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Almasri AMH, Hajeer MY, Ajaj MA, Almusawi AOA, Jaber ST, Zakaria AS, Alam MK. Patient Satisfaction Following Orthodontic Treatment: A Systematic Review. Cureus 2024; 16:e65339. [PMID: 39055972 PMCID: PMC11271306 DOI: 10.7759/cureus.65339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 07/28/2024] Open
Abstract
Patient-reported outcome measures (PROMs) have become increasingly important in orthodontic treatment as they reflect patients' perceptions of treatment outcomes. Understanding patient satisfaction with orthodontic treatment is crucial for improving healthcare delivery and patient-centered care. This systematic review aimed to critically appraise the evidence regarding patient satisfaction after orthodontic treatment, exploring the effects of different treatment types, patient demographics, and other factors on satisfaction levels. Eight electronic bibliographic databases were searched without publication time or language restrictions, including PubMed®, Scopus®, the Cochrane Central Register of Controlled Trials, Web of Science™, Embase®, Google™ Scholar, Trip, and OpenGrey. A manual search was conducted on the references in the included papers. Eligibility criteria were established based on the Population, Intervention, Comparison, Outcomes, and Study (PICOS) framework. Studies were included if they reported patient satisfaction levels following orthodontic treatment using standardized questionnaires. Two reviewers independently collected and analyzed the data. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2) for randomized clinical trials, and the methodologic quality for cohort and cross-sectional studies was assessed using the modified version of the Newcastle-Ottawa scale. Fourteen studies employed various questionnaires and timings to gauge post-orthodontic treatment satisfaction. Patient satisfaction levels were generally high, with most studies reporting satisfaction rates above 91%. Fixed orthodontic appliances were associated with higher satisfaction levels compared to removable appliances. While age and gender did not significantly influence satisfaction, the quality of care and doctor-patient relationships were crucial factors in patient satisfaction. This systematic review proves that patient satisfaction with orthodontic treatment is generally high, with fixed appliances and positive doctor-patient relationships contributing to higher satisfaction levels. However, the quality of the evidence was moderate to low, highlighting the need for further high-quality clinical studies in this area.
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Affiliation(s)
| | - Mohammad Y Hajeer
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, SYR
| | - Mowaffak A Ajaj
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, SYR
| | | | - Samer T Jaber
- Department of Orthodontics, Faculty of Dentistry, Al-Wataniya Private University, Hama, SYR
| | - Ahmad Salim Zakaria
- Department of Orthodontics, School of Dental Sciences, University Sains Malaysia, Kelantan, MYS
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Charavet C, Charpenay L, Kernitsky J, Dibart S. The biological effects of Piezocision™ on bone for accelerated tooth movement: A systematic review of animal studies. Int Orthod 2024; 22:100870. [PMID: 38552499 DOI: 10.1016/j.ortho.2024.100870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES This systematic review aimed to assess the biological response at tissue, cellular, and molecular levels following Piezocision™ surgery, and its efficacy in accelerating orthodontic tooth movement. MATERIAL AND METHODS A systematic review of the literature was conducted across 4 databases following the PRISMA guidelines up to May 2022. Prospective controlled animal studies involving healthy animals under active orthodontic treatment assisted by corticotomy performed with a piezotome (Piezocision™) published in the English language without time restrictions were included. The article selection, data extraction and risk of bias assessment (SYRCLE tool) were performed by two independent blinded review authors. RESULTS Out of 738 articles screened, 10 studies were included with various level of bias. Biological responses were categorized into tissue, cellular, and molecular levels. Tissue-level changes included a global decrease in bone mineral content post-Piezocision™. At the cellular level, increased bone turnover activity was noted. Molecularly, elevated RANKL and OPG expression, along with increased TRAP+ and cytokines, were observed after Piezocision™. Studies confirmed Piezocision's efficacy, reporting 1.35 to 3.26 times faster tooth movements, peaking between the 3rd and 50th day post-surgery. Biological responses were transient, reversible, and proportional to surgical insult, with reactivation possible through a second Piezocision™. CONCLUSIONS After Piezocision™ surgery, a transient and reversible biological response was described at the tissue, cellular and molecular levels, which induced faster orthodontic tooth movements. This biological response could be re-activated by an additional Piezocision™ and is proportional to the surgical injury. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42022303237.
