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

Effectiveness of low-intensity electrical current in accelerating the en-masse retraction of the upper anterior teeth following first-premolar extraction in young adult patients with Class II division 1 malocclusion: A randomized controlled clinical trial

INTRODUCTION

Many efforts have been made to shorten fixed appliance orthodontic treatment time by accelerating the rate of tooth movement. Low-intensity electrical stimulation (LIES) is one of the proposed physical methods that has not yet been well studied in the medical literature. This study aimed to evaluate the effectiveness of LIES in accelerating orthodontic tooth movement in cases of en-mass retraction of the upper anterior teeth.

METHODS

Patients who attended the Department of Orthodontics at the Faculty of Dentistry, University of Damascus, between September 2019 and February 2021, for treatment were carefully checked. All patients who met the eligibility criteria were invited to participate in this RCT. Young adult patients having class II division I malocclusion were equally and randomly assigned into the low-intensity electrical stimulation group (LIES), and traditional en-masse retraction group (TRAD). The mini-implants assisted en-masse retraction technique was used to close the extracted upper first premolar spaces in both groups. NiTi closed coil springs (250g/side) were used. Electrical stimulation of 15-20μA for each tooth was applied on the upper anterior teeth using a recently developed intraorally removable device in the LIES group. The primary outcome was the en-masse retraction rate, the secondary outcomes were changes in the first molar position, intermolar width, and intercanine width. These outcomes were measured on the digital photographs of the maxilla cast using the Image J program. Two-sample t-test with Bonferroni's correction was utilized to explore any significant differences between the two groups in all studied variables.

RESULTS

Of the 168 patients examined by the researcher, 38 patients with Class II division I malocclusion (30 females and 8 males; mean age: 21.1±2.31 years) were finally recruited in this RCT. The overall en-masse retraction rate was significantly greater in the LIES group compared to the TRAD group (1.02±0.08, 0.73±0.04mm/month respectively; P<0.001). In addition, the monthly rate of space closure was significantly greater in this group at all evaluation times (P<0.001). A small increase was noted in the intercanine width (1.60±0.27, and 1.65±0.33mm respectively). Negligible changes were noted in the first molar positions and intermolar width, with insignificant differences between the two groups.

CONCLUSIONS

LIES according to the protocol applied in this trial accelerated the upper anterior teeth en-masse retraction rate by approximately 28% compared to the traditional en-masse retraction method. While this acceleration was statistically significant, may not have substantial clinical implications.

REGISTRATION

This trial protocol was registered in the Clinical Trials database (ClinicalTrials.gov NCT05350280).

The effect of single versus multiple piezocisions on the rate of canine retraction: a randomized controlled trial

BACKGROUND

Piezocision is a minimally invasive surgical method aiming to accelerate tooth movement. However, its effect was found to be transient, appertaining to the regional acceleratory phenomenon (RAP). Hence, the aim of the study was to evaluate the effect of single and multiple piezocisions on the rate of orthodontic tooth movement (OTM). Moreover, the impact of both protocols on canine tipping and orthodontically induced inflammatory root resorption (OIIRR) has been assessed.

METHODS

Thirty indicated patients for the therapeutic extraction of maxillary first premolars were enlisted in this split-mouth study, and they were randomly split into two equal groups, each including 15 subjects. In the Single Application Group (SAG), one side of the maxillary arch arbitrarily received a single piezocision before the onset of canine retraction, whereas in the Multiple Application Group (MAG), piezocisions were randomly performed on one side, three times on a monthly basis, over the 12-week study period. The contralateral sides of both groups served as the controls. Canine retraction was carried out bilaterally using nickel-titanium closed-coil springs, delivering 150 g of force, and the rate of tooth movement, as well as canine tipping were evaluated on a monthly basis, over a 3-month period. Cone-bean computed tomography scans were also conducted pre- and post- canine retraction, and OIIRR was assessed using Malmgren Index.

RESULTS

The reported outcomes revealed a significant increase in the amount of canine retraction, canine tipping, as well as root resorption scores on the experimental sides in both groups SAG and MAG post-retraction (p < 0.001). However, upon comparing the experimental sides in both groups, non-significant differences have been observed between them regarding all the assessed outcomes (p > 0.05).

CONCLUSIONS

Single and multiple piezocisions effectively accelerate OTM in comparison to conventional orthodontic treatment, with relative outcomes reported by both intervention frequencies. Accordingly, single piezocision is recommended as an adjunct to OTM. Furthermore, significant tooth tipping as well as a significantly higher root resorption risk accompanies both single and multiple piezocision applications in conjunction with OTM.

