Miniscrews for orthodontic anchorage: a review of available systems

Introduction: In recent years, extensive research has introduced novel ways of reinforcing orthodontic anchorage using a variety of devices temporarily anchored in bone (miniscrews). Currently, there are numerous manufacturers with different miniscrew designs on the market.

Aims: The aim of this paper is to discuss the key design features of different miniscrew systems on the market. Furthermore, to present clinical selection criteria of miniscrews in different settings taking into account the determinant factors.

Methods: Review of the literature was carried out using the following search methods: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The search was focused on studies published until January 2018.

Results: We studied each individual miniscrew from all the identified manufacturers in details. All the features were then summarised and presented as a clinical guideline for the selection of miniscrews.

Conclusions: In this article, we reviewed the development of miniscrews and outlined the general design features of miniscrews as well as specific design features of the current miniscrews in the market. Extensive research of the current products was carried out to help clinicians better understand the difference between the various designs of miniscrews that can be used.     

Optimum force magnitude for orthodontic tooth movement: a systematic literature review

The aim of this study was to perform a meta-analysis of the literature concerning the optimal force or range of forces for orthodontic tooth movement. Over 400 articles both on human research and animal experiments were found in Medline and by hand searching of main orthodontic and dental journals. Articles on animal experiments were in the majority. A wide range of animal species such as rat, cat, rabbit, beagle dog, monkey, mouse, and guinea pig were used. Besides variation in species, there was also a wide range of force magnitudes, teeth under study, directions of tooth movement, duration of experimental period, and force reactivation. Furthermore, hardly any experiments were reported that provide information on the relation between the velocity of tooth movement and the magnitude of the applied force. Data from human research on the efficiency of orthodontic tooth movement appeared to be very limited. The large variation in data from current literature made it impossible to perform a meta-analysis. Therefore, we have systematically reviewed the literature. It appeared that no evidence about the optimal force level in orthodontics could be extracted from literature. Well-controlled clinical studies and more standardized animal experiments in the orthodontic field are required to provide more insight into the relation between the applied force and the rate of tooth movement.     

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.     

Interventions for accelerating orthodontic tooth movement: A systematic review

Objective:To evaluate the effectiveness of interventions on accelerating orthodontic tooth movement.Materials and Methods:We searched the databases of PubMed, Embase, Science Citation Index, CENTRAL, and SIGLE from January 1990 to August 2011 for randomized or quasi-randomized controlled trials that assessed the effectiveness of interventions on accelerating orthodontic tooth movement. The processes of study search, selection, and quality assessment were conducted independently in duplicate by two review authors. Original outcome data, if possible, underwent statistical pooling by using Review Manager 5.Results:Through a predefined search strategy, we finally included nine eligible studies. Among them, five interventions were studied (ie, low-level laser therapy, corticotomy, electrical current, pulsed electromagnetic fields, and dentoalveolar or periodontal distraction). Six outcomes were evaluated in these studies (ie, accumulative moved distance or movement rate, time required to move tooth to its destination, anchorage loss, periodontal health, pulp vitality, and root resorption).Conclusion:Among the five interventions, corticotomy is effective and safe to accelerate orthodontic tooth movement, low-level laser therapy was unable to accelerate orthodontic tooth movement, current evidence does not reveal whether electrical current and pulsed electromagnetic fields are effective in accelerating orthodontic tooth movement, and dentoalveolar or periodontal distraction is promising in accelerating orthodontic tooth movement but lacks convincing evidence.     

Bone grafting in orthognathic surgery: a systematic review

Bone grafting has been used in orthognathic surgery to fill the gaps created by jaw repositioning, with the intention of improving healing and stability. Since the majority of orthognathic cases have a satisfactory result, the decision to graft or not is a clinical dilemma. A systematic review of the literature was performed on the use of bone grafts in orthognathic surgery. A search of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials yielded 1927 articles published up until 2018. An additional 10 articles were retrieved through manual searching of the reference lists and citations. After title and abstract screening, 58 articles were potentially eligible; full-text screening excluded 10 of these. Thus 48 articles were included in this review. The present literature highlights the benefits of grafting bony gaps during orthognathic surgery in terms of healing, stability, and aesthetic outcomes. Generally, there was no difference between the various types of bone graft, although calcium phosphate cement and hydroxyapatite were found to increase the rate of infection. The conclusion of this review is that there remains a lack of evidence in the literature regarding the grafting of osteotomy sites in orthognathic surgery. Guidelines are proposed based on the present evidence; however, future research is needed to validate these.     

