Orthodontic appliances for the treatment of pediatric obstructive sleep apnea: A systematic review and network meta-analysis

This systematic review and network meta-analysis aims to preliminarily investigate the efficacy of different orthodontic appliances for the treatment of pediatric obstructive sleep apnea (OSA). Electronic databases were systematically searched. Randomized and non-randomized controlled trials with patients <18 y treated with either mandibular advancement appliance (MAA), rapid maxillary expansion (RME), or myofunctional therapy (MFT) were included. A network meta-analysis using multivariate random effects was conducted to estimate pooled differences using the apnea-hypopnea index (AHI) as the main outcome. Eleven studies (595 patients) were included in the analysis. Compared with control, MAA was associated with significant reductions in AHI of -2.18/h (95%CI -3.48 to -0.89, p = 0.001). Combined treatment of RME + adenotonsillectomy (AT) and RME + MAA showed a significant decrease in AHI, with -5.13/h (95%CI -7.50 to -2.76, p < 0.0001) and -3.79 (95%CI -5.21 to -2.37, p < 0.0001), respectively. MFT was associated with a -2.45/h (95%CI -4.76 to -0.14, p = 0.038) decrease in AHI. However, RME alone was not associated with significant AHI reduction (0.02, 95%CI -1.72 to 1.75, p = 0.985). The heterogeneity of the network meta-analysis was I2 = 32.6%. Limited evidence indicated that MAA (alone or combined with RME) and RME + AT were associated with benefits for pediatric patients with OSA. This study could not find convincing evidence of a significant benefit of other orthodontic appliances over control.

Differential Stability of One-layer and Three-layer Orthodontic Aligner Blends under Thermocycling: Implications for Clinical Durability

Objectives

To optimize the therapeutic usefulness of aligners, it is crucial to understand how their mechanical properties alter with time.

Materials and methods

Specimens from four different brands, including Duran+, CA® Pro, Zendura A, and Zendura FLX, were produced for material testing of thermoplastic orthodontic aligners (TOA) using dimensions measuring 4mm x 10mm. Each brand's 24 samples were split into three groups as follows: G1 being thermoformed, G2 being thermoformed and underwent 500 thermocycles (simulating 7 days), and G3 being thermoformed and underwent 1000 thermocycles (simulating 14 days). Surface roughness, modulus of elasticity in bending, and spectrophotometry were used to assess the effect of aging on TOAs.

Results

After 1000 thermocycles, Duran+ had the highest modulus of elasticity and differed statistically from all other groups. The intragroup comparison showed that only Duran+'s elastic modulus significantly changed after 1000 thermocycles in comparison with the control group. Surface roughness values (Ra), did not statistically differ among brands or thermocycling group measures. The change in chemical properties was not significant in any brand.

Conclusion

One-layer PETG (Duran+) failed to demonstrate stability after in vitro aging, thus suggesting that clinicians should be aware of the change in mechanical properties when using one-layer PETG (Duran +) in a 2 weeks regime.

[Biofilm and Orthodontic Materials: literature reviews and Scanning Electron Microscopy (SEM) images gallery]

INTRODUCTION

Plaque control remains a concern in oral health but also in orthodontics.

OBJECTIVE

The aim of this paper was to investigate the dental plaque adhesion to different orthodontic appliances.

MATERIALS AND METHODS

Four literature reviews were initiated to clarify the accumulation of dental plaque to different orthodontic appliances, namely the type of brackets (conventional versus self-ligating, metal versus clear), the type of ligatures (metal versus elastomeric) in addition to the type of archwires. Moreover, a gallery of Scanning Electron Microscopy (SEM) images was made on different orthodontic appliances before and/or after time in the oral cavity.

RESULTS

Considering the strong methodological heterogeneity of the included studies, there is no consensus on which type of bracket should be preferred for the prevention of plaque retention. Metal ligatures would be less prone to plaque accumulation compared to elastomeric ligatures, which are themselves color-dependent. The type of archwire was not investigated in this topic. SEM images highlighted the presence of anfractuosities on the surface of new orthodontic archwires as well as the presence of biofilm at different degrees of maturation on the appliances after time in the oral cavity.

CONCLUSION

Although it is not possible to establish a consensus on which orthodontic appliances should be preferred to decrease plaque retention, different stages of biofilm evolution are observable on their surface and therefore potentially associated with a proportional virulence.

Perspectives of Orthodontists of the Diagnosis, Prevention, and Management of White Spot Lesions: A Qualitative Study

Aims

Several factors influence the development of white spot lesions (WSLs), and one of these is fixed orthodontic appliances. This study aims to evaluate the awareness, preventive strategies, and management of WSLs among a group of Orthodontists.

