (18-35-year-old) were obtained. All patients were skeletal Class I, angle Class I malocclusion, arch length discrepancy (-10-10 mm), overjet (1-5 mm), overbite (1-5 mm), absence of congenital anomalies, or significant facial asymmetries or congenitally missing tooth other than the 3(rd) molar and absence of temporomandibular joint problems. Patient cephalograms were traced and digitized. 16 angular measurements and 13 linear measurements of facial form were used.

RESULTS

A comparison of the vertical dimension showed that the Saudi females had a significantly larger gonial angle, a significantly larger facial angle and longer lower face height compared to the Japanese females. Dentally, Saudi females had more protruded incisors with increased distances of the posterior teeth to the palatal plane. For the soft tissue dimension, the Saudi subjects had a significantly more prominent nose, retruded lip and a more protruded chin compared with Japanese.

CONCLUSIONS

There were significant differences in dentofacial morphology between Saudi and Japanese adult females. Both Asian countries have distinct cephalometric features, which should be considered as a reference in treating patients of varying ethnic backgrounds to optimize the final results.

Iatrogenic Damage to the Periodontium Caused by Orthodontic Treatment Procedures: An Overview

In orthodontic treatment, teeth are moved in to new positions and relationships and the soft tissue and underlying bone are altered to accommodate changes in esthetics and function. Function is more important than esthetics. The speciality of orthodontics has in addition to its benefits, complications as well as risks associated with its procedures. However the benefits outweigh the risks & complications in most of the treatment cases. Few of the unwanted side effects associated with treatment are tooth discolorations, enamel decalcification, periodontal complications like open gingival embrasures, root resorption, allergic reactions to nickel & chromium as well as treatment failure in the form of relapse.

Sagittal lip positions in different skeletal malocclusions: a cephalometric analysis

BACKGROUND

The objectives of this paper are to (1) study use of soft tissue analyses advocated by Steiner, Ricketts, Burstone, Sushner and Holdway to develop soft tissue cephalometric norms as baseline data for sagittal lip position in Northeast Chinese adult population, (2) compare the sagittal lip positions in different skeletal malocclusions and (3) compare the sagittal lip positions in Northeast Chinese adults with other reported populations.

METHODS

Lateral cephalometric radiographs of subjects were taken in natural head position. Radiographs were manually traced and five reference lines - Sushner, Steiner, Burstone, Holdway and Ricketts, were used. The linear distance between the tip of the lips and the five reference lines were measured. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) 21. Descriptive analysis was done for each variable for each subject. Coefficient of variation between lip positions as assessed by reference lines was determined. Post hoc Tukey's test was used for comparison of the mean cephalometric values of three skeletal malocclusions. The level of significance for the analysis was set at p < 0.05.

RESULTS

The findings showed significant difference in the sagittal lip positions in different skeletal malocclusions. There was variation in consistent reference line in each skeletal malocclusion. The S2 line was the most consistent reference line in skeletal class I and class II group. The B line was the most consistent line in skeletal class III. In skeletal class II group, upper lips were the most protrusive and lower lips were retrusive than in skeletal class I and class III groups. In case of skeletal class III group, upper lips were retrusive and lower lips were more protrusive than in skeletal class I and class II groups.

CONCLUSIONS

The sagittal lip positions were found to be associated with the skeletal malocclusion pattern. Northeast Chinese population has protrusive upper and lower lip in comparison to Caucasians. Each skeletal malocclusion group showed different preferable reference lines for analysis of sagittal lip position.

Are temporomandibular disorders associated with habitual sleeping body posture or nasal septal deviation?