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Affiliation(s)
- Carole Charavet
- Département d'Orthodontie, Faculté de Chirurgie Dentaire, université Côte d'Azur, Nice, France; Unité d'Orthodontie, Institut de Médecine Bucco-Dentaire, Centre Hospitalier Universitaire de Nice, Nice, France; Laboratoire MICORALIS (UPR 7354), Université Côte-d'Azur, Nice, France.
| | - Lucile Charpenay
- Institut de Médecine Bucco-dentaire, Centre Hospitalier Universitaire de Nice, Faculté de Chirurgie Dentaire, Université Côte d'Azur, Nice, France
| | - Jeremy Kernitsky
- Department of Periodontology, Boston University School of Dental Medicine, Boston, USA
| | - Serge Dibart
- Department of Periodontology, Boston University School of Dental Medicine, Boston, USA
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Zhou H, Zhang YF, Qi YX, Zhang QQ, Liu N, Chen Y. The efficacy and safety of corticotomy and periodontally accelerated osteogenic orthodontic interventions in tooth movement: an updated meta-analysis. Head Face Med 2024; 20:12. [PMID: 38368383 PMCID: PMC10874089 DOI: 10.1186/s13005-024-00409-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/22/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND The surgically facilitated orthodontic strategy has been a promising strategy for orthodontic treatment recently. Therefore, the present meta-analysis was conducted to assess the available scientific evidence regarding the clinical outcomes, including the potential detrimental effects associated with these surgical procedures, with the aim of providing much more evidence-based information for clinical practice. METHODS An electronic search of three databases (PubMed, Cochrane, and Embase) and a manual search of relevant articles published up to May 2023 were carried out. Clinical trials (≥ 10 subjects) that utilized surgically facilitated orthodontic strategies with clinical and/or radiographic outcomes were included. Meta-analyses and sub-group analyses were performed to analyze the standardized mean difference (SMD) or weighted mean difference (WMD), and confidence interval (CI) for the recorded variables. RESULTS Nineteen studies published from Oct 2012 to May 2023 met the inclusion criteria. Based on the analysis outcomes, corticotomy treatment significantly decreased the alignment duration (WMD: -1.08 months; 95% CI = -1.65, -0.51 months, P = 0.0002), and accelerated the canine movement (WMD: 0.72 mm; 95% CI = 0.63, 0.81 mm, P < 0.00001) compared to the traditional orthodontic group. The periodontally accelerated osteogenic orthodontic (PAOO) strategy markedly reduced the total treatment duration (SMD: -1.98; 95% CI = -2.59, -1.37, P < 0.00001) and increased the bone thickness (SMD:1.07; 95% CI = 0.74, 1.41, P < 0.00001) compared to traditional orthodontic treatment. CONCLUSION The present study suggests that facilitated orthodontic treatment in terms of corticotomy and PAOO strategy may represent attractive and effective therapeutic strategy for orthodontic patients.
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Affiliation(s)
- Huan Zhou
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Yi-Fan Zhang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Yan-Xin Qi
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Prosthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Qian-Qian Zhang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Na Liu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Yue Chen
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
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Gibreal O, Al-Modallal Y, Mahmoud G, Gibreal A. The efficacy and accuracy of 3D-guided orthodontic piezocision: a randomized controlled trial. BMC Oral Health 2023; 23:181. [PMID: 36978052 PMCID: PMC10053659 DOI: 10.1186/s12903-023-02902-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND No randomized controlled trial (RCT) has studied the accuracy of surgical guides used in terms of orthodontic treatment acceleration. Therefore the aim of this trial was to assess computer-guided piezocision-based orthodontic. MATERIALS AND METHODS Thirty-two patients with severely crowded upper anterior teeth were enrolled and randomly allocated to either the experimental group (ExpG) or the control one. Subjects of the ExpG received three-dimensional (3D) guided piezoelectric corticotomies on the buccal alveolar bone of the anterior region. Five piezocision cuts were properly performed between each anterior teeth and the adjacent in virtual models. Surgical guides were designed and 3D-printed with preplanned slots that guide gingival and then piezoelectric incisions. The patients underwent Cone-Beam Computed Tomography CBCT before and immediately after surgery. Thus, Predesigned piezocisions were compared to the actual ones in attempt to measure three dimensional deviations of the applied peizocisions. RESULTS Ninety-six severe maxillary dental crowding were assigned for eligibility, 40 of them met the inclusion criteria. Thirty-two participants were randomly allocated to the trial`s groups. No patient was lost to follow-up neither from the control nor the experimental group. Overall alignment time (OAT) was reduced by 53% in the experimental group compared to the control group. The mean of the 3D deviation of the surgical guide was 0.23 mm (standard deviation 0.19 mm). CONCLUSION The values of the surgical guide deviation was nearly null, which confirms that this innovative technique is clinically applicable. Furthermore, this technique was impressively effective in accelerating orthodontic tooth movement. TRIAL REGISTRATION This trial was registered at The ISRCTN registry (ID: ISRCTN65498676 Registration date: 07/04/2021).
