Nonsurgical synergistic full-arch vertical intrusion treatment of bimaxillary protruded hyperdivergent skeletal Class II malocclusion using aligners

A bone-borne full-arch vertical control strategy using miniscrews was deployed with aligners to treat a case of skeletal hyperdivergent Class II malocclusion with bimaxillary protrusion. Miniscrews were inserted in the posterior buccal and palatal regions and the anterior buccal region of the maxilla to distribute vertical intrusive force through the upper arch by anchoring vertical elastics from the miniscrews to the aligners. Synergetic lower anterior intrusion was completed using bilateral posterior miniscrews to counteract the extrusive force generated. Substantial full upper arch and lower anterior vertical intrusion was achieved. In conjunction with en masse anterior-posterior retraction, synergetic posterior and anterior vertical intrusion facilitated counterclockwise rotation of the mandible, creating significant esthetic improvement. Anterior vertical elastics also provided flaring of the anterior teeth, reducing the side effect of lingual tipping from en masse retraction, while successfully controlling overbite and incisor torque during space closure. The bone-borne full-arch vertical intrusion strategy can work well with aligners to address hyperdivergent skeletal Class II malocclusion with bimaxillary protrusion.

The change of state-trait anxiety among patients undergoing orthognathic surgery: A longitudinal study

INTRODUCTION

This study aimed to assess state-trait anxiety level changes in Chinese patients with dentofacial discrepancies before and after orthognathic surgery and to explore the feasibility of developing a reference index for the preoperative screening of postoperative patients with high anxiety.

METHODS

A total of 96 Chinese patients with dentofacial discrepancies who underwent orthognathic surgery were included in this study. Data were collected before orthognathic surgery and at 2 weeks (T2), 3 months, and 6 months (T4) after surgery using the State-Trait Anxiety Inventory. Receiver operating characteristic and linear regression analyses were performed to screen for preoperative indicators of postoperative high-state anxiety.

RESULTS

State-trait anxiety levels in patients with dentofacial discrepancies decreased after surgery (F = 18.95, P <0.01; F = 6.90, P <0.01). Trait Anxiety Inventory can be used to screen patients with high-state anxiety from T2 to T4 (area under cover 95% confidence interval: T2, 0.74 [0.62-0.86]; 3 months, 0.79 [0.69-0.90]; T4, 0.77 [0.66-0.87], P <0.01), corresponding to cutoff values of 48.5, 46.5, and 45.5, respectively.

CONCLUSIONS

All participants' state-trait anxiety levels improved after surgery compared with their preoperative levels. Preoperative trait anxiety levels can be used as a reference indicator to screen patients who may have high-state anxiety levels after orthognathic surgery. The creation of a screening scale will assist health care professionals to more pertinently help patients with high anxiety.

Thematic Analysis of Parental Experiences of Patients' Orthognathic Surgery

Orthognathic surgery often requires extensive orthodontic preparation and a prolonged postoperative recovery that can be stressful for patients and their families. Parents are a primary source of support for patients; accordingly, a better understanding of the parents' experience of orthognathic surgery can help inform clinical care. Using a prospective cross-sectional qualitative study design, 4 focus groups (2 English and 2 Spanish; mean length 65 min) were held with parents of patients who had completed orthognathic surgery for class II/III malocclusion. Thematic content analysis of the group transcriptions was conducted. Participants were 10 mothers and 3 fathers of 12 children (50% with cleft lip/palate) ages 17 to 23 who completed LeFort I (41.7%), LeFort I with bilateral sagittal split osteotomy (BSSO; 41.7%), or BSSO (16.7%) within the prior 3 to 16 months. Themes fit within a chronological framework: (1) Preparing for Surgery included their larger health context, anticipating surgery, surgery preparation by team and family, and religious faith; (2) Challenges after Surgery consisted of complications, pain, frustration, nutritional challenges, parental anxiety, activity changes, sleep, breathing issues, swelling, and unanticipated aspects of surgery; and (3) Supports after Surgery were nutritional support, appreciation of medical team, postoperative improvements, appearance changes, communicating, supporting patient, and patient coping. Parents also offered advice for families and medical teams. Surgeons and other providers who are part of orthognathic surgical preparation can implement recommendations based on parental experiences to increase patient and family readiness for surgery by providing early education, assisting with advocacy, focusing on nutrition, and supporting coping.