Materials and Methods

A qualitative methodology was applied; four focus groups made up a purposive sample from Orthodontists with various training backgrounds while working within the same healthcare services.

Results

Three main themes emerged: awareness and ability to diagnose WSLs, perceived influences on the development of WSLs, and prevention and management strategies and barriers to care delivery. All focus groups agreed that there is a need for continuous prevention and preventive strategies of WSLs, particularly among orthodontic patients. There was also a consensus that orthodontic treatment should be delayed until WSLs are managed appropriately.

Conclusions

Within the limitation of this study, WSLs were collectively agreed to be a significant issue during fixed orthodontic therapy, and continuous professional development for Orthodontists should include risk factors evaluation, diagnosis, prevention, and management of WSLs.

Comparison of dentoskeletal and soft tissue changes between tooth-borne and tooth-bone-borne hybrid nonsurgical rapid maxillary expansions in adults: a retrospective observational study

BACKGROUND

Despite the gradual increase in the use of rapid maxillary expansion (RME), specifically RME with the aid of skeletal anchorage in adults, there have been no reports comparing dentoskeletal and soft tissue changes between nonsurgical tooth-borne and tooth-bone-borne RMEs in adults. This study aimed to analyse differences in dentoskeletal and soft tissue changes between tooth-borne and tooth-bone-borne RMEs using a similar appliance design and the same expansion protocol in adult patients.

METHODS

Twenty-one patients with tooth-borne expansion (a conventional expansion screw with two premolars and two molar bands for dental anchorage [T-RME]) and the same number of patients with tooth-bone-borne hybrid expansion (a conventional expansion screw with two premolar and two molar bands for dental anchorage and four mini-implants in the palate for skeletal anchorage [H-RME]) were included. Dentoskeletal and soft tissue variables at pretreatment (T1) and after expansion (T2) were measured using posteroanterior and lateral cephalograms and frontal photographs. The sex distribution of the two groups was analysed using the chi-square test, and the change after RME in each group was evaluated using the Wilcoxon signed-rank test. Differences in pretreatment age, expansion duration, post-expansion duration, and dentoskeletal and soft tissue changes after RME between the two groups were determined using the Mann-Whitney U test.

RESULTS

There were no significant differences in the expansion protocol, pretreatment conditions, and sex distribution between the two groups. Despite similar degrees of dental expansion at the crown level between the two groups, H-RME induced increased skeletal and parallel expansion of the maxilla compared to T-RME. After expansion, H-RME demonstrated increased forward displacement of the maxilla without significant changes in the vertical dimension, while T-RME exhibited increased backward displacement of the mandible, increased vertical dimension, and decreased overbite. Both groups showed significant retroclination and extrusion of the maxillary incisors without significant intergroup differences. There were no significant soft tissue changes between the two groups.

CONCLUSION

This study suggests that using skeletal anchorage in RME may induce increased skeletal and parallel expansion of the maxilla without significant effects on the vertical dimension.

Does the exposure to cigarette smoke influence the colour stability and mechanical properties of different orthodontic elastic ligatures? - in vitro study

OBJECTIVE

The aim of this study was to evaluate the colour stability and mechanical resistance of orthodontic elastic ligature exposed to cigarette smoke.

METHODS

Four commercial brands were used: Aditek® (GA), Eurodonto® (GE), Morelli® (GM) and Orthometric® (GO). Eight elastic ligature rings (for mechanical analysis) and eight 5×5mm fragments of the material (for colour stability analysis) were separated from each commercial brand for the control group (C) (n=64) and experimental group (E) (n=64). The control group was not exposed to cigarette smoke. Colourimetric status (CIEL*a*b* System) and light transmittance (% transmitted light) were evaluated using Vita Easyshade Compact and CM2600 spectrophotometers, respectively. The mechanical resistance was evaluated using a universal testing machine (EMIC DL), performing tensile testing (speed 5mm/min). The analyses occurred at the following times: T0, before exposure to the smoke; T1, after the 1st exposure; and T2, after the 2nd exposure to cigarette smoke. Comparison between the groups and evaluation of the time effect were performed with the ANOVA/Tukey (a=0.05) and ANOVA-MR tests with Bonferroni correction (α=0.016).

RESULTS

Significant differences were only observed for colour stability in the GA-E (NBS T2: 15.94±1.88) and GM-E (NBS T2: 16.11±4.54) groups (P<0.05); transmittance in the GA-E group (T2-T0: -9.07±5.01) (P<0.016) and mechanical resistance in the GA-C group (T2-T0: -0.95±0.61N) (P<0.016).

CONCLUSION

The orthodontic elastic ligatures were sensitive to the cigarette smoke exposure regarding to loss of mechanical strength properties and change in colour stability.

