Skeletal and dental effects of Class III orthopaedic treatment: a systematic review and meta‐analysis

To summarise the skeletal, dental and soft tissue effects of orthopaedic treatment on growing skeletal class III patients compared with a concurrent untreated similar control group and to evaluate whether the design of the primary studies may affect the results. A literature search was performed up to the end of February 2016. No restrictions were applied concerning language and appliances. Once the quality score was assessed, a meta‐analysis was performed for the appliances used in more than three studies. A moderator analysis for study design was performed. The level of evidence was evaluated by means of the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool. The search resulted in 21 papers. The quality of most of the studies was medium. Each study reported skeletal sagittal improvement and overjet correction. Fourteen studies reported a significant increase in lower facial height. Follow‐up data showed slight relapses in about 15% of patients. Meta‐analyses were performed for the facemask and chin cup. The two appliances were efficient for correcting the sagittal discrepancy, increasing the divergence. In the analysis for study design, the retrospective studies showed a more efficient appliance than RCTs for 6 of 13 variables. The level of evidence was between very low and moderate. There is very low to low evidence that orthopaedic treatment is effective in the correction of Class III skeletal discrepancies and moderate evidence for the correction of the overjet. A common side effect is mandibular clockwise rotation in older subjects.     

Dental and skeletal effects of palatal expansion techniques: a systematic review of the current evidence from systematic reviews and meta‐analyses

The aim was to assess the quality and to summarise the findings of the Systematic Reviews (SRs) and Meta‐Analyses (MAs) on the dental and skeletal effects of maxillary expansion. Electronic and manual searches have been independently conducted by two investigators, up to February 2015. SRs and MAs on the dentoalveolar and skeletal effects of fixed expanders were included. The methodological quality was assessed using the AMSTAR (A Measurement Tool to Assess Systematic Reviews). The design of the primary studies included in each SR/MA was assessed with the LRD (Level of Research Design scoring). The evidence for each outcome was rated applying a pre‐determined scale. Twelve SRs/MAs were included. The AMSTAR scores ranged from 4 to 10. Two SRs/MAs included only RCTs. The current findings from SRs/MAs support with high evidence a significant increase in the short‐term of maxillary dentoalveolar transversal dimensions after Rapid Maxillary Expansion (RME). The same effect is reported with moderate evidence after Slow Maxillary Expansion (SME). However, there is moderate evidence of a non‐significant difference between the two expansion modalities concerning the short‐term dentoalveolar effects. With both RME and SME, significant increase of skeletal transversal dimension in the short‐term is reported, and the skeletal expansion is always smaller than the dentoalveolar. Even though dental relapse to some extent is present, long‐term results of the dentoalveolar effects show an increase of the transversal dimension, supported by moderate evidence for RME and low evidence for SME. Skeletal long‐term effects are reported only with RME, supported by very low evidence.     

Methodological quality and outcome of systematic reviews reporting on orthopaedic treatment for class III malocclusion: Overview of systematic reviews

Objectives: The aim of this overview of systematic reviews was to investigate methodological quality and outcome of current systematic reviews (SRs) reporting on orthopaedic treatment for class III malocclusion.

Materials and methods: Computerized and manual searches were performed in Medline, Google Scholar, Cochrane Library, Embase, LILACS, SciELO, American Journal of Orthodontics and Dentofacial Orthopaedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics, Conference abstracts and Grey literature. No restrictions were set on language or date of publication. The search covered the starting date of the relevant databases until 30 April 2015. MeSH terms and free-text terms included ‘malocclusion’, ‘Angle class III’, ‘orthodontic appliances’, ‘functional’, facemask, review and meta-analysis. Screening of eligible studies, assessment of the methodological quality of the SRs and data extraction were conducted in duplicate and independently by two reviewers. Methodological quality was assessed using AMSTAR (assessment of multiple systematic reviews).

Results: A total of 222 studies were retrieved and after removal of duplicates, irrelevant studies, literature reviews and surgical approach treatments, 14 SRs and/or meta-analyses were included for qualitative synthesis. Mean AMSTAR score was 7.7/11 with a range of 3–10. There was evidence to demonstrate that face mask therapy can move the maxilla forward whilst causing a backward rotation of the mandible and increased facial height. There was also some evidence of mandibular growth retardation with chin cup therapy.

Conclusions: Orthopaedic appliances can improve a class III malocclusion in growing patients over the short-term; however, each appliance has a characteristic effect on the underlying skeletal pattern.     

Contemporary Class II orthodontic and orthopaedic treatment: a review

The literature regarding the dental and facial soft tissue effects of various forms of contemporary Class II orthodontic and orthopaedic treatment is reviewed. Treatment outlined includes the use of headgear and functional appliances to attempt to modify the facial growth process and the extractions of premolar teeth as part of overall fixed appliance treatment. The conclusions of numerous articles highlight the fact that many approaches to treatment can be successful in correcting Class II malocclusions. Findings reported in recent literature also now show that the extractions of premolar teeth, for instance, as part of Class II treatment, do not necessarily lead to direct soft tissue effects. If lip profile changes do occur, it seems that they are far more likely to be positive aesthetically, than negative.     

