The last decade in orthodontics: A scoping review of the hits, misses and the near misses!

Why do patients transition between orthodontic appliances? A qualitative analysis of patient decision-making

OBJECTIVES

To gain an in-depth understanding of patients' decision-making processes when choosing to transition to a different orthodontic appliance (OA).

METHODS

This was a retrospective qualitative study using one-on-one in-depth semi-structured interviews. Patients were recruited through purposive convenience sampling. Participants who had elected to transition from and to one of these OAs: metal brackets, tooth-coloured brackets, or clear aligners before the end of treatment were recruited. Recruitment ceased when data saturation was achieved. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

Twenty-three adult participants (12 males, 11 females) with their ages ranging from 18 to 52 years were interviewed. The analysis of the data revealed that participants perceived two reasons for the transition: (1) insufficient initial information and (2) evolving life circumstances and personal style. Data analysis of participants who expressed a notable discrepancy between their expectations and the reality of the OA they chose revolved around three themes: (a) health benefits and threats, (b) personal control, and (c) financial considerations. Data analysis of participants who described transitioning between OAs due to changes in personal circumstances and style, revealed two themes: (a) change in personal values and motivations and (b) change in social and psychological influence.

CONCLUSIONS

This qualitative study highlighted the complex multifactorial nature of patient decision-making when choosing and transitioning OAs. Orthodontists can benefit from understanding these factors to engage in thorough patient-centered counselling, provide tailored treatment recommendations, and optimize the choice of appliances.

Content analysis of AI-generated (ChatGPT) responses concerning orthodontic clear aligners

OBJECTIVES

To assess the accuracy of ChatGPT answers concerning orthodontic clear aligners.

MATERIALS AND METHODS

A cross-sectional content analysis of ChatGPT generated responses to queries related to clear aligner treatment (CAT) was undertaken. A total of 111 questions were generated by three orthodontists based on a set of predefined domains and subdomains. The artificial intelligence (AI)-generated (ChatGPT) answers were extracted and their accuracy was determined independently by five orthodontists. The accuracy of answers was assessed using a prepiloted four-point scale scoring rubric. Descriptive statistics were performed.

RESULTS

The total mean accuracy score for the entire set was 2.6 ± 1.1. It was noted that 58% of the AI-generated answers were scored as objectively true, 18% were selected facts, 9% were minimal facts, and 15% were false. False claims included the ability of CAT to reduce the need for orthognathic surgery (4.0 ± 0.0), improve airway function (3.8 ± 0.5), achieve root parallelism (3.6 ± 0.5), alleviate sleep apnea (3.8 ± 0.5), and produce more stable results compared to fixed appliances (3.8 ± 0.5).

CONCLUSIONS

The overall level of accuracy of ChatGPT responses to questions concerning CAT was suboptimal and lacked citations to relevant literature. Ability of the software to offer current and precise information was limited. Therefore, clinicians and patients must be mindful of false claims and relevant facts omitted in the answers generated by ChatGPT.

L. Shayeb M. Future of Orthodontics-A Systematic Review and Meta-Analysis on the Emerging Trends in This Field

Technology is rapidly evolving in the modern world, and the accompanying developments due to its influence are shaping each and every aspect of our life, with the field of orthodontics being no exception. This systematic review and meta-analysis aimed to examine such trends in orthodontics and hypothesize which ones would emerge and continue in the near future. After a thorough search of online journals using keywords such as "3D printing," "Aligners," "Artificial intelligence," "Future trends," "Orthodontics," and "Teleorthodontics" across databases of PubMed-MEDLINE, Web of Science, Cochrane, and Scopus, a total of 634 papers were initially recovered. Technological advancements in 3D printing, Computer-aided design and Computer-aided manufacturing (CAD/CAM), biopolymers and Teleorthodontics were the most important categories of development seen across the 17 studies that we selected for our review. All the investigations selected for this systematic review depicted aspects of orthodontics that were influenced by rapid technological changes and could potentially become mainstream in the coming times. However, caution was sought to be observed in the usage/adoption of some of these trends, with social media usage amongst both patients as well as orthodontists being a prime example of this.