NAME OF THE REGISTRY

Clinicaltrials.gov TRIAL REGISTRATION NUMBER: NCT05782088 DATE OF REGISTRATION: 23/03/2023 "Retrospectively registered". URL: https://clinicaltrials.gov/ct2/show/NCT05782088.

Patient Satisfaction Following Orthodontic Treatment: A Systematic Review

Patient-reported outcome measures (PROMs) have become increasingly important in orthodontic treatment as they reflect patients' perceptions of treatment outcomes. Understanding patient satisfaction with orthodontic treatment is crucial for improving healthcare delivery and patient-centered care. This systematic review aimed to critically appraise the evidence regarding patient satisfaction after orthodontic treatment, exploring the effects of different treatment types, patient demographics, and other factors on satisfaction levels. Eight electronic bibliographic databases were searched without publication time or language restrictions, including PubMed®, Scopus®, the Cochrane Central Register of Controlled Trials, Web of Science™, Embase®, Google™ Scholar, Trip, and OpenGrey. A manual search was conducted on the references in the included papers. Eligibility criteria were established based on the Population, Intervention, Comparison, Outcomes, and Study (PICOS) framework. Studies were included if they reported patient satisfaction levels following orthodontic treatment using standardized questionnaires. Two reviewers independently collected and analyzed the data. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2) for randomized clinical trials, and the methodologic quality for cohort and cross-sectional studies was assessed using the modified version of the Newcastle-Ottawa scale. Fourteen studies employed various questionnaires and timings to gauge post-orthodontic treatment satisfaction. Patient satisfaction levels were generally high, with most studies reporting satisfaction rates above 91%. Fixed orthodontic appliances were associated with higher satisfaction levels compared to removable appliances. While age and gender did not significantly influence satisfaction, the quality of care and doctor-patient relationships were crucial factors in patient satisfaction. This systematic review proves that patient satisfaction with orthodontic treatment is generally high, with fixed appliances and positive doctor-patient relationships contributing to higher satisfaction levels. However, the quality of the evidence was moderate to low, highlighting the need for further high-quality clinical studies in this area.

Patient-reported outcomes during accelerating the en-masse retraction of the upper anterior teeth using low-intensity electrical stimulation: a randomized controlled trial

BACKGROUND

Low-intensity electrical stimulation (LIES) is considered a relatively recent technology that has received little attention in orthodontics as a method of acceleration. This study aimed to evaluate patient-reported outcome measures when LIES is used to accelerate the en-masse retraction of the upper anterior teeth.

MATERIALS AND METHODS

The sample consisted of 40 patients (8 males, 32 females; mean age 21.1 ± 2.3 years), with Class II division I malocclusion who required extraction of the first premolars to retract upper anterior teeth. They were randomly assigned to the LIES group (n = 20) and the conventional en-masse retraction group (CER; n = 20). Patient responses regarding pain, discomfort, burning sensation, swelling, chewing difficulty, speech difficulty, and painkillers' consumption were recorded at these nine assessment times: 24 h (T1), 3 days (T2), and 7 days (T3) after force application, then in the second month after 24 h (T4), 3 days (T5), and 7 days (T6) of force re-activation, and finally after 24 h (T7), 3 days (T8), and 7 days (T9) of force re-activation in the third month.

RESULTS

The mean values of pain perception were smaller in the LIES group than those in the CER group at all assessment times with no statistically significant differences between the two groups except during the second and third months (T5, T6, T8, and T9; P < 0.005). However, discomfort mean values were greater in the LIES group with significant differences compared to CER group during the first week of the follow-up only (T1, T2, and T3; P < 0.005). Burning sensation levels were very mild in the LIES group, with significant differences between the two groups at T1 and T2 only (P < 0.001). Speech difficulty was significantly greater in the LIES group compared to CER group at all studied times (P < 0.001). High levels of satisfaction and acceptance were reported in both groups, without any significant difference.

CONCLUSION

Both the LIES-based acceleration of en-masse retraction of upper anterior teeth and the conventional retraction were accompanied by mild to moderate pain, discomfort, and chewing difficulty on the first day of retraction. These sensations gradually decreased and almost disappeared over a week after force application or re-activation.