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Affiliation(s)
- Omar Gibreal
- Oral and Maxillofacial Surgery Department, University of Damascus Dental School, Damascus, Syria.
| | - Yasser Al-Modallal
- Department of Oral and Maxillofacial Surgery, University of Damascus Dental School, Damascus, Syria
| | - Ghiath Mahmoud
- Department of Orthodontics, University of Damascus Dental School, Damascus, Syria
| | - Ahmad Gibreal
- Department of Otorhinolaryngology, University of Damascus Medical School, Damascus, Syria
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Kilinc B, Baka ZM. Comparison of the effectiveness of piezocision and microosteoperforation in leveling mandibular anterior teeth. Am J Orthod Dentofacial Orthop 2022; 163:491-500. [PMID: 36517376 DOI: 10.1016/j.ajodo.2022.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The primary aim of this study was to evaluate the effectiveness of piezocision and microosteoperforation (MOP) in accelerating the leveling of mandibular anterior teeth. The secondary aim was to evaluate the changes in periodontal parameters and the differences in patient comfort. METHODS Forty-five patients in the study were randomly divided into 3 groups. After bonding mandibular teeth, the patients in the first group (9 girls, 6 boys) underwent piezocision, and the patients in the second group (10 girls, 5 boys) underwent MOP. Patients in the third group (7 girls, 8 boys) comprised the control group. The patients were asked to complete a visual analog scale for pain assessment during the first week of treatment and to complete the Oral Health Impact Profile-14 questionnaire at the end of the week. Little's irregularity index was measured from plaster models taken at the start of the mandibular bonding process, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after the mandibular bonding process. Periodontal parameters were also recorded at baseline and 16 weeks. RESULTS Our study results showed statistically significantly more orthodontic tooth movement in the piezocision group (mean difference, 7.60 ± 1.55) than in the control group (mean difference, 5.95±1.28) during the total study period (P = 0.015). In the MOP group, no significant difference in the alignment rate was observed at any time compared to the piezocision and control groups (P >0.05). CONCLUSIONS The leveling of mandibular anterior teeth was accelerated by piezocision over 16 weeks, predominantly in the first 12 weeks, whereas MOP had no effect. It was concluded that piezocision is an acceptable procedure and has no destructive effect on the periodontal tissue.
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One-stage versus two-stage piezocision-assisted orthodontic tooth movement: A preclinical study based on Nano-CT and RT-PCR analyses. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e663-e669. [PMID: 35276408 DOI: 10.1016/j.jormas.2022.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of a second-stage piezocision on the biological response. MATERIALS AND METHODS 60 rats were randomly allocated to 6 experimental groups of 10 rats. Rats undergoing a one-stage piezocision were sacrified on day 7, 28 and 42 (groups 1-3) while rats undergoing a two-satge piezocision were sacrified on day 42, 63 and 90 (groups 4-6), respectively. The biological response was investigated in 3D at the tissue level using Nano-computed tomography (Nano-CT) and, at the molecular level using the qRT-PCR technique. Bone Volume Fraction (BVF) loss was the primary endpoint. RESULTS Similar loss of BVF were observed both after the first and second piezocisions. The change in BVF loss between 7 and 28 days after each piezocision were 25.1 ± 13.0 (SE)% and 11.2 ± 11.6 (SE)% respectively and did not differ from each other (p = 0.43). Changes in BVF loss from 7 to 42 days were also comparable in one-stage and two-stage piezocision (4.9 ± 12.3 (SE) vs. -19.9 ± 13.4 (SE), p = 0.19). At the molecular level, all parameters except Translating Ribosome Affinity Purification (TRAP) protein had identical patterns. CONCLUSION Within the limits of the present study, a second piezocision allowed to re-induce the Regional Acceleratory Phenomenon (RAP) effect. Nevertheless, the relevance of the findings to the clinical effect has not been tested.
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Gasparro R, Bucci R, De Rosa F, Sammartino G, Bucci P, D’Antò V, Marenzi G. Effectiveness of surgical procedures in the acceleration of orthodontic tooth movement: Findings from systematic reviews and meta‐analyses. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:137-154. [PMID: 35469172 PMCID: PMC9034096 DOI: 10.1016/j.jdsr.2022.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/14/2022] [Accepted: 03/21/2022] [Indexed: 01/03/2023] Open
Abstract
The current overview aimed to summarise the findings provided by systematic reviews (SRs) on the effect of surgical procedures in the acceleration of tooth movement and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs addressing the effects of surgical procedures on the acceleration of tooth movement were included. The methodological quality of the included SRs was assessed using the updated version of “A Measurement Tool to Assess Systematic Review” (AMSTAR‐2). Twenty-eight (28) SRs were included. The methodological quality of the included reviews ranged between critically low (6 studies) and high (12 studies). The most common critical weakness in the included reviews was the absence of clearly a‐prior established review methods and any significant deviations from the protocol. The most studied surgical procedure was corticotomy, followed by micro-osteoperforation, piezocision and periodontally accelerated osteogenic orthodontics. The majority of the included SRs supported short-term favourable effects of corticotomy on treatment time and tooth movement rate, in the short-term. However, the authors of the included SRs reported that results were based on weak quality evidence. Conflicting results arise from the existent SRs with regards to the effectiveness of piezocision and micro-osteoperforation. Few SRs summarised complications and side effects of surgical techniques, supporting absence of loss of tooth vitality, periodontal problems, or severe root resorption. The current overview of SRs highlighted the need of high quality SRs comparing different surgical approaches for tooth movement acceleration though network meta-analysis, in order to determine the most efficient instrument for orthodontic movement acceleration.