Numerous factors can be considered for the etiology of temporomandibular disorders (TMD). The aim of the present study was to investigate whether the presence of both nasal septal deviation (NSD) and habitual prone sleeping posture (HPSP) predisposes TMD. We evaluated 200 subjects in 4 groups. Group I (NSD-, HPSP-/control group), Group II (NSD+, HPSP-), Group III (NSD-, HPSP+), Group IV (NSD+, HPSP+). All patients were examined according to the research diagnostic criteria to determine the presence of TMD. Group IV had the highest value for TMD incidence (44 %). Thus, we found that the presence of both NSD and HPSP parameters increased TMD incidence in Group IV compared to the control group (p = 0.000). Additionally, Group IV showed significantly higher values than Group II (p = 0.012) and Group III (p = 0.039). For Group III (NSD-, HPSP+), TMD was determined higher compared to the control group (p = 0.009). A statistically higher value of presence of TMD was determined in Group II (NSD+, HPSP-) than control group (p = 0.029). The incidence of TMD was significantly higher in women than men (p = 0.020). We concluded that one having an unilateral obstructive nasal septal deviation in addition to a habit of sleeping in prone position must be alert for potential TMD.

Periodontal health during clear aligners treatment: a systematic review

BACKGROUND

Clear aligner treatment (CAT) has been cited as a safe and comfortable orthodontic procedure for adult patients. However, the available evidence is scarce.

OBJECTIVE

To perform a systematic review of the existing literature in order to assess periodontal health during CAT.

SEARCH METHODS AND SELECTION CRITERIA

Pubmed, Pubmed Central, National Library of Medicine's Medline, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACS were searched from January 1945 to September 2014 to identify all peer-reviewed papers potentially relevant to the review.

DATA COLLECTION AND ANALYSIS

After duplicate selection and extraction procedures, the risk of bias was assessed according to the Centre for Reviews and Dissemination criteria, and a 3-point grading system, as described by the Swedish Council on Technology Assessment in Health Care (SBU), was used to rate the methodological quality of the selected papers. A PICOS table was used for data extraction.

RESULTS

Five relevant articles were selected from the 1247 identified articles. The level of evidence was moderate for all the studies. A significant improvement of the periodontal health indexes was revealed, in particular when CAT was compared to fixed appliances. No periodontal CAT adverse effects were observed in the selected studies.

CONCLUSIONS

Periodontal health indexes were significantly improved during CAT. The results of this review should be interpreted with some caution because of the number, quality, and heterogeneity of the included studies.

Comparison of two three-dimensional cephalometric analysis computer software

BACKGROUND

Three-dimensional cephalometric analyses are getting more attraction in orthodontics. The aim of this study was to compare two softwares to evaluate three-dimensional cephalometric analyses of orthodontic treatment outcomes.

MATERIALS AND METHODS

Twenty cone beam computed tomography images were obtained using i-CAT(®) imaging system from patient's records as part of their regular orthodontic records. The images were analyzed using InVivoDental5.0 (Anatomage Inc.) and 3DCeph™ (University of Illinois at Chicago, Chicago, IL, USA) software. Before and after orthodontic treatments data were analyzed using t-test.

RESULTS

Reliability test using interclass correlation coefficient was stronger for InVivoDental5.0 (0.83-0.98) compared with 3DCeph™ (0.51-0.90). Paired t-test comparison of the two softwares shows no statistical significant difference in the measurements made in the two softwares.

CONCLUSIONS

InVivoDental5.0 measurements are more reproducible and user friendly when compared to 3DCeph™. No statistical difference between the two softwares in linear or angular measurements. 3DCeph™ is more time-consuming in performing three-dimensional analysis compared with InVivoDental5.0.

Skeletal malocclusion: a developmental disorder with a life-long morbidity

The likelihood of birth defects in orofacial tissues is high due to the structural and developmental complexity of the face and the susceptibility to intrinsic and extrinsic perturbations. Skeletal malocclusion is caused by the distortion of the proper mandibular and/or maxillary growth during fetal development. Patients with skeletal malocclusion may suffer from dental deformities, bruxism, teeth crowding, trismus, mastication difficulties, breathing obstruction and digestion disturbance if the problem is left untreated. In this review, we focused on skeletal malocclusion that affects 27.9% of the US population with different severity levels. We summarized the prevalence of class I, II and III of malocclusion in different ethnic groups and discussed the most frequent medical disorders associated with skeletal malocclusion. Dental anomalies that lead to malocclusion such as tooth agenesis, crowding, missing teeth and abnormal tooth size are not addressed in this review. We propose a modified version of malocclusion classification for research purposes to exhibit a clear distinction between skeletal vs. dental malocclusion in comparison to Angle’s classification. In addition, we performed a cross-sectional analysis on orthodontic (malocclusion) data through the BigMouth Dental Data Repository to calculate potential association between malocclusion with other medical conditions. In conclusion, this review emphasizes the need to identify genetic and environmental factors that cause or contribute risk to skeletal malocclusion and the possible association with other medical conditions to improve assessment, prognosis and therapeutic approaches.