Mid-term follow up effectiveness of facemask treatment in class III malocclusion: A systematic review

OBJECTIVE

This systematic review aims to investigate and summarize the mid-term effects and stability of the treatment with facemask appliance.

METHODS

Search without restrictions in five databases (Pubmed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials) since inception and hand searching until March 2021 was conducted. Detailed search strategies were based on the PubMed strategy and adapted accordingly. Studies assessing the mid-term effects of facemask appliance, with a follow-up post-treatment period of more than 6 years or after the peak of pubertal growth, were to be included. The risk of bias in individual studies was assessed using the Cochrane guidelines for the RCT and the ROBINS-I tool for the non-RCT studies.

RESULTS

Five studies were finally considered eligible for inclusion (one RCT and four CCTs). According to the reported evidence, the mid-term success rate ranged from 62.7% to 100%. Mid-term success was identified with positive overjet as well as acceptable aesthetic and functional characteristics.

CONCLUSIONS

Class III malocclusion treated with facemask presents a high percentage of success in the mid-term follow-up period. The mid-term effects of facemask were stable for the maxilla, in terms of sagittal and anteroposterior dentoskeletal dimensions, and any kind of relapse is attributed to uncontainable residual growth of the mandible. However, considering the high risk of bias and the follow-up period limitations, more high-quality studies are necessary in order to achieve further clarification. Future research should be based also on identifying biomarkers to indicate likely treatment responses.

REGISTRATION NUMBER

PROSPERO: CRD42020179402.

[What are the factors influencing the aesthetic requirement in the choice of orthodontic appliances in adults?]

Although adult patients are said to be demanding in terms of discretion of the orthodontic appliance, the factors influencing the choice of the appliance are still poorly understood. The main objective of this study was to determine if there is a correlation, in adults, between the importance of the orthodontic treatment need and the aesthetic preference of the orthodontic appliance (metal braces, ceramic braces in buccal, lingual or aligner). The secondary objectives were to evaluate the impact of the patient's personal factors, his eventual orthodontic past and his perceived orthodontic need. Patients were interviewed by questionnaire before the first consultation. An index, depending of the discretion of the appliance, was used. The need for treatment was calculated via dental health component and aesthetic component of IOTN. Given the size of the sample, only trends can be emitted. The real need for treatment had no influence on the choice of the aesthetic appliance. The most demanding patients would be women, in their thirties, single, employed, executive or practicing a higher profession, with previous orthodontic treatment and having recently consulted an orthodontist, as an adult. These patients felt that their orthodontic treatment need was minimal or significant. Patients estimated the duration of treatment at 17 months. Lingual was considered the most aesthetic appliance far ahead of the aligners. A larger scale study is needed to determine the influence of each factor.

Evaluation of total bone and cortical bone thickness of the palate for temporary anchorage device insertion

BACKGROUND/PURPOSE

The palate has become a popular site for the placement of temporary anchorage devices (TADs) owing to its bone quantity and quality. This study aimed to investigate total and cortical bone thicknesses in the whole palate as well as palatal width using a standard grid system and cone-bean computed tomography (CBCT) images.

MATERIALS AND METHODS

The CBCT images of 43 samples were selected. The total bone and cortical bone thicknesses of the palate were surveyed on 64 points per patient. The palatal width was measured. The difference between the age and sex groups was analyzed.

RESULTS

The total palatal bone thickness in the adult group ranged from 9.85 ± 2.04 to 1.87 ± 0.79 mm. In the adolescent group, we found one-third of the incisor roots in the area 3 mm distal to the incisive foramen and 8 mm lateral to the mid-palatal suture. The cortical bone thickness in adults was significantly thicker in the posterior paramedian area than that in adolescents.

CONCLUSION

The thickest vertical bone is located in the zone 3 mm distal to the incisive foramen and 4-8 mm lateral to the midpalate. The zone 6 mm posterior to the incisive foramen and 2-8 mm lateral to the midpalate exhibited optimal thickness and was away from the incisor roots. This region could be a safe zone for adolescent patients to place TADs. When TADs are to be inserted at the posterior palate, the 2-mm paramedian area should be the first region of choice.

Orthopedic outcomes of hybrid and conventional Hyrax expanders

OBJECTIVES

To compare the effects of a hybrid miniscrew-supported expander versus a conventional Hyrax (CH) expander in growing patients.

MATERIALS AND METHODS

Forty patients were randomized into two groups: a hybrid Hyrax (HH) expander group using a Hyrax expander with two miniscrews and a CH expander group. The final sample had 18 subjects (8 female, 10 male; initial age of 10.8 years) in the HH group and 14 subjects (6 female, 8 male; initial age of 11.4 years) in the CH group. Cone-beam computed tomography examinations and digital dental models were obtained before expansion and 11 months postexpansion. The primary outcomes included the orthopedic transverse effects of expansion. Intergroup comparison was performed using analysis of covariance (P < .05).