Decoding Deep Learning applications for diagnosis and treatment planning

INTRODUCTION

Artificial Intelligence (AI), Machine Learning and Deep Learning are playing an increasingly significant role in the medical field in the 21st century. These recent technologies are based on the concept of creating machines that have the potential to function as a human brain. It necessitates the gathering of large quantity of data to be processed. Once processed with AI machines, these data have the potential to streamline and improve the capabilities of the medical field in diagnosis and treatment planning, as well as in the prediction and recognition of diseases. These concepts are new to Orthodontics and are currently limited to image processing and pattern recognition.

OBJECTIVE

This article exposes and describes the different methods by which orthodontics may benefit from a more widespread adoption of these technologies.

Efficacy of Anterior Tooth Simulations with Clear Aligner Therapy - A Retrospective Cohort study of Invisalign and Flash Aligner Systems

Purpose:

The purpose of this study was to compare the efficacy of tooth movement between two clear aligner systems by comparing the predicted treatment outcomes versus actual outcomes achieved using a 3D best-fit algorithm.

Materials & Methods:

Clear aligner therapy (CAT) was used to treat 62 patients; n=38 Invisalign® and n=24 Flash®. The Invisalign group had a male to female distribution of 13:25 and a mean age of 35.5, while the Flash group had a male to female distribution of 6:18, with a mean age of 29.2. Differences in predicted versus achieved actual outcomes were compared using eModel Compare 8.1 software.

Results:

1) Intra-group differences between predicted and achieved tooth movements for angular movements were statistically (P<0.05) and clinically (>2°) significant with both treatment methods, except for tipping of maxillary and mandibular incisors for Flash® (<2◦). 2) Inter-group results demonstrated statistically significant differences in favor of Flash® for maxillary central incisor Tip (1.3°), BL movements for maxillary canines (0.1mm), and mandibular central incisor Rotations (1°). These did not exceed the threshold for the clinical relevance of 2° or 0.5mm.

Conclusions:

There were no differences in clinical accuracy and efficacy between Invisalign or Flash aligner systems in achieving predicted tooth movement.

Digital model superimpositions: are different software algorithms equally accurate in quantifying linear tooth movements?

Background

To evaluate the accuracy of three different 3D digital model registration software packages for linear tooth movement measurements, with reference to a 3D digital virtual setup (DS).

Methods

Twenty maxillary and mandibular pre-treatment scans of patients undergoing clear aligner therapy were used. Digital Setups were generated from pre-treatment scans using OrthoAnalyzer software. Both the pretreatment digital scans (T1) and Digital Setups (T2) were converted to STL files to be imported to the three studied software packages: Geomagic, OrthoAnalyzer and Compare. Linear changes in tooth positions were calculated for all the registered pairs.

Results

The change in tooth position was compared between the calculated tooth movement using each of the registration software packages versus the actual generated tooth movement from the Digital Setups. Continuous data was expressed as mean and standard deviation. Intraclass Correlation Coefficients for agreements between Digital Simulation and each software was used. Intra and Inter-examiner reliabilities were also assessed using Intraclass Correlation Coefficients. Significance of the obtained results was expressed at p ≤ 0.01. Geomagic software showed agreements > 0.90 for maxillary linear tooth movements and between 0.75 and 0.90 for mandibular measurements. OrthoAnalyzer software showed agreements between 0.50 and < 0.75 for maxillary and mandibular measurements. Compare software showed agreements > 0.90 for maxillary and mandibular linear tooth movements, indicating the best consistency.