[White spot lesions and orthodontic treatment. Prevention and treatment]

Decalcification of the enamel surface adjacent to fixed orthodontic appliances, in the form of white spot lesions, is a common and frequent well-known side-effect of orthodontic treatment. Fixed appliances and the bonding materials increase the retention of biofilm and encourage the formation of white spot lesions. Management of these lesions begins with a good oral hygiene regime and needs to be associated with use of fluoride agents (fluoridated toothpaste, fluoride containing mouth rinse, gel, varnish, bonding materials, elastic ligature), CPP-ACP, antiseptics, LASER, tooth whitening, resin infiltration, micro-abrasion. The purpose of this review is to access the direct evidence regarding the prevention and management of white spot lesions during and after orthodontic treatment.

The effect of orthodontic therapy on periodontal health: a review of the literature

Objectives. This review aims to evaluate the effect of orthodontic therapy on periodontal health. Data. Original articles that reported on the effect of orthodontic therapy on periodontal health were included. The reference lists of potentially relevant review articles were also sought. Sources. A literature search was conducted using the databases, Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The search was carried out by using a combined text and the MeSH search strategies: using the key words in different combinations: “periodontal disease,” “orthodontics” and “root resorption.” This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Articles published only in English language were included. Letters to the Editor, historical reviews and unpublished articles were not sought. Conclusions. Within the limitations of the present literature review, it was observed that there is a very close inter-relationship between the periodontal health and the outcome of orthodontic therapy.

Mixed dentition analysis in Libyan schoolchildren

OBJECTIVES

The primary aim of the present study was to assess the applicability of Tanaka and Johnston and Moyers' methods of prediction in Libyan subjects and secondary aim was to develop a new prediction method for the examined population if required.

MATERIALS AND METHODS

The study sample comprised 343 Libyan schoolchildren with age ranged from 12 to 17 years; 169 males age matched with 174 females, all with no craniofacial abnormalities and orthodontically untreated. The mesiodistal (MD) tooth widths were measured and compared with the estimated values derived from Tanaka and Johnston equations and from Moyers' probability tables at 35%, 50% and 75% respectively using Paired t-tests. The constants a and b in the linear regression equation (y = a + bx), the correlation coefficient, the coefficient of determination and the standard errors of estimate were computed.

RESULTS

Significant sexual dimorphism in lower incisors mesiodistal width was observed. There were significant discrepancies between the current measurements and those estimated from Tanaka and Johnston's equation and Moyers' tables. New linear regression equations were derived for both sexes to allow precise prediction for Libyan subjects. The correlation coefficients between the total MD width of the mandibular permanent incisors and that of the maxillary and mandibular canines and premolars were found to be 0.66 and 0.68 for males and 0.57 and 0.58 in females, respectively.

CONCLUSIONS

It appears that there is a limitation in the application of Tanaka and Johnston's equation and Moyers' methods to Libyan subjects. The developed prediction equation is more accurate for predicting the MD widths of unerupted canine and premolars of Libyan population.

An odontometric study of tooth size in normal, crowded and spaced dentitions

OBJECTIVE

To assess the mesio-distal tooth width in normal, crowded, or spaced dentitions.