RESULTS

Significantly greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width were found for the HH group. No intergroup differences were observed for dental arch width or shape changes.

CONCLUSIONS

The HH group showed greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width. No differences were observed for intermolar, interpremolar, or intercanine widths; arch length; or arch perimeter. Arch size and shape showed similar changes in both groups.

Effect of photobiomodulation on external root resorption during orthodontic tooth movement - a randomized controlled trial

OBJECTIVE

The objective of the study was to compare external root resorption during orthodontic tooth movement between patients who were subjected to photobiomodulation and those who were not.

MATERIALS AND METHODS

The study was designed as a split-mouth, single-blind randomized controlled trial conducted on twenty-two orthodontic patients requiring extraction of maxillary first premolars (age group 13-30years). A buccal force was applied to all the premolars using a 0.019″×0.025″ beta-titanium cantilever spring for 28days. The test group premolars were irradiated by indium-gallium-arsenide (InGaAs) diode laser (980nm, 100mW) 0, 3, 7, 11, 15 and 28days after force application. Each premolar was irradiated at ten locations on the buccal and palatal gingiva resulting in a total energy of 10J delivered per tooth. After 28days, the root surface of all the premolars were studied for the number and volume of resorption craters using three-dimensional optical profilometry by a blinded assessor. One-sample Kolmogorov-Smirnov test was used to ascertain normality and Mann-Whitney U test was applied for data analysis.

RESULTS

All twenty-two patients enrolled completed the study. The root surface analysis showed formation of 32.78% less number of resorption craters (P<0.05) and 39.49% less volume of resorption craters (P<0.05) in the test group premolars relative to the control group premolars.

CONCLUSIONS

The results of the present study, therefore, suggest that photobiomodulation reduces external root resorption during orthodontic tooth movement.

TRIAL REGISTRATION/REGISTRATION NUMBER

CTRI/2018/04/013520.

Plaque-removal effect of ultrafine bubble water: Oral application in patients undergoing orthodontic treatment

During orthodontic treatment, plaque tends to form around fixed orthodontic appliances, which increases the risk of dental caries. It has been reported that ultarafine bubble with a diameter <1 μm water (UFBW) effectively removes organic matter. In addition, UFBW is harmless and stable for at least one month with refrigeration. The aim of this study was to examine the plaque-removal effect of ultrafine bubble water (UFBW) to establish a new method to prevent dental caries in patients during orthodontic treatment procedures. The in vitro study examined different concentrations of UFBW and compared the cleaning effect to that of existing mouthwashes. High-concentration UFBW (HUFBW) was most effective in cleaning. In the subsequent clinical study, HUFBW showed a significantly higher plaque-removal effect compared to distilled water (p<0.01). Thus, supplementary use of HUFBW could decrease the incidence of dental caries during orthodontic treatment.

THE ROLE OF NEW TECHNOLOGIES IN DEFINING SALIVARY PROTEIN COMPOSITION FOLLOWING PLACEMENT OF FIXED ORTHODONTIC APPLIANCES - BREAKTHROUGH IN THE DEVELOPMENT OF NOVEL DIAGNOSTIC AND THERAPEUTIC PROCEDURES

Human saliva is rich in proteins of variable functions (e.g., enzymes, immunoglobulins, cytokines) and origin (blood plasma, salivary glands, or oral microflora). Circadian dynamics, volume and composition (electrolytes, pH, protein, etc.) of secreted saliva vary with local and systemic physiological and pathophysiological conditions. Therefore, the composition of saliva, protein in particular, has been intensively investigated to identify the potential markers and/or mechanisms of systemic and local diseases. Proteomic techniques used for the analysis of biological fluids have enabled great advances in salivary protein stabilization (as the main precondition for their analysis) and detection of those found in saliva in very low concentrations, including small proteins and peptides. This review brings the main characteristics of current proteomic techniques such as liquid chromatography-mass spectrometry, two-dimensional electrophoresis-mass spectrometry, and surface-enhanced laser desorption ionization/time of flight/mass spectrometry. These techniques enable simultaneous identification of hundreds and thousands of protein molecules, as well as identifying those of a potential biological value in particular states. This literature review is focused on the state-of-the-art and possibilities offered by proteomic techniques in analyzing the effects of orthodontic appliances on salivary protein composition and searching for potential markers of therapeutic success/failure or for the molecules by which therapeutic effects are achieved.