The treatment effects of Invisalign orthodontic aligners: a systematic review

BACKGROUND: The authors conducted a systematic review of the literature to determine the treatment effects of the Invisalign orthodontic system (Align Technology), Santa Clara, Calif.). TYPES OF STUDIES REVIEWED: The authors reviewed clinical trials that assessed Invisalign's treatment effects in nongrowing patients. They did not consider trials involving surgical or other simultaneous fixed or removable orthodontic treatment interventions. RESULTS: The authors searched electronic databases (PubMed, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Evidence Based Medicine Reviews, EMBASE Excerpta Medica, Thomsen's ISI Web of Science and LILACS) with the help of a senior health sciences librarian. They used "Invisalign" as the sole search term, and 22 documents appeared in the combined search. Thereafter, they used "clinical trials," "humans" and "Invisalign treatment effects" as abstract selection criteria. Only two published articles met these inclusion criteria, though after reading the actual articles, the authors determined that they did not adequately evaluate Invisalign treatment effects. Both articles identified methodological issues. CLINICAL IMPLICATIONS: The inadequately designed studies the authors found represented only a lower level of evidence (level II). Therefore, the authors found that no strong conclusions could be made regarding the treatment effects of Invisalign appliances. Future prospective randomized clinical trials are required to support, with sound scientific evidence, the claims about Invisalign's treatment effects. Clinicians will have to rely on their Invisalign clinical experience, the opinions of experts and the limited published evidence when using Invisalign appliances.     

Early orthodontic treatment of skeletal open-bite malocclusion: a systematic review

The aim of this study was a systematic review of the literature to assess the scientific evidence on the actual outcome of early treatments of open-bite malocclusions. A literature survey was done by applying the Medline database (Entrez PubMed). The survey covered the period from January 1966 to July 2004 and used the MeSH, Medical Subject Headings. The following study types that reported data on the treatment effects included: randomized clinical trials (RCT), prospective and retrospective studies with concurrent untreated as well as normal controls, and clinical trials comparing at least two treatment strategies without any untreated or normal control group involved. The search strategy resulted in 1049 articles. After selection according to the inclusionary/exclusionary criteria, seven articles qualified for the final review analysis. No RCTs of early treatment of anterior open bite have been performed. Two controlled clinical trials of early anterior open bite have been performed, and these two studies indicated the effectiveness of treatment in the mixed dentition with headgears or functional appliances (or both). Most of the studies had serious problems of lack of power because of small sample size, bias and confounding variables, lack of method error analysis, blinding in measurements, and deficient or lack of statistical methods. Thus, the quality level of the studies was not sufficient enough to draw any evidence-based conclusions.     

Factors affecting the duration of orthodontic treatment: a systematic review

The aim of this study was to systematically investigate the literature for articles referring exclusively to the duration of orthodontic therapy and to explore the various factors that could affect this. A Medline search from 1990 to the first week of March 2005 was conducted, the Cochrane Database for Systematic Reviews was utilized, five orthodontic journals were hand searched, the abstracts of related articles were reviewed to search for any relevant studies that might have been missed, and the reference lists of the retrieved articles were hand assessed. Eligibility was determined by reading the reports identified by the search. The end result of this search provided 41 articles. Although there is a need for more conclusive research, the present review revealed several conclusions concerning the duration of orthodontic treatment: (1) there are indications that extraction treatment lasts longer than the non-extraction therapy; (2) age does not seem to play a role provided the patients are in the permanent dentition; (3) when Class II division 1 malocclusions are considered, there is evidence that the earlier the orthodontic treatment begins the longer its duration; (4) there is conflicting information regarding treatment duration within public health systems; (5) combined orthodontic-surgical treatment duration is variable and appears to be operator sensitive; (6) various factors, such as the technique employed, the skill and number of operators involved, the compliance of the patients, and the severity of the initial malocclusion, all seem to play a role; and (7) impacted maxillary canines appear to prolong treatment.     

Attachment systems for mandibular implant overdentures: a systematic review

PURPOSE

The aim of this systematic review was to address treatment outcome according to attachment systems for mandibular implant overdentures in terms of implant survival rate, prosthetic maintenance and complications, and patient satisfaction.

MATERIALS AND METHODS

A systematic literature search was conducted using PubMed and hand searching of relevant journals considering inclusion and exclusion criteria. Clinical trial studies on mandibular implant overdentures until August, 2010 were selected if more than one type of overdenture attachment was reported. Twenty four studies from 1098 studies were finally included and the data on implant survival rate, prosthetic maintenance and complications, patient satisfaction were analyzed relative to attachment systems.

