Pain and Oral-Health-Related Quality of Life in Orthodontic Patients During Initial Therapy with Conventional, Low-Friction, and Lingual Brackets and Aligners (Invisalign): A Prospective Clinical Study

The Impact of Non-Extraction Orthodontic Treatment on the Oral-Health-Related Quality of Life between a Modified Aligner Appliance with Ni-Ti Springs and the Traditional Fixed Appliances: A Randomized Controlled Clinical Trial

Background and Objectives: To compare the oral-health-related quality of life (OHRQoL) outcomes between patients treated with modified Ni-Ti spring-based alignment appliances or conventional fixed appliances using the Oral Health Impact Profile 14 (OHIP-14), as well as the levels of satisfaction with the appliance appearance, treatment progress, and outcomes. Materials and Methods: Thirty-six patients (11 males, 25 females) were randomly divided into two groups: either the modified aligner appliance with Ni-Ti springs group (MAA) or the traditional fixed appliances group (FA). The allocation ratio was 1:1, and the randomization process was carried out by an independent investigator not involved in this study. Mild crowding cases were included in this study. The OHRQoL of patients was evaluated using the short-form Oral Health Impact Profile (OHIP-14) at five time points: before the treatment commencement (T0); 2 weeks (T1), 1 month (T2), and 2 months (T3) after the treatment initiation; and post-treatment (T4). The visual analog scale (VAS) was used to evaluate the patient satisfaction. Blinding was performed only during the outcomes assessment. Results: This randomized controlled trial had no dropouts, and the demographic characteristics of the groups were comparable. The MAA group experienced significantly greater functional limitations compared with the FA group at all three evaluation time points (T1, T2, and T3), as evidenced by the statistically significant p-values (p = 0.004, p = 0.001, and p < 0.001, respectively). The psychological disability in the MAA group was significantly lower than in the FA group at both T2 (p = 0.005) and T3 (p = 0.003). The patient satisfaction with the appliance appearance was significantly higher in the MAA group than in the FA group (p = 0.002). Conclusions: The OHRQoL improved in both the modified aligner appliance with Ni-Ti springs and fixed appliance groups after the treatment. Moreover, the functional limitations during the treatment were less severe in the FA group, while the psychological disability was lower, and the patient satisfaction with the appliance appearance was higher in the MAA group.

Adult orthodontics, motivations for treatment, choice, and impact of appliances: A qualitative study

INTRODUCTION

Understanding the rationale for adult patients undertaking orthodontic treatment and the impact of appliances on their quality of life has become increasingly important to research efforts and clinical care. This study aimed to understand why adult patients undergo orthodontic treatment and their overall experience with the choice of appliance.

METHODS

A cross-sectional qualitative study using semistructured interviews with adult patients from 4 private specialist orthodontic practices in the London region involving a purposive homogeneous sampling technique to obtain variation regarding gender, treatment modalities (fixed ceramic [FC], removable aligner [RA], and fixed lingual [FL] appliances), and stages of treatment (early, late, and posttreatment stage) was undertaken. A piloted topic guide was used to standardize data collection. Interviews were audio recorded, and field notes were taken. Data were transcribed verbatim and analyzed using framework methodology until data saturation was reached.

RESULTS

A total of 22 participants (FC, 8; RA, 8; and FL, 6), with a mean age of 38.9 ± 11.7 years, with the majority being female (n = 13; 59.1%), were interviewed. Psychosocial and dental health-related factors were reported as the main reasons to seek orthodontic treatment. Social factors and appliance features influence an adult's decision-making in selecting a specific orthodontic appliance. Wearing FC, RA, and FL was seen to have both positive and negative impacts on an adult's quality of life. Functional and psychological factors were the strong influencers on patients' treatment experience.

CONCLUSIONS

The study highlighted the influence of psychosocial factors and dental health concerns in the decision-making processes of adults seeking orthodontic treatment. FC, RA, and FL appear to affect an adult's quality of life, with functional and psychosocial factors being commonly reported.

Effect of aligners on patients' oral health-related quality of life and anxiety: a prospective pilot study

BACKGROUND

This prospective study explored the impact of aligners on the oral health-related quality of life and anxiety of patients during the first month of orthodontic treatment and the first month of the retention phase.

METHODS

A total of 23 male and female patients (median age 25 y) treated with clear aligners were included. The OHRQoL questionnaire was used at certain time points during treatment (T1: placement of the first aligner; T2: after one day of use; T3: after seven days; T4: after one month; and T5: after one month in the retention phase). The State-Trait Anxiety Inventory (STAI) was also self-administered to assess state and trait anxiety (Y1 and Y2 subscales, respectively) at the T1, T4 and T5 time points. A population average generalized estimating equations logistic regression model was fit to assess the effect of time on the responses, and the Wald test was used to examine the overall effect of time.

