Class II functional orthopaedic treatment: a systematic review of systematic reviews

This Systematic Review (SR) aims to assess the quality of SRs and Meta‐Analyses (MAs) on functional orthopaedic treatment of Class II malocclusion and to summarise and rate the reported effects. Electronic and manual searches were conducted until June 2014. SRs and MAs focusing on the effects of functional orthopaedic treatment of Class II malocclusion in growing patients were included. The methodological quality of the included papers was assessed using the AMSTAR (Assessment of Multiple Systematic Reviews). The design of the primary studies included in each SR was assessed with Level of Research Design scoring. The evidence of the main outcomes was summarised and rated according to a scale of statements. 14 SRs fulfilled the inclusion criteria. The appliances evaluated were as follows: Activator (2 studies), Twin Block (4 studies), headgear (3 studies), Herbst (2 studies), Jasper Jumper (1 study), Bionator (1 study) and Fränkel‐2 (1 study). Four studies reviewed several functional appliances, as a group. The mean AMSTAR score was 6 (ranged 2–10). Six SRs included only controlled clinical trials (CCTs), three SRs included only randomised controlled trials (RCTs), four SRs included both CCTs and RCTs and one SR included also expert opinions. There was some evidence of reduction of the overjet, with different appliances except from headgear; there was some evidence of small maxillary growth restrain with Twin Block and headgear; there was some evidence of elongation of mandibular length, but the clinical relevance of this results is still questionable; there was insufficient evidence to determine an effect on soft tissues.     

Effectiveness of adjunctive interventions for accelerating orthodontic tooth movement: a systematic review of systematic reviews

This study was aimed to summarise published systematic reviews (SRs) that assess the effects of adjunctive interventions on the acceleration of orthodontic tooth movement (OTM). Electronic and manual searches were performed up to August 2016. Systematic reviews investigating the impact of adjunctive techniques on the promotion of OTM were included. The methodological quality of the included reviews was evaluated using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) scale. The quality of evidence for each intervention was assessed using GRADE. The Jadad decision algorithm was used to select a study to provide body evidence from discordant reviews on the same intervention. A total of 11 SRs were included in this study. AMSTAR scores ranged from 4 to 10 of 11. The quality of evidence ranged from very low to low. The short‐term (1–3 months) effects of low‐level laser therapy (LLLT, 5 and 8 J cm^?2) and corticotomy were supported by low‐quality evidence. The evidence regarding the efficacy of photobiomodulation, pulsed electromagnetic field, interseptal bone reduction, two vibrational devices (Tooth Masseuse and Orthoaccel) and electrical current was of very low quality. Relaxin injections and extracorporeal shock waves were reported to have no impact on OTM according to low‐ and very low‐quality evidence, respectively. Based on currently available information, we conclude that low‐quality evidence indicates that LLLT (5 and 8 J cm^?2) and corticotomy are effective to promote OTM in the short term. Future high‐quality trials are required to determine the optimal protocols, as well as the long‐term effects of LLLT and corticotomy, before warranting recommendations for orthodontics clinics.     

Skeletal and dentoalveolar effects of slow vs rapid activation protocols of miniscrew-supported maxillary expanders in adolescents: A randomized clinical trial

ObjectivesTo compare between skeletal and dentoalveolar effects of slow and rapid activation of miniscrew-supported expanders.Materials and MethodsA total of 30 patients were randomly allocated to two groups using block randomization and the allocation ratio 1:1. Both groups received maxillary expanders anchored using four miniscrews. Activation protocol was once every other day in the slow expansion (SME) group and twice daily in the rapid expansion (RME) group. Cone-beam computed tomography (CBCT) scans were obtained before expansion and after removal of the expanders. Transverse skeletal and dentoalveolar changes were measured using CBCT.ResultsA total of 12 patients in the SME group (mean age, 14.30 ± 1.37 years) and 12 patients in the RME group (mean age, 15.07 ± 1.59 years) were analyzed. RME showed significantly greater widening of the mid-palatal suture at the level of first molars (mean difference [SME − RME] = −0.61 mm), and a greater increase in right and left molar buccal inclination (mean difference= −3.83° and −2.03°, respectively). Percentage of skeletal expansion relative to the jackscrew opening was not significantly different between the groups. Palatal inflammation was evident following appliance removal. Miniscrew mobility and bending were observed with RME.ConclusionsBoth SME and RME were effective in correcting skeletal transverse maxillary deficiency. However, RME resulted in more buccal tipping of maxillary molars and in miniscrew failures and bending.     