TRIAL REGISTRATION

ClinicalTrials.gov, ClinicalTrials.gov, NCT05920525. Registered 17 June 2023 - retrospectively registered, http://clinicaltrials.gov/study/NCT05920525?term=NCT05920525&rank=1 .

Pain Intensity of Skeletally Anchored Maxillary Molar Distalization in Conjunction with Micro-osteoperforations: A Randomized Clinical Trial

Objective To assess pain intensity levels during orthodontic therapy of Class II malocclusion patients undergoing skeletally anchored maxillary molar distalization assisted with different micro-osteoperforation (MOP) approaches. Methods Twenty-seven patients (12 males and 18 females) with a mean age of 16.1 ± 0.3 years were randomized into three equal groups (n=9): Group 1 comprised MOPs on buccal surface, Group 2 comprised MOPs on buccal and palatal surface, and Group 3 comprised the control or no-MOP group. The patients underwent maxillary molar distalization using skeletally anchored distal jet appliance assisted with or without MOPs. The MOPs were applied repeatedly on the buccal and buccal and palatal sides, or no MOP (control). Pain intensity was assessed using a 10 cm visual analog scale after each device activation at 24, 48, 72 hours, and at seven days. Data were analyzed using one-way ANOVA and repeated measures ANOVA for non-paired and paired means. Results Both approaches of buccal and buccal and palatal application of MOPs showed statistically significant (p< 0.01) higher levels of pain intensity after the first activation at 24 hours. Nevertheless, pain intensity levels decreased significantly in both MOP groups and between the two activations. Conclusion The repeated application of MOPs on either the buccal side only or on both buccal and palatal sides during maxillary molar distalization did not affect the levels of pain experienced; however, these levels were reported to be higher than that obtained in the control group. Moreover, it is observed that these pain levels tend to gradually reduce to mild levels over the subsequent days.

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.

Patient-Reported Outcome Measures of Flapless Corticotomy with Low-Level Laser Therapy in En Masse Retraction of Upper Anterior Teeth: A Three-Arm Randomized Controlled Trial

(1) Background: This study aimed to compare patient-reported outcome measures when accelerating en masse retraction between the piezocision procedure and the subsequent application of low-level laser therapy (FC+LLLT), with the piezocision alone (FC), and in a control group. (2) Methods: A three-arm randomized controlled trial (RCT) was conducted involving 60 patients (41 females and 19 males) with Class II division I malocclusion. The en masse retraction was performed using NiTi closed coil springs attached to miniscrews. The LLLT was performed using an 808 nm Ga-Al-As diode laser. Patient responses regarding pain, discomfort, swelling, and chewing difficulties were reported at ten assessment points. (3) Results: The greatest pain levels were observed 24 h after the application of force during the first and third months of retraction. The mean pain, discomfort, swelling, and chewing difficulties were significantly smaller in the control group than in the FC and FC+LLLT groups. High satisfaction levels were reported in all three groups (p < 0.05). (4) Conclusions: The accelerated en masse retraction via piezocision, followed by a small course of LLLT, was accompanied by significantly fewer pain, discomfort, and chewing difficulties than the control group. LLLT is a valuable addition to piezocision, with an improved patient experience.

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.

A Novel Method to Accelerate Orthodontic Tooth Movement Using Low-Intensity Direct Electrical Current in Patients Requiring en-Masse Retraction of the Upper Anterior Teeth: A Preliminary Clinical Report

BACKGROUND

Shortening the duration of orthodontic treatment by speeding up the rate of tooth movement has become an essential goal for both orthodontists and patients. This preliminary report aimed to investigate the safety and effectiveness of a new intraoral removable electrical device in accelerating the en-masse retraction of the upper anterior teeth using low-intensity direct electrical current.

METHODS

This prospective preliminary interventional clinical study was conducted at the Department of Orthodontics, Faculty of Dentistry, Damascus University, Syria, between March 2019 and February 2020. The sample consisted of six patients (four females and two males; mean age: 19.55 ± 0.89 years) whose initial diagnosis was class II division I malocclusion, and their treatment plan suggested the extraction of upper first premolars followed by en-masse retraction. The electrical stimulation was applied on the maxillary anterior region during the en-masse retraction phase using a specially fabricated removable device that was designed by two coauthors of this manuscript (RIS, MYH). Patients were asked to wear their own electrical devices inside their mouths for five hours daily. The primary outcomes were the en-masse retraction rate and duration. The secondary outcomes were safety and patient acceptance.

