Evaluation of the Best Method for Orthodontic Correction of Skeletal Deep Bites in Growing Patients: A Systematic Review.

This review aimed to evaluate the currently available evidence regarding the best method of correcting deep bites in growing patients. In September 2023, a search was conducted electronically across the following databases: PubMed®, Web of Science™, Scopus®, Embase®, Google™ Scholar, and Cochrane Library. In this systematic review, randomized control trials (RCTs), controlled clinical trials (CCTs), and cohort studies of growing patients with deep bite malocclusion who received treatment with the primary objective of treating the deep bite were included. Risk of bias of the included studies was assessed using two different tools; one tool was applied for RCTs and the other one for the CCTs and cohort studies. One RCT, one CCT, and one cohort study were included (85 patients). The flat fixed acrylic bite plane was superior in terms of duration of treatment when compared to the inclined fixed acrylic bite plane and the utility arch with posterior intermaxillary elastics. Limited evidence indicates that the inclined fixed acrylic bite plane causes a significant increase in the lower incisor inclination and a significant increase in the angle between the mandible and the anterior cranial base (SNB). However, limited evidence indicates that the utility arch with posterior intermaxillary elastics causes a significant decrease in the angle between the maxilla and the anterior cranial base (SNA). Regarding the vertical skeletal changes, it was found that the three methods were comparable; in each case, the vertical dimension of the face increased because of a significant increase in the lower first molar height. There is a need for further studies to strengthen the evidence of the treatment efficacy of the employed methods, with more RCTs to be conducted in this regard.

Temperature Changes in the Pulp Chamber During Orthodontic Bonding Using a High-Power Light-Emitting Diode Device With Two Different Exposure Times and Intensities: An In-Vitro Study.

OBJECTIVE: This study used a high-power light-emitting diode (LED) device to evaluate the effects of two exposure times and intensities on pulp chamber temperature and cooling time during bracket bonding. MATERIALS AND METHODS: Sixty upper premolars were used in the sample in this study. These premolars were split into two main groups based on the exposure time and intensity: the first group employed a traditional curing mode (TCG) for 20 seconds with an intensity of 1200 mw/cm2, whereas the second group had a quick curing mode (QCG) for 3 seconds with an intensity of 2500 mw/cm2. The pulp chamber's temperature variations and cooling times were recorded using a thermal imaging camera. The Mann-Whitney U test was used to find differences between the two-group comparison of the pulp chamber's temperature and cooling time. RESULTS: The two groups had statistically significant differences regarding the temperature increase in the pulp chamber and cooling time (p > 0.001). The mean temperature increase in the traditional curing group was 3.52°C, which is greater than that in the quick curing group (i.e., a mean value of 1.28°C). The mean cooling time in the traditional curing group was 38.83 seconds, which is greater than that in the quick curing group (9.97 seconds). CONCLUSIONS: Reducing the exposure time to 3 seconds and increasing the intensity to 2500 mw/cm2 is considered safer for the pulp chamber during and after the curing process.

Evaluation of the External Soft Tissue Changes Following the Correction of Class II Skeletal Malocclusion in the Adolescence Period Using Removable and Fixed Functional Appliances: A Systematic Review and Meta-Analysis.

