Effectiveness of part-time vs full-time wear protocols of Twin-block appliance on dental and skeletal changes: A randomized controlled trial

The effect of text message reminders on compliance with Twin Block appliances: A randomised controlled trial

AIMS

The aim of this study was to evaluate whether text reminders influence patient compliance with Twin Block appliances. The null hypothesis was that there was no statistically significant differences in Twin Block compliance between those who receive text reminders and those that do not.

DESIGN

Single-blind parallel randomised controlled clinical trial.

SETTING

Health Service Executive (HSE) orthodontic outpatient clinic in Dublin, Ireland.

PARTICIPANTS

A total of 59 patients aged 11-15 years with a 5a Index of Orthodontic Treatment Need (IOTN grade) starting treatment with Twin Block appliances.

METHODS

A computer-generated unstratified allocation sequence was used to randomise the participants into the control group (CG) or the text group (TG). Both groups were asked to wear their appliances full-time. In addition to the same verbal and written instruction received by the CG, the TG received text message reminders, every 3 days, to wear their appliances. The primary outcome measure was wear time reported by Theramon® sensors embedded in the appliances. Data on wear time were uploaded from the Theramon® sensors onto cloud software. Participants in both groups were asked to fill out wear diaries and submit these at each visit. Treating clinicians and the primary investigator were blinded to the allocation group. Participants were followed up for 4 months. Participants were not blinded to their treatment group.

RESULTS

In total, 29 participants were allocated to the CG and 30 to the TG. The data for 53 participants were analysed, 24 from the CG and 29 from the TG. The median hours/day of wear recorded using the Theramon® sensors was 13.77 (interquartile range [IQR] = 10.19) for the CG and 17.72 (IQR = 5.62) for the TG. The difference in wear time recorded was not statistically significant (P = 0.16).

CONCLUSION

The study concluded that text message reminders had no statistically significant influence on patient compliance with Twin Block appliances.

Myobrace versus twin block in the treatment of class II malocclusion in Children: A systematic review

Background

One of today's largest global problems is malocclusion. We must prevent this through the screening and early treatment of young children, because malocclusion treatment conducted during a child's growth and development stage either the primary or mixed dentition era yields the best outcomes. Functional appliances are usually used during initial orthodontic treatment, such as myobrace and twin block appliances. Myobraces come in various sizes. The size chosen depends on the treatment objectives, which may include correcting class II malocclusions. The twin block appliance is a functional device commonly employed to treat class II malocclusions.

Purpose

This investigation's main goal was to compare the efficacy of the myobrace and twin block appliances in class II malocclusion treatment to select a more appropriate pediatric dentistry device.

Results

A total of 5 articles were selected from 306 articles based on relevant keywords. All selected studies were conducted within the last 10 years.

Discussion

Myobrace and twin block appliances can address overjet issues and achieve significant overjet measurement reductions. This appliance promotes mandibular growth and enhances the facial profiles of individuals with class II malocclusions.

Conclusion

In order to treat individuals with class II malocclusions, the myobrace and the twin block both address skeletal and dentoalveolar discrepancies. But compared to the myobrace, the twin block appliance had more noteworthy outcomes.

Functional therapy and adenotonsillectomy clinical trial for class II malocclusion (FACT-II): protocol for a randomised controlled trial

INTRODUCTION

Class II malocclusion with mandibular retrognathia is a common complication of paediatric obstructive sleep apnoea (OSA), often accompanied by transverse maxillary deficiency. In early orthodontic treatment, a twin block (TB) is a regular functional appliance for correcting this malocclusion. For paediatric OSA, the most common risk factor is adenotonsillar hypertrophy (AHT). Untreated AHT may lead to the persistence and worsening of obstructive sleep-disordered breathing traits, including habitual mouth breathing. Additionally, the clockwise mandibular rotation associated with AHT-induced pharyngeal crowding can undermine the effectiveness and stability of TB treatment. Adenotonsillectomy (T&A) is currently the first-line treatment for paediatric OSA. This proposed trial will investigate the impact of T&A surgery timing on the efficacy and stability of TB functional treatment in children with class II mandibular retrognathia and ATH.

