Leveling and alignment time and the periodontal status in patients with severe upper crowding treated by corticotomy-assisted self-ligating brackets in comparison with conventional or self-ligating brackets only: a 3-arm randomized controlled clinical trial

Duration of orthodontic treatment with clear aligners versus fixed appliances in crowding cases: a systematic review

OBJECTIVE

To critically appraise and assess the currently observed evidence about the difference in orthodontic treatment duration between clear aligners and fixed appliances in crowding cases.

MATERIALS AND METHODS

An electronic search without limitations was conducted from inception to June 2023 covering nine databases: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, Web of Science, Google Scholar, Trip, CINAHL via EBSCO, EMBASE via OVID and ProQuest. Randomized controlled trials (RCTs) and matched non-randomized studies were included in this systematic review. Risk of Bias was assessed via Cochrane's tool (RoB 2) for RCTs and ROBINS-I tool for non-randomized studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was employed to evaluate the overall quality of evidence.

RESULTS

Out of the 3537 articles initially identified, ten eligible studies were included in this systematic review; six were RCTs. Only one study offered extraction-based treatment, while the other nine adopted non-extraction treatments. According to the GRADE, there is low evidence that treatment duration in mild to moderate crowding cases with clear aligners is similar to that in fixed orthodontic appliances. Meta-analysis was not administered due to high inconsistency.

CONCLUSIONS

Based on currently available information, there was no significant difference in the treatment duration between the CA and FA groups in mild to moderate crowding cases. Further well-performed RCTs, especially in severe cases, are required.

CLINICAL RELEVANCE

Time efficiency is an essential outcome measure for clinical orthodontic practice. While the type of appliance used is a critical determinant of treatment duration, orthodontists should be aware of other factors that can significantly impact treatment time, such as patient and treatment-related factors.

Evaluation of Patient-Reported Outcome Measures (PROMs) Associated With the Acceleration of Canine Retraction by Piezosurgery in Comparison With Low-Level Laser Therapy: A Three-Arm Randomized Controlled Clinical Trial

Background and objectives Recently, both surgical and non-surgical interventions have gained popularity in accelerating orthodontic tooth movement, but there is no randomized controlled trial (RCT) comparing both modalities in terms of patient-reported outcome measures (PROMs) during maxillary canine retraction. Therefore, this trial aimed to assess the PROMs associated with either low-level laser therapy (LLLT) or piezocision-assisted acceleration in the context of maxillary canine retraction. Materials and methods This was a single-blinded, single-center, three-arm RCT. A total of 54 patients (12 males, 42 females, mean age 20.65 ± 2.85) whose treatment needed upper-first-premolar extraction to facilitate canine retraction were enrolled and randomly divided into three groups: piezocision group (PG), LLLT group (LLLTG), and the control group (CG). Standardized questionnaires using a visual analog scale were distributed to patients at five assessment times: 1 (T1), 3 (T2), 7 (T3), 14 (T4), and 28 days following the canine retraction initiation (T5). The patients' pain, discomfort, swelling, chewing difficulty, satisfaction, and acceptance were recorded. Results Regarding pain and discomfort, the levels were significantly lower in the LLLTG during the first two weeks of canine retraction compared to the other two groups (p<0.017). At the same time, these levels were significantly greater in the PG than the CG in the first week of canine retraction (p<0.017). Patients in the PG had a "mild to moderate" perception of swelling at T1 and T2, which was significantly different than that of the other two groups (p<0.001). Regarding chewing difficulty, the levels in the LLLTG were significantly lower than those in PG at the first three assessment times (p<0.017). Patients' satisfaction with canine speed was significantly greater in the intervention groups compared to the CG (p<0.001). In contrast, no statistically significant differences were found between the three groups regarding satisfaction with gum appearance surrounding the canine (p=0.061) and acceptance (p=0.125). Conclusion The LLLT-assisted canine retraction was associated with significantly lower negative patient-reported outcomes during the first two weeks of retraction than piezocision-assisted retraction. However, the levels of pain and discomfort were significantly greater in the piezocision-assisted retraction group than those in the conventional canine retraction group, which in turn were greater than those with the LLLT-assisted canine retraction group during the first week of retraction. Patient satisfaction and acceptance were high with both piezocision and LLLT interventions.