RESULTS

Overall time was a significant predictor for most of the questions. However, time was marginally significant for the OHRQoL questions evaluating oral symptoms such as bad taste/smell, sores, and food accumulation. Tooth discolouration did not differ between time points. The general activity disturbance was significantly lower in the retention phase. Higher depression and anxiety scores were reported at the initial appointment and decreased thereafter.

CONCLUSIONS

CAT has a negative impact on quality of life and psychological status during the initial days of treatment. These impairments ameliorate at later treatment stages.

Orthodontic System Modeled and Simulated with the Lingual Technique to Assess Tooth Forces

CBCT (cone beam computed tomography) is an imaging investigation that provides three-dimensional (3D) images of craniofacial structures. The purpose of this study is to determine the mechanical behavior of an orthodontic system where the lingual treatment technique was used in a 25-year-old female patient from whom a set of CBCT scans was used. CBCT images were processed through software programs such as Invesalius, Geomagic, and Solid Works, to create models containing virtual solids. These models were then imported into Ansys Workbench 2019 R3 (a finite element method software program) for successive simulations to generate displacement maps, deformations, stress distributions, and diagrams. We observed that in the lingual technique, the lowest force occurring on the maxillary teeth is at 1.1, while the highest force appears at 2.3. In the mandible, the lowest force occurs at 4.6, and the highest force at 3.1. The values of the forces and the results of the finite element method can represent a basis for the innovation of new orthodontic springs and also of bracket elements. Thus, by using new technologies, orthodontic practice can be significantly improved for the benefit of patients. Other virtual methods and techniques can be used in future studies, including the application of virtual reality for orthodontic diagnosis.

Comparison of anxiety, pain, and quality of life in individuals with mild or moderate malocclusion between conventional fixed orthodontic treatment versus Invisalign: a randomised clinical trial

BACKGROUND

We evaluated anxiety, pain, and oral-health-related quality of life in individuals treated with conventional fixed appliances (Group A) and clear aligners (Group B) for moderate malocclusion during the initial phase of orthodontic treatment.

METHODS

Sixty individuals, separated into Group A (n = 30) and Group B (n = 30), were included in the study. They completed the Anxiety Levels, Oral Health Impact Profile-14, and Oral Health Related Quality of Life - United Kingdom/Surveys after the application of attachments on days 0 (T1), 10 (T10), and 20 (T20). Their pain levels were evaluated with the Visual Analogue Scale on days 0, 2, and 6 in the 2nd and 6th hours and on the 1st, 3rd, 7th, 14th, and 21st days.

RESULTS

Per the VAS questionnaire, pain levels in the 2nd hour, 6th hour, 1st day, and 3rd day were significantly lower in Group B than in Group A. In the OHIP-14 survey results, the comparison between Group A and Group B showed a significant difference only on the 1st day. The STAI and OHRQoL-UK survey results did not differ significantly between the groups.

CONCLUSIONS

We found no significant difference between the two groups in terms of anxiety levels, and pain among individuals in Group A was higher than in Group B only at the beginning of the treatment. No significant differences were observed in terms of individuals' quality of life.

TRIAL REGISTRATION

NCT06133296 (retrospectively registered)- Registration Date:15/11/2023.

Influence of pain duration and severity on oral health-related quality of life and patient satisfaction during adult treatment with clear aligners

BACKGROUND

This study aims to compare the impact of pain on quality of life and patient satisfaction during treatment with aligners.

METHODS

Ninety-four subjects in active treatment were invited to answer self-reported questions concerning pain severity and duration, occurrence of other signs and symptoms, and level of satisfaction with their treatment. Also, the OHIP-14 questionnaire was applied to assess patients' OHRQoL.

RESULTS

Ninety-four patients (49 women and 45 men) answered the survey. Pain duration of 1-3 days was reported by 69.1% of patients (n = 60). For those who reported pain (n = 84), it was considered mild severity by 42.9% and moderate by 52.4%. Almost sixty-four percent of the sample were very satisfied with the aligner's aesthetics (n = 60) and forty-nine percent were satisfied with treatment in general (n = 46). Mean OHIP-14 score was 3.36 ± 2.54. OHRQoL was significantly associated with pain severity, whereas patients who reported having experienced moderate pain presented a significantly higher mean OHIP-14 score than those who reported having experienced mild pain (3.92 ± 1.93 and 2.69 ± 2.83, respectively; p = 0.036). The "psychological discomfort" OHIP-14's domain was the most influenced by the level of pain.

CONCLUSION

Pain severity significantly influenced OHRQoL, in adult patients under treatment with clear aligners. However, high levels of patient satisfaction were reported, regardless of pain duration or severity.