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Mousa MM, Hajeer MY, Burhan AS, Almahdi WH. Evaluation of patient-reported outcome measures (PROMs) during surgically-assisted acceleration of orthodontic treatment: a systematic review and meta-analysis. Eur J Orthod 2022; 44:622-635. [PMID: 35796046 DOI: 10.1093/ejo/cjac038] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With the widespread of surgically-assisted orthodontic acceleration, the analysis of patient-reported outcome measures (PROMs) has become very important to assure patient acceptance and satisfaction before adopting any acceleration procedure. OBJECTIVE This review aimed to critically appraise the available evidence regarding the levels of pain, discomfort, functional impairments, and other patient-reported outcome measures during surgically-assisted acceleration of orthodontic treatment compared with the traditional non-accelerated treatment. SEARCH METHODS Eight electronic bibliographic databases were searched from January 1990 till May 2022. A manual search of the selected orthodontic journals was also undertaken. SELECTION CRITERIA Randomized controlled trials (RCTs) were included in this systematic review on patients undergoing orthodontic treatment with one group subjected to an acceleration procedure. DATA COLLECTION AND ANALYSIS Cochrane's risk of bias tool (RoB2 tool) was used to assess the risk of bias of the included RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence. RESULTS Thirteen RCTs were included in this review (333 patients), and only minimally invasive surgically-assisted acceleration studies were included. Two RCTs were included in the quantitative synthesis of data. After the first day of surgical intervention, the levels of pain and discomfort ranged from mild to moderate in the surgical groups (mean values ranged from 0.8 to 6.8), while it was mild in the control groups. However, on the seventh day after the surgical intervention, the levels of pain, discomfort, swelling, and functional impairments were almost similar between groups. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low. CONCLUSIONS All surgical interventions were minimally invasive. There was very low to low evidence that acceleration caused mild to moderate pain and discomfort on the first day after the surgical intervention and disappeared completely at one week following surgery. Functional impairments were found within acceptable limits immediately and in the short-term follow-up. More high-quality randomized controlled clinical trials are needed to establish good evidence in this field. REGISTRATION The protocol of this systematic review was registered in PROSPERO database (CRD42021274481) during the first stages of this review.
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Affiliation(s)
- Mudar Mohammad Mousa
- Department of Orthodontics, University of Damascus Dental School, Damascus, Syria
| | - Mohammad Y Hajeer
- Department of Orthodontics, University of Damascus Dental School, Damascus, Syria
| | - Ahmad S Burhan
- Department of Orthodontics, University of Damascus Dental School, Damascus, Syria
| | - Wael H Almahdi
- Department of Periodontics, University of Damascus Dental School, Damascus, Syria
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Effect of piezocision procedure in levelling and alignment stage of fixed orthodontic treatment: a randomized clinical trial. Sci Rep 2022; 12:6230. [PMID: 35422071 PMCID: PMC9008391 DOI: 10.1038/s41598-022-09851-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/11/2022] [Indexed: 12/15/2022] Open
Abstract
This clinical trial compared the time to complete the levelling and alignment stage with flapless piezocision procedure in the treatment of severe maxillary malocclusion with premolar extraction cases. Two-arm parallel group randomized controlled trial was performed at the Orthodontics Unit of Universiti Sains Malaysia, Malaysia. Sixteen patients with severe anterior maxillary crowding (Little’s irregularity index: 7–9 mm) and required bilateral first premolars extraction was recruited. The participants were randomly assigned to a study group according to a simple randomization method using a sealed envelope mentioned about the group name. Both groups were treated with fixed orthodontic appliance using the 0.022-in. slot of McLaughlin Bennett Trevisi prescription brackets. The piezocision group received flapless piezocision corticotomy about 4–5 mm in length and 3 mm depth on the labial mucogingiva between the roots of six anterior teeth. The number of days since treatment started, Little’s irregularity index, gingival recession, pocket depth, pulp vitality, patient perception of the pain and satisfaction level were recorded before the treatment, at about 1 month and 2 months post-treatment, and at the completion of the levelling and alignment stage. The overall time to complete levelling and alignment stage was significantly shorter in the piezocision group than the control group (mean difference = 31.5 days, 95% CI 6.5, 56.5; p = 0.018). Greater reduction in Little’s irregularity index and faster alignment rate in the first 2 months were found in the piezocision group compared to the control group (p < 0.05). No changes in the gingival recession, pocket depth, and pulp vitality in both groups were observed. Patients who received piezocision surgery experienced no or mild pain and were satisfied with the treatment. Flapless piezocision corticotomy is an effective adjunct that shortens treatment time during levelling and alignment stage without any adverse effects on the teeth and surrounding tissues. It is also painless, acceptable and satisfactory to the patients. Trial registration: ACTRN12621001350819.