Skeletal and dental changes with fixed slow maxillary expansion treatment: a systematic review

BACKGROUND: The authors were not able to identify any systematic reviews or meta-analysis on the dental or skeletal changes associated with slow maxillary expansion (SME). Therefore, they conducted a study to evaluate skeletal and dental changes after fixed SME treatment in orthodontic patients with constricted arches. METHODS: The authors included in their evaluation clinical trials that assessed skeletal and dental arch changes through measurements on dental casts or cephalometric radiographs. The authors did not consider trials involving surgical or other simultaneous treatment interventions during the active expansion period. RESULTS: With the help of a health sciences librarian, the authors searched the following electronic databases: PubMed, MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Evidence Based Medicine Reviews (Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects and Cochrane Central Register of Controlled Trials), EMBASE Excerpta Medica, Thomsen's ISI Web of Sciences and LILACS. Eight articles met the initial inclusion criteria. The authors found that a significant deficiency in the studies was the lack of a control group to factor out changes in the dental arch and skeletal structures associated with normal growth. CONCLUSIONS AND CLINICAL IMPLICATIONS: The authors found only a lower level of evidence. Therefore, they could make no strong conclusions on dental or skeletal changes that occurred after SME treatment. Clinicians need to rely on their clinical experience, experts' opinions and the presented limited evidence concerning SME treatments.     

Methodological Quality Assessment of Meta-analyses and Systematic Reviews of the Relationship Between Periodontal and Systemic Diseases

ObjectivesThe aims of this article are to identify all the published systematic reviews (SRs) and meta-analyses (MAs) that studied the relationship between periodontal and systemic diseases and to assess their quality using 2 scales (the Overview Quality Assessment Questionnaire [OQAQ] and A Measurement Tool to Assess Systematic Reviews [AMSTAR] checklist).MethodsFor SRs and MAs to be included, they should have investigated one of the following systemic diseases: pulmonary conditions, cardiac conditions, endocrine conditions, cancer, blood disorders, psychological conditions, anxiety, depression, mood disorders, and several other diseases. Two investigators screened MEDLINE via PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews. The tools used to evaluate quality were the AMSTAR scale and OQAQ. The protocol was prospectively registered in PROSPERO (CRD42018102208).ResultsThe search strategy found 691 unique articles, 42 of which met the eligibility criteria and were included in this review. Diabetes mellitus was the most investigated disease (14 out of 42 studies), followed by obesity (11 studies) and cardiovascular diseases (5 studies). A total of 40 reviews reported on the characteristics of included studies, and, as per the AMSTAR scale, 39 reviews had an a priori design. The number of reviews that fulfilled the status of publication criterion was the lowest (7 reviews only), followed by the number used in the assessment of publication bias (11 reviews). The number of high-quality reviews was higher with the OQAQ than with the AMSTAR checklist (33 vs 25 studies), but the AMSTAR showed a higher number of medium-quality reviews than the OQAQ (14 vs 6 studies). Both showed the same number of low-quality reviews.ConclusionsHigh-quality SRs and MAs are crucial to understanding the relationship between systemic and periodontal diseases. Medical practitioners must be able to inform patients about oral health and specific periodontal health concerns.     