METHODS AND ANALYSIS

This will be a single-centre, parallel-group, superiority randomised controlled trial with participants randomised to intervention (T&A followed by TB treatment) or control arms (TB treatment followed by T&A) in a 1:1 ratio. A total of 40 patients aged 8-14 years, diagnosed with class II mandibular retrognathia and co-existing ATH-induced OSA, and indicated for both T&A surgery and TB treatment, will be recruited at the School and Hospital of Stomatology, Wuhan University. The primary outcomes will be the changes in the apnoea-hypopnoea index and the point A-nasion-point B angle from baseline to postorthodontic treatment between the two groups. Secondary outcomes will include other dental, skeletal, upper airway and soft tissue changes, as well as subjective sleep-related and oral-related quality of life. Outcome changes within each group and between groups will be analysed.

ETHICS AND DISSEMINATION

This study is approved by the Ethics Committee of the School and Hospital of Stomatology, Wuhan University (no. 2022-D07). The research findings will be faithfully disseminated through scientific conferences or published articles.

TRIAL REGISTRATION NUMBER

ChiCTR2200061703 (https://www.chictr.org.cn).

Contemporary Twin Block appliance wear protocols: A survey of UK orthodontists

OBJECTIVE

This study was undertaken to determine contemporary trends in the use of the Twin Block appliance among UK orthodontists, including the wear time currently prescribed. In addition, the study explored if there had been any change in wear time prescribed, considering recent research evidence proposing part-time wear.

DESIGN

Cross-sectional, online survey.

PARTICIPANTS

Members of the British Orthodontic Society (BOS).

METHODS

The questionnaire was emailed to all BOS members in November 2021 and hosted on the QualtricsXM platform. The questionnaire was piloted for content validity and tested for reliability.

RESULTS

A response rate of 19% was attained. Nearly all (n = 244, 99%) participants used the Twin Block, and 90% (n = 218) prescribed full-time wear including/excluding eating. Although the majority (n = 168, 69%) had not made changes to their wear time prescriptions, nearly one-third (n = 75, 31%) had. Those who reported a change in their prescriptions currently prescribe less wear time than before, and commonly quoted 'research evidence' as the reason. A wide range in success rates (41%-100%) was reported, with patient compliance as the main reason for treatment discontinuation.

CONCLUSION

The Twin Block is a popular functional appliance among orthodontists in the UK, originally designed by Clark to be worn full time to maximise functional forces applied to the dentition. However, this wear regime may place considerable strain on patient compliance. Most participants prescribed full-time Twin Block wear excluding eating. Approximately one-third of orthodontists made changes to their wear time prescriptions during their practising career, and currently instruct less wear time than before.

Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives

OBJECTIVE

Information regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment.

DESIGN

PSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019).

RESULTS

Two themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits.

CONCLUSION

Multifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.

The use of the Hanks Herbst vs Twin-block in Class II malocclusion: A randomized controlled trial

INTRODUCTION

This 2-arm parallel study aimed to compare and evaluate the efficiency of Hanks Herbst (HH) and Twin-block (TB) functional appliances in treating adolescents with Class II malocclusion.

METHODS

A parallel-group randomized controlled trial was undertaken in a single United Kingdom hospital. Eighty participants were recruited and randomized in a 1:1 ratio to receive either the HH or TB appliance. Eligibility criteria included children aged 10-14 years with an overjet of ≥7 mm without dental anomalies. The primary outcome was the time (in months) required to reduce overjet to normal limits (<4 mm). Secondary outcomes included treatment failure rates, complications and their impact on oral health-related quality of life (OHRQOL). Randomization was accomplished using electronic software with allocation concealed using sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for outcome assessment. Data were analyzed using descriptive statistics and regression analyses to detect between-group differences, including Cox regression for time to treatment success.