MATERIALS AND METHODS

A sample of 192 maxillary and mandibular dental casts of Libyan subjects was selected from a larger cohort. These subjects did not present with craniofacial anomaly, hypodontia, significant attrition, caries, restorations, or history of permanent tooth extraction or orthodontic treatment. The sample was divided into normal, crowded, and spaced groups according to tooth size/arch length discrepancy. Each group included 32 upper and lower dental casts with equal numbers of males (mean (SD) age = 14.7 (1.9) years) and females (mean (SD) age = 15.7 (2.5) years). The mesiodistal (MD) tooth width, sum of the MD tooth widths mesial to the first molars (TTM), sum of the MD width of the four incisors (I), and the sum of the MD width of canine and first and second premolars (CPP) were calculated for each group. The independent Student t-test was applied sequentially to detect significant differences between paired groups. The ANOVA test was undertaken to explore significant differences between the three groups. Pearson coefficient of correlation was used to evaluate the correlation between I and the corresponding CPP in maxillary and mandibular arches.

RESULTS

MD tooth width, TTM, I, and CPP were significantly wider in the crowded compared to normal and spaced dentitions (P<0.001), except for the width of the upper left lateral incisors in both normal and crowded groups. Although there was a trend for smaller tooth widths in spaced dentitions compared to normal ones, this was only significant in the maxillary left central incisor, maxillary right and left lateral incisors, maxillary right first premolar, mandibular right lateral incisor, and mandibular right canine (P<0.05). However, the maxillary TTM, I, and CPP in the normal group were significantly greater than in the spaced group (P<0.05). Significant positive correlations existed between the mean values of I and CPP in both the maxillary and mandibular dentitions of all groups (P<0.01).

CONCLUSIONS

It appears that in the studied Libyan population, the MD tooth width is a significant component of crowding/spacing.

Prevalence of malocclusion in urban libyan preschool children

OBJECTIVES

This cross-sectional observational study aimed at quantifying primary dentition parameters and exploring differences in those parameters between included age groups.

MATERIALS AND METHODS

The examined sample comprised 800 preschool children, 3- to 5-year-old in Benghazi city, of which 500 fulfilled the inclusion criteria. Primary canine relationship, spacing/crowding, overjet (OJ) and overbite (OB), occlusal relationship was carried out using Federation Dentaire Internationale (1973), modified to the primary dentition.

RESULTS

The prevalence of bilateral Class I, Class II, and Class III canine relationship was 69.6%, 22.4%, and 4.4%, respectively. The prevalence of asymmetric canine relationship was 3.6% with no significant difference between gender and age groups. Spacing, closed dentition, and crowding were observed in: 81.6%, 13,4% and 5% respectively in the upper arch, and 58.5%, 24.8%, and 16.7% correspondently in the lower arch. OJ and OB ranging between 1 and 3 mm were found in 82.6% and 56.5%, respectively. An OJ and OB of >3 mm was observed in 11.4% and 35%, respectively, and of edge to edge incisal relationship anteroposteriorly and vertically in 4.6% and 6% in this order. Anterior crossbite and anterior openbite were noted in 1.4% and 2.6%, respectively. There was no significant correlation between OJ and OB and age (P≥0.241). Additionally, there was no significant sex difference in the value of OJ (P=0.561). But, the mean OB value in boys was significantly greater than in girls.

CONCLUSIONS

The current findings provide an insight into the prevalence of occlusal traits in urban Libyan preschool children and highlight the significance of early detection of malocclusion to assist in achieving effective and individualized long-term treatment planning.

Transmigration of mandibular canines

The purpose of this paper is to present the first case of unusual reverse oblique (110 degrees to midsagittal plane) migration of mandibular right canine crossing the jaw midline and piercing the lower border of the mandible at the level of the opposite canine and also to report two more cases of transmigrated mandibular canine and one case of transmigrating mandibular canine. Mandibular canines are "cornerstone" of dental arch; their importance is manifested by their efficiency in masticatory function, stability of dental arch, and aid in maintaining natural facial expression. Early detection of this anomaly can help preserving these canines by orthodontic intervention or by surgical transplantation. This developmental anomaly is properly diagnosed by radiographic evaluation, which is primarily based on the panoramic radiograph. In patients with overretained deciduous canines or missing permanent canines, an intraoral radiograph should be supplemented with panoramic radiograph. This paper discusses the importance of early diagnosis of canine transmigration in treatment planning and reviews the various possible treatment options.