A Review on Orthodontic Brackets and Their Application in Clinical Orthodontics

Braces are undoubtedly a blessing for those whose teeth are misaligned in various ways, yet many people may not enjoy the traditional metal braces. However, some people are totally fine with having their teeth fused with the set of metal brackets and various metal components flowing through. A few people may simply not feel comfortable in that way. Orthodontists have developed a huge array of bracket styles by concentrating on the wide range of preferences and financial constraints that their patients present. These various dental bracket types are all advantageous from one point of view or another. Orthodontic supplies and materials are being produced using technology that is advancing exponentially. Every day, more technologies, processes, and designs emerge. These tools assist the orthodontist in providing patients with the best functional and cosmetic outcomes. Since Edward Hartley Angle's time through MBT brackets and then lingual brackets, orthodontic brackets have advanced significantly. Orthodontists' lives have been greatly facilitated by these brackets. Numerous new materials and designs will be developed as technology progresses. The purpose of this article was to give a general overview of the different orthodontic brackets and demonstrate how the logic underlying them helps orthodontists in their day-to-day jobs.

Adult periodontal comparison after treatment of palatally impacted canines aligned by conventional or accelerated minimally-invasive corticotomy-assisted orthodontic traction: A randomized controlled trial

OBJECTIVE

To compare the post-treatment periodontal status of the palatally impacted canines and their adjacent teeth treated by an accelerated minimally-invasive corticotomy-assisted method versus the conventional traction method.

MATERIAL AND METHODS

A parallel-group two-arm randomized controlled trial was conducted on patients with palatally or mid-alveolar unilateral impacted canines. Participants were randomly selected and allocated to receive the conventional treatment (CT) with a closed surgical approach, or accelerated treatment (CAT). The evaluated periodontal variables were periodontal pocket depth (PPD), keratinized tissue width (KTW), gingival recession level (GRL), papillary bleeding index (PBI) and Gingival Index (GI). All post-treatment periodontal measurements were performed two weeks after removing the fixed orthodontic appliance.

RESULTS

In total, 46 patients were included (CT group: n=23; mean age: 20.26±2.17 years), or accelerated treatment (CAT group: n=23; mean age: 20.39±2.27 years). The differences between the two study groups were non-significant for all periodontal outcomes at all measurement points (P>.05). The mean total values of PPD around the aligned canine did not exceed 2mm (XPPD=1.99±0.25mm; 1.91±0.26mm, in the CT and CAT group, respectively, P=0.677). The results of total values of PPD on the adjacent teeth were nearly similar in the two study groups (mean difference: 0.12mm; 0.02mm, for the lateral incisor and the first premolar, respectively). Very low GRL values were detected in the two study groups.

CONCLUSIONS

The use of corticotomy-assisted method did not impair the periodontal health in the short follow-up term. Both treatment modalities are considered acceptable in terms of post-treatment periodontal outcomes, as the gingival indices levels were at low values.

Effectiveness of Flapless Cortico-Alveolar Perforations Using Mechanical Drills Versus Traditional Corticotomy on the Retraction of Maxillary Canines in Class II Division 1 Malocclusion: A Three-Arm Randomized Controlled Clinical Trial

BACKGROUND AND OBJECTIVES

Both invasive and minimally invasive surgical methods have recently gained popularity in accelerating orthodontic tooth movement. Traditional corticotomy (TC) was one of the first effective invasive surgical techniques in shortening orthodontic treatment time, whereas the flapless cortico-alveolar perforations (FCAPs) technique is a modern minimally invasive method that has recently shown good results in different types of orthodontic tooth movement. Therefore, this study aimed to compare the effectiveness of TC versus FCAPs in maxillary canine retraction when treating Class II division 1 malocclusion patients.

MATERIALS AND METHODS

This was a single-blinded, single-center, three-arm randomized controlled trial. A total of 51 patients (22 males, 29 females, mean age 20.98 ± 1.95) whose treatment planning included the extraction of maxillary first premolars were enrolled and randomly divided into three groups: the TC group, the FCAPs group, and the control group. The assessed outcomes were the amount of canine retraction, anchorage loss, and canines' rotation, which was evaluated at five-time points till the completion of canine retraction.