Evaluation of methodology and quality characteristics of systematic reviews in orthodontics

Systematic reviews (SRs) are published with an increasing rate in many fields of biomedical literature, including orthodontics. Although SRs should consolidate the evidence-based characteristics of contemporary orthodontic practice, doubts on the validity of their conclusions have been frequently expressed. The aim of this study was to evaluate the methodology and quality characteristics of orthodontic SRs as well as to assess their quality of reporting during the last years. Electronic databases were searched for SRs (without any meta-analytical data synthesis) in the field of orthodontics, indexed up to the start of 2010. The Assessment of Multiple Systematic Reviews (AMSTAR) tool was used for quality assessment of the included articles. Data were analyzed with Student's t-test, one-way ANOVA, and linear regression. Risk ratios (RR) with 95% confidence intervals were calculated to represent changes during the years in reporting of key items associated with quality. A total of 110 SRs were included in this evaluation. About half of the SRs (46.4%) were published in orthodontic journals, while few (5.5%) were updates of previously published reviews. Using the AMSTAR tool, thirty (27.3%) of the SRs were found to be of low quality, 63 (57.3%) of medium quality, and 17 (15.5%) of high quality. No significant trend for quality improvement was observed during the last years. The overall quality of orthodontic SRs may be considered as medium. Although the number of orthodontic SRs has increased over the last decade, their quality characteristics can be characterized as moderate.     

Do adjunctive interventions in patients undergoing rapid maxillary expansion increase the treatment effectiveness?: A systematic review

ObjectivesTo evaluate the clinical effectiveness of adjunctive interventions in individuals undergoing rapid maxillary expansion (RME).Materials and MethodsMEDLINE, Web of Science, Cochrane, Scopus, LILACS, and Google Scholar were searched without restrictions up to June 2020. Trials involving participants undergoing orthopedic or surgical RME, along with adjunctive interventions, were included. Risk-of-bias assessments were performed using the Cochrane tool for randomized trials-2. The certainty level of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation tool.ResultsSix randomized clinical trials, with low to high risk of bias, were included. Low certainty of the evidence suggested that low-level laser facilitated opening of the midpalatal suture during the active phase of RME. Likewise, moderate certainty demonstrated that low-level laser accelerated the healing process of the suture during the retention phase. The clinical impact of this outcome, that is, stability and retention time, was not evaluated. Very low evidence indicated that osteoperforations along the midpalatal suture increased maxillary transverse skeletal gains in young adults undergoing RME. Low evidence suggested that platelet-rich plasma therapy did not minimize the vertical and thickness bone loss after RME in the short term.ConclusionsBased on currently available information, the use of low-level laser associated with maxillary expansion seems to provide a more efficient suture opening and bone healing. Limited evidence suggests that osteoperforations improve the skeletal effects of RME in non-growing individuals. There are no adjunctive interventions capable of reducing the periodontal side effects of RME.     

Long-term skeletal changes with rapid maxillary expansion: a systematic review

The objective was to evaluate long-term transverse, anteroposterior and vertical skeletal changes after rapid maxillary expansion (RME). The data were clinical trials that assessed skeletal changes through cephalometric analysis. No surgical or other simultaneous treatment during the evaluation period was accepted. Electronic databases (PubMed, Medline, Medline In-Process & Other Non-Indexed Citations, Cochrane Database of Systematic Reviews, ASP Journal Club, DARE, CCTR, Embase, Web of Sciences and Lilacs) were searched with the help of a senior Health Sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus. The original articles were then retrieved. A methodological checklist was used to evaluate the quality of the selected articles. Their references were also hand-searched for possible missing articles. Articles without an adequate control group to factor out growth changes were excluded. Only three articles (one measuring transverse and two anteroposterior and vertical changes) measured RME stability after active expansion, all of them had some methodological flaws, which limit the attainable conclusions. An individual analysis of these articles was made. Long-term transverse skeletal maxillary increase is approximately 25% of the total dental expansion for prepubertal adolescents. Better long-term outcomes are expected in transverse changes because of RME in less skeletally mature patients. RME appears not to produce clinically significant anteroposterior or vertical changes in the position of the maxilla and mandible. The conclusions from this systematic review should be considered with caution because only a secondary level of evidence was found. Long-term randomized clinical trials are needed.     