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

This systematic review was performed to compare dental, skeletal, and aesthetic outcomes between orthodontic camouflage and surgical-orthodontic treatment, in patients with a skeletal class II malocclusion and a retrognathic mandible who have already finished their growth period. A literature search was conducted, and a modified Downs and Black checklist was used to assess methodological quality. The meta-analysis was conducted using the DerSimonian–Laird random-effects method to obtain summary estimates of the standardized mean differences and corresponding 95% confidence intervals. Nine articles were included in the qualitative synthesis and seven in the meta-analysis. The difference between treatments was not statistically significant regarding SNA angle, linear measurement of the lower lip to Ricketts’ aesthetic line, convexity of the skeletal profile, or the soft tissue profile excluding the nose. In contrast, surgical-orthodontic treatment was more effective with regard to ANB, SNB, and ML/NSL angles and the soft tissue profile including the nose. Different treatment effects on overjet and overbite were found according to the severity of the initial values. These results should be interpreted with caution, due to the limited number of studies included and because they were non-randomized clinical trials. Further studies with larger sample sizes and similar pre-treatment conditions are needed.     

Influence of Laser‐Microtextured Surface Collar on Marginal Bone Loss and Peri‐Implant Soft Tissue Response: A Systematic Review and Meta‐Analysis

Background: A laser‐microtextured surface (LMS) dental implant collar appears to promote a more tooth‐like gingival collagen fiber attachment, which may help to stabilize peri‐implant tissues. The purpose of this systematic review is to assess the clinical effect of an LMS versus non‐LMS collar on crestal bone level and peri‐implant soft tissue response. Methods: Electronic and manual literature searches were performed by two independent reviewers for articles written in English up to December 2016. Studies were included if they were human clinical trials with the purpose of evaluating the impact of an LMS collar on peri‐implant hard and soft tissues. Cumulative marginal bone loss (MBL), probing depth (PD), and survival rate (SR) with 95% confidence intervals (CIs) were calculated to show the performance of LMS implant collars. MBL, PD, and SR data were analyzed with a random effects model to compare the influence of LMS collars with non‐LMS collars (e.g., roughened surface and machined surface). Results: Fifteen human clinical studies (three randomized controlled trials, six cohort studies, and six case series) with 772 implants met the inclusion criteria. For the overall data, the weighted mean MBL was 0.72 mm (95% CI: 0.59 to 0.85 mm), PD was 1.81 mm (95% CI: 1.13 to 2.49 mm), and SR was 0.97 (95% CI: 0.95 to 0.98). MBL around an LMS collar was significantly less than around machined‐surface collars (weighted mean difference [WMD]: ?0.77; 95% CI: ?1.01 to ?0.52; I² = 95.2%; P <0.001). PD in the LMS group was significantly shallower than in the machined‐surface group (WMD: ?1.34; 95% CI: ?1.62 to ?1.05; I² = 81.4%; P <0.001). However, no statistically significant difference was detected for MBL between the LMS and roughened‐surface groups (WMD: ?0.04; 95% CI: ?0.16 to 0.08; I² = 0.0%; P = 0.75). No statistically significant difference was found for SR between the LMS and non‐LMS groups (risk ratio: 1.01; 95% CI: 0.97 to 1.04; I² = 0.0%; P = 0.91). Conclusions: Meta‐analysis showed that an LMS collar can reduce the amount of MBL and PD compared with a machined‐surface collar. Due to high heterogeneity between the included studies, results should be interpreted cautiously.     

Changes in temporomandibular joint morphology in class II patients treated with fixed mandibular repositioning and evaluated through 3D imaging: a systematic review

To estimate the effects of skeletal class II malocclusion treatment using fixed mandibular repositioning appliances on the position and morphology of the temporomandibular joint (TMJ). Two independent reviewers performed comprehensive electronic searches of MEDLINE, EMBASE, EBM reviews and Scopus (until May 5, 2015). The references of the identified articles were also manually searched. All studies investigating morphological changes of the TMJ articular disc, condyle and glenoid fossa with 3D imaging following non‐surgical fixed mandibular repositioning appliances in growing individuals with class II malocclusions were included in the analysis. Of the 269 articles initially reviewed, only 12 articles used magnetic resonance imaging and two articles used computed tomography (CT) or cone‐beam CT images. Treatment effect on condyle and glenoid fossa was discussed in eight articles. Treatment effect on TMJ articular disc position and morphology was discussed in seven articles. All articles showed a high risk of bias due to deficient methodology: inadequate consideration of confounding variables, blinding of image assessment, selection or absence of control group and outcome measurement. Reported changes in osseous remodelling, condylar and disc position were contradictory. The selected articles failed to establish conclusive evidence of the exact nature of TMJ tissue response to fixed mandibular repositioning appliances.     