Comparison of Patient Satisfaction between Invisible Appliance and Fixed Orthodontic Appliances - A Systematic Review

To compare the patient acceptance between fixed orthodontic appliances and clear aligners. An electronic search was completed in PubMed, Cochrane Database, Web of Science, Scopus, Lilacs, Google Scholar, and Open Grey databases without any restrictions until August 23. All comparative study types contrasting patient perception between clear aligners and fixed appliances were included. After removal of duplicates, exclusion by title and abstract, and reading the full text, only eight articles were included. The studies used an observational questionnaire study design. Of the observational studies, one was retrospective and three prospective, one online survey, and the other three cross sectional. Though the response varied in terms of patient preference and acceptance, it was found that clear aligners have a positive impact with respect to quality of life, tolerance, and improved confidence. However, there is not enough evidence to make a final conclusion about treatment outcomes.

Clear aligner therapy versus conventional brackets: Oral impacts over time

Background

The objective is to compare the impact of clear aligner treatment (CAT) versus conventional fixed appliance treatment (FAT) on oral health-related quality of life (OHRQoL) among adults at five-time points: pretreatment (T0), 1 week (T1), 1 month after (T2), and 6 months after (T3) treatment initiation, and in the long-term follow-up (T4).

Materials and Methods

Search terms were based on Medical Subject Headings (MeSH) and non-MeSH. Potentially eligible studies compared OHRQoL in clear aligner (CA) and fixed appliance (FA) patients. In February 2023, Scopus, Web of Science, Cochrane, and PubMed were searched for published studies. Nine out of 94 shortlisted papers were eligible for a systematic review. Of these nine papers, five studies were considered for a meta-analysis.

Results

At T0, CA and FA patients had similar oral health impact profile (OHIP)-14 questionnaire scores with a standard mean difference (SMD) of 0.105 (confidence interval [CI]: -1.029-1.48). The SMD of the OHRQoL related to T1, T2, and T3 was -3.119 (CI: -0.145, 0.355), -1.527 (CI: -5.597, -0.64), and - 2.331 (CI: -1.906, -1.148). T4 showed no difference between groups (SMD = 0.007, CI: CI: -4.286, -0.376). Regarding the OHIP-14 domains, functional limitations remained consistent in both groups across all time intervals. Psychological discomfort exhibited a notable difference only at T2. Throughout the treatment, CAT showed significantly lower levels of physical, psychological, and social disability, as well as handicap, though these differences did not persist beyond T4. Notably, physical pain was the sole domain that remained elevated in the FAT group up to T4.

Conclusion

During the 1st day of the orthodontic treatment, both the CA and FA groups had comparable OHRQoL statuses. However, as time passed, the CA group notably improved their OHRQoL compared to the FA group. Interestingly, after a year or the completion of treatment, both groups eventually reached similar OHRQoL levels. Nevertheless, it is worth noting that FA patients continued to experience more physical pain even a year later.

Periodontal health status, oral microbiome, white-spot lesions and oral health related to quality of life-clear aligners versus fixed appliances: A systematic review, meta-analysis and meta-regression

Objective

: Assess and evaluate the different indicators of oral health-related quality of life (OHRQoL) among patients treated with clear aligners (CAs) versus those treated with conventional fixed orthodontics (FAs).

Methods

: An electronic search was performed on the database is Web of Science, Scopus, and Embase databases. Randomized and non-randomized control trials, cross-sectional, prospective cohort and retrospective trials were included. Quality was assessed with risk of bias tool and risk of bias in non-randomised studies. Meta-analyses were performed with random effects models, estimating the standardized and non-standardized mean differences, odds ratio and risk ratio as the measure of effect. The effect on time was determined using a meta-regression model.

Results

: Thirty one articles were included in the qualitative synthesis and 17 in the meta-analysis. CAs had a significantly lower negative impact on QoL, with an "important" effect size, while the influence of time was not significant. Periodontal indicators plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing show significantly better values in patients treated with CAs, with moderate to large effect sizes. PI and GI have a significant tendency to improve over time. In microbiological indicators, CAs present a lower biofilm mass without differences in the percentage of patients with high counts of Streptococcus mutans and Lactobacilli bacteria. The risk of white spot lesion onset is ten times lower in carriers of CAs.

Conclusions

: Patients wearing CAs show better periodontal indicators, less risk of white spot development, less biofilm mass and a better QoL than patients with FAs.

Comparison of pain intensity and impacts on oral health-related quality of life between orthodontic patients treated with clear aligners and fixed appliances: a systematic review and meta-analysis

OBJECTIVE

This study aimed to compare the pain intensity and impacts on oral health-related quality of life (OHRQoL) between orthodontic patients treated with clear aligners (CAs) and fixed appliances (FAs).