RESULTS

HH was significantly faster than TB in reducing the overjet to within normal limits (95% confidence interval [CI], -3.00 to -0.03; P = 0.046). Mean overjet reduction was more efficient with the HH than the TB appliance (ß = 1.3; 95% CI, 0.04-2.40; P = 0.04). Fifteen (37.5%) of the participants in the TB group and 7 (17.5%) in the HH group failed to complete the treatment (hazard ratio = 0.54; 95% CI, 0.32-0.91, P = 0.02). However, TB was associated with fewer routine (incidence rate ratio = 0.81; 95% CI, 0.7-0.9; P = 0.004) and emergency (incidence rate ratio = 0.1; 95% CI, 0.1-0.3; P = 0.001) visits. Chairside time was greater with the HH (ß = 2.7; 95% CI, 1.8-3.6, P = 0.001). Participants in both groups experienced complications with similar frequency. A greater deterioration in OHRQOL was found during treatment with the TB.

CONCLUSIONS

Treatment with HH resulted in more efficient and predictable overjet reduction than TB. More treatment discontinuation and greater deterioration in OHRQOL were observed with the TB. However, HH was associated with more routine and emergency visits.

REGISTRATION

ISRCTN11717011.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

No specific external or internal funding was provided. Treatment for participants was provided as part of routine orthodontic treatment in the hospital.

Compliance with retainer wear using audiovisual integration and reminder: a randomized clinical trial

Active audiovisual representation of instructions ensures vibrant knowledge acquisition and improves acquaintance needed for self-care with retainer wear. The aim of this trial is to assess the impact of audiovisual instructions with additional weekly electronic reminder messages on improving adherence to instructed wear time of Hawley retainer, periodontal outcomes, and participants' experiences. Fifty-two participants (mean age 26.1 y) planned for removable retention, were randomly assigned to two parallel groups to receive either (1) audiovisual instructions with an additional weekly reminder, or (2) verbal instructions alone. Each participant received a Hawley retainer equipped with a TheraMon microsensor and was instructed to wear it for 22 h daily. Participants were monitored for adherence to the wear time after 3 (T1) and 6 months (T2), and had their periodontal health and experiences assessed at T2. Overall, the mean objectively measured daily wear time at T1 was 14.9 (± 4.9 h), and 14.3 (± 5.4 h) at T2. After 3 months, no significant differences were found between the groups (p = 0.065), however, a significant difference favoring better compliance with wear instructions was observed in the audiovisual group after 6 months (p = 0.033). A non-significant difference was observed between both groups regarding the gingival (p = 0.165) and plaque index scores (p = 0.173). Participants' experiences were similar in both groups, except for satisfaction with the way of delivering instructions, being favorably reported in the audiovisual group. Audiovisual instructions with weekly reminders seem to have a significant effect on patient compliance in the longer term.Trial registration: TCTR20230220002.

Comparison of part-time and full-time mandibular advancement: enlightenment based on type H vessel coupling osteogenesis

OBJECTIVES

This study was aimed at resolving the controversy over the wearing time of mandibular advancement (MA) appliances by comparing the differences between part-time and full-time MA (PTMA and FTMA) from the perspective of promoting H-type vessel coupling osteogenesis in the condylar heads.

MATERIALS AND METHODS

Thirty 30-week-old male C57BL/6J mice were randomly divided into 3 groups: the control (Ctrl), PTMA, and FTMA groups. The mandibular condyles were analyzed by morphology, micro-computed tomography, histological staining, and immunofluorescence staining to investigate the changes of the condylar heads in the PTMA and FTMA groups after 31 days.

RESULTS

Both PTMA and FTMA models promoted condylar growth and achieved stable mandibular advancement at day 31. However, compared with PTMA, FTMA has the following characteristics. First, new bone formation in the condylar head was detected in the retrocentral region in addition to the posterior region. Second, the condylar proliferative layer was thicker, and the number of pyknotic cells in the hypertrophic and erosive layers was higher. Moreover, endochondral osteogenesis of the condylar head was more active. Finally, the retrocentral and posterior regions of the condylar head had more vascular loops or arcuate H-type vessel coupling Osterix⁺ osteoprogenitors.