Thickness of orthodontic clear aligners after thermoforming and after 10 days of intraoral exposure: a prospective clinical study

Background

Clear aligners (CA) are among the most chosen orthodontic therapies for patients who require an invisible treatment. Previous studies showed that the thermoforming process and the complexity of the intraoral environment might alter the properties of these devices. The aim of the current prospective clinical study was to assess the thickness changes of the CA after 10 days of intraoral use. The secondary aim was to assess the reproducibility of the thermoforming process, in terms of aligner thickness.

Materials and methods

CA from 18 consecutive patients (13 women, 5 men, mean age 28.8 ± 9.6 years) were investigated. Before intraoral exposure (T0), the thickness of the unused CA was measured at different occlusal points on a 3D model with a dedicated software (Geomagic Qualify 2013; 3D Systems, Rock Hill, SC, USA). Two CA configurations were studied: passive maxillary aligner (P—no tooth movement; no shape for attachments) and active maxillary aligner (A—tooth movement; shape for attachments and divot). The used aligners were returned after 10 days (T1) and the thickness measurements were repeated. A Student’s t test for paired data (T1 vs. T0) was applied to compare the thicknesses of used and unused devices (significance level after Bonferroni correction for multiple comparison was set at p < 0.0014). Furthermore, to study the reproducibility of the thermoforming process, P and A aligners were thermoformed twice, and the thicknesses of the two unused thermoformed devices were compared by means of Student’s t test for paired data (significance level after Bonferroni correction for multiple comparison was set at p < 0.0014) and Dahlberg’s error.

Results

The thermoforming process showed good reproducibility for both aligner configurations, with a maximum Dahlberg’s error of 0.13 mm. After intraoral use, the thickness of P showed some statistically significant, but not clinically relevant, thickness changes as compared to the unused aligners, while A did not show any significant changes.

Conclusion

Considering the thickness changes, the thermoforming process is reliable both with active and passive aligner configurations. Also, the CA examined show good thickness stability after physiological intraoral ageing in a population of healthy adults.

Pharyngeal dimensional changes in class II malocclusion treatment when using Forsus® or intermaxillary elastics - An exploratory study

OBJECTIVE

Pharyngeal airway obstruction can facilitate some forms of sleep disorder breathing (SDB) in susceptible children, especially in those having class II malocclusion. Changes in the anatomic areas surrounding the pharyngeal region during orthodontic treatment could hypothetically impact the pharyngeal airway dimensions. Management of a class II malocclusion on a growing individual with either intermaxillary elastics or different removable or fixed class II appliance designs have been proposed over the last century. The objective of this retrospective exploratory cohort study is to investigate to what extent the class II malocclusion treatment with either intermaxillary elastics (IME) or Forsus® fatigue resistance device (FFRD) leads to changes in oropharyngeal airway dimensions.

MATERIALS AND METHODS

Twenty-nine patients diagnosed as class II with an average age of 12.7years were included in this study, (11 males, 18 females). The sample was divided into group 1: IME and group 2: FFRD. CBCT's scans before (T1) and after treatment (T2) were obtained and analysed using Dolphin software. Reliability was obtained using Intraclass Correlation Coefficient (ICC). Descriptive statistics, ANOVA and paired t-test were used for analysis.

RESULTS

Intra-rater reliability test was excellent in all measurements for both groups. There were no statistically significant differences in pharyngeal airway dimensions between both groups (P=0.919). A statistically significant correlation was found for sex, where male patients had the highest increase in oro-space area (ORS), and in oropharyngeal volume. Children under 14-year-old in IME group showed statistically negative correlation for sub-mandibular (SM) and for ORS, meaning the younger the greatest increase. Additionally, individuals younger than 14years had a statistically significant increase in the vertical dimension.

CONCLUSIONS

Both orthodontic treatment approaches appear to be associated with a similar increase in oropharyngeal airway dimensions. Male patients under 14-year-old had a greater significant increase compared to female patients and older children. Normal pharyngeal dimensions changes were not accounted for.

Do Dietary Habits Influence Trace Elements Release from Fixed Orthodontic Appliances?

The objective was to investigate the effect of dietary habits on the release of Cr and Ni ions from orthodontic appliances by hair mineral analysis. Patients (N = 47) underwent electronic questionnaire survey to investigate the effect of dietary habits on Cr and Ni levels in hair. The research was carried out on hair sampled at the beginning and in the 4th, 8th, and 12th months of the treatment. The content of Cr and Ni in the collected samples was determined by ICP-OES. The study showed that consumption of acidic dietary products may have the effect on increasing the release of Cr and Ni ions from orthodontic appliances. The release of Cr from orthodontic appliances in patients who consumed fruit juice, coffee, yoghurt, and vinegar was higher. The coefficients enabling comparison of metal ions release pattern at a given sampling points were defined. The comparison of the coefficients yielded the information on the possible magnification of metal ions released as the result of the additional factor consumption of acidic food or drink that intensifies metal ions release. The following magnification pattern was found for chromium: coffee (7.57 times) > yoghurt (2.53) > juice (1.86) > vinegar (1.08), and for nickel: vinegar (2.2) > coffee (1.22) > juice (1.05). Yoghurt did not intensify the release of nickel. Concluding, orthodontic patients should avoid drinking/eating coffee, yoghurt, fruit juices, and vinegar.