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Sipiyaruk K, Santiwong P, Sommaluan K, Mokkasak S, Rachuratchata C, Rattanaopas T. The implementation of PROMs/PREMs in the assessment of orthodontic treatment outcomes: A questionnaire survey. J Int Soc Prev Community Dent 2022; 12:210-215. [PMID: 35462744 PMCID: PMC9022384 DOI: 10.4103/jispcd.jispcd_275_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/14/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The aim of this study was to explore the impact of self-perceived treatment outcomes and experiences on psychological aspects, reflecting the importance of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in orthodontic practice. Materials and Methods: A questionnaire was constructed using the PROMs/PREMs concepts. It contained five parts: “Demographic data”, “Self-perceived esthetics”, “Self-perceived functional concern”, “Satisfaction of treatment procedures”, and “Psychological aspect”. The questionnaire was piloted in five experts and 50 orthodontic patients to ensure its quality, using content validity, test-retest reliability, and Cronbach’s alpha. The validated version was provided to patients who had a complete fixed appliance orthodontic treatment. These data were analyzed using descriptive statistics, Mann-Whitney U test, and Spearman correlation. In addition, a multiple linear regression was used to analyze whether there were any influential factors on a psychological aspect. Statistical significance was taken at P < 0.05. Results: A total of 271 respondents completed the questionnaire. They tended to have positive perceptions toward the outcomes of orthodontic treatment. There was a significant difference in self-perceived esthetics between the male and female groups. Self-perceived esthetic and functional concerns as well as satisfaction of treatment procedures were found to have significant correlations with the psychological aspect. Sex and self-perceived esthetics were also found to be significant predictors of the psychological aspect. Conclusion: PROMs/PREMs should be considered as an important tool to assess treatment outcomes in orthodontic practice. There appeared to be significant impact of self-perceived esthetics on psychological aspects. Consequently, PROMs and PREMs should be introduced in orthodontic postgraduate programs to enhance the concept of patient-centered care in orthodontic practice.
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Gao J, Nguyen T, Oberoi S, Oh H, Kapila S, Kao RT, Lin GH. The Significance of Utilizing A Corticotomy on Periodontal and Orthodontic Outcomes: A Systematic Review and Meta-Analysis. BIOLOGY 2021; 10:biology10080803. [PMID: 34440034 PMCID: PMC8389689 DOI: 10.3390/biology10080803] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022]
Abstract
Simple Summary The collaboration between periodontics and orthodontics has the potential to allow safer orthodontic tooth movement and improve vulnerable oral conditions especially for patients with very thin bone and soft tissue. By providing this interdisciplinary surgical approach where thin bone and soft tissue are surgically augmented to convert a fragile-thin to a robust-thick tissue phenotype, this permits orthodontic treatment in these previously thin tissue cases to proceed without iatrogenically induced adverse effects. This is an infrequently performed procedure with few clinical recommendations. This review paper provides the rationale and the currently available evidence on the benefits of this novel surgical approach. Abstract Purpose: This systematic review compares the clinical and radiographic outcomes for patients who received only a corticotomy or periodontal accelerated osteogenic orthodontics (PAOO) with those who received a conventional orthodontic treatment. Methods: An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles published in English between January 1980 and June 2021 were performed. Human clinical trials of ≥10 patients treated with a corticotomy or PAOO with radiographic and/or clinical outcomes were included. Meta-analyses were performed to analyze the weighted mean difference (WMD) and confidence interval (CI) for the recorded variables. Results: Twelve articles were included in the quantitative analysis. The meta-analysis revealed a localized corticotomy distal to the canine can significantly increase canine distalization (WMD = 1.15 mm, 95% CI = 0.18–2.12 mm, p = 0.02) compared to a conventional orthodontic treatment. In addition, PAOO also showed a significant gain of buccal bone thickness (WMD = 0.43 mm, 95% CI = 0.09–0.78 mm, p = 0.01) and an improvement of bone density (WMD = 32.86, 95% CI = 11.83–53.89, p = 0.002) compared to the corticotomy group. Conclusion: Based on the findings of the meta-analyses, the localized use of a corticotomy can significantly increase the amount of canine distalization during orthodontic treatment. Additionally, the use of a corticotomy as a part of a PAOO procedure significantly increases the rate of orthodontic tooth movement and it is accompanied by an increased buccal bone thickness and bone density compared to patients undergoing a conventional orthodontic treatment.