CONCLUSIONS

While both PTMA and FTMA induced new bone formation in the condylar heads of middle-aged mice, FTMA promoted more osteogenesis by volume and region. Furthermore, FTMA presented more H-type vessel coupling Osterix⁺ osteoprogenitors in both the retrocentral and posterior regions of the condylar head.

CLINICAL RELEVANCE

FTMA is better at promoting condylar osteogenesis, especially in non-growing patients. We suggest that enhancing H-type angiogenesis could be an effective strategy to achieve favorable MA outcomes, especially for patients unable to meet the FT-wearing requirement or being non-growing.

Wearable Orofacial Technology and Orthodontics

Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual's current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw's functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual's current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.

Comparative Evaluation of Twin Block Appliance and Fixed Orthodontic Appliance in Early Class II Malocclusion Treatment: A Randomized Controlled Trial

AIMS

To compare skeletal, dentoalveolar, and soft tissue changes between Twin block and early fixed orthodontic appliance for class II division 1 malocclusion treatment through a randomized controlled trial.

MATERIALS AND METHODS

Sample and randomization: This study was a randomized controlled trial with a 1:1 allocation ratio in which 40 patients were divided equally into two groups: control and experimental; each group had an equal number of boys and girls. Randomization was achieved using random blocks of 20 patients with allocation concealed in sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for data analysis of radiographic measurements. Intervention: Twin block appliance was used in the experimental group for 1 year. However, control group was treated with fixed appliance. Inclusion criteria: Skeletal class II division 1 malocclusion with mandibular retrognathism; cephalometric angular measurements: SNA ≥ 82, SNB ≤ 78, ANB ≥ 4; overjet ≥6 mm; and patient in circumpubertal stage cervical vertebral maturation (CVM2 and CVM3). Parameters for evaluation: Cephalometric skeletal, dental, and soft tissue angular and linear measurements were used for evaluation.

RESULTS

SNB increased remarkably by 4° in the Twin block group, but only by 0.68 in the control group. There was a significant decrease in vertical dimensions (SN-GoGn) in the Twin block group compared to control group (p = 0.002). Significant enhancement in the facial profile of the patients was observed.

CONCLUSIONS

The Twin block appliance induced significant skeletal and dental changes. These changes were more obvious relative to the slight changes induced by natural growth.

CLINICAL SIGNIFICANCE

Early treatment of Class II due to mandibular retrusion with Twin block functional appliance is recommended due to its favourable skeletal effect. Early treatment with fixed appliance affects mainly the dentoalveolar component. Long term follow-up is needed for further insights.

Orthodontic Compliance Assessment: A Systematic Review

OBJECTIVES

The aim of this review was to determine whether the type of removable appliance, as well as the age and sex of the patient, may affect the extension or reduction of wear time by assessing the correlation between the mean actual and orthodontist-recommended wear times.

METHODS

Randomised case control trials, cohort studies, case series, observational studies, reviews, and retrospective analyses were identified. The quality of the studies was assessed using the Cochrane Collaboration Tool and modified Newcastle-Ottawa Scale. The electronic databases Embase, PubMed, Scopus, and Web of Science were reviewed, and 542 articles were obtained, of which 31 were qualified for qualitative synthesis. The data from 1674 participants were collected and a weighted average was determined for the mean wear time of each appliance.

RESULTS

Regardless of the type of extra- or intraoral appliances, mean wear time was shorter than recommended, although patients using intraoral appliances cooperated more. The best compliance was noted for Schwarz appliances (73.70%) and plate retainers (85%). There was no evidence of an influence of patients' age and sex on compliance during treatment.

CONCLUSIONS

The considerable inconsistency and imprecision of articles could affect the reliability of the results. Previous studies analysing the effectiveness of treatment with removable appliances based on an arbitrarily assumed average wear time need to be revised in order to verify the actual wear time with the use of microsensors.

Patient compliance with Twin Block appliance during treatment of Class II malocclusion: a randomized controlled trial on two check-up prescriptions

BACKGROUND

Compliance is crucial for the treatment outcome with removable appliances. Previous studies on treatment with the Twin Block appliance have focused on effectiveness in relation to other treatment methods or wear-time. Studies on different check-up intervals to improve compliance seem to be lacking.