Class II malocclusion treatment effects with Jones Jig and Distal Jet followed by fixed appliances

OBJECTIVES

To compare the skeletal, dentoalveolar, and soft tissue changes in Class II malocclusion patients treated with Jones Jig and Distal Jet distalizers followed by fixed appliances.

MATERIALS AND METHODS

The experimental groups comprised 45 Class II malocclusion subjects divided into two groups. Group 1 consisted of 25 patients treated with the Jones Jig, and group 2 consisted of 20 patients treated with the Distal Jet. Group 3 comprised 19 untreated Class II subjects. Cephalograms were analyzed before and after orthodontic treatment. For intergroup comparisons, one-way analysis of variance and post hoc Tukey tests were performed.

RESULTS

During treatment, the experimental groups exhibited significant increases in occlusal plane inclination and maxillary second molar mesial tipping. Additionally, the molar relationship improved and overjet decreased significantly in the experimental groups. The Jones Jig group showed greater mandibular incisor proclination and greater overbite reduction than the control group. No significant intergroup differences in nasolabial angle changes were found.

CONCLUSIONS

Treatment protocols using the Jones Jig and Distal Jet followed by fixed appliances were effective in correcting Class II malocclusion by means of dentoalveolar changes without significant skeletal and soft tissue changes. The experimental groups showed occlusal plane clockwise rotation and greater mesial tipping of maxillary second molars when compared to the untreated group.

Alteration in Taste Perception among Young Children during the use of Removable Orthodontic Appliance Therapy

BACKGROUND

The sense of smell is very influential in the taste of foods. If the smell pleases us, we anticipate the taste of the food with a great deal of relish. If our sense of smell is impaired, so is our taste. The effect of appliance on taste perceptions has always had a controversial subject.

MATERIALS AND METHODS

The present study was designed to analyze the change in taste perception in children using removable orthodontic appliances. All the selected volunteers were given different taste stimuli and were asked to score as per their perception. The verbal score was calculated based on the correct and incorrect taste stimuli given to them. Visual analog scale was used to assess intensity and hedonic (palatability) estimation of the volunteers.

RESULTS

The volunteers from both study and control groups scored different values for taste stimuli. The majority of stimuli were estimated correctly by both groups. There was no statistically significant difference between the study and control groups.

CONCLUSION

In different testing sessions, the scoring of the volunteers was nearly constant, indicating that an appliance does not play a major role in the alteration of taste stimuli.

CLINICAL SIGNIFICANCE

The appliance brings about transient change in taste perception, we should educate the patient before delivering the appliance about the transient change in taste perception and encourage full-time wear of the appliance, including during meals, without fear of affecting taste sensations.

The microbial changes in subgingival plaques of orthodontic patients: a systematic review and meta-analysis of clinical trials

Background

Orthodontic treatment was found to have an impact on the quantity and constitution of subgingival microbiota. However, contradictory findings regarding the effects of fixed appliances on microbial changes were reported. The aim of this systematic review was to investigate the microbial changes in subgingival plaques of orthodontic patients.

Methods

The PubMed, Cochrane Library, and EMBASE databases were searched up to November 20, 2016. Longitudinal studies observing microbial changes in subgingival plaques at different time points of orthodontic treatment are included. The methodological quality of the included studies was assessed by Methodological index for non-randomized studies (MINORS). The studies that reported the frequency of subgingival periodontopathogens were used for quantitative analysis. Other studies were analysed qualitatively to describe the microbial changes during orthodontic treatment.

Results

Thirteen studies were selected, including two controlled clinical trials, three cohort studies and eight self-controlled studies. Four periodontopathogens, including Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi) and Tannerella forsythia (Tf), were analysed. Following orthodontic appliance placement, the frequencies of Pg and Aa showed no significant change (P = 0.97 and P = 0.77), whereas the frequency of Tf significantly increased (P < 0.01) during short-term observation (0–3 months). The frequency of Pi showed a tooth-specific difference, as it presented no significant difference (P = 0.25) at the site of the first molar but was significantly increased (P = 0.01) at the incisor. During long-term observation (> = 6 months), two studies reported that the levels of subgingival periodontopathogens exhibited a transient increase but decreased to the pretreatment levels afterwards. After removal of the orthodontic appliance, the four periodontopathogens showed no significant difference compared with before removal.