牙周治疗干预类风湿性关节炎的系统评价

目的 评价牙周治疗措施在缓解类风湿性关节炎(RA)患者症状和体征中的效果及安全性.方法 电子检索Medline(OVID,1950年-2010年9月)、荷兰医学文摘(EMBASE,1984年-2010年9月)、Cochrane图书馆临床随机对照试验库(CENTRAL,2010年第3期)、中国生物医学文献数据库(1978...     

Effect of mechanical debridement on distal periodontal aspects of second molars after the extraction of third molars: a systematic review

Background: The risk of periodontal defects after the extraction of third molars continues to challenge clinicians. Methods: Intervention trials, including subgingival scaling and/or root planing, were systematically reviewed. Data sources included the Cochrane Oral Health Group Trials Register and MEDLINE. The primary outcome was postoperative change in pocket probing depth (PD). Results: The electronic search yielded 751 abstracts, and manual searching added one study. From them, four trials fulfilled the inclusion criteria and were selected for review. The overall sample size of the studies was small, ranging from 15 to 30 participants. Only one trial was considered to present with low risk for bias in the sequence generation, the concealment of allocation to treatment, and the strategy for masking. The lack of information provided by the authors of the remaining studies resulted in unclear or high risk of bias for the chief dimensions of trial quality. The heterogeneity of the studies did not allow the use of meta‐analysis to summarize the results of several studies. Preliminary evidence originating from a small study suggests that ultrasonic root debridement of the second molar and a three‐visit plaque control program may have a beneficial effect on PD levels on the second molar. Conclusion: The available intervention trials on this topic have important limitations, and, consequently, there is insufficient evidence to recommend the use of mechanical debridement of second molars after the extraction of third molars.     

Maxillary molar distalization with miniscrew-supported appliances in Class II malocclusion: A systematic review

Objectives:To evaluate the quantitative effects of miniscrew supported appliances for maxillary molar distalization in Class II malocclusion.Materials and Methods:The systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles. The date of the last search was January 30, 2017. Methodological quality of the retrospective studies was graded by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP) and prospective studies by means of Newcastle–Ottawa Scale.Results:In total, 298 studies were identified for screening, and 14 studies were eligible. The Quality Assessment Tool for Quantitative Studies rated all of the four included retrospective studies as moderate. The Newcastle–Ottawa Scale rated seven studies as high quality and three studies as low quality. The mean molar distalization values varied from 1.8 mm to 6.4 mm. Mean distal tipping of molars varied from 1.65° to 11.3°. The mean distal movement of premolars and incisors varied from 1.75 mm to 5.4 mm and 0.1 mm to 2.7 mm, respectively.Conclusions:Miniscrew-supported appliances are effective in molar distalization with distal movement of premolars with minimal anchorage loss and distal tipping of the molar teeth.     

功能矫治器对骨性Ⅱ类错(牙合)下颌骨生长作用的系统研究

目的 系统分析经过功能性矫治器治疗的骨性Ⅱ类患者下颌骨的生长变化是否大于未治疗的Ⅱ类错患者.方法 以骨性Ⅱ类错(牙合)为关键词,先通过网络数据库检索后再用手工方法查找原文献,获得全文.从收集到的符合纳入和排除标准的文献中提取需要的数据资料,对其进行质量评估,并采用RevMan 4.2软件进行Meta分析.结果 符合纳入...     

Effects of miniplate anchored and conventional Forsus Fatigue Resistant Devices in the treatment of Class II malocclusion

Objective:To compare the skeletal, dentoalveolar, and soft tissue effects of the miniplate anchored Forsus Fatigue Resistant Device (FRD) and the conventional Forsus FRD in the treatment of Class II malocclusion.Materials and Methods:The study was carried out with 30 patients (10 girls, 20 boys). In the MA-Forsus group, 15 patients (2 girls, 13 boys) were treated with a miniplate anchored Forsus FRD for 9.40 ± 2.25 months. In the C-Forsus group, 15 patients (8 girls, 7 boys) were treated with a conventional Forsus FRD for 9.46 ± 0.81 months. A total of 16 measurements were calculated and statistically analyzed to find intragroup and intergroup differences.Results:Statistically significant differences were found between the groups in IMPA, SN/Occ, SN/GoGn, overjet, overbite, and Li-S measurements (P < .05). In the C-Forsus group, a substantial amount of lower incisor protrusion was observed, whereas retrusion was found in the MA-Forsus group (P < .001). The mandible rotated backward in the MA-Forsus group, whereas it remained unchanged in the C-Forsus group (P < .05). Reductions in overjet (P < .001) and overbite were greater in the C-Forsus group (P < .05).Conclusion:Stimulation of mandibular growth and inhibition of maxillary growth were achieved in both treatment groups. In the C-Forsus group, a substantial amount of lower incisor protrusion was observed, whereas retrusion of lower incisors was found in the MA-Forsus group. The MA-Forsus group was found to be more advantageous as it had no dentoalveolar side effects on mandibular dentition.