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Affiliation(s)
- Jonathan Gao
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94131, USA; (J.G.); (T.N.); (S.O.); (S.K.); (R.T.K.)
| | - Trung Nguyen
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94131, USA; (J.G.); (T.N.); (S.O.); (S.K.); (R.T.K.)
| | - Snehlata Oberoi
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94131, USA; (J.G.); (T.N.); (S.O.); (S.K.); (R.T.K.)
| | - Heesoo Oh
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA 94103, USA;
| | - Sunil Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94131, USA; (J.G.); (T.N.); (S.O.); (S.K.); (R.T.K.)
| | - Richard T. Kao
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94131, USA; (J.G.); (T.N.); (S.O.); (S.K.); (R.T.K.)
- Private Practice, San Jose, CA 95125, USA
| | - Guo-Hao Lin
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94131, USA; (J.G.); (T.N.); (S.O.); (S.K.); (R.T.K.)
- Correspondence:
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Afzal E, Fida M, Malik DS, Irfan S, Gul M. Comparison between conventional and piezocision-assisted orthodontics in relieving anterior crowding: a systematic review and meta-analysis. Eur J Orthod 2021; 43:360-366. [PMID: 32812636 DOI: 10.1093/ejo/cjaa046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prolonged duration of orthodontic treatment is of great concern and poses risks to the teeth and surrounding tissues. Orthodontic tooth movement can be accelerated by introducing regional insult. Evidence suggests piezocision to be minimally invasive and clinically effective. OBJECTIVE The aim of the present study was to compare the effectiveness of conventional and piezocision-assisted orthodontics in relieving anterior crowding. SEARCH METHODS Electronic and manual searches were conducted in databases including PubMed, Dental and Oral Science, CINAHL, and Cochrane Central Register of Controlled Trials until April 2019. SELECTION CRITERIA Randomized and non-randomized controlled trials were included. DATA COLLECTION AND ANALYSIS Data were extracted independently by two authors from the studies that fulfilled inclusion criteria. The primary outcome assessed was time required for the alleviation of crowding. The secondary outcomes evaluated were pain, root resorption, and periodontal health. The risk of bias in the clinical trials was evaluated according to the Cochrane Collaboration's tool. Studies having homogenous data were included in the meta-analysis using the RevMan software. RESULTS Initial search yielded 3018 studies with eight articles meeting the inclusion criteria, six were randomized controlled trials and two were non-randomized controlled trials. Significant differences were found in alignment time between conventional and piezocision-assisted orthodontic treatment. However, gingival health, pain experienced by the patient, and root resorption showed non-significant differences. The forest plot of meta-analysis depicted significant mean difference of -46.44; 95 per cent confidence interval (CI) -87.95, -4.93; P ≤ 0.03 in the alignment time. Difference in pain levels was found to be non-significant (P = 0.78). LIMITATIONS There is a shortage of high-quality randomized controlled trials with a limited sample size and lack of standardization of piezocision protocol. CONCLUSIONS AND IMPLICATIONS According to the existing evidence, piezocision is effective in reducing tooth alignment time and alleviating crowding when compared to conventional therapy. Pain levels showed insignificant differences revealed in meta-analysis. Weak evidence suggests that there are no negative effects on periodontal health and root resorption after performing piezocision. REGISTRATION PROSPERO (CRD42019134398).
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Affiliation(s)
- Erum Afzal
- Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mubassar Fida
- Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Durre Shahwar Malik
- Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Sarah Irfan
- Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Meisha Gul
- Department of Operative Dentistry, Bahria University Medical and Dental College, Karachi, Pakistan
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Charavet C, Van Hede D, Maes N, Albert A, Lambert F. Disentangling the effects of CAD/CAM customized appliances and piezocision in orthodontic treatment: New evidence. Angle Orthod 2021; 91:764-771. [PMID: 33961005 DOI: 10.2319/112620-962.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To discern the effects of computer-aided design (CAD)/computer-aided manufactured (CAM) customized appliances and piezocision on orthodontic treatment (OT). MATERIALS AND METHODS The study combined findings from two previously published randomized controlled trials: (1) standard OT vs piezocision-assisted standard OT, and (2) CAD/CAM OT vs piezocision-assisted CAD/CAM OT. Piezocision is a minimally invasive corticotomy surgical procedure used to accelerate orthodontic treatment and CAD/CAM refers to CAD/CAM customized brackets and archwires. The outcomes were the overall treatment time, and the durations of the alignment phase and fine-tuning phase. Clinical and radiological features also were evaluated. RESULTS The combined study included 48 patients with similar baseline characteristics. Compared to the standard treatment, CAD/CAM technology alone significantly decreased the overall median OT time from 543 to 394 days (P < .001) and from 543 to 254 days (P < .0001) when combined with piezocision. Although piezocision significantly reduced the duration of the alignment phase in the mandible and maxilla, CAD/CAM technology considerably shortened the fine-tuning phase. All periodontal and radiographic parameters remained stable from the start to the end of treatment in all groups. CONCLUSIONS CAD/CAM technology combined with piezocision accelerates the entire OT process, during the alignment phase for piezocision and during the fine-tuning phase for CAD/CAM, with a global reduction of the overall treatment time of more than 50%.