Conclusion

The levels of subgingival pathogens presented temporary increases after orthodontic appliance placement, and appeared to return to pretreatment levels several months later. This indicates that orthodontic treatment might not permanently induce periodontal disease by affecting the level of subgingival periodontal pathogen levels. Further studies of high methodological quality are required to provide more reliable evidence regarding this issue.

Patients' and Parents' Perception of Functional Appliances: A Survey Study

OBJECTIVE

To evaluate patients' and parents' perception of removable, fixed rigid, and fixed hybrid functional appliances and to compare their impacts on anxiety and discomfort during treatment in different age groups and genders.

METHODS

Data were gathered by means of a questionnaire that included items presumed to be associated with orthodontic compliance. A self-administered questionnaire was used to quantify patients' and parents' perceptions. Three groups were formed regarding the type of functional appliance used: fixed rigid (Functional Mandibular Advancer, FMA), fixed hybrid (Forsus Fatigue Resistant Device, FRD), and removable (Twin Block, TB). Two separate questionnaires were used for the patients and their parents comprising the necessary context. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were used for data analysis.

RESULTS

Patients needed less time to adapt to the FRD appliance. Eating difficulties were encountered by patients in the FMA group. Adolescents who had completed functional orthodontic treatment with a removable appliance had difficulties in controlling their saliva. Patients' and parents' perceptions were found to be in accordance with each other.

CONCLUSION

Adolescents who had completed functional orthodontic treatment with fixed appliances had more difficulty in their daily life. Orthodontists should be aware of this impact caused by functional orthodontic treatment and should regularly encourage patients by reminding them of the improvements to be had by fixing the malocclusion.

Orthodontic Therapy for Paediatric Cancer Survivors: A Review

The paper aims at reviewing the possibilities of orthodontic therapy for paediatric cancer survivors. It is important to understand the fundamental disease, it's treatment protocols, effects on growing skeleton, dental development, oral cavity and oral mucosa, dental caries, bone, orthodontic tooth movement.

Insight into orthodontic appliance induced pain: Mechanism, duration and management

Most of the orthodontic patients experience pain during treatment and this significantly influences their attitudes and the approach towards treatment. A number of factors that influence pain response include age, gender, personal pain threshold, mood and stress level of the person, cultural differences and types of orthodontic treatment. Pain is a often overlooked subject by orthodontists, it is nevertheless important to understand the source and mechanism of the pain that occurs during treatment, as well as the methods for managing and controlling this pain. This review attempts to overview the mechanism, duration and current management strategies of orthodontic treatment.

Influence of activation protocol on perceived pain during rapid maxillary expansion

OBJECTIVE

To investigate the influence of two different activation protocols on the timing and intensity of pain during rapid maxillary expansion (RME).

MATERIALS AND METHODS

A total of 112 prepubertal patients (54 males and 58 females, mean age 11.00 ± 1.80 years) with constricted maxillary arches underwent RME with two different activation protocols (group 1: one activation/day; group 2: two activations/day). Patients were provided with a numeric rating scale (NRS) and the Faces Pain Scale (FPS) to correctly assess their daily pain.

RESULTS

Subjects treated with RME at two activations/day reported statistically significantly greater amounts of pain than subjects treated with RME at one activation/day. Differences related to gender and skeletal maturity were found.

CONCLUSION

The choice of activation protocol influences the perceived pain during RME, and less daily expansion is correlated to less pain. Pain reported during RME could be influenced by skeletal maturity and gender of the subjects under treatment.

Impact of wearing fixed orthodontic appliances on quality of life among adolescents: Case-control study

OBJECTIVE

To investigate the impact of wearing a fixed orthodontic appliance on oral health-related quality of life (OHRQoL) among adolescents.

MATERIALS AND METHODS

A case-control study (1 ∶ 2) was carried out with a population-based randomized sample of 327 adolescents aged 11 to 14 years enrolled at public and private schools in the City of Brumadinho, southeast of Brazil. The case group (n  =  109) was made up of adolescents with a high negative impact on OHRQoL, and the control group (n  =  218) was made up of adolescents with a low negative impact. The outcome variable was the impact on OHRQoL measured by the Brazilian version of the Child Perceptions Questionnaire (CPQ 11-14) - Impact Short Form (ISF:16). The main independent variable was wearing fixed orthodontic appliances. Malocclusion and the type of school were identified as possible confounding variables. Bivariate and multiple conditional logistic regressions were employed in the statistical analysis.