In this systematic review, we aimed to assess the current evidence regarding the effectiveness of functional treatment with both removable and fixed appliances to normalize the external soft tissue for skeletal class II adolescent individuals. We performed a broad electronic search to retrieve relevant studies from nine databases to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that investigated soft tissue changes following functional treatment and evaluated the changes using 2D lateral cephalometric radiographs and 3D-optical surface laser scanning. A total of three RCTs and eight CCTs were included. Ages ranged from 11 to 16 years with the fixed functional appliances, and from eight to 12 years with the removable ones, including 689 skeletal class II patients. Version 2 of Cochran's risk-of-bias (RoB2), and the risk of bias in non-randomized studies of interventions (ROBIN-I) were used to assess the risk of bias for the included papers. Of the 11 eligible studies, three studies were included in the meta-analysis to assess the upper and lower lip position in relation to the E-line (Ricketts's aesthetic line) in addition to the nasolabial angle. The meta-analysis showed that the upper lip retracted after functional treatment with Twin-block in relation to E-line (mean difference (MD) = -1.93; 95% CI: -2.37, -1.50; p < 0.00001; χ² = 5.43; p = 0.07; I2 = 63%), while the lower lip position did not change after functional treatment with Twin-block in relation to E-line (MD = 0.03; 95% CI: -0.56, 0.61; p = 0.92; χ² = 1.74; p = 0.42; I2 = 0%). The nasolabial angle increased after Twin-block treatment (MD = 5.75; 95% CI: 4.57, 6.93; p < 0.00001; χ² = 6.77; p = 0.03; I2 = 70%). The mentolabial angle and Z-angle also increased after functional therapy, where the facial convexity angle decreased, regardless of the functional devices used. On the other hand, using the 3D-optical surface laser scanning showed that the upper lip length and the commissural width did not change following therapy, but the lower lip increased in length, as well as the total face height. More high-quality RCTs are required to obtain accurate evidence in this field.

Evaluation of the Impact of Orthodontic Treatment on Patients' Self-Esteem: A Systematic Review.

Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.

Effectiveness of Two Intensity Levels of Diode Laser in Debonding Metallic Brackets Regarding Enamel Surface Integrity and Pulpal Temperature: An Ex-Vivo Study.

INTRODUCTION: The traditional methods of deboning metal brackets exert excessive force, resulting in enamel scratches, fractures, and patient discomfort. The objective of this study was to evaluate the effectiveness of using two intensity levels of a diode laser for debonding metallic orthodontic brackets as an alternative to the conventional debonding method. MATERIALS AND METHODS: Sixty intact, extracted human premolar teeth were used in this study, and metal orthodontic brackets were bonded to the buccal surface of these teeth. The teeth were divided into three groups for the experiment: (1) the control group, where conventional bracket debonding was performed using a debonding plier, (2) the first experimental group, where a diode laser (2.5W, 980nm) was utilized for laser debonding, and (3) the second experimental group, where a diode laser (5W, 980nm) was used for laser debonding. The laser was applied using a sweeping movement for 5 seconds. After debonding, the adhesive remnant index (ARI), the lengths, and the frequency of enamel cracks were compared among the groups. Additionally, an increase in intra-pulpal temperature was measured. RESULTS: In all groups, there were no instances of enamel fractures. Laser debonding resulted in a significant reduction in both the frequency and length of newly formed enamel cracks compared to the conventional debonding method. The laser debonding group exhibited increases in intra-pulpal temperature of 2.37°C and 3.60°C in the second and third groups, respectively. These temperature increases were significantly lower than the threshold of 5.5°C. There were no significant differences observed in the ARI scores among the groups. CONCLUSION: With all debonding methods, an increase in the length and frequency of enamel cracks should be anticipated. However, laser-assisted debonding of metal brackets offers the advantage of reducing the risk of enamel damage while avoiding thermal damage to the pulp.

The Efficacy of Accelerating Orthodontic Tooth Movement by Combining Self-Ligating Brackets With One or More Acceleration Methods: A Systematic Review.