RESULTS

The average total retraction rate during the treatment period was 0.97±0.06 mm/month. The total amount of retraction achieved during follow-up was 5.65 ± 0.85 mm, which was about 91.86% of the space resulting from the extraction of the upper first premolars. The mean treatment duration to complete the en-masse retraction was 5.66±0.81 months. No side effects of the electrical stimulation were found during the follow-up.

CONCLUSIONS

Low-intensity direct electrical current could be an effective method to accelerate orthodontic movement. The electrical accelerating device used in this study effectively increased the en-masse retraction rate of the upper anterior teeth without any side effects and with high patient acceptance.

Effects of Flapless Laser Corticotomy in Upper and Lower Canine Retraction: A Split-mouth, Randomized Controlled Trial

Aim One of the major difficulties in orthodontic treatment is the lengthy course of therapy, particularly in situations involving extractions. Hence, various methods for accelerating tooth movement rate had been devised. Flapless corticotomy is one of those methods. This study aimed to evaluate the effects of flapless laser corticotomy (FLC) compared to the conventional retraction (CR) method on the rate of canine retraction. Methods A split-mouth, randomized controlled trial included 56 canines from 14 patients (12 females and two males) with a mean age of 20.4 ± 2.5 years, who were complaining of bimaxillary protrusion requiring extraction of four premolars. All canines were randomly assigned to four groups (maxillary FLC, maxillary control CR, mandibular FLC, and mandibular control CR). Randomization was performed by creating two equal, random computer-generated lists with a 1:1 allocation ratio-one list for the right side and one for the left. The allocation concealment was achieved using opaque sealed envelopes until the time of intervention. FLC was applied on the experimental sides before canine retraction by drilling six holes penetrating 3 mm into the bone on the mesial and distal sides of the canines. Subsequently, all canines were retracted employing closed coil springs to deliver a force of 150 g using indirect anchorage from temporary anchorage devices (TADs). All canines were assessed at T0 (before retraction), T1 (one month after retraction), T2 (two months), and T3 (three months) using three-dimensional (3D) digital models. Additionally, canine rotation, molar anchorage loss assessed using 3D digital models, root resorption assessed using cone beam computed tomography (CBCT), probing depth, plaque, gingival indices, and pulp vitality were all evaluated as secondary outcomes. It was possible to blind only the outcome analysis expert (single-blinded). Results The measurements of canine retraction during the follow-up period from T0 to T3 were 2.46 ± 0.80 mm and 2.55 ± 0.79 mm in maxillary FLC and control groups, respectively, and 2.44 ± 0.96 mm and 2.31 ± 0.95 mm in mandibular FLC and control groups, respectively. The results demonstrated a statistically non-significant difference in the distance of canine retraction between the FLC and control groups at all time points. Moreover, no differences were observed between groups in canine rotation, molar anchorage loss, root resorption, probing depth, plaque, gingival indices, and pulp vitality (p > 0.05). Conclusion In the FLC procedure performed in this study, the rate of upper and lower canine retraction could not be accelerated and no significant differences were observed between FLC and control groups in canine rotation, molar anchorage loss, root resorption, periodontal condition, and pulp vitality.

Evaluation of the Patient-Reported Outcome Measures (PROMs) With Temporary Skeletal Anchorage Devices in Fixed Orthodontic Treatment: A Systematic Review

Analysis of patient-reported outcome measures (PROMs) is essential to ensure that the skeletal and traditional anchoring methods are appropriately and effectively utilized in the context of patient acceptance and satisfaction. This review's objective was to assess the available data on the levels of discomfort, soft-tissue irritation, functional impairment, and other patient-reported outcomes related to the usage of mini-implants in the context of fixed orthodontic treatment for adult patients. A total of seven electronic bibliographic databases were searched between January 1995 and February 2022. Moreover, a manual search was done in the selected orthodontic journals. This systematic review (SR) covered cohort studies, retrospective studies, randomized clinical trials (RCTs), and controlled clinical trials (CCTs) that studied the use of mini-implants, mini-plates, or onplants as anchorage devices on patients receiving orthodontic treatment. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2 tool). Three RCTs and two cohorts were included in this SR with a total of 468 patients. Three of the four included studies were at high risk of bias. The pain level was in the "mild-to-moderate" category on the first day following the insertion of mini-implants, then decreased to a mild level from the fifth day to the seventh day of insertion (mean values are 36.61, 16.36, and 11.33, respectively). The levels of functional impairments were found to be located between the "mild-to-moderate" and "moderate" categories after the placement of mini-plates and intermaxillary fixation screws, while they experienced a mild level with mini-implants. The greatest pain levels were found after the insertion of the temporary anchorage devices (TADs) and then decreased until they became mild or disappeared completely after one month. Speaking, chewing, and cleaning difficulties were more problematic when using TADs compared to conventional anchorage. To obtain good evidence in this area, more high-quality RCTs are needed.

