Self-perceived pain in Hyrax versus other maxillary expansion orthodontic appliances: a systematic review of clinical studies

PURPOSE

To evaluate self-perceived pain levels in the Hyrax compared to other types of maxillary expansion (ME) appliances in growing patients.

METHODS

An unrestricted search of indexed databases and manual searching were performed up to October 2022. Randomized controlled trials (RCTs) comparing the Hyrax appliance with other ME appliances were included. Data screening, extraction, and Risk of Bias (RoB) assessment with the Cochrane tool were performed by two authors.

RESULTS

Six RCTs were included. The number of participants in the included RCTs ranged between 34 to 114 and included both male and female growing patients. Various tools were used to measure self-perceived pain including the Graphic Rating Scale for Pain, the Wong-Baker Faces Pain Scale, the Numerical Rating Scale, the visual analogue scale, and a questionnaire. One RCT reported that pain intensity in patients treated with the Hyrax was higher than in the Haas appliance, with a statistically significant difference limited to the first day. Two RCTs reported that pain intensity in patients treated with the Leaf expander was lower than in the Hyrax during the first 7 days of treatment. Two RCTs reported no significant differences in pain intensity between the Hyrax and other ME appliances. One RCT reported that pain intensity in patients using the computer-guided skeletal ME appliance was higher than in the Hyrax appliance at the first day after expansion. Four RCTs had a high RoB, and two RCTs had a moderate RoB.

CONCLUSIONS

Within the limitations of the present systematic review and based on the currently available evidence, it is challenging and inconclusive to identify the best maxillary expansion appliances, regarding pain levels for growing patients.

Anti-nociceptive efficacy of essential oil-based extracts for the management of orofacial pain: a systematic review of available evidence

OBJECTIVE

Experimental studies have shown that essential oil (EO)-based extracts derived from medicinal plants exhibit antinociceptive activity. The aim of the present systematic review was to assess the anti-nociceptive efficacy of EO-based extracts for the management of orofacial pain (OFP).

MATERIALS AND METHODS

To address the focused question "Are EO-based formulations effective for the management of OFP disorders?", indexed databases were searched without time and language restrictions using the preferred reporting items for systematic reviews and meta-analysis guidelines. Risk of bias (ROB) was assessed.

RESULTS

Eight studies were included and processed for data extraction. Two studies were clinical (one in adults and one in children) and 6 were performed in rodents. Results from one clinical study showed that inhalation of EO-extracts does not affect subjective toothache scores; and results from the study on children reported that inhalation of lavender oil reduces anxiety and pain during and after tooth extraction. Results from all experimental studies showed that administration of EO-extracts reduces orofacial nociceptive behavior. The ROB was high in 50% and 83.3% of the clinical and experimental studies, respectively.

CONCLUSIONS

The anti-nociceptive efficacy of EO-extracts for the management of OFP remains debatable. Further well-designed and power-adjusted randomized clinical trials are needed in this regard.

Efficacy of photobiomodulation in the management of tinnitus: A systematic review of randomized control trials

There is a controversy in regards to the efficacy of photobiomodulation (PBM) in the management of tinnitus. The aim was to systematically review randomized controlled trials (RCTs) that assessed the efficacy of PBM (low-level laser therapy) in the management of tinnitus. The focused question was "Is PBM effective in the management of tinnitus?". Indexed databases were searched up to and including June 2020 using different combinations of the following key words: (a) laser; (b) diode; (c) low-level laser therapy; (d) photobiomodulation; (e) tinnitus; (f) medium-level laser; (g) photo-biomodulation; and (h) low-power laser; and RCTs performed on humans were included. Letters to the editor; case reports/series; commentaries; experimental studies and historic reviews were excluded. The risk of bias was assessed using the modified cochrane collaboration tool. The format of the current systematic review was personalized to summarize the appropriate information. Ten RCTs (2 single-blinded and 8 double-blinded) were included. One study reported 30% and 100% resolution of tinnitus using diode and Neodymium-doped Yttrium Aluminum Garnet lasers; respectively. One study reported that PBM was effective in relieving tinnitus for up to 3 months. Eight studies reported that PBM was ineffective in the management of chronic tinnitus. The risk of bias was high; medium and low in 4; 5 and 1 studies; respectively. The effectiveness of PBM in the management of tinnitus remains debatable. Further power-adjusted and well-designed RCTs with long-term follow-up are needed.

Influence of mini-screw implant-assisted intrusion on orthodontically induced inflammatory root resorption: a systematic review

AIM

To systematically review indexed literature related to the influence of mini-screw implant (MSI)-assisted intrusion on orthodontically induced inflammatory root resorption (OIIRR).

METHODS

Indexed databases were searched without time and language restrictions using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (a) original studies; (b) patients/subjects undergoing MSI-assisted intrusion; and (c) tomographic and/or histological assessment of OIIRR. Letters to the Editor, commentaries, case reports/series, reviews, and studies based on two-dimensional radiographic assessment of OIIRR were excluded. For experimental and clinical studies, the risk of bias assessment was performed using the Systematic Review Centre for Laboratory animal Experimentation risk of bias tool and the Risk of Bias in Non-randomized Studies of Interventions guidelines, respectively.

RESULTS

The initial search yielded 453 studies, out of which 6 (3 clinical and 3 on animal-models) were included. The clinical studies were performed on males and females with a mean age ranging between 16.07 and 25.5 years. Duration of the clinical studies ranged from 3.8 to 9 months. The animal studies were performed on mini-pigs, rats, and dogs. The mean age in the studies on rats and mini-pigs was 2.76 and 18 months, respectively. In the study on canine models, mean age was not reported. In all studies, MSI-assisted intrusion was shown to cause OIIRR. Power analysis was performed in one study. All studies had a moderate risk of bias.

CONCLUSIONS

MSI-assisted intrusion is a risk factor for OIIRR; however, from a clinical perspective, further well-designed and power-adjusted studies are needed.

Radiographic features associated with temporomandibular joint disorders among African, White, Chinese, Hispanic, and Indian racial groups

Context

Various radiographic features have been associated with temporomandibular joint disorders (TMDs); however, these characteristics have not been compared among different racial groups.

Aims

To radiographically evaluate and compare craniofacial patterns and condylar findings suggestive of TMD among African, White, Chinese, Hispanic, and Indian racial groups.

Settings and Design

This multicenter retrospective study used data from three private orthodontic practices and a University Orthodontic Clinic.

Subjects and Methods

Panoramic and lateral cephalometric radiographs were collected from 250 subjects who were equally divided into five racial groups: Africans, Whites, Chinese, Hispanics, and Indians. All radiographs were initial records from patients seeking orthodontic treatment. Linear and angular cephalometric measurements were used to evaluate and compare cephalometric characteristics associated with TMD among groups. Panoramic radiographs were analyzed to compare the presence of condylar abnormalities and antegonial notching among groups.

Statistical Analysis Used

One-way analysis of variance, followed by Tukey's test.

Results

African and Chinese groups had the smallest mean cranial base measurements, while the Indians had the largest. The mean Y-axis value was significantly larger in the Chinese group compared with the other groups. Increased mandibular plane angles were seen in the Chinese and African patients, compared with subjects from other groups. The mean percentage of condylar anomalies was higher in the Chinese subjects compared with all other groups.

Conclusions

Chinese patients presented with more radiographic features suggestive of TMD, whereas the Indians showed the least, compared with subjects from the White, Black, and Hispanic racial groups.