RESULTS

There were statistically significant differences in the amount of canine retraction between the three groups in the first two months (p < 0.001), with greater mean values in the TC group (p < 0.001) in the first month. However, the amount of canine retraction in the FCAPs group was significantly greater in the second month compared to the TC group (p = 0.003) and the control group (p < 0.001). In the first month of canine retraction, anchorage loss, and canine rotation were significantly lesser in the TC and FCAPs groups than in the control group (p < 0.001). On the contrary, the canines' rotation amount after the completion of retraction was greater in the TC group than in the other two groups (p < 0.001).

CONCLUSION

TC and FCAPs are efficient adjunctive surgical methods for accelerating canine retraction. At the end of the first month, the TC accelerated canine retraction by 59.85% and FCAPs by 44% compared to the conventional retraction. At the end of the second month, the acceleration was less than recorded in the first month (35.44% and 50.20%, respectively). The acceleration effect of the surgical interventions appeared transient and did not last in the following observation period.

Evaluation of Patient-Centered Outcomes Associated With the Acceleration of en-Masse Retraction of Upper Anterior Teeth Assisted by Flapless Corticotomy Compared to Traditional Corticotomy: A Two-Arm Randomized Controlled Trial

OBJECTIVE

This study aimed to assess the levels of pain, discomfort, and functional impairment associated with the en-masse retraction of the upper anterior teeth when treating Class II division 1 malocclusion patients using traditional corticotomy or flapless corticotomy. In addition, an assessment of patients' satisfaction with the selected surgical intervention was undertaken at one-month post-operatively.

MATERIALS AND METHODS

The study sample comprised 40 patients with Class II division 1 malocclusion, randomly assigned to either the traditional corticotomy group (n=20) or the flapless corticotomy group (n=20). Patients underwent extraction of the maxillary first premolars, and orthodontic mini-screws were placed between the maxillary second premolars and the first molars for skeletal anchorage. An en-masse retraction was accomplished in both groups. Patients were asked to fill in a questionnaire at 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) after the surgical intervention using standardized questionnaires. Most questions were answered on a visual analog scale where zero scores meant the absence of pain, discomfort, or functional impairment, and 100 scores meant the worst feelings of these traits.

RESULTS

All patients in both groups entered data analysis with no dropouts. All measured levels were significantly greater in the traditional corticotomy group during the first two weeks following the corticotomy intervention in terms of pain perception (P˂0.001), discomfort (P=0.004), and difficulty in chewing (P=0.015). Additionally, during the first week following corticotomy, levels of perception of discomfort (P˂0.001), difficulty in swallowing (P=0.001), and limitation of jaw movement (P˂0.001) were significantly greater in the traditional corticotomy group. Patient satisfaction, the recommendation to a friend, and acceptance of flapless corticotomy were significantly greater than traditional corticotomy (P=0.002, P=0.001, respectively). 78% of patients in the traditional corticotomy group considered it more discomfort than a tooth extraction, while 50% of patients in the flapless corticotomy group considered tooth extraction more discomfort, with a significant difference between the two groups (P=0.001).

CONCLUSIONS

The levels of negative patients' reported outcomes were significantly smaller with flapless corticotomy than with traditional corticotomy. Traditional corticotomy was associated with mild to moderate levels of pain, swallowing difficulty, moderate levels of discomfort, chewing difficulty, and jaw movement limitation after 24 hours of the surgical procedure. In contrast, flapless corticotomy was less problematic and associated with mild pain, swelling, chewing difficulty, jaw movement limitation, and swallowing difficulty at the same assessment time. Patient satisfaction, acceptance, and recommendation to a friend were greater for flapless corticotomy than traditional intervention.