Conclusions

Compare and Geomagic software packages consistently showed maximum accuracy in measuring the amount of tooth movement in the maxillary arch compared to the reference standard. Compare software showed the highest agreements in the mandibular arch. None of the three studied software packages showed poor agreement with the Digital Setup across all tooth movement measurements. Buccolingual tooth movements showed the highest agreements amongst linear measurements.

TIP, TORQUE & ROTATIONS: How accurately do digital superimposition software packages quantify tooth movement?

Background

To investigate the accuracy of three different 3D digital model registration software for tip, torque and rotation measurements, with reference to a 3D digital virtual setup. Twenty maxillary and mandibular pre-treatment scans of patients undergoing clear aligner therapy were used. Digital setups were generated from pre-treatment scans using a tooth movement software. Both the pretreatment digital scans (T1) and digital setups (T2) were converted to STL files to be exported to the 3 studied software that employed: (1) Semiautomatic best fit registration (S-BF), (2) Interactive surface-based registration (I-SB), and (3) Automatic best fit registration (A-BF) respectively. Changes in tip, torque and rotation were calculated for all the registered pairs.

Results

The change in tooth position was compared between the calculated tooth movement using each of the registration software packages versus the actual generated tooth movement from the digital setups. Continuous data was expressed as mean and standard deviation. Intra Class Correlation Coefficient for agreement between digital simulation and each software was used. Intra and Inter-examiner reliabilities were also assessed using Intra Class Correlation Coefficient. Significance of the obtained results was expressed at p ≤ 0.01. Semiautomatic best fit registration software showed excellent agreement (> 0.90) for all tooth movements, except for good agreement for torque (0.808). Interactive surface-based registration software showed moderate agreement for all measurements (0.50 and < 0.75), except for good agreement for rotation (0.783). Automatic best fit registration software demonstrated excellent agreement (> 0.90) for rotation, good agreement for tip (0.890) and moderate agreement for torque (0.740).

Conclusions

Overall, semiautomatic best fit registration software consistently showed excellent agreement in superimpositions compared to other software types. Automatic best fit registration software consistently demonstrated better agreement for mandibular superimpositions, compared to others. Accuracy of digital model superimpositions for tooth movements studied in superimposition studies, can be attributed to the algorithm employed for quantification.

Patients' perceptions of orthodontic treatment experiences during COVID-19: a cross-sectional study

BACKGROUND

COVID-19 has impacted the care of patients undergoing orthodontic treatment. We aimed to provide an overall view of patients' perspectives, concerns, and expectations towards their treatment throughout the clinic lockdown during the pandemic; and to assess patients' levels of mental distress and its association with their confidence in resuming care.

METHODS

An anonymous, validated, in-person paper questionnaire was distributed to adult orthodontic patients' post-lockdown at an academic institution. The survey focused on the clinical aspects and patients' perspectives regarding orthodontic treatment during the pandemic. The Kessler Mental Distress Scale (K10) was used to evaluate their psychological status. Survey responses were descriptively summarized and confidence in resuming care was compared between normal patients and patients with mental distress using Mann-Whitney tests.

RESULTS

One hundred fifty-four patients were surveyed from July to October 2020. Mean age of the participants was 29.30 (SD = 12.01) years and 62% were females. Emergencies during the closure (21%, 32/154) involved primarily irritation with protruding wires. Patients were neutral regarding tele-dentistry and preferred their current fixed appliances over clear aligners. Upon resuming care, 80.51% were extremely pleased with the restrictive protocols and with high level of confidence in resuming treatment. The average level of anxiety was low, and a modest association was found between mental distress and reduced confidence in resuming treatment.

CONCLUSIONS

Few numbers of minor emergencies occurred during the clinic closure. Despite the rising interest in tele-dentistry, patients were neutral on considering this option to monitor treatment and were content with fixed appliances. Patients had high confidence levels to resume their care based on the protocols established upon reopening. The association of mental distress and confidence in resuming care is suggestive and needs further investigation.