The Frequency of Temporomandibular Disorders, Surgical Complications, and Self-Reported Mental Health Problems in Orthognathic Patients

OBJECTIVE

To evaluate the frequency of signs and symptoms of temporomandibular disorders (TMD), surgical complications, and patient's self-reported mental health problems during orthognathic treatment.

MATERIAL AND METHODS

The clinical records of 145 patients treated with orthognathic treatment were retrospectively studied. Variables regarding occlusal parameters, treatment duration, TMD symptoms, complications, and self-reported mental health status at time points of T0 (beginning of the treatment), T1 (before surgery), and T2 (final examination) were evaluated. The variables were statistically compared with significance level of P < 0.05.

RESULTS

A total of 51% (n = 74) of the patients had TMD symptoms at 1 or several time points, women having significantly more TMD signs and symptoms (P = 0.002). Temporomandibular disorder signs and symptoms decreased significantly after orthognathic treatment (P=0.001). At least 1 self-reported mental health-related factor during 1 or several time points (T0-T2) was recorded in 17.2% (n = 25) of the patients. There was no significant difference in frequency of self-reported mental health problems in patients with TMD signs and symptoms compared with patients without TMD signs and symptoms (P > 0.05). The frequency of postoperative complications was 39.3%, being significantly higher after Bilateral Sagittal Split Osteothomy (BSSO, 48.7%). There was no difference in treatment duration of patients with self-reported mental health problems compared with patients without (P > 0.05).

CONCLUSIONS

In this study population, TMD signs and symptoms seem to be typical both in patients with or without self-reported mental health problems. Women had significantly more TMD symptoms. Orthognathic surgery treatment seems to have a positive effect on TMD signs and symptoms.

Psychosocial changes in patients submitted to orthodontic surgery treatment: a systematic review and meta-analysis

OBJECTIVE

This systematic review aims to answer the following question: What is the psychological impact of orthognathic surgery on patients with dentofacial deformities undergoing orthodontic-surgical treatment?

MATERIAL AND METHODS

The search was adapted for each of the following databases: American and Caribbean Center on Health Sciences (LILACS), Cochrane Library, Embase, Psychinfo, PubMed/Medline, Scopus and Web of Science, and gray literature using Google Scholar, OpenGrey, and ProQuest. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. This study performed estimates of interest, random-effects meta-analyses, and calculated heterogeneity using Higgins inconsistency index (I²).

RESULTS

A total of 6751 references were found in all searches. After applying the eligibility criteria after full-text reading, 37 studies comprised the final qualitative synthesis. Thirteen studies were included in quantitative synthesis, and it was possible to meta-analyze data from the following questionnaires: GHQ-28, MMPI, RSES, and SCL-90-R. There was an improvement in psychological aspects related to depression, hysteria, self-esteem, anxiety, obsessive-compulsiveness, interpersonal sensitivity, paranoid ideas, and psychoticism (p < 0.05).

CONCLUSIONS

Correction of dentofacial deformity through orthodontic-surgical treatment is associated with improvements observed in several psychological domains, especially in relation to depressive states.

CLINICAL RELEVANCE

This result highlights the importance of surgeons and orthodontists in promoting adequate control of patients' expectations and treatment goals taking into account the individual's psychological aspects.

Longitudinal Course of Depressive, Anxiety, and Posttraumatic Stress Disorder Symptoms After Heart Surgery: A Meta-Analysis of 94 Studies

OBJECTIVE

This study aimed to analyze the longitudinal course of depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in patients with cardiac disease after heart surgery (HS).

METHODS

We conducted a systematic review and random-effects meta-analysis of cohort studies in patients undergoing HS, measuring anxiety, depressive, and PTSD symptoms before and at least 30 days thereafter. Subgroup and meta-regression analyses, investigation of publication bias, and quality assessment were undertaken.