This review aimed to evaluate the effectiveness of using one or more acceleration methods with self-ligating brackets to accelerate orthodontic tooth movement in adults and the associated effects of these interventions. An electronic search of the following databases (PubMed, Scopus, Google Scholar, EMBASE) was performed (From January 1990 to November 2021). ClinicalTrials.gov and the International Clinical Trials Registry Platform were also electronically searched to find any unpublished studies and ongoing trials. The selected randomized controlled trials (RCTs) involved adult patients treated using self-ligating brackets combined with one or more acceleration methods compared with self-ligating brackets or conditional brackets alone. The risk of bias was assessed using Cochrane's risk of bias tool. A total of seven RCTs and one controlled clinical trial (CCT) were included in this review. Combining self-ligating brackets with flapless corticotomy, low-level laser therapy (LLLT), and infrared light accelerated orthodontic movement by 43% and 50% for surgical methods, 20-50% for LLLT, and 22% for infrared light. Regarding side effects on periodontal tissues, neither flapless corticotomy nor low-frequency vibrational forces caused any damage. Combining self-ligating brackets and flapless corticotomy, low-level laser, or infrared light effectively accelerated orthodontic movement by 20% to 50 %. In contrast, the combination of self-ligating brackets with vibrational forces did not affect speeding tooth movement. The acceleration methods did not have any side effects on the periodontal tissues, but the available evidence was insufficient. There is a need for further primary research regarding the effectiveness of combining self-ligating brackets with acceleration methods and the possible untoward side effects.

The Relationship Between Vertical Facial Type and Maxillary Anterior Alveolar Angle in Adults Using Cone-Beam Computed Tomography.

Background Cone-beam computed tomography (CBCT) imaging provides detailed and thorough information about the dentofacial complex. However, not all aspects have been yet explored among different types of malocclusion. The maxillary anterior alveolus is one of the components of the maxillary bone which affects the upper lip position and the esthetics of the smile. The inclination of this alveolus may vary between the different vertical growth patterns of patients who may seek orthodontic treatment. The objective of this study was to investigate possible differences in maxillary anterior alveolar angle (MAAA) among orthodontically untreated adults with different vertical facial types in a Syrian sample. Methods CBCT images of 84 orthodontically untreated adult patients were included. Three groups of vertical facial type (n=28 for each group; 14 males, 14 females) were created using disproportionate multi-stratified random sampling. CBCT-derived lateral cephalograms were used to categorize the patients into three groups. Measurements were made at three regions (region 1 (R1), region 2 (R2), and region 3 (R3)), located in the maxillary anterior alveolar bone using OnDemand3D™ software (Cypermed Inc., Seoul, South Korea). Results No significant differences in the mean MAAA were detected between females and males for the three measured regions in all groups. Analysis of variance showed significant inter-group differences in the MAAA (p<0.05) for all measured regions. The hyperdivergent facial type group had the greatest MAAA mean value of 68.72° (± 6.01), 67.30° (± 4.15), and 68.01° (± 5.12) at R1 in the female, male, and the entire sample of both sexes respectively. Whereas the hypodivergent facial type group had the least mean MAAA values of 58.47° (± 5.34) at R3, 59.83° (± 6.23) at R2, and 59.23° (± 5.75) at R3 in the female, male, and the entire sample of both sexes respectively. Conclusions The maxillary anterior alveolar bone was more buccally inclined in the hypodivergent facial type. The MAA bone inclination did not differ between females and males in the same vertical facial type group.

Evaluation of rapid versus slow maxillary expansion in early adolescent patients with skeletal maxillary constriction using cone-beam computed tomography: A short-term follow-up randomized controlled trial.

BACKGROUND: Maxillary expansion is one of the treatment options for the correction of the skeletal constriction of the upper jaw. However, evidence regarding the best treatment effects with the use of rapid vs. slow maxillary expansion in the early adolescence period (i.e., between the age of 12 and 16 years) is still lacking in the available literature. OBJECTIVES: The aim of the present study was to investigate the effectiveness of rapid and slow maxillary expansion in treating posterior skeletal constriction, and to compare the 2 techniques in terms of skeletal and dentoalveolar changes by using cone-beam computed tomography (CBCT). MATERIAL AND METHODS: The sample consisted of 34 patients (15 males and 19 females) suffering from posterior skeletal constriction. They were randomly allocated either to the rapid maxillary expansion (RME) group (17 patients aged 13.76 ±0.32 years) or to the slow maxillary expansion (SME) group (17 patients aged 14.02 ±0.28 years). The skeletal and dental landmarks, and changes in the posterior dimensions were examined using CBCT radiographs at the beginning of treatment (T1) and at the end of the observation period (T2). RESULTS: There were no significant differences between the 2 groups in terms of skeletal and dental changes except the amount of change in the inter-premolar width at the root apex, which was greater in the SME group (p = 0.007), as well as the amount of change in the skeletal palatal width in the molar region, which was also greater in the SME group (p = 0.008). CONCLUSIONS: Both maxillary expansion protocols were effective in treating posterior skeletal constriction. The average changes in the skeletal and dental widths were generally similar in both groups. Therefore, SME can be considered as an alternative to RME in patients with skeletal maxillary constriction in the early adolescence period.