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Shahrin AA, Ghani SHA, Norman NH. Effect of micro-osteoperforations on external apical root resorption: A randomized controlled trial. Korean J Orthod 2021; 51:86-94. [PMID: 33678624 PMCID: PMC7940811 DOI: 10.4041/kjod.2021.51.2.86] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to investigate the effect of micro-osteoperforations (MOPs) on external apical root resorption (EARR) during the initial orthodontic alignment phase of maxillary anterior crowding. Methods Thirty patients (25 females, 5 males; mean age, 22.66 ± 3.27 years) who presented with moderate crowding of the upper labial segment and underwent extraction-based fixed appliance treatment were recruited. They were randomly allocated to receive adjunctive therapy with MOPs (n = 15) or treatment with fixed appliances only (control group; n = 15). EARR was measured from long-cone periapical radiographs taken at the start and the sixth month of treatment. A correction factor for the enlargement difference was used to calculate EARR. Data were analyzed with descriptive statistics and repeated-measures analysis of variance. Results The mean root lengths of 168 teeth were measured and showed no statistically significant difference (p > 0.05) after six months of fixed appliance treatment in the MOP (mean difference [MD] = 0.13 mm; 95% confidence interval [CI] = −0.10–0.35) and control group (MD = 0.14 mm; 95% CI = −0.10–0.37). Most of the roots in the MOP and control groups (42.86% and 52.38%, respectively) showed only mild resorption. Less than 8% of the roots in both groups (7.14% in the MOP group and 4.76% in the control group) showed moderate resorption. Conclusions Acceleration of orthodontic tooth movement with adjunctive MOPs therapy during the alignment phase does not exacerbate EARR in patients with moderate crowding of the upper labial segment in comparison with controls.
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Affiliation(s)
- Azaitun Akma Shahrin
- Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Malaysia
| | - Sarah Haniza Abdul Ghani
- Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Malaysia
| | - Noraina Hafizan Norman
- Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Malaysia
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Charavet C, Lecloux G, Vandenberghe B, Lambert F. Buccal bone regeneration combined with piezocision in adult orthodontic patients: Clinical, 3D radiographic, and patient-reported outcomes. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:549-556. [PMID: 33289660 DOI: 10.1016/j.jormas.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/04/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Assess the clinical effects, 3D radiographic results and patient-reported outcome measures (PROMs) of buccal bone regeneration combined with piezocision. METHODS Ten patients presenting roots prominence with a thin buccal bone thickness or buccal bone dehiscence in the lower front region were enrolled. Patients received orthodontic treatment assisted by piezocison which was combined with a buccal alveolar bone regeneration using a tunneling approach. A comparison between pre- and post-treatment alveolar bone measurements based on CBCT was performed. Periodontal parameters such as recession scores and root resorption were recorded before and after treatment. The PROMs were also investigated. RESULTS An overall significant buccal bone gain of 2.7 ± 2.7% was found after the treatment. The apical region reached the highest gain of 8.9 ± 5.5% whereas the most coronal region showed no significant increase of the bone envelope (1.2 ± 2.7%). No adverse event such as the appearance of recession or root resorption were observed. However, in 2 patients, the biomaterial was not properly integrated and seemed to be encapsulated. The pain level and the paracetamol consumption were equivalent to those after the placement of the orthodontic appliance except on the day of the surgery. CONCLUSIONS Within the limitation of this study, piezocision combined with buccal bone regeneration using a tunneling technique seems to be effective to augment bone and did not lead to gingival recession. However, in 2 cases the biomaterial seemed encapsulated, and therefore the predictability of the integration of the material can be questioned. ClinicalTrials.gov registration : NCT03655938.
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Affiliation(s)
- Carole Charavet
- Department of Orthodontics and DentoFacial Orthopedics, University Hospital of Liège, Liège, Belgium; Université Côte d'Azur, UFR Odontologie, Nice, France; Dental Biomaterials Research Unit (d-BRU), University of Liège, Liège, Belgium.