Cephalometric evaluation of rapid and slow maxillary expansion in patients with BCLP: Secondary data analysis from a randomized clinical trial

Objective:To compare the dentoskeletal effects of rapid (RME) and slow (SME) maxillary expansion in patients with bilateral complete cleft lip and palate (BCLP).Materials and Methods:This was a secondary analysis of a previous randomized controlled trial (RCT). Forty-six patients (34 male, 12 female) with BCLP and posterior crossbite (mean age of 9.2 years) were randomly assigned to two study groups. Group RME comprised subjects treated with Haas/Hyrax expander. Group SME included patients treated with quad-helix appliance. Cone-beam computed tomography (CBCT) was performed before expansion (T1) and after appliance removal at the end of a 6-month retention period (T2) for a previous RCT that compared the transverse skeletal effects of RME and SME. CBCT-derived cephalometric images were generated and cephalometric analysis was performed using Dolphin Imaging Software (Chatsworth, Calif). Intergroup comparisons were performed using t tests (P < .05).Results:Baseline forms were similar between groups. No significant differences between RME and SME groups were found.Conclusions:Rapid and slow maxillary expansion produced similar sagittal and vertical changes in patients with BCLP. Both Haas/Hyrax and quad-helix appliances can be used in patients with vertical facial pattern. Clinical relevance: RME and SME can be equally indicated in the treatment of maxillary arch constriction in patients with BCLP.     

Long-term effects of rapid maxillary expansion: a posteroanterior cephalometric evaluation.

The aim of this study was to investigate long-term effects induced by rapid maxillary expansion (RME), followed by comprehensive orthodontic treatment, in a sample of 42 patients compared with normal growth changes in a sample of 20 subjects. Treated subjects underwent Haas-type RME with 2 turns a day (0.25 mm per turn) until the expansion screw reached 10.5 mm (about 21 days). The Haas expander was kept on the teeth as a passive retainer for an average of about 2 months. Immediately after the Haas expander was removed, fixed standard edgewise appliances were placed. Posteroanterior cephalograms were analyzed for each subject in both groups at T1 (pretreatment) and at T2 (long-term observation). The mean age at T1 was 11 years 10 months for both the treated and the control groups. The mean ages at T2 also were comparable (20 years 6 months for the treated group, and 17 years 8 months for the control group). The study included transverse measurements on dentoalveolar structures, maxillary and mandibular bony bases, and other craniofacial regions (nasal, zygomatic, orbital, and cranial). RME followed by edgewise appliance therapy appears to be an effective procedure to increase transverse facial dimensions in the long term, at both the skeletal and the dentoalveolar levels. Significant pretreatment deficiencies in maxillary width, maxillary incisor apex width, and maxillary first molar width remained corrected at a mean age of about 20 years. The initial deficiency in lateroorbital width was also eliminated.     

Methodological and Reporting Quality of Systematic Reviews and Meta-analyses in Endodontics

Introduction

The aim of this systematic review (SR) was to evaluate the quality of SRs and meta-analyses (MAs) in endodontics.

青春期上颌快速扩弓对上呼吸道尺寸和功能的影响及长期有效性的系统评价再评价

目的:对青春期上颌快速扩弓(rapid maxillary expansion,RME)对上呼吸道尺寸和功能的影响及长期有效性的系统评价进行再评价.方法:检索Cochrane,EMBASE,Medline和PubMed数据库,搜索公开发表的关于上颌快速扩弓与上呼吸道关系的系统评价,时限均为建库至2020年4月,2名作者...     