Volumetric Analysis of the Jaws in Skeletal Class I and III Patients with Different Facial Divergence Using CBCT Imaging.

Aim: The main objective was to evaluate any possible maxillary or mandibular volumetric difference between hyperdivergent skeletal Class III (CIII), normodivergent skeletal CIII, hypodivergent skeletal CIII, and normodivergent skeletal Class I (CI) patients using cone-beam computed tomography (CBCT) images. Also, the secondary objective was to investigate any possible correlation between CBCT-derived lateral cephalometric variables and the mandibular and maxillary volumes (MdV and MxV, respectively). Materials and Methods: 80 CBCT images of patients between 18 and 32 years of age were taken with one CBCT imaging device (Scanora 3D®, Soredex, Tuusula, Finland). The sample consisted of four groups: 20 hypodivergent skeletal CIII (11 males and 9 females), 20 normodivergent skeletal CIII (7 males and 13 females), 20 hyperdivergent skeletal CIII (8 males and 12 females), and 20 normodivergent skeletal CI (5 males and 15 females). The volumes of both jaws and the ratio of MxV/MdV were obtained using Mimics™ 19 software (Materialise, NV, Belgium), and 2D variables were obtained from CBCT-derived lateral cephalogram using AudaxCeph™ software (Orthodontic software suite, Ljubljana, Slovenia). One-way ANOVA test and Kruskal-Wallis analysis were employed to detect any possible significant difference between the volumetric variables, whereas Pearson's and Spearman's correlation coefficients were calculated to detect any possible relationship between the 2D variables and the volumetric measurements. Results: There were no statistically significant differences in the maxillary volume or maxillary/mandibular ratio between the four groups (p=0.081 and 0.432, respectively). There was a significant difference in MdV between CIII hypodivergent (higher mean) and CIII hyperdivergent (p=0.039). There were some correlations between the MdV and 2D variables in the four studied groups especially in the posterior facial height (S-Go) and the facial depth (N-Go). There were some weaker correlations between the MxV and some 2D variables in the CIII hypodivergent and hyperdivergent groups. Conclusions: The mandibular volume of the Class III hypodivergent patient was significantly greater than that of the Class III hyperdivergent patients. Correlations between the maxillary or mandibular volumes were found with some of the 2D variables. The volume of both jaws increased when the maxillofacial complex moved toward a horizontal growth pattern.

Three-Dimensional Assessment of the Temporomandibular Joint Changes Following Reversed Twin Block Therapy of Patients With Skeletal Class III Malocclusion in Conjunction With the Photobiomodulation Therapy: A Randomized Controlled Clinical Trial.