| | - Geoffrey Lecloux
- Department of Periodontology, Oral Surgery and Implant Surgery, University Hospital of Liège, Belgium; Dental Biomaterials Research Unit (d-BRU), University of Liège, Liège, Belgium
| | - Bart Vandenberghe
- Advimago, Center for Advanced Oral Imaging, Brussels, Liège, Belgium
| | - France Lambert
- Department of Periodontology, Oral Surgery and Implant Surgery, University Hospital of Liège, Belgium; Dental Biomaterials Research Unit (d-BRU), University of Liège, Liège, Belgium
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Mheissen S, Khan H, Samawi S. Is Piezocision effective in accelerating orthodontic tooth movement: A systematic review and meta-analysis. PLoS One 2020; 15:e0231492. [PMID: 32320408 PMCID: PMC7176130 DOI: 10.1371/journal.pone.0231492] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/24/2020] [Indexed: 01/22/2023] Open
Abstract
Objective This meta-analysis aimed at critically assessing currently available evidence regarding the overall effectiveness of Piezocision in accelerating orthodontic tooth movement, as well as the adverse effects of this intervention in orthodontic patients. Search methods Electronic search of 6 databases and additional manual searches up to April 2019 without restrictions, also update the search was done by 20th November. Selection criteria Randomized controlled trials (RCT) and controlled clinical trials (CCT) reporting piezocision-assisted orthodontics versus conventional orthodontics were included in the review. Data collection and analysis The data are expressed by mean differences (MD), 95% confidence intervals, fixed-effect model or random-effect model in the meta-analysis in regard to statistical heterogeneity analyses (tau2, and I2). Included randomized studies were assessed for risk of bias using the new Cochrane Risk of Bias tool (ROB.2) and the non-randomized studies were assessed using (ROBINS I) tool. The studies were graded according to the GRADE approach. Results Fourteen papers for 13 unique trials were included in this systematic review and eight studies were included in the meta-analysis. The meta-analysis showed that the mean difference of the canine retraction rate in the first and second month after piezocision was 0.66 mm/month and 0.48mm/month, respectively. A total canine retraction rate in the first two months after piezocision was statistically significant (0.57 mm/month, p<0.00001), favoring the piezocision group with a high heterogeneity between studies I2 = 69%. For the total treatment time outcome measure, there was a statistically significant difference in the overall treatment time (MD 101.64 Days, 95% CI, 59.24–144.06) favoring the piezocision group. Conclusions Low quality evidence suggests that piezocision is an effective surgical procedure in accelerating the rate of canine retraction in the first two months and reducing the treatment duration. However, this effect appears to be clinically insignificant. Systematic review registration CRD42019136303.
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Affiliation(s)
- Samer Mheissen
- DDS, Syrian Board in Orthodontics, Former instructor in Orthodontic Department, Syrian Ministry of Health Private Practice, Damascus, Syrian Arab Republic
- * E-mail:
| | - Haris Khan
- BDS, FCPS, FFDRCSI, Associate Professor of orthodontics, CMH institute of dentistry Lahore, National University of Medical Sciences, Punjab, Pakistan
| | - Shadi Samawi
- BDS, MMedSci(Orth), MOrthRCSED, Private Practice, Argentina, Jordan
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Charavet C, Van Hede D, Anania S, Maes N, Lambert F. Multilevel biological responses following piezocision to accelerate orthodontic tooth movement: A study in rats. J World Fed Orthod 2019. [DOI: 10.1016/j.ejwf.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Shahabee M, Shafaee H, Abtahi M, Rangrazi A, Bardideh E. Effect of micro-osteoperforation on the rate of orthodontic tooth movement—a systematic review and a meta-analysis. Eur J Orthod 2019; 42:211-221. [DOI: 10.1093/ejo/cjz049] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Background
The micro-osteoperforation can be used to increase the rate of tooth movement, simplify complex orthodontic movements, and also help adjust the anchorage but there are conflicting reports on the effectiveness and adverse effects of this intervention.
Objectives
The aim of our systematic review and meta-analysis was to evaluate the effects of micro-osteoperforation on the rate of tooth movement in patients undergoing orthodontic treatment.
Search methods
A comprehensive search of MEDLINE, ISI web of science, EMBASE, Scopus, and CENTRAL online databases for studies measuring the effects of micro-osteoperforation on the rate of orthodontic tooth movement from inception to February 2019 was performed.
Selection criteria
Based on the PICO model, human studies which evaluated the effects of MOP on the rate of tooth movement in patients undergoing orthodontic treatment were selected for this review.
Data collection and analysis
The relevant data from the eligible studies were extracted using piloted custom extraction forms. The data were combined and analysed using inverse-variance random-effect meta-analysis and the mean difference was used for comparing the outcome measures.
Results
Six randomized clinical trials were finally included in this meta-analysis. The rate of canine retraction per month was significantly higher in the MOP group [mean difference (MD) = 0.45 mm, 95% CI = 0.17–0.74]. These results were similar with regard to different malocclusions, the jaw on which it was performed, and MOP methods. The patients did not report any significant differences in terms of pain severity levels after MOP. With regard to the adverse effects, one study reported higher amounts of root resorption among patients undergoing MOP.
Conclusions
The rate of tooth movement was increased after performing MOP but in at least one study higher root resorption was observed. Therefore, the use of MOP can be recommended after weighing the benefits and disadvantages this intervention can bring for each patient.
Registration
The protocol for this review was registered via crd.york.ac.uk/prospero with the ID CRD42019115499.
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Affiliation(s)
- Mostafa Shahabee
- Orthodontic Department, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hooman Shafaee
- Orthodontic Department, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Abtahi
- Orthodontic Department, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Erfan Bardideh
- Orthodontic Department, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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