The effectiveness of minimally-invasive corticotomy-assisted orthodontic treatment of palatally impacted canines compared to the traditional traction method in terms of treatment duration, velocity of traction movement and the associated dentoalveolar changes: A randomized controlled trial

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (P<0.05). The mean velocity of traction movement in the CAT group was greater than the TT group ( x velocity=1.15±0.35 mm/month; 0.70±0.33 mm/month, P=0.027, respectively). The duration of the active traction and the overall orthodontic treatment in the CAT group were significantly shorter than the TT group by 36% and 29%, respectively. The mean bone support ratios of the aligned canines did not differ significantly between the two groups (88% vs. 89% in the CAT and TT groups, respectively). No significant differences were found between the two groups regarding the mean amount of root resorption on the adjacent laterals ( x resorption = 1.30±1.18 mm; 1.22±1.02 mm, P=0.612, in CAT and TT groups, respectively). Conclusions: The traction movement velocity of the palatally impacted canines can be increased using minimally-invasive corticotomy-assisted orthodontic treatment. The side effects of the acceleration procedure were minimal and almost similar to those of the traditional technique.

The efficacy and accuracy of 3D-guided orthodontic piezocision: a randomized controlled trial

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).

Assessment of Dentoalveolar Changes Following Leveling and Alignment of Severely Crowded Upper Anterior Teeth Using Self-Ligating Brackets Alone or With Flapless Piezocision Compared to Traditional Brackets: A Randomized Controlled Clinical Trial

Introduction Dental crowding is one of the most common types of malocclusions. It can be treated with or without extraction, depending on the severity of the crowding. Extraction-based orthodontic treatments are the preferred treatment option in cases of severe crowding, but they take longer than non-extraction cases. Objective This study aimed to evaluate the dentoalveolar changes following the orthodontic treatment of severely crowded maxillary anterior teeth in adults using self-ligating brackets alone or combined with flapless piezocision. Materials and methods The participants in this study were 63 patients (46 females and 17 males; mean age SD: 19.71 ± 2.74 years) who attended the Department of Orthodontics at the University of Damascus from January 2020 to December 2021. The participants were divided into three groups at random: Group (1): traditional brackets group, Group (2): self-ligating brackets group; and Group (3): self-ligating brackets with flapless piezocision group. Little's Irregularity Index (LII) was measured at five assessment times: before the onset of orthodontic treatment (T0), after one month (T1), after two months (T2), after three months (T3), and at the end of the leveling and alignment phase (T4). The intercanine width (lingual), the intercanine width (cusp), and the canine rotation angle were measured at two assessment times: before the onset of orthodontic treatment (T0) and at the end of the leveling and alignment phase (T4). Results The three studied groups had statistically significant differences in terms of LII during the first three months, and the most significant improvement of LII was in the self-ligating brackets with the piezocision group (P < 0.001). In addition, the intercanine width (cusp) at the end of the leveling and aligning phase revealed greater mean values in both self-ligating brackets groups compared to the traditional brackets group, and the differences were statistically significant (P < 0.001). Otherwise, no statistically significant differences were found at the end of the leveling and aligning phase in the intercanine width (lingual) or the canine rotation angle between the three studied groups (P > 0.05). Conclusion Using self-ligating brackets with flapless piezocision revealed more significant results concerning LII as compared to other groups. Thus, combining these two acceleration methods could get more effective results in aligning severely crowded teeth. Self-ligating brackets, whether used alone or with flapless piezocision, resulted in greater intercanine width at the cusp level. The type of brackets (traditional or self-ligating) did not affect the canine rotation angle.

Effect of Interdental Enamel Reduction on Clinical Attachment Loss, Bleeding on Probing, and Incidence of Caries in Treating Class I Malocclusion Cases: A Retrospective Cohort Study