BACKGROUND: Despite the positive effect of the photobiomodulation therapy (PBMT) application on animals, the primary role of this technique on the human condyle is still unclear. Several experimental reports have shown the efficacy of PBMT in inducing cellular changes in the temporomandibular joint (TMJ) region during functional treatment of patients with skeletal deformities. Still, the lack of information about its effects on human condyles requires further studies. OBJECTIVES: This study aimed to evaluate the effect of PBMT on the TMJ components following Class III treatment with the reversed twin block (RTB) appliance in growing patients.  Materials and Method: Forty children (12 females, 28 males) between the age of nine and eleven years with skeletal Class III were assigned randomly to the RTB group with photobiomodulation (RTB+PBMT) or the control group (RTB). The PBMT was applied to the TMJ region using an 808-nm wavelength Ga-Al-As semiconductor laser device with 5 Joules/cm2 energydensity on days 1, 3, 7, and 14 of the first month. Afterwards, the irradiation was conducted every 15 days until the end of the treatment. Cone-beam computerized tomography (CBCT) images were taken before (T1) treatment and following the end of treatment (T2) to assess TMJ and skeletal changes. RESULTS: Condylar volume was significantly increased in the RTB group only by a mean of 287.97 mm3 (p<0.001). The significantly backward and upward condylar movement was observed in the RTB and RTB+PBMT groups (superior joint space (SJS): 0.26 mm, 0.15 mm; posterior joint space (PJS): 0.42mm, 0.11mm, respectively). The RTB group showed the most remarkable changes. Significant improvement of the sagittal maxilla-mandibular relationship was greater in the RTB+PBMT group compared to the RTB group (p=0.02). CONCLUSION: There were no considerable differences in the condylar position after Class III treatment between the RTB and the RTB+PBMT groups. But a difference in the condylar volume was noticed between the two group.

The impact of non-extraction orthodontic treatment on oral health-related quality of life: clear aligners versus fixed appliances-a randomized controlled trial.

OBJECTIVE: To assess the impact of clear aligner treatment on oral health-related quality of life (OHRQoL) compared to fixed appliance treatment. TRIAL DESIGN: Two-arm parallel group single-centre randomized controlled trial. METHODS: Forty-four adult patients (8 males, 36 females) were randomly and equally assigned to either the fixed appliances group (FA) or the clear aligners group (CA). Randomization with an allocation ratio of 1:1 was performed by a researcher who is not involved in the study using a random sample table. Non-extraction cases were included in this study. Outcome measures were the OHRQoL of patients and the duration of orthodontic treatment. The OHRQoL of patients was assessed by the short-form Oral Health Impact Profile (OHIP-14) at the following assessment times: before the start of treatment (T0), 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after the start of orthodontic treatment and post-treatment (T5). The assessor was blinded during outcomes assessment and statistical analysis. RESULTS: Two hundred and eighteen patients were evaluated for eligibility, 44 of them fulfilled the inclusion criteria and were randomly allocated to treatment groups. None of the patients was lost to follow-up. Accordingly, the results of 44 patients were statically analysed. The total OHIP-14 score was not statistically different between the FA and the CA groups at T0 (P = 0.91) and T5 (P = 0.16), whereas it was significantly lower in the CA group as compared to the FA group at T1 (mean difference [MD] = 11.04, 95% CI 8.7 to 13.42, P < 0.001), T2 (MD = 6.00, 95% CI: 4.3 to 7.7, P < 0.001), T3 (MD = 3.37, 95% CI: 1.5 to 5, P < 0.01), and T4 (MD = 3.32, 95% CI: 1.7 to 4.9, P < 0.001). Treatment duration in the CA group was significantly shorter than in the FA group (MD = 4.18, 95% CI: 2.8 to 5.5, P < 0.001). No harms were observed. LIMITATIONS: The results were limited to the non-extraction treatment of mild to moderate crowding cases. CONCLUSIONS: Patients treated with clear aligners reported higher OHRQoL and shorter treatment duration as compared to those treated with fixed appliances. TRIAL REGISTRATION: Retrospectively registered (DRKS-ID: DRKS00023977).

Assessment of Patient-Centered Outcomes When Treating Maxillary Constriction Using a Slow Removable Versus a Rapid Fixed Expansion Appliance in the Adolescence Period: A Randomized Controlled Trial.

