Quality of Life in Orthodontic Cancer Survivor Patients-A Prospective Case-Control Study

Characteristics of Orthodontic Treatment in Cancer Survivors: A Systematic Review

Background: Survival rates of cancer patients have increased globally and across age groups. Challenges arising from craniofacial growth-development disturbances and dental abnormalities might warrant modifications to standard orthodontic pathways of care. Objective: The aim of this study was to systematically summarize and critically assess the available literature regarding the characteristics of orthodontic treatment in cancer survivors. Materials and Methods: A systematic search was conducted in seven databases for studies on malignant tumor survivors having undergone orthodontic intervention with fixed appliances following cancer treatment up to August 2023. The outcomes of interest included quantitative data regarding various characteristics of orthodontic treatment and the post-treatment period. The risk of bias was assessed individually with the Newcastle-Ottawa scale. Results: Out of 347 records, 4 cohort studies were eventually included in the qualitative synthesis. Leukemia was the most common malignancy type, with treatment involving mainly chemotherapy and/or radiotherapy. The duration of orthodontic treatment in cancer survivors varied. Occlusal results, quality of life, and satisfaction were comparable to healthy peers. However, in some survivors' groups, treatment was shorter and the final results were compromised. Root resorption and oral mucositis were reported among the treated cancer survivors. Reduced occlusal outcome stability during the retention period was also reported. Conclusions: Overall, the duration of orthodontic treatment varied among cancer survivors. The occlusal results achieved were similar to those of their healthy peers, though potentially less stable. Patient-reported outcomes did not differ significantly between cancer survivors and healthy individuals treated orthodontically.

THE USE OF DENTAL PATIENT-REPORTED OUTCOMES AMONG COMPARATIVE OBSERVATIONAL STUDIES IN ORTHODONTICS: A METHODOLOGICAL STUDY

OBJECTIVE

To identify and summarize the presence and characteristics of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) within comparative observational studies published in 5 leading orthodontic journals.

METHODS

Electronic searching was performed to identify intervention (therapeutic or preventive) related comparative observational studies published in selected journals between 2015 and 2021. Two authors extracted the characteristics of each included study independently and in duplicate and summarized the dPROs and dPROMs used in these studies. All dPROs were classified into 2 general types (oral health-related quality of life [OHRQoL] and others), while dPROMs were divided into 3 categories (single-item questionnaires, generic multiple-item questionnaires, and specific multiple-item questionnaires). In addition, dPROMs were examined, if they evaluated the 4 dimensions of OHRQoL (oral function, orofacial pain, orofacial appearance, and psychosocial impact).

RESULTS

A total of 683 observational studies were eligible and included of which 117 (17.1%) used dPROs and dPROMs. Seven different dPROs (OHRQoL, patients' satisfaction with treatment, preferences, concerns, compliance, duration, and unwanted events) and 33 different dPROMs (including 8 single-item questionnaires, 11 generic multiple-item questionnaires, and 14 specific multiple-item questionnaires) were identified in these studies. OHRQoL was the most commonly used dPRO (92/117, 78.6%), while Oral Health Impact Profile 14 (OHIP-14) was the most frequently used dPROM (20/92, 21.7%). In terms of study design, cross-sectional studies had the highest proportion of dPRO usage (62/148, 41.9%), followed by cohort studies (63/505, 12.5%) and case-control studies (1/30, 3.3%).

CONCLUSIONS

Only one-sixth of comparative observational studies published in leading orthodontic journals could reflect patients' perspectives. Observational studies in orthodontics need to provide more patient-important information through the use of dPROs and dPROMs.

A Systematic Review and Meta-Analysis of the Impact of Cancer and Its Treatment Protocol on the Success of Orthodontic Treatment

BACKGROUND

There are several significant gaps in current studies of the relationship between anti-cancer medications and orthodontic care that call for more investigation. As a result, the main goals of this systematic review and meta-analysis were to summarise and assess the information that was available regarding the effect of radiotherapy and anti-cancer medications on the overall successful completion of an orthodontic treatment plan.

METHODS

A standardised data extraction form was devised in accordance with the PRISMA guidelines to conduct a systematic review and meta-analysis, with specific criteria implemented for selecting studies with low to moderate risk of bias.

