Duration of canine retraction with fixed appliances: A systematic review and meta-analysis

An Innovative Approach to Accelerate Maxillary Canine Retraction With Low-Amperage Direct Electric Current: A Preliminary Clinical Study

Background and objective Accelerating orthodontic tooth movement is a significant goal for clinicians and patients. This study aimed to investigate the effectiveness of a low-ampere, electrically inducible tooth movement accelerator device. The study focuses on an innovative intraoral removable device designed to expedite the retraction of maxillary canines. Methods This research was conducted in the Orthodontics Department at Damascus University, Syria, between September 2022 and March 2023, and involved seven patients (five females and two males; mean age: 20.85 ± 1.34 years) initially diagnosed with class II, division I malocclusion. The treatment plan included retraction of the upper anterior teeth in two stages following the extraction of the first premolars on each side. Electrical stimulation was applied during the retraction of the maxillary canines using a removable, custom-manufactured device developed by the researchers. Patients were instructed to wear the device for five hours daily. The variables investigated included the rate of canine retraction, safety, and patient acceptance of the device. Results The average rate of canine retraction was consistent, averaging 1.25 ± 0.13 mm/month. No side effects, such as irritation or discomfort, were observed. Patients reported no adverse effects and stated that they would recommend the technique to others. Five out of seven patients found it easy to adapt to the device, while two found it moderately challenging. Conclusions Our findings showed that low-amperage direct current electrical stimulation effectively accelerated orthodontic movement. The maxillary canine retraction was significantly sped up without any adverse effects. Patients responded positively, indicating feasibility and acceptability. This technique could reduce treatment duration, which is pending further validation.

Evaluation of the Efficacy of Corticotomy and Piezocision on Canine Retraction: A Systematic Review

Background: In order to reduce the prolonged duration of orthodontic treatment, several surgical techniques have been proposed over the years. Corticotomy and piezocision are the two most widely used techniques, and, given the lack of consensus in the literature, along with the renewed interest in these approaches in recent years, the primary objective of this study is to evaluate their effectiveness in accelerating canine retraction in patients requiring extraction of the upper first premolar and, as a secondary objective, to assess if there is a worsening of periodontal health and how the surgical approach is perceived by the patient. Methods: An electronic search was performed on PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to 30 November 2024. The PRISMA statement was adopted for the realization of the review, and the Cochrane Collaboration's risk of bias assessment tool (RoB 2) was used to assess the studies' quality. Results: After full text assessment, fifteen randomized clinical trials (14 split mouth design, 1 single-blind, single-center design) covering 326 patients (mean age 20, 19 years) were included. The data collected reveal that corticotomy accelerates canine retraction by 1.5 to 4 times, while piezocision achieves retraction 1.5 to 2 times faster, making corticotomy the most effective technique. No statistically significant adverse effects on periodontal ligament, molar anchorage loss, or root resorption were observed following the two surgical techniques. In addition, patients reported experiencing mild to moderate pain. Conclusions: Corticotomy and piezocision are effective techniques for accelerating upper canine retraction in extraction cases, significantly reducing the overall duration of orthodontic treatment.

Occlusal outcome of orthodontic treatment: a systematic review with meta-analyses of randomized trials

BACKGROUND

Several appliances or treatment protocols are marketed to either patients or orthodontists as being associated with improved orthodontic outcomes. However, clinical decision-making should be based on robust scientific evidence and not marketing claims or anecdotal evidence.

OBJECTIVE

To identify appliances/protocols being associated with improved outcomes of fixed appliance treatment.

SEARCH METHODS

Unrestricted literature searches in seven databases/registers for human studies until March 2024.

SELECTION CRITERIA

Randomized or quasi-randomized clinical trials on human patients of any age, sex, or ethnicity receiving comprehensive orthodontic treatment with fixed appliances and assessing occlusal outcome with either the Peer Assessment Rating (PAR) or the American Board of Orthodontics-Objective Grading System (ABO-OGS) index.