Short-term skeletal and dentoalveolar effects of overexpansion:: A pilot randomized controlled trial

ObjectivesTo evaluate whether the amount of rapid maxillary expansion differentially affects the skeletal and dentoalveolar changes that occur.Materials and MethodsThis randomized controlled trial included 23 patients who had rapid maxillary expansion (RME). Subjects were randomly assigned to a conventional expansion control group (n = 12) or an overexpansion group (n = 11), who started treatment at 13.2 ± 1.5 and 13.8 ± 1 years of age, respectively. Cone beam computed tomography scans (11 cm) were obtained prior to rapid maxillary expander (RME) delivery and approximately 3.7 months later. Initial hand-wrist radiographs were used to determine the participants'' skeletal maturity.ResultsThe RME screws were activated 5.6 ± 1.2 mm and 10.1 ± 0.6 mm in the conventional and overexpansion groups, respectively. Overexpansion produced significantly greater expansion of the nasal cavity (2.1X–2.5X), maxillary base (2.3X), buccal alveolar crest (1.4X), and greater palatine foramina (1.9X). Significantly greater intermolar width increases (1.8X) and molar inclination (2.8X) changes were also produced. The nasal cavity and maxillary base expanded 23%–32% as much as the screws were activated. Skeletal expansion was positively correlated with RME screw activation (R = 0.61 to 0.70) and negatively correlated (R = −0.56 to −0.64) with the patients'' skeletal maturation indicators (SMIs). Together, screw activation and the patients'' SMI scores explained 48%–66% of the variation in skeletal expansion.ConclusionsThis pilot study shows that overexpansion produces greater changes than conventional expansion, with greater skeletal effects among less mature patients.     

手术辅助快速扩弓矫治上颌横向发育不足的临床疗效分析

目的:评价手术辅助快速扩弓矫治成人上颌横向发育不足病例牙齿和基骨的变化。方法:上颌发育不足患者20例(男13例,女7例)按年龄分为扩弓组和手术组,扩弓组(平均年龄12.51±0.82岁)行矫形快速扩弓治疗;手术组(平均年龄19.07±2.54岁)行手术协助快速扩弓治疗。所有患者治疗前后摄头颅定位正侧位片和咬合片,头影测量分析、比较。结果:两组病例均有明显的扩弓效果,手术组牙弓宽度增加更为显著,扩弓组牙弓长度增加明显,但组间均无显著性差异;治疗前后,手术组B点显著后移,而扩弓组B点前移,组间有显著性差异(P<0.05);治疗前后,手术组腭平面后旋,扩弓组腭平面前旋,组间有显著性差异(P<0.01);治疗前后,两组病例上颌切牙均内倾,组间无显著性差异。结论:手术协助快速扩弓治疗成人上颌横向发育不足,可取得良好的扩弓效果;对上下颌骨、上颌切牙在矢状面的改变更有利于III类错畸形的矫正;在病例的选择上,更适用于低角病例。     

成人RME矫治后长期稳定性的初步探讨

目的　通过对 2 1例成人经上颌快速扩大 (RME)矫治后的牙关系进行了随访观察 ,旨在对成人RME矫治后的长期稳定性进行初步探讨。材料　本研究对象由 2 1例经RME矫治的成人所构成。均经Hass型扩弓器扩弓和方丝弓矫治器联合矫治。在矫治前 (T1 )和矫治结束时 (T2 )分别制取牙石膏模型 ,并戴用Hawley式保持器进行保持。保持器戴用时间最短 1年 ,最长 5年。在停止戴用保持器后至少 1年 (大部分 5年 ) ,制取随访模 (T3)。方法　对 2 1例保持前后 (T2 ,T3)的模型进行以下测量 :1 上颌第一磨牙间宽度 ;2 上颌第二前磨牙间宽度 ;3 上颌第一前磨牙间宽度 ;4 上颌尖牙间宽度 ;5 第一磨牙颊侧牙槽间宽度。对所测量数据用Sigmastate统计软件进行配对t检验。结果　观察所有样本保持前后的模型 ,未见有样本在保持后 ,其后牙咬合关系为反关系。但测量数据的统计结果显示 :除第一磨牙间宽度外其余指标的变化均有统计学意义。结论　成人经RME矫治保持后 ,虽有轻度复发 ,但未见有复发至后牙反的状况 ,故总体疗效是基本稳定的     