RESULTS

Five studies involving different methodologies were selected at the conclusion of the search strategy. The statistical analysis revealed an estimated odds ratio (OR) of 0.31 and relative risk (RR) of 0.48, indicating a statistically significant association between the use of radiotherapy and anti-neoplastic drugs and a noticeable reduction in the successful completion of orthodontic treatment. The heterogeneity analysis showed significant heterogeneity among the studies.

CONCLUSIONS

This review emphasises that, although orthodontic therapies can still be beneficial for children receiving chemotherapy, the effectiveness of the therapy may be diminished in older populations. The findings further highlight how crucial it is to take cancer therapies into account when planning and managing orthodontic treatment in order to optimise results and reduce problems.

Significance of Non-Statistically Significant Results in the Prediction of Oral Health-Related Quality of Life in Orthodontic Patients: A Survey Using Two Linking Questionnaires

Patients with a fixed orthodontic appliance may have difficulties in maintaining good oral health-related quality of life (OHRQoL), and evaluating self-perceived OHRQoL in orthodontic patients could be challenging for their orthodontists. Therefore, this research was conducted to investigate whether orthodontic postgraduates would accurately evaluate the OHRQoL of their patients. Two self-administered questionnaires were designed for patients to rate their OHRQoL and for their orthodontic postgraduates to evaluate them on OHRQoL. All pairs of patients and their orthodontic postgraduates were requested to independently complete the questionnaires. Pearson's correlation and multiple linear regression were performed to determine the relationships of the variables and to identify significant predictors on OHRQoL, respectively. There were 132 pairs of orthodontic patients and their residents who completed the questionnaires. There were no significant correlations between OHRQoL perceived by patients and evaluated by their orthodontic postgraduates in all aspects of treatment needs and dietary difficulties (p > 0.05). In addition, the regression model demonstrated no significant predictors for the self-perceived treatment needs and dietary difficulties of orthodontic patients. There seemed to be challenges for orthodontic postgraduates to evaluate their patients' oral health-related quality of life. Therefore, the OHRQoL measures should be increasingly implemented in orthodontic education and practice in order to enhance the concept of patient-centered care.

Maxillary Sinus Pleomorphic Adenoma: A Systematic Review

Background: Pleomorphic adenoma (PA), also known as a mixed tumor, is a neoplasm of the glandular tissue. The maxillary sinus (MS) is an atypical location of PA; however, as an empty cavity inside the bone, it predisposes tumors to develop unnoticed. The aim of the following systematic review was to identify and characterize the diagnostics and prognosis of maxillary sinus pleomorphic adenoma (MSPA). Methods: The cases of MSPA that underwent treatment and were observed for possible recurrence were qualified for the review. The medical databases were searched using the following engines: ACM, BASE, Google Scholar and PubMed. The risk of bias was assessed using the JBI Critical Appraisal Tool for Case Reports. The extracted data were tabulated and summarized in a descriptive manner. Results: To the best knowledge of the authors, only seven cases of MSPA were described in the last 20 years. Relapse occurred in three of these cases and malignant transformation occurred in two. The longest recorded time without recurrence was 4 years. The size of the detected MSPA in the largest dimension ranged in various cases from 40 to 60 mm, with an average of 48 mm. Discussion: All but one of the seven included reports showed flaws during the risk of bias assessment. Only in two of seven reported cases was there no reason to suspect that the tumor had penetrated the sinus from the oral or nasal cavity. The MS is disadvantageous as a location as tumors occupying the entire volume of the sinus are often diagnosed. Recurrences and malignant transformations seem to be frequent and often remain undetected for a prolonged period. Other information: This research received no external funding. OSF Registries number: 8KVGM.

Camouflage orthodontic treatment combined with genioplasty distraction osteogenesis for skeletal class II relationship secondary to osteosarcoma excision surgery

OBJECTIVE

The treatment of orthodontic patients who survive head and neck tumors is challenging because of dentoskeletal deformities and other unexpected dental and facial complications. This case report describes the case of a 26-year-old woman who presented with mandibular retrognathia after survival from osteosarcoma.

CLINICAL CONSIDERATIONS

Camouflage orthodontic treatment was chosen instead of combined orthodontic-orthognathic surgery after primary reconstructive surgery with an iliac bone graft. Genioplasty distraction osteogenesis (DO) was performed to achieve an optimal facial profile. Although unexpected condyle dislocation and epithelial hyperplasia occurred during treatment, a favorable facial profile and optimal skeletal and dental relationships were accomplished after 32 months of treatment.