OBJECTIVES

To compare the impact of two different check-up prescriptions on patient compliance and treatment outcome during treatment with Twin Block.

TRIAL DESIGN

Two-arm parallel group, single-centre, randomized controlled trial.

MATERIALS AND METHODS

Seventy-three patients, 38 boys, and 35 girls, mean age 11.2 years, were included and block-randomized into two groups treated with a Twin Block appliance. Group 1 was called for check-up visit every sixth week and group 2 every fourth week. Compliance was evaluated with a TheraMon® microsensor, moulded into the appliance, measuring wear-time. Overjet, overbite, and molar relationships were assessed on study casts before and after treatment. The treatment outcomes were analysed on an intention-to-treat basis.

RESULTS

In group 1, the reduction of overjet was 5.2 mm and the mean wear-time was 6.9 hours. In group 2, the reduction was 4.7 mm and the wear-time was 6.1 hours. Seventy-four per cent of the patients presented an overjet of 4 mm or less. Wear-time did not correlate to age, gender, or severity of malocclusion.

HARMS

No harm was observed in any patient. Lateral open bites were registered during treatment but were normalized at the end of the treatment.

LIMITATIONS

The trial was a single-centre study and long-term effects were not evaluated.

CONCLUSIONS

During treatment with the Twin Block appliance, a 4-week check-up interval did not improve treatment outcome or increase wear-time, compared to a 6-week check-up interval. The mean wear-time was 6.5 hours per day, even if the recommendation was 12 hours.

CLINICAL TRIAL REGISTRATION

NCT05155774.

Comparison of the treatment duration and effects of magnetic mandibular repositioning appliances and non-magnetic twin block in the treatment of growing patients with skeletal Class II malocclusion due to mandibular retrognathism – A systematic review

Over the past two decades, magnets have been used in orthodontics and dentofacial orthopedics and various attempts have been made to evaluate the biological implications of magnets and magnetic fields. This systematic review aims to provide a detailed comparison between magnetic mandibular repositioning appliances and non-magnetic twin blocks on mandibular growth modification. The objective was to evaluate the treatment duration and effects of magnetic mandibular repositioning appliances and non-magnetic twin block in growing children with skeletal Class II malocclusion due to mandibular retrognathism. Literature search of electronic databases and additional manual search was done till June 2021. Randomized controlled clinical trials (CCTs), non-randomized CCTs, case reports, case series, and retrospective clinical trials in which magnetic appliances and non-magnetic twin blocks were used for the correction of skeletal Class II malocclusion are included in the present review. Correction of skeletal Class II malocclusion was achieved in a shorter treatment duration with magnetic mandibular repositioning appliances. Similar dental and skeletal effects were observed with both the appliances; however, maxillary restraining effect and reduced mandibular incisor proclination was evident with magnetic mandibular repositioning appliances. Magnetic appliance is proven to be more effective in correction of skeletal Class II malocclusion with mandibular retrognathism and maxillary prognathism with proclined lower incisors. This systematic review was registered on Prospero with registration number CRD42020165297.

Correlation of twin-block appliance efficacy and wear durationas assessed with a compliance indicator

BACKGROUND

The aim of this study was to investigate the association between objective wear time and treatment efficacy of a twin block (TB) appliance.

METHODS

A TB appliance incorporating a compliance indicator was delivered to 44 children in the age group of 11-14 years (25 boys and 19 girls). Participants were instructed to wear the appliance full time and were recalled at 3-4- week intervals. Cephalograms and study models were taken at baseline and after 6 months of appliance therapy.

RESULTS

Data from 41 of the 44 participants were analyzed. A wide variation in daily wear time among participants was observed. Based on wear time, they were divided into full time (FT >17 h/d) and part time (PT < 12 h/d) wear groups. Mean wear durations were 20.86 hours in the FT-wear group and 9.55 hours in the PT-wear group. In skeletal changes, the ANB (A point, nasion, B point) angle was reduced by 2.69° in the FT-wear group, and 1.33° in the PT-wear group, and statistically significant increases were seen for the mandibular base measurement (Pg/OLp) in the FT-wear group (2.22mm), compared with those in the PT-wear group (0.44mm). . In dental changes, overjet were reduced by 3.91 mm and 2.0 mm in the FT-wear and PT-wear group, respectively. This difference was statistically significant.