RESULTS

We included 94 studies relating to 15,561 patients. HS included coronary artery bypass graft surgery, valve replacement, implantable cardioverter-defibrillator placement, left ventricular assist device placement, heart transplantation, and other types of HS. Across studies, symptoms of depression (g = 0.32; 95% confidence interval [CI] = 0.25 to 0.39; p < .001) and anxiety improved after HS (g = 0.52; 95% CI = 0.43 to 0.62; p < .001), whereas PTSD symptoms worsened (g = -0.42; 95% CI = -0.80 to -0.04; p = .032). The reduction of depression and anxiety levels was more pronounced for patients with underlying coronary artery disease and heart failure and persisted for 1 year after HS, whereas the increase in PTSD symptoms returned to baseline after 6 months. Depression improvement was inversely associated with older age, diabetes, hypertension, and dyslipidemia and positively with baseline heart failure. No additional clinical or demographic variables were associated with the course of anxiety symptoms. Quality of included studies was low overall. Publication bias was nonsignificant.

CONCLUSIONS

Depressive and anxiety symptoms improve for 1 year after HS, whereas PTSD symptoms might worsen. Older patients and those with metabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.

Impact of orthodontic-surgical treatment on quality of life: a meta-analysis

Background

Orthognathic surgery involves a change in the patient’s functional and aesthetic aspects.

Objective

The objective was to answer the following focused question: what is the impact on quality of life (QoL; aesthetic, function, social, and psychological aspects) in patients undergoing orthodontic-surgical treatment?

Search methods

Appropriate word combinations and truncations were selected and tailored specifically for each electronic database: PubMed/Medline, Scopus, Web of Science, PsycInfo, and Latin American and Caribbean Health Sciences Literature and gray literature.

Selection criteria

Studies that met the following criteria was included: patients with dentofacial deformity (P); surgical correction through orthodontic-surgical treatment (E/I); before orthodontic-surgical treatment or patients with no dentofacial deformity (C); QoL (O); cross-sectional, cohort, case-control and randomized or non-randomized clinical trial (S).

Data collection and analysis

In phase 1, two reviewers independently reviewed the titles and abstracts of all references. All articles that did not meet the inclusion criteria were excluded. In phase 2, the same reviewers completely read the selected articles independently.

Results

A total of 2879 articles were retrieved during the final database search. Fifty-two articles were selected for full reading, of which 16 were excluded, resulting in 36 included articles. The meta-analysis was performed using 13 of the selected studies. When comparing the period before any treatment with the post-operative period of 4–8 weeks, there was an association only for facial aesthetics (mean difference = 3.00; 95 per cent confidence interval = 1.10–4.89; inconsistency index = 63 per cent). The comparison between the period before any treatment with the 6 month post-operative period showed an improved QoL in all of the domains evaluated and, when comparing data after the orthodontic-surgical preparation (before surgery) and after 5–12 months of surgery, there was also statistical significance with an increased QoL for all of the domains evaluated.

Conclusions

In conclusion, based on the results of this systematic review and meta-analysis, the evidence suggests an improvement in the QoL of patients undergoing orthodontic-surgical treatment regarding aesthetic, functional, social, and psychological aspects.

Registration

CRD42017069495

Anxiety and knowledge of patients before being subjected to orthognathic surgery

ABSTRACT Objective: to verify the correlation between anxiety level and degree of knowledge in patients before they are subjected to orthognathic surgery. Method: Descriptive cross-sectional study with 40 patients in the preoperative period before orthognathic surgery of a private clinic in the city of São Paulo. Results: IDATE-trait anxiety levels feature prevalence of medium-level anxiety with 72.5% (n=29), followed by low-level anxiety with 72.5% (n=29) and high-level level anxiety with 10% (n=4). In the pre-operative period, transitory IDATE-state anxiety levels feature medium-level anxiety with 65% (n=26), followed by high-level anxiety with 22.5% (n=9) and low-level anxiety with 10% (n=4). Pearson’s correlation coefficient resulted in negative r (−0.2) for anxiety-trait (p 0.197) and in negative r (−0.1) for anxiety-state (p 0.417). Conclusion: The data shows a weak correlation in which greater knowledge about the surgical procedure reduces levels of anxiety that may be related to the absence of appropriate guidance about the surgical procedure.