DATA COLLECTION AND ANALYSIS

Duplicate/independent study selection, data extraction, and risk of bias assessment with the Cochrane RoB 2 tool. Random-effects meta-analyses of averages or mean differences with their 95% Confidence Intervals (CI), followed by meta-regression/subgroup/sensitivity analyses and assessment of the quality of clinical recommendations with the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Data from 20 small- to moderately-sized trials covering 1470 patients indicated that orthodontic treatment with fixed appliances is effective and results on average in a final PAR score of 6.0 points (95% CI 3.9-8.2 points), an absolute PAR reduction of 23.0 points (95% CI 15.6-30.4 points), a % PAR reduction of 82.6% (95% CI 70.8%-94.4%), and an absolute ABO-OGS score of 18.9 points (95% CI 11.7-26.2 points). However, very high between-study heterogeneity (I2 > 75%) was seen for both PAR and ABO-OGS. Extraction treatment was associated with significantly better occlusal outcome than non-extraction treatment with ABO-OGS (12.9 versus 16.6 points; P = .02). There was no statistically significant difference in occlusal outcome with (i) 0.018″-slot or 0.022″-slot brackets; (ii) customized or prefabricated brackets; (iii) anchorage reinforcement with temporary anchorage devices; (iv) use of vibrational adjuncts; and (v) aligners or fixed appliances (P > .05 in all instances), while small benefits were seen with indirectly bonded brackets.

CONCLUSIONS

Considerable between-study heterogeneity exists in the reported occlusal outcome of fixed appliance treatment, and different appliances or adjuncts have little effect on this. Standardization and/or automatization of the scoring procedures for PAR and ABO-OGS might help to improve consistency and reliability of outcome measurement in orthodontic trials.

REGISTRATION

PROSPERO (CRD42024525088).

Evaluation of stress and displacement of maxillary canine during the single canine retraction in the maxillary first premolar extraction cases- A finite element study

OBJECTIVES

This finite element study aimed to simulate maxillary canine movement during anterior teeth retraction.

MATERIALS AND METHODS

Three methods of maxillary canine movement including miniscrew sliding with high hooks (MSH), miniscrew sliding with low hooks (MSL), and the traditional sliding method (TS) without using miniscrews were simulated using three-dimensional finite element analysis. The initial displacement of the maxillary canine, the maximum principal stress of the periodontal ligament and the Von Mises stress were calculated.

RESULTS

The distolingual tipping movements of the canine were shown in three movement modes. MSH showed a small tendency to lingual tipping movement and a extrusion movement while MSL had the largest lingual inclination. TS demonstrated a tendency toward distolingual torsion displacement. Compressive stress values were mainly concentrated in the range - 0.003 to -0.006 MPa. For tensile stress, the distribution of MSH and MSL was concentrated in the range 0.005 to 0.009 MPa, TS was mainly distributed about 0.003 MPa. Von Mises equivalent stress distribution showed no significant difference.

CONCLUSIONS

The loss of tooth torque was inevitable, irrespective of which method was used to close the extraction space. However, miniscrew application and higher hooks reduced the loss of torque and avoided lingual rotation.

CLINICAL RELEVANCE

This study shows that miniscrew implants with different hooks can better control the movement of the maxillary canines. The non-invasive nature of the finite element analysis and its good simulation of dental stress and instantaneous motion trend have a clinical advantage in the analysis of tooth movement.

Clinical evaluation of marketed and non-marketed orthodontic products: are researchers now ahead of the times? A meta-epidemiological study

BACKGROUND

The advertisement and adoption of untested orthodontic products is common. This study aimed to provide an update regarding the prevalence of clinical trials in orthodontics evaluating commercially marketed products. Associations between marketed/non-marketed products and study characteristics such as direction of effect, declaration of conflict of interest and industry sponsorship were evaluated. In addition, within the marketed products associations between direction of effect and study characteristics were explored.

MATERIAL AND METHODS

Electronic searching of a single database (Medline via PubMed) was undertaken to identify Randomized controlled trials (RCTs) published over a 5-year period (1st January 2017 to 31st December 2021). Descriptive statistics and associations between trial characteristics were explored.

RESULTS

196 RCTs were analysed. RCTs were frequently published in Angle Orthodontist (18.4%), American Journal of Orthodontics and Dentofacial Orthopedics (14.8%) and European Journal of Orthodontics (13.3%). 65.3% (128/196) of trials assessed marketed products after their introduction. The majority of trials assessed interventions to improve treatment efficiency (33.7%). Growth modification appliances were typically analysed in non-marketed compared to marketed products. An association between the type of product (marketed vs non-marketed) and both the declaration of conflict of interest and industry sponsorship was detected. For individual RCTs assessing marketed products either a positive effect (45.3%) or equivalence between interventions or between intervention and untreated control (47.7%) was evident. In 27% of these trials either no conflict of interest or industry funding was not clearly declared. Within the marketed products, no association between the direction of the effect and conflict of interest or funding was detected.

CONCLUSIONS

The analysis of marketed orthodontic products after their introduction is still common practice. To reduce research waste, collaboration prior to the licensing and marketing of orthodontic products between researchers, industry and manufacturers is recommended.