Surgically assisted rapid maxillary expansion compared with orthopedic rapid maxillary expansion

The objective of this study is to evaluate and compare the dental and skeletal changes occurring during orthopedic rapid maxillary expansion (RME) and surgically assisted RME during the active phase of treatment. The study was divided into two groups. The first group of 10 patients (six males, four females; mean age, 15.51 years) received orthopedic RME. The second group of 10 patients (seven males, three females; average age: 19.01 years) received surgically assisted RME (SARME). All patients underwent maxillary expansion with occlusal-coverage Hyrax-type expanders activated two turns a day (0.25 mm per turn). Preexpansion and postexpansion lateral and posteroanterior cephalograms were obtained for each patient. Statistically significant differences between the SARME and RME groups were found in the N-ANS, SN/ PP (P < .01) and SNA, SNB, mandibular dentoalveolar, and maxillary bony base (P < .05) measurements. Clinically, there is no difference in patient response between the RME and SARME groups. The only difference between the groups was their indication for RME or SARME, which is based on the age and skeletal maturation of the patient.     

上颌快速扩弓联合前方牵引治疗骨性Ⅲ类错牙合畸形对上气道影响的锥形束 CT 分析

目的：研究上颌快速扩弓联合前方牵引治疗骨性Ⅲ类错(牙合)畸形对上气道影响的三维变化。方法：选择53例伴上颌骨横向发育不足的骨性Ⅲ类错(牙合)畸形患者。所有患者先采用 Hyrax 矫治器进行上颌快速扩弓,然后前方牵引矫治。平均扩弓16 d,前方牵引平均5个月。分别于扩弓前（T0）、扩弓结束时（T1）及前方牵引结束时（T2）拍摄锥形束 CT 并进行三维重建和测量。结果：扩弓结束时鼻咽段最小截面积、最小截面积处冠状径和鼻咽段容积显著增大（P ＜0．05）;前方牵引矫治后鼻咽段4项指标与扩弓治疗前相比明显增大（P ＜0．05）。结论：上颌骨快速扩弓联合前方牵引可显著增加鼻咽段上气道容积。     

Long-term results of surgically assisted maxillary protraction vs regular facemask

Objective:To evaluate the short- and long-term treatment results of rapid maxillary expansion (RME) and surgical assistance during maxillary protraction with a facemask (FM).Materials and Methods:This study was carried out in 28 patients (12 male, 16 female) with maxillary retrognathism, anterior crossbite, and Class III skeletal and dental malocclusion characteristics. Seventeen patients (9 male, 8 female) with mild maxillary retrognathism were treated by RME and FM. The other 11 patients (8 female, 3 male), who had moderate to severe maxillary retrognathism, were treated with surgically assisted FM treatment. Patients treated with RME and FM were recalled after 5.64 years, and the surgically assisted FM group was recalled after 6.08 years. Cephalometric films taken before treatment (T₀), right after maxillary protraction (T₁), and at recall (T₂) were used to evaluate and compare the results.Results:In the short term, good maxillary advancement and a shorter treatment period were achieved with surgically assisted FM therapy. However, in the long term, maxillary advancement and some soft tissue improvements were lost. On the other hand, in the RME and FM protraction group, maxillary advancement and soft tissue improvement were well maintained.Conclusion:In the short term, statistically significant maxillary advancement was achieved with surgically assisted maxillary protraction. However, in the long term, these sagittal changes were not stable, whereas RME and FM provided stability.