CONCLUSIONS

The patient underwent genioplasty DO and experienced unexpected left condyle dislocation. However, the treatment achieved esthetic goals after intermaxillary elastics were applied.

Comparative Study of Malocclusions between Cancer Patients and Healthy Peers

Background. There is lack of data related to dental occlusion among children cured from cancer. The aim of our study was to compare the prevalence of malocclusion in cancer survivors and in healthy peers. Methods. A cross-sectional study was conducted on 225 children aged between 4 and 18 years, including 75 cancer survivors, and 150 sex and age-matched controls. All patients were orthodontically examined and malocclusion traits were recorded. In the cancer group, 75 panoramic radiographs were used to evaluate the prevalence of dental anomalies and dental age using the Demirjian scale. Data were analyzed by univariate statistical analysis with p-values p < 0.05 considered as statistically significant. Results. Malocclusion was found in 49 (65.33%) cancer survivors and 99 (65.56%) controls (p > 0.05). The cancer group demonstrated significantly higher likelihood of crossbite (p < 0.01) and malalignment of teeth (p = 0.031). The healthy controls were more likely to demonstrate open bite (p = 0.038). Cancer patients with posterior crossbite (p = 0.023) or dental malalignment had a more advanced dental age (p = 0.022). Survivors with crossbite had more teeth with short roots (p = 0.016). Those who were older when they started their cancer therapy were more likely to suffer from tooth disturbances (p = 0.019). Conclusion. Oncological treatment can alter the development of occlusion in cancer patients.

Cancer survivors present significantly lower long-term stability of orthodontic treatment: a prospective case-control study

Background/Objectives

The aim of the study was to compare the stability of orthodontic treatment in cancer survivors who had been treated with cytotoxic drugs with a generally healthy control group.

Materials/Methods

The study included 52 cancer survivors treated orthodontically and 52 healthy control subjects matched for age, gender, and malocclusion. The weighted Peer Assessment Rating (w-PAR) index, the Index of Complexity, Outcome and Need (ICON) were assessed before treatment, after the treatment, and at the 3-year follow-up. Patients Satisfaction Score was assessed after the treatment and at the 3-year follow-up. A repeated analysis of variance test was used to check the statistical significance between the scores.

Results

Ideal occlusion was achieved in all patients. The mean w-PAR and ICON values were significantly reduced in both groups after the end of the orthodontic treatment with no significant differences between the groups regarding the obtained results. However, after the 3-year follow-up, only the cancer survivors’ group presented statistically significant (P < 0.001) increase of the w-PAR and ICON values comparing to the values obtained at the end of the treatment. There was no significant change in Patients’ Satisfaction Score within 3 years after treatment.

Limitations

The limited size of the study sample as well as different types of oncological diagnoses could have had an impact on the final results of the study.

Conclusions/Implications

Previous cytotoxic drug treatment significantly decreases the stability of orthodontic treatment among the cancer survivors, particularly within first 12 months after the end of the treatment.

Comparison of Oral Health Impact Profile (OHIP-14) Values in Cancer Survivor Patients Treated Orthodontically with Either Rapid or Standard Duration Protocols of Treatment-A Prospective Case-Control Study

BACKGROUND

The aim of the study was to compare the oral-health-related quality of life (OHRQoL) between cancer survivors: with rapid orthodontic treatment (TX) (up to 12 months) and standard TX (orthodontic treatment time longer than 16 months).

METHODS

There were 76 cancer survivors (48 women and 28 men) allocated into groups with rapid (36 people) or standard (40 people) duration of TX. OHRQoL was assessed on the basis of Oral Health Impact Profile (OHIP-14) values, measured before TX, 2 weeks and 3 months after the onset of TX, and after the end of TX. A repeated ANOVA test was used to check the statistical significance between the scores.

RESULTS

There were no significant differences regarding the OHIP-14 values between the examined groups at all stages of the examination. Both groups presented significant (p < 0.001) improvement of the values of OHRQoL at the end of TX comparing to the values achieved before the onset of TX.

CONCLUSIONS

Duration of orthodontic treatment by itself had no impact on oral-health-related quality of life.