Introduction Interdental Enamel Reduction (IER) is a clinical procedure that reduces the mesiodistal size of permanent teeth by enamel removal and anatomical re-contouring. The aim of this study was to investigate the effect of IER on patients' gingival health status, including clinical attachment loss (CAL) and bleeding on probing (BOP). Furthermore, in this study, the incidence of caries after IER with or without fluoride therapy was evaluated. Methods In this retrospective cohort study, 90 patients who had started and completed their orthodontic treatment within the past two years were divided into three groups as follows: In group 1, patients had received interproximal stripping on their anterior mandibular teeth. Patients in group 2 had also received interproximal stripping on their mandibular anterior teeth and topical fluoride had been applied after IER. Patients in group 3 had only received orthodontic treatment without any interproximal stripping. Then, patients were examined for CAL, BOP, and incidence of caries. Results CAL for patients in the IER and control groups were 2.06±0.18 and 2.08±0.16, respectively. Also, BOP for patients in the IER and control groups were 3.01±0.14 and 3.05±0.19, respectively. Incidences of caries, BOP, and CAL were not significantly different between the group of patients who received IER and the control group (P>0.05). Moreover, the incidence of caries was not significantly different between the patients who received topical fluoride after IER and those who did not receive fluoride (P=0.999). Conclusion Interproximal stripping of mandibular anterior teeth before orthodontic treatment does not significantly increase the incidence of caries, BOP, and CAL. Moreover, the application of topical fluoride after IER has no significant effect on the incidence of caries.

Investigating the Effectiveness of Low-Level Laser in Reducing Root Resorption of the Upper Incisors During Intrusion Movement Using Mini-Implants in Adult Patients With Deep Overbite: A Randomized Controlled Clinical Trial

BACKGROUND

Deep bite is a common characteristic of malocclusion, and many methods are used to treat it, including mini-implants used for the intrusion of the upper incisors. Orthodontically induced inflammatory root resorption (OIIRR) is an inevitable and unexpected side effect of orthodontic therapy. However, resorption of the root could be affected by the type of tooth movement, such as intrusion. Several studies have indicated the effectiveness of low-level laser therapy (LLLT) in accelerating orthodontic movement, but studies that have evaluated the role of this laser in reducing the risk of OIIRR have been limited. This trial aimed to investigate the effectiveness of LLLT in reducing the resorption of the roots of the upper incisors during their intrusion in the context of deep bite correction.

MATERIALS AND METHODS

Thirty patients (13 males, 17 females; mean age 22.4±3.37 years) with deep overbite were recruited and allocated to the laser or the control groups. Mini-implants were inserted between the roots of the upper central incisors and the lateral incisors from the labial aspect at the gingival-mucosal junction on both sides with a force of 40 g on each side through an NiTi coil spring. A low-level laser (Ga-Al-As) with 808 nm wavelength in a continuous mode, with the parameters 250 milliwatt power output, 4 Joules/point energy density, and 16 seconds irradiation per point, was applied to the root of each of the upper incisors. The laser was applied on the first day of the upper incisor intrusion (T1), then on days 3, 7, and 14 of the first month. In the second month, the laser was applied every 15 days, adjusting the spring strength every four weeks until the end of the intrusion stage (T2), which was determined by reaching a normal overbite. As for patients in the control group, the strength of the nickel-titanium springs was adjusted every four weeks to the required strength of 40 g on each end until reaching a normal overbite.

RESULTS

There was a volumetric decrease in both groups' upper central and lateral incisors roots, and this decrease was statistically significant (P<0.001). However, the difference between the two groups was not statistically significant in each central and lateral incisor volume root (P=0.345 and 0.263 for U1 and U2, respectively). Also, both groups had a linear decrease in upper central and lateral incisors roots, which was statistically significant (P<0.001). At the same time, the difference between the two groups was not statistically significant in each central and lateral incisor root length (P=0.343 and 0.461 for U1 and U2, respectively).

CONCLUSION

The low-level laser irradiation using the current protocol did not significantly affect the amount of root resorption induced by incisor intrusion in the experimental group compared to the control group.

Accelerated Canine Retraction by Using Mini Implant With Low-Intensity Laser Therapy