CONCLUSIONS

Skeletal effects were pronounced in the FT-wear group, and dentoalveolar changes were comparable in the 2 wear groups. The maximum skeletal treatment effect of a TB appliance was found to occur with FT wear over a 6-month treatment period.

The effectiveness of a bespoke mobile application in improving adherence with removable orthodontic retention over 12 months: A randomized controlled trial

INTRODUCTION

The primary aim was to analyze the effect of providing a mobile application (My Retainers) on adherence with removable retention.

METHODS

Eighty-four participants planned for thermoplastic retainers were randomly allocated to 2 groups. The intervention group was given access to a bespoke mobile application, while the control group was not given access. Baseline data were obtained at the removal of orthodontic appliances with follow-up at 3 months, 6 months, 9 months, and 12 months. The primary outcome was objectively assessed retainer wear recorded using a TheraMon microelectronic sensor (MC Technology GmbH, Hargelsberg, Austria). Secondary outcomes were stability and periodontal implications.

RESULTS

The objectively assessed wear time at 12 months was low in both groups, being marginally higher in the intervention (median, 3.09 h/d; interquartile range, 8.1) than the control group (median, 1.44 h/d; interquartile range, 9.22) with no between-group statistical difference (P = 0.30, 95% confidence interval [CI], -3.91 to 1.19). No statistically significant difference was identified between the groups in terms of stability and periodontal outcomes. Improvement in plaque scores (P <0.0001; 95% CI, -0.20 to 0.15) and bleeding on probing (P <0.0001, 95% CI, -0.23 to -0.12) was noted over time with no periodontal attachment loss detected over the study period.

CONCLUSIONS

Provision of the mobile application did not lead to improved adherence with thermoplastic retainer wear. Similarly, no benefit in respect of either occlusal stability or periodontal health was observed over the 12-month study period. Further novel approaches to improve adherence with retainer wear and oral hygiene measures are required.

REGISTRATION

NCT03224481.

PROTOCOL

Not published.

FUNDING

This work was supported by funding from the European Orthodontic Society.

Comparison of objective wear time between monoblock and twin-block appliances measured by microsensor

OBJECTIVES

To assess the objective compliance levels in skeletal Class II patients with mandibular retrognathia wearing monoblock and twin-block appliances.

MATERIALS AND METHODS

A prospective clinical study was conducted with 30 patients between 10 and 15 years old who were equally divided into two study groups. Group 1 was treated with monoblock, and group 2 was treated with twin-block appliances. The patients were instructed to wear their appliance for 15 hours per day. Wear times were monitored by a microsensor. (TheraMon; MCTechnology, Hargelsberg, Austria) for an average of six appointments. Patients were also instructed to record their wear times on a chart, and this record was admitted as subjective wear time. Statistical analysis was performed with the data derived from both the patients' charts and the monitoring records.

RESULTS

The mean wear time by the patients was 10.67 ± 3.93 hours, which was less than the 15 hours prescribed by the orthodontist, with no difference between the two appliances (P > .05). The regular use rate, which included the days with a wear time of 8 hours or more per day, was 75%. Compliance levels decreased by 35% throughout the six control appointments. Patients declared that their wear time was more than their objective wear time by an average of 3.76 hours.

CONCLUSIONS

Despite their different designs, there was no significant difference between the monoblock and twin-block appliances in terms of compliance.

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

BACKGROUND/OBJECTIVE

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

SEARCH METHODS

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

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

RESULTS

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

CONCLUSIONS

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

REGISTRATION

PROSPERO (CRD42019120525).

Does daily wear time of Twin Block reliably predict its efficiency of class II treatment?

PURPOSE

The objective of this study was to investigate how daily wear time (DWT) influences class II malocclusion treatment efficiency.