Smartphone applications used in orthodontics: A scoping review of scholarly literature

Mobile applications (apps) play an increasingly important role in day to day life. With the number of orthodontic-related apps continuing to increase, and the rapid development of artificial intelligence, the potential to yield tremendous benefits to both clinicians and patients is apparent. However, if orthodontic apps are to become mainstream and obtain greater acceptance, scientific validation and investigation of these apps are to be undertaken. This scoping review aimed to determine the scope and extent of the published literature on mobile apps in orthodontics, as well as identify the types of studies published, and summarize the outcomes studied- thus also giving direction for future research in a rapidly evolving subject area.

Evaluation of root resorption following orthodontic intrusion: a systematic review and meta-analysis

BACKGROUND/OBJECTIVE

To quantify the expected amount of orthodontically induced root resorption (OIRR) after orthodontic intrusion and assess the treatment-related factors.

SEARCH METHODS AND ELIGIBILITY CRITERIA

Six electronic databases and partial grey literature were searched without limitations regarding language or publication year until April 2020. Randomized clinical trials and non-randomized prospective and retrospective studies evaluating root resorption after orthodontic intrusion were included.

DATA COLLECTION AND ANALYSIS

Risk of bias (RoB) assessment was performed with the Cochrane Collaboration's RoB Tool 2.0 and ROBINS-I tool for the randomized and non-randomized studies, respectively. The data were combined into two random-effects meta-analyses estimating OIRR following orthodontic intrusion. One evaluated OIRR in the anterior region, while the other assessed OIRR in the posterior region. Sub-group analyses regarding the type of mechanics applied, duration of intrusion, amount of force, and sensitivity analysis of the study design and imaging examinations were also performed. The certainty of the evidence was assessed through the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

The qualitative analysis included 14 studies; however, the meta-analysis was performed with 7 records. The random-effects model assumes that 0.72 mm [95% confidence interval (CI): 0.16 to 1.28] and 0.41 mm (95% CI: -0.24 to 1.07) of OIRR should be expected in the incisors and the molars, respectively. Sub-group analyses showed that the assessed treatment-related factors presented minimum impact in OIRR after orthodontic intrusion. The GRADE resulted in moderate and low certainty regarding the meta-analysis.

LIMITATIONS

The major limitation of the present meta-analysis is that OIRR can be affected by several factors, some of which are assessed in this review.

CONCLUSIONS

Orthodontic intrusion, evaluated as an isolated mechanic, caused less than 1 mm of OIRR, which is within the acceptable limits for clinical implication. Treatment-related factors did not show a significant influence on OIRR.

REGISTRATION

This review was registered in PROSPERO, protocol number CRD42018098495.

Impact of SARS-CoV-2 on orthodontic education and global practice guidance: A scoping review

The acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, has had unprecedented impact on orthodontic care and education. Dental schools and clinics have stopped their normal educational and clinical activities worldwide, while only accepting emergency cases. It is still unknown when students will return to clinics to resume patient care and receive training. This scoping review aims to examine, summarize, and reference current resources to analyze the impact of SARSCoV-2 on orthodontic practice recommendations and orthodontic education. This review summarizes recommended global guidelines to provide a better understanding of the current consensus for protocols of safe orthodontic care; this scoping review serves to help create concrete guidelines for orthodontists to deal with the current SARS-CoV-2 pandemic, and for future infectious diseases, and assessing the impact on orthodontic education. Using inclusion/exclusion criteria, 456 articles were screened by two independent screeners and data were extracted and charted from 50 relevant sources. These 50 sources conveyed similar guidelines for provider and patient safety in orthodontic practices, with some stressing certain protocols such as personal protective equipment over others. Impacts on orthodontic education conveyed changes in protocols for learning, competency, and clinical skills. As this respiratory illness progresses, the field of orthodontics needs cohesive universal clinical guidelines and further assessment of the impacts of SARS-CoV-2 on orthodontic education.