METHODS

A systematic search was conducted up to December 2022 using PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Embase. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) comparing pain intensity or OHRQoL between patients treated with CAs and FAs were included. The risk of bias (RoB) of individual studies was evaluated using the Cochrane RoB tool 2.0 and ROBINS-I tool for RCTs and non-RCTs, respectively. Further, meta-analyses were separately conducted for each included study using the total oral health impact profile (OHIP)-14 and visual analog scale (VAS) scores to evaluate OHRQoL and pain intensity, respectively.

RESULTS

Overall, 12 studies (5 RCTs and 7 non-RCTs) were included in the study. Subgroup analyses conducted according to the total OHIP-14 scores revealed that patients treated with CAs had higher OHRQoL at 1 week, 1 month, and 6 months of the treatment. Meanwhile, subgroup analyses conducted according to the VAS scores revealed that pain levels were lower in the CA group only at 3 and 4 days of the treatment.

CONCLUSIONS

Patients treated with clear aligners had higher OHRQoL than those treated with fixed appliances during orthodontic treatment. However, OHRQoL appeared to be similar between the two groups at the end of the treatment. Moreover, patients treated with clear aligners experienced lesser pain than those treated with fixed appliances on the third and fourth day after the initial treatment. The difference in pain intensity between the two treatment modalities was not noted at other time points.

Comparative analysis of periodontal pain and quality of life in patients with fixed multibracket appliances and aligners (Invisalign®): longitudinal clinical study

BACKGROUNDS

The aim of this longitudinal clinical study is to analyse and compare according to location, degree and type, the pain presented by patients during their first year of treatment, as well as the quality of oral life after the placement of two types of orthodontic appliances: conventional brackets and removable Invisalign ® aligners.

METHODS

The sample consisted of 140 patients grouped into 2 study groups of 70 patients each. The first group (brackets group- BG), with fixed multibracket appliances, using the MBT technique and a 0.022" slot. The second group (invisaling group- IG), in treatment with removable aligners (IG), using the Invisalign ® system. They were providen with a questionnare where they had to record the degree (mild, moderate or intense), the type and location of the pain monthly during the first year of treatment. The second form was the Spanish version of the OHIP-14, oral quality of life questionnaire, which was provided the twelfth month after the start of treatment.

RESULTS

In both groups, we found that the most frequent location of pain occurred during the first phase: mandibular for the IG group and maxillary in the BG group. Throughout the whole analysis, the intensity was mild-moderate with lower values in the conventional brackets' group. The BG group reported acute pain while the IG group reported sensitive pain during the first month; later both reported sensitive pain.

CONCLUSIONS

There are differences in terms of periodontal pain in its degree, location, and type according to the different orthodontic techniques used.

TRIAL REGISTRATION

The study was approved by the bioethics committee of the University of Salamanca (USAL_20/516).

Sulfate-Reducing Bacteria in Patients Undergoing Fixed Orthodontic Treatment

OBJECTIVES

The oral microbiological environment may be implicated in the corrosion of orthodontic metals. This study aimed to examine the prevalence of sulfate-reducing bacteria (SRB) in orthodontic patients undergoing fixed appliance treatment.

METHODS

Sixty-nine orthodontic and 69 healthy non-orthodontic participants were enrolled in the study. Supragingival and subgingivaloral biofilm were collected and tested for the presence of SRB. The DNA extraction, polymerase chain reaction (PCR), and 16sRNA Sanger sequencing method was performed from the SRB-positive samples. The sequenced PCR products were analysed and compared with databases to identify the bacterial genus.

RESULTS

Amongst 69 orthodontic patients, characteristic black precipitates developed in 14, indicating the presence of iron sulfides which demonstrates the likelihood of SRB. Alternatively, 2 out of 69 showed the presence of SRB in healthy non-orthodontic participants (controls). Desulfovibrio spp was confirmed by analyses of 16sRNA sequencing, which revealed that the SRB prevalence was 20% in the examined participants with orthodontic appliances.

CONCLUSIONS

The prevalence of SRB was found to be significantly higher amongst orthodontic patients compared to non-orthodontic participants. Presence of stainless steel in the oral environment may have facilitated the colonisation of SRB.

A systematic review of biocompatibility and safety of orthodontic clear aligners and transparent vacuum-formed thermoplastic retainers: Bisphenol-A release, adverse effects, cytotoxicity, and estrogenic effects

Background

An ever-increasing demand is seen for clear aligners and transparent vacuum-formed retainers. They are esthetic and convenient. However, the biomaterials used in these appliances might pose biological safety and biocompatibility threats in terms of their bisphenol-A (BPA) release, cytotoxicity, adverse effects, and estrogenic effects. Due to the controversial results and the lack of any systematic reviews in this regard, we conducted this systematic review.