MATERIALS AND METHODS

The study group consisted of 55 patients (mean age 10.4 years) diagnosed with a class II/1 malocclusion. Twin block appliances, with built-in Theramon® microsensors (MC Technology, Hargelsberg, Austria) to monitor patients' cooperation (daily wear time assessment), were used for treatment. Cephalograms were taken and the following initial and final measurements were compared: Co-Gn, Co-Go, Co-Olp, Pg-Olp, WITS, SNA, SNB, ANB, Co-Go-Me, overjet, molar and canine relationships. The Shapiro-Wilk test, Wilcoxon signed-rank test, Student's t-test, Levene's test, Mann-Whitney U test, Kruskal-Wallis test, χ² test, and Spearman's rank correlation coefficient with p < 0.05 set as the statistical significance level were used to determine the correlation of the outcomes with DWT; a ROC (receiver operating characteristic) curve was calculated to illustrate diagnostic ability of the binary classifier system.

RESULTS

DWT was very highly positively correlated with change of the Pg-Olp parameter and highly with an improvement in the ANB, SNA, and SNB angles, an increase in the WITS parameter and an increase in Co-Gn distance. DWTs < 7.5 h correlated with significantly less improvement of the investigated variables. However, DWT > 7.5 h did not significantly correlate with the improvement of the overjet and most of the linear parameters in the mandible. The ROC curve and its AUC (area under curve) allowed the determination of a DWT of 7 h and 48 min to be capable of establishing a class I relationship with 83% probability.

CONCLUSIONS

Class II treatment efficiency was influenced by DWT; an 8 h threshold value had an 83% probability of establishing a class I relationship.

Treatment compliance of adolescent orthodontic patients with headgear activator and twin-block appliance assessed prospectively using microelectronic wear-time documentation

Background

Success of orthodontic removable appliance treatment relies on patient compliance. The aim of this quantitative and qualitative study was to explore the compliance and self-reported experience of adolescents in orthodontic treatment with headgear activator (HGA) or twin-block (TB) appliance.

Materials/methods

The study group comprised 52 adolescents with a mean age of 12.6 (±1.3) years at the start of the treatment. The patients were treated at a free-of-charge public dental clinic. Participants were randomly allocated to two equal groups to be treated with either HGA or TB. Patient compliance was evaluated as appliance wear time and subjective experience. Appliance wear time was recorded with Theramon® microchip, and the self-reported subjective experience using a questionnaire.

Results

In total, 30 patients completed the treatment during the follow-up period. HGA was worn on average 7 hours per day and TB 9 hours per day by those patients, who successfully completed the treatment. During a mean observation period of 13 months (range 7–23 months), the mean actual wear time was 43 per cent less than the advised 12 or 18 hours per day in the whole patient group, and 55 per cent in those patients, who completed the treatment. Compliance level was unrelated to the appliance type.

Limitations

Study assessed a relatively small number of patients.

Conclusions/implications

Adolescent patients wear HGA and TB less than advised. Individual variation in treatment adherence is considerable. Thereby, microelectronic wear-time documentation can be a cost-effective mean of identifying non-compliance.

Evaluation of the effectiveness of a tailored mobile application in increasing the duration of wear of thermoplastic retainers: a randomized controlled trial

Background

The ‘My Retainers’ mobile application is a patient-informed intervention designed to enhance removable retainer wear and associated patient experiences during the retention phase.

Objectives

To evaluate the effect of receiving the ‘My Retainers’ application on objectively assessed thermoplastic retainer (TPR) wear time, stability, periodontal outcomes, patient experiences, and knowledge related to retainers.

Materials and methods

Eighty-four participants planned for removable retention with TPRs were assigned either to receive the ‘My Retainers’ application or to control not receiving electronic reminders during the 3-month period. Randomization was based on computer-generated random numbers and allocation was concealed using opaque, sealed envelopes. The primary outcome was objectively assessed retainer wear recorded using an embedded TheraMon® micro-electronic sensor. Secondary outcomes, including irregularity of the maxillary and mandibular incisors, plaque levels, bleeding on probing and probing depth, were assessed at baseline and 3-month follow-up; and analysed using a series of mixed models. Experiences and knowledge related to orthodontic retainers were recorded using questionnaires. The outcome assessor was blinded when possible.