RESULTS

A multiple conditional logistic regression model demonstrated that adolescents wearing fixed orthodontic appliances had a 4.88-fold greater chance of presenting high negative impact on OHRQoL (95% CI: 2.93-8.13; P < .001) than those who did not wear fixed orthodontic appliances. A bivariate conditional logistic regression demonstrated that malocclusion was significantly associated with OHRQoL (P  =  .017), whereas no statistically significant association was found between the type of school and OHRQoL (P  =  .108).

CONCLUSIONS

Adolescents who wore fixed orthodontic appliances had a greater chance of reporting a negative impact on OHRQoL than those who did not wear such appliances.

Do soft drinks affect metal ions release from orthodontic appliances?

OBJECTIVE

The effect of orange juice and Coca Cola(®) on the release of metal ions from fixed orthodontic appliances.

MATERIALS AND METHODS

A continuous flow system designed for in vitro testing of orthodontic appliances was used. Orange juice/Coca Cola(®) was flowing through the system alternately with artificial saliva for 5.5 and 18.5h, respectively. The collected samples underwent a multielemental ICP-OES analysis in order to determine the metal ions release pattern in time.

RESULTS

The total mass of ions released from the appliance into orange juice and Coca Cola(®) (respectively) during the experiment was calculated (μg): Ni (15.33; 37.75), Cr (3.604; 1.052), Fe (48.42; ≥ 156.1), Cu (57.87, 32.91), Mn (9.164; 41.16), Mo (9.999; 30.12), and Cd (0.5967; 2.173).

CONCLUSIONS

It was found that orange juice did not intensify the release of metal ions from orthodontic appliances, whereas Coca Cola(®) caused increased release of Ni ions.

Modelling of Cr and Ni ions release during orthodontic treatment: in vitro and in vivo methods

The kinetics of metal ions release from orthodontic appliances in in vitro, in in vivo on pigs, and in vivo trials on patients (where hair samples were taken) was discussed. We have evaluated (by means of ICP-OES and ISO 17025) and compared the mass of Cr and Ni ions released. Not all the metal ions released from the appliance were transferred to hair tissue. The transfer factor was expressed as coefficient ω and evaluated as: ωCr(patients) 33.0%, ωCr(pigs) 17.2%, ωNi(patients) 49.8%, ωNi(pigs) 0.553%. The kinetics was described by a power function. Coefficient ω was used to combine the models: the in vitro and in vivo on animals on the one hand and the in vitro and in vivo on human on the other, which enabled the extrapolation of in vitro and translation of the results into in vivo conditions. The dose of metal ions released during orthodontic treatment was estimated.

Enhancement of oscillatory activity in the endopiriform nucleus of rats raised under abnormal oral conditions

Endopiriform nucleus (EPN) is located deep to the piriform cortex, and has neural connections with not only neighboring sensory areas but also subcortical areas where emotional and nociceptive information is processed. Well-balanced oral condition might play an important role in stability of brain activities. When the oral condition is impaired, several areas in the brain might be affected. In the present study, we investigated whether abnormal conditions of oral region influence neural activities in the EPN. Orthodontic appliance that generates continuous force and chronic pain-related stress was fixed to maxillary incisors of rats, and raised. Field potential recordings were made from the EPN of brain slices. We previously reported that the EPN has an ability to generate membrane potential oscillation. In the present study, we have applied the same methods to assess activities of neuron clusters in the EPN. In the case of normal rats, stable field potential oscillations were induced in the EPN by application of low-frequency electrical stimulation under the medium with caffeine. In the case of rats with the orthodontic appliance, stable field potential oscillations were also induced, but both duration of oscillatory activities and wavelet number were increased. The enhanced oscillations were depressed by blockade of NMDA receptors. Thus, impairment of oral health under application of continuous orthodontic force and chronic pain-related stress enhanced neural activities in the EPN, in which up-regulation of NMDA receptors may be concerned. These findings suggest that the EPN might be involved in information processing with regard to abnormal conditions of oral region.

Restoring Function and Aesthetics in a Class II Division 1 Patient with Amelogenesis Imperfecta: A Clinical Report

Amelogenesis imperfecta (AI) encompasses a complicated group of hereditary conditions that cause developmental alterations in the structure of the enamel in the absence of a systemic disorder. AI primarily affects the quality and/or quantity of dental enamel, and it may affect all or only some of the teeth in the primary and/or permanent dentition. This clinical report describes the oral rehabilitation of a 21-year-old man diagnosed with hypomaturation-type AI. He presented with discolored and mutilated teeth. Cephalometrically, the patient has skeletal class II malocclusion due to mandibular deficiency considered as a result of maxillary constriction. The interdisciplinary approach was followed because of the complex needs of the patient. The aim of treatment was to restore aesthetics, improve malocclusion and masticatory function. Aesthetic and functional expectations were met with metal ceramic restorations. In this report, the interdisciplinary approach for a patient with AI and a malocclusion is described.