Background The continuous increase in demand for reduced treatment times has led researchers to think in terms of "accelerated orthodontics." Generally, the duration for fixed orthodontic treatment is around two to three years. Prolonged use of braces leads to external root resorption, a high risk of caries, and decreased patient compliance. Therefore, finding an optimal supplementary approach to achieve faster tooth movement is still considered a subject of interest. Low-intensity laser therapy (LILT) is one of the non-invasive surgical techniques in the field of accelerated orthodontics. Low-level laser therapy (LLLT) has demonstrated faster healing, less bleeding, and biostimulation and anti-inflammatory effects. According to all studies, it accelerates tooth movement, thereby reducing braces treatment time. It is simple, safe, and minimally invasive. Despite these pieces of evidence, studies have shown variable findings in low-level laser therapy. This study evaluates the effect of LLLT on accelerated orthodontics in comparison with conventional canine retraction. An aluminum gallium arsenide-type diode laser with a wavelength of 940 nm has been used in this study. Methodology This study was conducted using the split-mouth method, which included 20 patients with permanent dentition who required first premolar extractions. A miniscrew implant was placed on both the right and left sides for maximum anchorage. Irradiation doses were applied on days 0, 3, 7, and 14 of the first month. Subsequently, irradiations were given every 15 days until the canine's retraction was complete in the test group. Results The study results three months after the canine retraction in the test and control groups (M1) were 0.81 ± 0.03 mm/month and 0.74 ± 0.04 mm/month, respectively, indicating a significantly higher rate of canine retraction in the test group than in the control group (P < 0.0001). The average increase in the amount of tooth movement at three months was 40.1% and 36.3% in the test and control groups, respectively. However, the average increase in the amount of movement of teeth following canine retraction was 100% in the test group and 68.2% in the control group. There were significant variations in the pain score between Day 1 and Day 3 (P = 0.003) in the test group; however, there was no analytic variation in the pain score between Day 1 and Day 30 in the test group (P = 0.18). The pain score between Day 3 and Day 30 was significantly lower. Conclusions It was concluded that the rate of canine retraction increases when it is combined with LILT-assisted accelerated orthodontics in comparison to conventional canine retraction. Although LLLT does not provide immediate pain relief, it relieves the sensation of pain after 24-72 hours. LILT is an innovative, non-invasive technique that allows rapid orthodontic tooth movement. The rate of canine retraction increases when it is combined with LILT-assisted accelerated orthodontics in comparison to conventional canine retraction using mini-implants.

The Efficacy of Accelerating Orthodontic Tooth Movement by Combining Self-Ligating Brackets With One or More Acceleration Methods: A Systematic Review

This review aimed to evaluate the effectiveness of using one or more acceleration methods with self-ligating brackets to accelerate orthodontic tooth movement in adults and the associated effects of these interventions. An electronic search of the following databases (PubMed, Scopus, Google Scholar, EMBASE) was performed (From January 1990 to November 2021). ClinicalTrials.gov and the International Clinical Trials Registry Platform were also electronically searched to find any unpublished studies and ongoing trials. The selected randomized controlled trials (RCTs) involved adult patients treated using self-ligating brackets combined with one or more acceleration methods compared with self-ligating brackets or conditional brackets alone. The risk of bias was assessed using Cochrane's risk of bias tool. A total of seven RCTs and one controlled clinical trial (CCT) were included in this review. Combining self-ligating brackets with flapless corticotomy, low-level laser therapy (LLLT), and infrared light accelerated orthodontic movement by 43% and 50% for surgical methods, 20-50% for LLLT, and 22% for infrared light. Regarding side effects on periodontal tissues, neither flapless corticotomy nor low-frequency vibrational forces caused any damage. Combining self-ligating brackets and flapless corticotomy, low-level laser, or infrared light effectively accelerated orthodontic movement by 20% to 50 %. In contrast, the combination of self-ligating brackets with vibrational forces did not affect speeding tooth movement. The acceleration methods did not have any side effects on the periodontal tissues, but the available evidence was insufficient. There is a need for further primary research regarding the effectiveness of combining self-ligating brackets with acceleration methods and the possible untoward side effects.

Evaluation of patient-reported outcome measures (PROMs) during surgically-assisted acceleration of orthodontic treatment: a systematic review and meta-analysis

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.

Three-Dimensional Assessment of the Temporomandibular Joint Changes Following Reversed Twin Block Therapy of Patients With Skeletal Class III Malocclusion in Conjunction With the Photobiomodulation Therapy: A Randomized Controlled Clinical Trial

Background: Despite the positive effect of the photobiomodulation therapy (PBMT) application on animals, the primary role of this technique on the human condyle is still unclear. Several experimental reports have shown the efficacy of PBMT in inducing cellular changes in the temporomandibular joint (TMJ) region during functional treatment of patients with skeletal deformities. Still, the lack of information about its effects on human condyles requires further studies.