Objective This study aimed to evaluate and compare the levels of pain, discomfort, and functional impairments between slow and rapid maxillary expansion (RME) in treating skeletal maxillary constriction in the adolescence period (i.e., between 12 and 16 years). Materials and methods The study sample consisted of 52 patients (21 males and 31 females) with maxillary skeletal constriction in the posterior region. The patients were randomly distributed into either RME (26 patients, with a mean age of 13.87 (± 1.31) years) or slow maxillary expansion group (SME, 26 patients, with a mean age of 14.31 (± 1.19) years). The levels of pain, discomfort, and functional difficulties were assessed after 24 hours (T1), 7 days (T2), 15 days (T3), one month (T4), and four months (T5) following the onset of the expansion procedure. Results Patients in the RME group encountered significantly greater levels of pain and discomfort than those in the SME group at T1, T2, and T3 (p>0.001). Chewing and swallowing difficulties were significantly greater in the RME group at T1, T2, T3, and T4 (P≤0.001). The pressure on soft tissue was greater in the RME group at T2 and T3 (p>0.001). After four months (T5), the levels of pain and discomfort decreased to their lowest levels, as well as the difficulties of chewing and swallowing, and the pressure on soft tissue were almost non-existent in both groups. Conclusion Patients treated with the removable slow maxillary expander reported lower levels of pain and discomfort, fewer chewing and swallowing difficulties, and less pressure on soft tissues than those treated with the bonded rapid maxillary expander. These difficulties gradually decreased over time in both groups. The lower levels of pain and discomfort may make the SME an effective and comfortable treatment alternative for adolescents with skeletal maxillary constriction.

Evaluation of the acceleration, skeletal and dentoalveolar effects of low-level laser therapy combined with fixed posterior bite blocks in children with skeletal anterior open bite: A three-arm randomised controlled trial.

OBJECTIVES: To evaluate the effectiveness of the low-level laser therapy (LLLT) in accelerating the early treatment of the skeletal anterior open bite (AOB) and to evaluate the associated skeletal and dentoalveolar changes. MATERIALS AND METHODS: A three-arm, parallel-group, randomized controlled trial was conducted on 42 patients aged 8-10 years with skeletal AOB. Patients were randomly allocated to three groups: the fixed posterior bite block+low-level laser therapy (FPBB+LLLT) group; the fixed posterior bite block (FPBB) group; and the untreated control group (UCG) in a 1:1:1 allocation ratio. The LLLT dose in the FPBB+LLLT group was applied using 808-nm wavelength Ga-Al-As semiconductor laser device with the energy of 4-joules/point and irradiation time of 16 seconds/point. LLLT was applied in the first visit; then, it was applied on day 3, 7 and 14 of the first month. Afterwards, it was applied every 15 days until the end of the treatment. Lateral cephalometric images were taken at the beginning of the treatment (T0) and at the end of the active phase (T1). The primary outcome measures were the overall time needed to correct the AOB and the skeletal and dentoalveolar changes. RESULTS: The correction of the AOB required significantly less mean time in the FPBB+LLLT group compared to the FPBB group (x̅=7.07, x̅=9.42 months, respectively; P=0.001). The mean upper first molar intrusion in the FPBB+LLLT group was 1.21mm and significantly greater than that of the FPBB group (0.82mm; P=0.018). However, there was a slight mean extrusion of the upper first molar in the UCG (0.32mm). CONCLUSIONS: The overall time needed to correct the AOB was shorter in the FPBB+LLLT group. The LLLT appeared to be effective in accelerating orthodontic tooth movement. FPBB alone or LLLT were effective in the early treatment of anterior open bite (AOB). The two interventional groups produced similar dentoalveolar and skeletal changes; most of which were dentoalveolar in the correction of the anterior open bite.

The effectiveness of traditional corticotomy vs flapless corticotomy in miniscrew-supported en-masse retraction of maxillary anterior teeth in patients with Class II Division 1 malocclusion: A single-centered, randomized controlled clinical trial.