Materials and Methods

Web of Science, PubMed, Cochrane, Scopus, and Google Scholar as well as references of the found articles were searched (independently by 3 researchers) up to December 22, 2021, to find studies relevant to the biocompatibility of clear aligners and thermoplastic retainers. The search keywords were a combination of the following (and more): Essix, vacuum-formed aligner, thermoplastic aligner, clear aligner, Invisalign, vacuum-formed retainer, BPA release, monomer release, cytotoxicity, estrogenicity, biocompatibility, chemical properties, and oral epithelial cell. As eligibility criteria, articles in all languages would be included as long as their text could be translated clearly using online translators or by professional translators; all types of publications (article, book, and thesis) would be included if containing relevant studies and information; they should have been on clear liners or thermoplastic retainers; and they should have been on biocompatibility, safety, cytotoxicity, or estrogenicity of clear aligners or thermoplastic retainers. There were no restrictions on the type of study (randomized clinical trials, experimental in vitro studies). Studies focusing merely on the mechanical properties of clear aligners or thermoplastic retainers (without examining their chemical properties) would be excluded. The risk of bias was assessed.

Results

The risk of bias was rather low. However, the methodologies of the studies were quite different. Overall, 16 articles (1 randomized clinical trial and 15 in vitro studies) were identified. The data for BPA release were reported in four articles (1 clinical trial and 3 in vitro studies). Quantitatively speaking, the amount of released BPA reported by in vitro studies was very low, if not zero. However, the BPA level was very high in the only randomized clinical trial. Many adverse effects were linked to using clear aligners or transparent retainers, including pain and soft-tissue issues such as burning, tingling, sore tongue, lip swelling, blisters, ulceration, dry mouth, periodontal problems, and even systemic problems such as difficulty in breathing. Besides these biological adverse effects, oral dysfunctions and speech difficulties and tooth damage may be associated with clear aligners and should as well be taken into consideration.

Conclusion

Given the very high levels of BPA leach observed in the only clinical trial and considering other possible dangers of small traces of BPA (even at low doses) and also given the numerous adverse events linked to clear aligners or transparent retainers, it seems that safety of these appliances might be questionable and more clinical studies of biocompatibility are needed in this regard.

Oral Health-Related Quality of Life throughout Treatment with Clear Aligners in Comparison to Conventional Metal Fixed Orthodontic Appliances: A Systematic Review

BACKGROUND

Orthodontic clear aligners constitute an alternative and increasingly used orthodontic treatment modality, offering enhanced esthetics with potential consequences regarding patients' oral health-related quality of life (OHRQoL).

OBJECTIVE

Summarize and systematically evaluate existing evidence on the OHRQoL of patients treated with orthodontic clear aligners compared to treatment with conventional metal, fixed appliances.

SEARCH METHODS

We searched without limitations six databases and searched manually the reference lists of relevant studies up to the end of October 2022.

SELECTION CRITERIA

We looked for data from prospective studies that compared OHRQoL, using instruments that had undergone full psychometric validation, between orthodontic patients with clear aligners and labial, fixed, metal orthodontic appliances.

DATA COLLECTION AND ANALYSIS

We extracted the data from the located studies, and we assessed the risk of bias with the Cochrane Collaboration suggested tools. The quality of available evidence was based on the GRADE approach.

RESULTS

Three studies were identified. OHRQoL was impacted less by clear aligners compared to treatment with conventional labially placed, fixed, metal appliances. The exploratory meta-regression, with the time point of assessment as predictor, did not reveal any statistically significant effect. The quality of the available evidence ranged from very low to low.

CONCLUSIONS

According to the exploratory synthesis of the limited available dataset, treatment with clear aligners could be associated with better OHRQoL ratings compared to treatment with conventional labially placed, metal, fixed appliances. However, the quality of the presented evidence renders further high-quality studies warranted to be able to reach safer conclusions.

Evaluation of the cell viability and antimicrobial effects of orthodontic bands coated with silver or zinc oxide nanoparticles: An in vitro study

Objective

We aimed to evaluate the cell viability and antimicrobial effects of orthodontic bands coated with silver or zinc oxide nanoparticles (nano-Ag and nano-ZnO, respectively).

Methods

In this experimental study, 30 orthodontic bands were divided into three groups (n = 10 each): control (uncoated band), Ag (silver-coated band), and ZnO (zinc oxide-coated band). The electrostatic spray-assisted vapor deposition method was used to coat orthodontic bands with nano-Ag or nano-ZnO. The biofilm inhibition test was used to assess the antimicrobial effectiveness of nano-Ag and nano-ZnO against Streptococcus mutans, Lactobacillus acidophilus, and Candida albicans. Biocompatibility tests were conducted using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay. The groups were compared using oneway analysis of variance with a post-hoc test.