Objectives: This study aimed to evaluate the effect of PBMT on the TMJ components following Class III treatment with the reversed twin block (RTB) appliance in growing patients. 

Materials and Method: Forty children (12 females, 28 males) between the age of nine and eleven years with skeletal Class III were assigned randomly to the RTB group with photobiomodulation (RTB+PBMT) or the control group (RTB). The PBMT was applied to the TMJ region using an 808-nm wavelength Ga-Al-As semiconductor laser device with 5 Joules/cm² energydensity on days 1, 3, 7, and 14 of the first month. Afterwards, the irradiation was conducted every 15 days until the end of the treatment. Cone-beam computerized tomography (CBCT) images were taken before (T1) treatment and following the end of treatment (T2) to assess TMJ and skeletal changes.

Results: Condylar volume was significantly increased in the RTB group only by a mean of 287.97 mm³ (p<0.001). The significantly backward and upward condylar movement was observed in the RTB and RTB+PBMT groups (superior joint space (SJS): 0.26 mm, 0.15 mm; posterior joint space (PJS): 0.42mm, 0.11mm, respectively). The RTB group showed the most remarkable changes. Significant improvement of the sagittal maxilla-mandibular relationship was greater in the RTB+PBMT group compared to the RTB group (p=0.02).

Conclusion: There were no considerable differences in the condylar position after Class III treatment between the RTB and the RTB+PBMT groups. But a difference in the condylar volume was noticed between the two group.

The Effectiveness of Conventional and Accelerated Methods of Orthodontic Traction and Alignment of Palatally Impacted Canines in Terms of Treatment Time, Velocity of Tooth Movement, Periodontal, and Patient-Reported Outcomes: A Systematic Review

The objective of the current review was to evaluate the effectiveness of traditional and accelerated methods of palatally impacted canine's (PIC) traction in terms of treatment duration, velocity, periodontal, and patient-reported variables.

An electronic search for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) published between January 1990 and October 2021 was conducted in nine databases. Five major orthodontic journals were hand searched for additional studies. The participants were patients with unilateral or bilateral PICs who received conventional or accelerated orthodontic treatment with fixed appliances. Cochrane’s risk of bias tool (RoB 2 tool) for RCTs and ROBINS-I tool for CCTs were used to assess the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence.

Nine articles (eight RCTs and one CCT) were included in this review (371 patients). There was no clarity in most studies about the possible effect of the mechanical traction method on treatment outcomes. The treatment duration decreased (about three to six months) when the open surgical method was used with traditional techniques and the traction velocity increased significantly (about 1-1.5 mm/month) when acceleration methods were used. No significant differences were found between the conventional intervention groups, as well as between the traditional and accelerated groups, in terms of most periodontal variables (p > 0.005).

No significant differences were found in the pain levels associated with traditional PICs' traction when comparing different exposure methods in the short-term follow-up (1-10 days), while contradictory results were found in the pain incidence between these methods. The relationship between the pain/discomfort levels and the type of mechanical traction method was not evaluated. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low.

The combination of the open surgical technique with various designs of either superelastic wires or elastic traction means can lead to a reduction in the orthodontic treatment duration of PICs. The use of direct anchorage by miniscrews to move the PICs away from the adjacent teeth roots can lead to a reduction in root resorption and shorten the treatment duration. The evidence supporting these findings ranged from low to very low. The use of different types of mechanical means for conventional PICs' traction, with the use of open or closed traction techniques, does not lead to significant differences in periodontal outcomes between intervention groups. Contradictory results exist regarding the severity of the perceived pain in relation to the surgical exposure type, and the relationship between this variable and the mechanical traction method is still unclear. The use of accelerated methods for PICs' traction can lead to an increase in the velocity of traction movement with no significant differences in periodontal outcomes between accelerated and conventional methods. The evidence supporting these findings ranged from low to very low. More high-quality randomized CCTs are needed to establish good evidence in this field.

The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021274476) during the first stages of this review.