RESULTS

Four studies presented implant survival rates (95.8 - 97.5% for bar, 96.2 - 100% for ball, 91.7% for magnet) according to attachment system. Ten other studies presented an implant survival rate ranging from 93.3% to 100% without respect to the attachment groups. Common prosthetic maintenance and complications were replacement of an assay for magnet attachments, and activation of a matrix or clip for ball or bar attachments. Prosthetic maintenance and complications most commonly occurred in the magnet groups. Conflicting findings were found on the rate of prosthetic maintenance and complications comparing ball and bar attachments. Most studies showed no significant differences in patient satisfaction depending upon attachment systems.

CONCLUSION

The implant survival rate of mandibular overdentures seemed to be high regardless attachment systems. The prosthetic maintenance and complications may be influenced by attachment systems. However patient satisfaction may be independent of the attachment system.     

低强度激光促进正畸牙移动的Meta分析和系统评价

目的：评价低强度激光治疗（low?level laser therapy ,LLLT）促进正畸牙移动的有效性及相关风险。方法依据Cochrane Handbook的规范化要求,检索1980年-2014年Medline、PubMed等数据库,运用Review Manager 5.1软件进行Meta分析。结果共纳入6个国家6篇随机对照试验,3篇不完全随机对照试验,211名患者。偏倚风险评价显示5个研究为中度偏倚风险,4个研究为高度偏倚风险。Meta分析结果显示：与对照组相比,LLLT组治疗后7 d,正畸牙移动速度显著增加（MD=0.19,95%CI 0.02?0.37,P=0.03）,该优势持续到治疗后2个月（MD=1.08,95%CI 0.16?2.01,P=0.02）;相对于高能量密度（20或25 J/cm2）的LLLT治疗,低能量密度（2.5,5或8 J/cm2）的LLLT治疗更为有效。结论低能量密度（2.5、5或8 J/cm2）的LLLT能有效促进正畸牙移动,但还需要更多临床随机对照试验支撑。     

Tooth wear during orthodontic treatment with fixed appliances: a systematic review

ABSTRACT

Objectives: Tooth wear, additional to the physiologic alterations of the dentition, may occur during orthodontic treatment. The objective of the present review was to investigate systematically the literature relevant to its progression in patients having undergone comprehensive orthodontic treatment.

Data sources: Search without restrictions in eight databases since inception and hand searching until October 2017 was performed.

Data selection: Studies evaluating tooth wear immediately before and after the completion of orthodontic treatment with fixed appliance were evaluated independently and in duplicate.

Data extraction: Following study retrieval and selection, data on volumetric and surface tooth wear was extracted. Individual study risk of bias assessment was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.

Data synthesis: All three finally included studies reported wear of teeth during the period of treatment but were at serious risk of bias. Two of them investigated tooth wear by 3D volumetric measurements and one used grading scales. The mean volume reduction was 1.02?mm³ per tooth for the incisor group [95% Confidence Interval (CI): 0.84–1.20], 1.62?mm³ for the canines [95% CI: 0.8–2.38; I^2?=?96%; random effects method] and 0.95?mm³ for premolars and molars [95% CI: 0.84–1.07]. The overall quality of evidence limited the confidence in the observed estimates.

Conclusions: Varying degrees of tooth wear were reported after comprehensive orthodontic treatment. Further studies are needed in order to elucidate how much is associated with orthodontic treatment and/or physiologic alterations of the dentition.     

Quantifying plaque during orthodontic treatment:: A systematic review

Objective:To evaluate the literature on different methods of scoring plaque in patients with fixed orthodontic appliances.Materials and Methods:A systematic electronic and hand search using MEDLINE and PubMed was conducted.Results:Most orthodontic trials have used the original Silness and Löe plaque index. Indices vary in several potentially important aspects. Only two papers have reported reproducibility of methods of plaque scoring in orthodontic patients.Conclusion:Some plaque indices are inappropriate for orthodontic patients. Newer digital planimetric methods are promising if more complex. There is a need to further assess the reproducibility and practicability of the advocated methods.     