Results

The Ag group showed a significantly higher reduction in the number of L. acidophilus, C. albicans, and S. mutans colonies than the ZnO group (p = 0.015, 0.003, and 0.005, respectively). Compared with the control group, the Ag group showed a 2-log₁₀ reduction in all the microorganisms' replication ability, but only S. mutants showed a 2-log₁₀ reduction in replication ability in the ZnO group. The lowest mean cell viability was observed in the Ag group, but the difference between the groups was insignificant (p > 0.05).

Conclusions

Coating orthodontic bands with nano-ZnO or nano-Ag induced antimicrobial effects against oral pathogens. Among the nanoparticles, nano-Ag showed the best antimicrobial activity and nano-ZnO showed the highest biocompatibility.

The Impact of Mobile Health Use on the Self-care of Patients With Type 2 Diabetes: Protocol for a Randomized Controlled Trial

Background

Chronic diseases are a substantial public health issue worldwide and affect an individual’s quality of life. Due to the alarming rise in type 2 diabetes, health care that was primarily focused on diagnosis and treatment of the disease is increasingly focused on prevention and self-care. Patients who adhere to a constant and strict treatment regimen (physical activity, diet, medication) and regularly monitor their health are more likely to maintain self-care and health, prevent the exacerbation of the disease, and avoid the complications of diabetes (retinopathy, diabetic feet, etc). In recent years, many innovative devices that have become increasingly present in inpatient health care, such as mobile apps, are available to help patients maintain consistency in monitoring their health status. Mobile apps make it easier for individuals to monitor their self-care and illness and follow instructions regarding disease control.

Objective

This study aims to determine the impact of mobile app use on self-care in patients with type 2 diabetes. We will evaluate and test the usefulness of the forDiabetes app as a tool to improve the self-care of individuals with type 2 diabetes.

Methods

We will perform a double-blind randomized controlled trial. The study will include individuals aged over 18 years diagnosed with or have regulated type 2 diabetes who are treated in family medicine practices. Additionally, the individuals included in the study should not have any acute complications due to the consequences of type 2 diabetes. They will use an Android or iOS mobile phone and a blood glucose meter during the investigation. With the help of simple randomization, individuals will be divided into the intervention and control groups. Individuals in the intervention group will use the forDiabetes mobile app to monitor their self-care for type 2 diabetes. Individuals in the control group will not receive a particular intervention. Data will be collected using the Self-care of Diabetes Inventory questionnaire and Brief Illness Perception Questionnaire. Blood sugar, blood pressure, glycated hemoglobin (HbA_1c), and weight measurements will be monitored using calibrated instruments during the study by the nurses employed at the family medicine practice. Data will be collected at the beginning of the study and after a patient visits the family medicine practice.

Results

In the first half of 2020, we have prepared a translation of the mobile app that will be used by the participants of the intervention group, as well as more detailed instructions for using the app. We have also prepared a translation of the questionnaires in Slovene. The research results will be published in 2023.

Conclusions

This research contributes to greater visibility and usability of mobile apps for the self-care of patients with type 2 diabetes and raises awareness of the possible use of innovative methods.

Trial Registration

Clinicaltrials.gov NCT04999189; https://clinicaltrials.gov/ct2/show/NCT04999189

International Registered Report Identifier (IRRID)

PRR1-10.2196/31652

Evaluation of the Oral Health-Related Quality of Life (OHRQoL) in Patients Undergoing Lingual Versus Labial Fixed Orthodontic Appliances: A Randomized Controlled Clinical Trial

Background

Wearing fixed orthodontic appliances may negatively impact oral health-related quality of life (OHRQoL) during treatment. This study aimed to compare the OHRQoL of patients treated with labial or lingual appliances.

Methodology

A total of 38 patients (23 females, 15 males; mean age: 21.3 years) with class I malocclusion and moderate crowding in the upper and lower dental arches were included. These patients were planned to be treated on a non-extraction basis and were randomly divided into the following two groups: the lingual appliance (LA) group and the buccal appliance (BA) group. The Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to measure the OHRQoL at the following six assessment times: before treatment (T0), one week after treatment (T1), one month after treatment (T2), three months after treatment (T3), six months after treatment (T4), and at the end of the active treatment (T5).

Results

In total, 19 patients in each group were included in the final analysis with no dropouts. In both groups, the overall OHIP-14 scores increased and peaked on the first week following appliance placement and then significantly decreased over time. The LA group had significantly greater overall OHIP‑14 scores than the labial group at T1 (p < 0.001) and T2 (p = 0.004) only.

Conclusions

The OHRQoL improved in both lingual and labial groups after treatment. Moreover, it was better in the labial group compared to the lingual group during the first month of treatment. In both groups, the greatest deterioration in OHRQoL occurred in the first week and gradually decreased over time.