Results

Receipt of the mobile application resulted in slightly higher median wear time (0.91 hours/day); however, this difference was not statistically significant (P = 0.56; 95% confidence interval [CI]: −2.19, 4.01). No significant differences were found between the treatment groups in terms of stability (P = 0.92; 95% CI: −0.03, 0.04), plaque levels (P = 0.44; 95% CI: −0.07, 0.03), bleeding on probing (P = 0.61; 95% CI: −0.05, 0.03) and probing depth (P = 0.79; 95% CI: −0.09, 0.07). Furthermore, similar levels of patient experiences (P = 0.94) and knowledge related to retainers (P = 0.26) were found. However, marginally better levels of knowledge were identified in the intervention group. No harms were observed.

Limitations

A relatively short follow-up period with the study confined to a single-center in a university-based hospital.

Conclusions

Provision of the bespoke ‘My Retainers’ application did not lead to an improvement in adherence with TPR wear over a 3-month follow-up period. Further refinement and research are required to develop and investigate means of enhancing adherence levels.

Clinical registration

NCT03224481.

What evidence exists for myofunctional therapy with prefabricated appliances? A systematic review with meta-analyses of randomised trials

OBJECTIVE

To assess the treatment efficacy/efficiency with prefabricated myofunctional appliances (PMA) for children with malocclusion.

DATA SOURCES

Nine databases searched without limitations till July 2019.

DATA SELECTION

Randomised trials comparing PMAs to functional appliance treatment or no treatment.

DATA EXTRACTION

Study selection, data extraction and risk of bias assessment were done in duplicate.

DATA SYNTHESIS

Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted on seven publications (three published and one unpublished trials; 232 patients; 53% male; mean age 10.2 years). Compared to no treatment, one trial indicated that PMAs were somewhat effective in reducing overjet (MD -2.4; 95% CI -3.3 to -1.5), reducing overbite (MD -2.5; 95% CI -3.2 to -1.8), reducing mandibular crowding (RR 0.4; 95% CI 0.2-0.8) and establishing Class I canine relationship (RR = 2.3; 95% CI 1.1-4.9). However, compared to custom-made functional appliances, three trials indicated that PMAs were less effective in reducing the ANB angle (MD 0.9; 95% CI 0.5-1.4), increasing mandibular ramus length (MD -2.2; 95% CI -2.9 to -1.51), reducing overjet (MD 1.5; 95% CI 0.9-2.1), establishing a solid Class I molar relationship (RR 0.3; 95% CI 0.2-0.7), reducing the nasolabial angle (MD 5.8; 95% CI 0.8-10.8) and reducing facial convexity (MD -2.6; 95% CI -4.3 to -0.9). Finally, the quality of evidence was moderate to low due to risk of bias.

CONCLUSIONS

PMAs are more effective in reducing overjet, overbite, mandibular crowding and establishing Class I canine relationship than no treatment. However, compared to custom-made functional appliances, PMAs are less effective in producing dental, skeletal or soft-tissue changes, even though they are less costly.

Elastodontic appliance assisted fixed appliance treatment: A new two-phase protocol for extraction cases

Elastodontic appliance (EA) is a type of removable appliance that has been widely used in interceptive orthodontics. The present case report describes a severe crowding case treated with a new two-phase protocol by using an EA and a fixed appliance. A 13-year-old patient with severe dental crowding, increased overjet and overbite on a skeletal Class II base was selected. The patient had four bicuspids extracted; during the first phase of treatment, she wore the EA for 2 h during the daytime plus overnight, combined with a myofunctional exercise. During the second phase of treatment, a fixed appliance was employed to close residual space and improve the teeth angulations. The total treatment time was 14 months, of which the second phase with fixed appliance lasted 10 months. Satisfactory improvements of the overjet and teeth alignment were achieved. This case report used a new two-phase treatment protocol which resulted in a favourable outcome after comparatively short treatment.