Interventions for pain during fixed orthodontic appliance therapy: A systematic review

Objective:To compare the different methods of pain control intervention during fixed orthodontic appliance therapy.Materials and Methods:A computerized literature search was performed in MEDLINE (1966–2009), The Cochrane Library (Issue 4, 2009), EMBASE (1984–2009), and CNKI (1994–2009) to collect randomized controlled trials (RCTs) for pain reduction during orthodontic treatment. Data were independently extracted by two reviewers and a quality assessment was carried out. The Cochrane Collaboration''s RevMan5 software was used for data analysis. The Cochrane Oral Health Group''s statistical guidelines were followed.Results:Twenty-six RCTs were identified and six trials including 388 subjects were included. Meta-analysis showed that ibuprofen had a pain control effect at 6 hours and at 24 hours after archwire placement compared with the placebo group. The standard mean difference was −0.47 and −0.48, respectively. There was no difference in pain control between ibuprofen, acetaminophen, and aspirin. Other analgesics such as tenoxicam and valdecoxib had relatively lower visual analog scale (VAS) scores in pain perception. Low-level laser therapy (LLLT) was also an effective approach for pain relief with VAS scores of 3.30 in the LLLT group and 7.25 in the control group.Conclusions:Analgesics are still the main treatment modality to reduce orthodontic pain despite their side effects. Some long-acting nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase enzyme (COX-2) inhibitors are recommended for their comparatively lesser side effects. Their preemptive use is promising. Other approaches such as LLLT have aroused researchers'' attention.     

Comparison between orthodontic and surgical uprighting of mandibular molars: a systematic review

ObjectivesTo evaluate and compare the efficiency of orthodontic treatment and surgical uprighting of first and second mandibular molars.Materials and MethodsAn electronic literature search in PubMed, Science Direct, Embase, Scopus, Web of Science, Cochrane Library, LILACS, and Google Scholar, as well as a hand search was conducted by two independent researchers to identify relevant articles up to January 2022. In addition, a manual search was done that included article reference lists, grey literature, and dissertations. The risk of bias of the included prospective and retrospective studies was assessed with the Risk Of Bias Tool In Non-randomized Studies of Interventions (ROBINS-I) assessment tool.ResultsA total of six nonrandomized clinical trials (non-RCT) evaluating the efficiency of mandibular molar orthodontic and/or surgical uprighting were included. The quality analysis showed certain defects of the Non-RCTs included and, according to the criteria used, the majority of the articles were judged to be of moderate quality.ConclusionsBased on the evidence, orthodontic and surgical uprighting appear to be effective treatment methods for mandibular molars. Surgical uprighting may be associated with more complications than orthodontic uprighting. However, the existing literature on the subject is limited, heterogeneous, and methodologically limited. Therefore, the outcomes should be interpreted carefully.     

Survival and failure rates of orthodontic temporary anchorage devices: a systematic review

Aim: The purpose of this study was to systematically review the literature on the survival rates of palatal implants, Onplants^®, miniplates and mini screws. Material and methods: An electronic MEDLINE search supplemented by manual searching was conducted to identify randomized clinical trials, prospective and retrospective cohort studies on palatal implants, Onplants^®, miniplates and miniscrews with a mean follow‐up time of at least 12 weeks and of at least 10 units per modality having been examined clinically at a follow‐up visit. Assessment of studies and data abstraction was performed independently by two reviewers. Reported failures of used devices were analyzed using random‐effects Poisson regression models to obtain summary estimates and 95% confidence intervals (CI) of failure and survival proportions. Results: The search up to January 2009 provided 390 titles and 71 abstracts with full‐text analysis of 34 articles, yielding 27 studies that met the inclusion criteria. In meta‐analysis, the failure rate for Onplants^® was 17.2% (95% CI: 5.9–35.8%), 10.5% for palatal implants (95% CI: 6.1–18.1%), 16.4% for miniscrews (95% CI: 13.4–20.1%) and 7.3% for miniplates (95% CI: 5.4–9.9%). Miniplates and palatal implants, representing torque‐resisting temporary anchorage devices (TADs), when grouped together, showed a 1.92‐fold (95% CI: 1.06–2.78) lower clinical failure rate than miniscrews. Conclusion: Based on the available evidence in the literature, palatal implants and miniplates showed comparable survival rates of ≥90% over a period of at least 12 weeks, and yielded superior survival than miniscrews. Palatal implants and miniplates for temporary anchorage provide reliable absolute orthodontic anchorage. If the intended orthodontic treatment would require multiple miniscrew placement to provide adequate anchorage, the reliability of such systems is questionable. For patients who are undergoing extensive orthodontic treatment, force vectors may need to be varied or the roots of the teeth to be moved may need to slide past the anchors. In this context, palatal implants or miniplates should be the TADs of choice.