Does Clear Aligner Treatment Result in Different Patient Perceptions of Treatment Process and Outcomes Compared to Conventional/Traditional Fixed Appliance Treatment: A Literature Review

This study sought to systematically review the literature to determine whether clear aligner treatment results in different patient perceptions of treatment process and outcomes compared with conventional fixed appliance treatment. A systematic review was conducted to identify studies that examined differences in patient perceptions between clear aligners and conventional fixed appliance treatment. Studies were identified through searching relevant terms using PubMed and Embase. Following review of identified articles, key information about the studies including study design, setting, comparison groups, sample size/response rate, study location, primary outcomes, and statistical tests used were extracted. A total of 13 articles were identified that met the inclusion criteria for this study. These studies described a variety of outcomes which were divided into two broad categories: treatment process (pain, chewing, speech, daily routine, etc.) and treatment outcomes (satisfaction level, smile outcome perceptions, etc.). There was the strongest evidence that clear aligners had a positive impact with respect to treatment process compared with fixed orthodontic appliances. This study highlights that clear aligners may be effective for improving treatment-process-related outcomes among orthodontic patients. More studies need to be conducted to determine whether clear aligners have a beneficial impact with respect to treatment outcomes.

The Impact of COVID-19 on Dental Research in Educational Settings: What are the Opportunities?

The COVID-19 pandemic has significantly impacted dental education and research activities, creating challenges for students, educators, and health-care professionals. The unfolding crisis has shed the light on how technology can facilitate not only the delivery of dental education and improving access to dental care but also new and ongoing research. While dental schools worldwide have re-structured their policies and curricula in terms of incorporating appropriate methods of distance learning, this now needs to be applied to dental research where appropriate. By conducting a "strengths, weaknesses, opportunities, and threats" analysis and describing the authors' experiences, here we discuss the impact of the pandemic on various aspects of dental research to provide a timely perspective on dental research activity in academic institutions to help achieve research outcomes despite the pandemic's impact.

Effectiveness of a Selective Etching Technique in Reducing White Spots Formation around Lingual Brackets: A Prospective Cohort Clinical Study

The risk of developing white spot lesions (WSLs) after orthodontic treatment with lingual brackets is generally considered lower than with labial ones, even if plaque accumulation is frequently higher due to the increased difficulty level in oral hygiene maintenance. In this prospective clinical study, selective enamel etching technique effectiveness in reducing plaque accumulation and WSLs was tested. Thirty patients were bonded with a split-mouth approach: two randomly selected opposite quadrants were used as the test sides, using customized plastic etching guides, and the other two as control sides, applying traditional direct etching methods. The plaque presence around the braces was recorded after 1, 3, 6, and 12 months according to a lingual plaque accumulation index (LPAI), as was the presence of WSLs. PAI measured values were significantly higher in the control sides during the observation period. Test and control sides differed significantly for new WSL onset only after 12 months of treatment. Therefore, the present research demonstrated that this guided enamel etching technique allowed for significant reduction in plaque accumulation around the lingual brackets and reduced onset of white spots after one year of treatment.

Comparative Analysis of Periodontal Pain According to the Type of Precision Orthodontic Appliances: Vestibular, Lingual and Aligners. A Prospective Clinical Study

The objective of this prospective clinical study was to analyze the pain (intensity, location and type) that patients presented after the placement of different types of orthodontic appliances: conventional, low friction, lingual and aligners. The sample consisted of 120 patients divided into four groups: conventional (CON), low friction (LF), lingual (LO) and aligners (INV). The participants were given the Short-Form McGill Pain Questionnaire (Ortho-SF-MPQ), where they had to record the pain intensity (no pain, mild, moderate or intense) and the periodontal location at different time points, from the first 4 h to 7 days after the start of treatment. In all the study groups, the most frequent location was both anterior arches, with maximum values between 56.7% (CON group at 24 h) and 30% (LO group at 4 h). The "whole mouth" and "complete lower arch" locations were indicated only by the patients in the lingual group. Regarding pain intensity, the patients reported a higher percentage of mild-moderate pain during the first 3 days of treatment (96.7% in LO at 4 h, 86.7% in CON, 83.3% in LF and 90% in INV at 24 h); later, the reported pain decreased to no pain/mild pain, especially in the lingual group, until reaching values close to zero at 7 days post-treatment. The most frequent type of pain was acute in the low friction and lingual groups (with maxima of 60% and 46.7% at 24 h, respectively). On the contrary, in the conventional (36.7% at 4 h) and Invisalign (40% at 24 h) groups, the sensitive type was the most frequent. There are differences regarding periodontal pain in its intensity, location and type according to the use of different orthodontic techniques.