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.

Pain, Discomfort, and Functional Impairments When Retracting Upper Anterior Teeth Using Two-Step Retraction With Transpalatal Arches Versus En-Masse Retraction With Mini-implants: A Randomized Controlled Trial

Background This study aimed to evaluate the levels of pain and discomfort associated with employing mini-implants as a temporary skeletal anchorage device compared to the traditional transpalatal arches (TPAs) during upper anterior teeth retraction in patients with upper dentoalveolar protrusion and to determine the level of acceptance of both techniques among patients. Methodology The study sample consisted of 38 patients (29 women and nine men) with an average age of 21.7 years. The patients were randomly and equally distributed into two groups. In the first group: upper anterior teeth were en-masse retracted using mini-implants (the TAD group), whereas, in the second group, TPAs were used during the two-step retraction of upper anterior teeth (the TPA group). Standardized questionnaires were distributed to all patients after 24 hours of mini-implant application. The questionnaire asked the patients to rate their pain perception, swelling sensation, eating difficulties, talking impairments, and cleansing difficulties on a four-point Likert scale on the third-day, one-week, two-week, and one-month follow-ups after the anchorage application. Wilcoxon matched-pairs signed-rank tests were used to evaluate intragroup changes, whereas Mann-Whitney U tests were employed to examine intergroup differences. Results Patients in the TAD group had higher pain and swelling levels than those in the TPA group, and differences were statistically significant at the first three assessment time points. The differences between the two groups were statistically insignificant regarding eating and talking difficulties, whereas differences were statistically significant for brushing difficulties. These impairments decreased to almost normal levels after one month of treatment initiation. Conclusions TPAs, when used for anchorage in the two-step retraction technique, were less problematic compared to mini-implants with en-masse retraction, where the sensation of pain or swelling around the mini-implants did not last for more than a week. The difficulties of cleaning, chewing, and speaking in the presence of mini-implants were temporary and mostly disappeared within two weeks of mini-implant application.

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.

Assessment of Patient-Centered Outcomes When Treating Palatally Impacted Canines Using Conventional Versus Accelerated Minimally Invasive Corticotomy-Assisted Orthodontic Treatment: A Randomized Controlled Trial

Objective

This study aimed to investigate whether there were any differences in pain levels, discomfort, and functional impairments when treating palatally impacted canines (PICs) using the conventional treatment method compared to the accelerated minimally invasive corticotomy-assisted method.

Materials and methods

Fifty-two patients (11 males and 41 females) with unilateral PICs were included. The patients were randomly assigned to the conventional traction group (26 patients, mean age of 20.37 ± 2.15 years) or the minimally-invasive corticotomy-assisted group (26 patients, mean age of 20.18 ± 2.18 years). The levels of pain, discomfort, and functional difficulties were assessed using a visual analog scale (VAS) after 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) following the surgical exposure procedure.

Results

There were no statistically significant differences between the two treatment groups for any patient-centered outcome at all assessment times (P>0.01). The levels of pain and discomfort were slightly greater in the conventional group than in the corticotomy-assisted group on the first day after surgical exposure, with no significant difference between the two groups (mean pain: 4.11, P=0.481; mean discomfort: 9.00, P=0.223). Pain and discomfort required seven days to reach low levels and four weeks to reach the lowest levels in both study groups. The levels of swelling, mastication difficulties, swallowing difficulties, limitation in jaw movements and speech changes were mild to moderate on the first postoperative day and the recovery time was four days postoperatively for swallowing difficulties and speech changes. In comparison, the recovery time was seven days for the other three outcomes in both study groups.

Conclusions

After one day of the surgical intervention, either by conventional or corticotomy-assisted methods, the patients reported mild to moderate pain, discomfort, and functional impairments. These disabilities gradually reached low levels during the first and second weeks to reach their lowest levels four weeks postoperatively in both study groups. The similarity between the conventional and the acceleration methods in pain levels and other oral disabilities may make corticotomy-assisted treatment a comfortable and effective method when treating adult patients with PICs. In addition, patient satisfaction with the corticotomy-assisted procedure was high.