The Influence of Friction on Design of the Type of Bracket and Its Relation to OHRQoL in Patients Who Use Multi-Bracket Appliances: A Randomized Clinical Trial

Background and objectives: The aim of this study was to evaluate the influence of friction on design of the type of bracket, patients’ perception of pain and the impact on their oral health-related quality of life. Materials and Methods: A randomized clinical trial was carried out with 90 patients (62.2% women and 37.8% men) with three kinds of fixed multi-bracket appliances: Conventional (GC), fixed multi-bracket low friction (GS) and self-ligating (GA). The VAS (Visual Analogue Scale) was used to determine pain during the first seven days of treatment at different points in time. The patients were also given the OHIP-14 (Oral Health Impact Profile) questionnaire to analyse their oral health-related quality of life (OHRQoL) after the first 30 days of treatment. The ANOVA test was used for the analysis of the variables and the post hoc Bonferroni test for the comparison between groups. Results: Maximum pain was observed between one and two days after the start of treatment. The GC group showed the greatest degree of pain, with maximum values (4.5 ± 2.0) at 24 h. The self-ligation brackets show lower impact on patients’ oral health-related quality of life (0.8 ± 2.2, p < 0.01). Conclusions: Friction in the type of bracket influences pain and the Oral Health-Related Quality of Life of patients who use multi-bracket fixed orthodontics.

The effect of vestibular, lingual, and aligner appliances on the quality of life of adult patients during the initial stages of orthodontic treatment

Background

Patient quality of life (QoL) during orthodontic treatment is an important consideration that requires greater academic investigation as greater focus is placed on enhancing patient experience. Quality of life (QoL) was assessed in three orthodontic appliance groups, i.e., vestibular, lingual, and aligners during the initial stages of treatment. The sample was comprised of 117 adult patient-subjects distributed into 3 groups: vestibular (n = 41), lingual (n = 37), and aligner (n = 39). A WHOQOL-BREF questionnaire surveyed four domains (physical health, psychological health, social relationships, and environment).

Results

Mean scores for domain 1, physical health, showed that the aligner group (28.1) had significantly greater scores than that of the vestibular (22.7) or lingual (22) groups. Domain 2, psychological health, demonstrated significant differences (P < 0.001) between all groups, with the aligner group scoring the highest (23.2), followed by the lingual (18.4) and vestibular (15.2) groups. Domain 3, social relationship, showed that aligner (10.9) and lingual (10.2) scores were significantly greater (P < 0.001) than those of the vestibular group (7.8). Domain 4, environment, displayed significant differences between all groups, with the aligner group scoring highest (32.1), followed by the lingual group (29.3), and lastly the vestibular group (26.4). Overall, the highest mean score was obtained by the aligner group (23.1) and the lowest mean score was by the vestibular group (18). The mean domain scores for all three groups were significantly different (P ≤ 0.005) from each other (Table 2).

Conclusions

Overall, patients undergoing Aligner therapy reported the overall highest QoL scores, followed by lingual and vestibular groups.

Relationship between oral health impacts and personality profiles among orthodontic patients treated with Invisalign clear aligners

This within subject clinical experiment assessed oral health impacts before and after Invisalign orthodontic treatment and their relationships with personality characteristics. 50 patients (26 females and 24 males; mean age = 27.62 ± 8.25 years, SE = 1.17, 95% CI = 24.71–29.89 years) were assessed before and after treatment with Invisalign orthodontic treatment. Treatment clinical success was evaluated according defined clinical guidelines. Oral health impacts before and after Invisalign orthodontic treatment were measured via the Oral Health Impact Profile (OHIP). Personality features were measured via the NEO Five-Factor Inventory (NEO-FFI). Probability of α = .05 was utilized to identify significant findings. Females scored less OHIP scores after treatment (had less negative impacts) in comparison to baseline OHIP scores (t = 3.782, df = 25, P = .001, 95% CI of mean difference = 2.750–9.327). Among males, openness scores (R² = .911, B = 5.235, 95% CI for B = 0.062–10.407, t = 2.601, P = .048) were able to predict OHIP scores before treatment; meanwhile, extraversion (R² = .959, B = − 8.224, 95% CI for B = − 14.605–1.843, t = − 3.313, P = .021), openness (R² = .959, B = 21.795, 95% CI for B = 10.737–32.853, t = 5.067, P = .004), and conscientiousness (R² = .959, B = 10.293, 95% CI for B = 4.796–15.790, t = 4.813, P = .005) scores were useful to predict OHIP scores after treatment (R² = .959, P < .05). NEO-FFI scores were not useful to predict OHIP scores before or after treatment among females (P > .05). These findings demonstrate that oral health impacts of Invisalign orthodontic treatment and personality profiles contribution to oral health impacts were different between genders.