INTRODUCTION: This single-centered, parallel-groups trial aimed to evaluate the efficacy of traditional corticotomy vs flapless corticotomy in accelerating en-masse retraction. In addition, to assess the skeletal, dental, and soft-tissue variables, as well as the external apical root resorption (EARR) of the maxillary anterior teeth. METHODS: Forty patients with Class II Division 1 malocclusion aged >18 years at the beginning of treatment, requiring maxillary first premolar extractions, were randomly distributed into 2 groups (n = 20 each): 1 group was treated using traditional corticotomy, and the other group was treated with flapless corticotomy in en-masse retraction with anchorage based on miniscrews placed between maxillary second premolars and first molars bilaterally. Randomization was implemented with a computer-generated list of random numbers; allocation was concealed in sequentially numbered, opaque, sealed envelopes. The study was single-blinded (outcomes' assessor). The primary outcome was the en-masse retraction duration. Secondary outcomes were the skeletal, dental, and soft-tissue changes on lateral cephalometric and the EARR of maxillary anterior teeth on digital panoramic radiographs. RESULTS: The en-masse retraction duration in the flapless corticotomy group was longer than the traditional corticotomy group. The average retraction duration was 4.04 ± 1.10 months for the flapless corticotomy group and 3.75 ± 2.14 months for the traditional corticotomy group, with no significant difference between the 2 groups (95% confidence interval [CI], -0.81 to 1.39; P = 0.59). No significant differences were observed between the 2 groups regarding changes in several lateral cephalometric variables (eg, SNA angle [95% CI, -2.55° to 1.66°; P = 0.67], SN-U1 angle [95% CI, -1.70° to 1.32°; P = 0.80], and UL-E [95% CI: -1.33 to 1.00 mm; P = 0.78]) or in the amount of EARR in the maxillary anterior teeth (P = 0.31). The proportion of the observed EARR ranged from 1% to 6% of root length in both corticotomy groups. No serious harms were observed in both groups. CONCLUSIONS: No significant differences between the flapless and traditional corticotomies were found in terms of the skeletal, dental, and soft-tissue variables as well as in the amount of EARR. Corticotomy-assisted en-masse retraction led to improvements in skeletal structures and facial profile and resulted in sufficient retraction of maxillary anterior teeth, slight distal movement of maxillary first molars, and an intrusion movement for both anterior and posterior teeth. Both corticotomy techniques did not cause significant EARR. REGISTRATION: ClinicalTrials.gov (Identifier: NCT03279042). PROTOCOL: The protocol was not published before the trial commencement.

Evaluation of patient-centered outcomes associated with the acceleration of canine retraction by using minimally invasive surgical procedures: A randomized clinical controlled trial.

BACKGROUND: Only a few studies in the literature have reported patient-centered outcomes associated with minimally invasive corticotomy, and thus, related scientific evidence is limited. OBJECTIVES: The objective of this study was to evaluate patient-centered outcomes associated with upper canine retraction assisted with piezocision or laser-assisted flapless corticotomy (LAFC). MATERIAL AND METHODS: Thirty-two patients (19 females, 13 males) at a mean age of 18.25 ±3.05 years were randomly divided into 2 equal groups: the LAFC group (LG; n = 16) and the piezocision group (PG; n = 16). In each group, the surgical procedure was randomly assigned to one side of the maxillary arch, and the other side served as the control. Standardized questionnaires using the numerical rating scale (NRS) were distributed to all patients during the 1st month after the surgical procedure at 4 time points: 24 h (T1); 3 days (T2); 7 days (T3); and 14 days (T4). The patients' responses were obtained, regarding their feelings of pain, discomfort, swelling, eating difficulty, jaw movement restriction, analgesic consumption, and satisfaction. RESULTS: The levels of pain, discomfort, swelling, and difficulty in chewing were significantly greater at the experimental sides as compared to the control sides only at T1 in both groups (p < 0.05). The levels of pain and discomfort in LG were significantly lower than those in PG only at T1 (p = 0.013 and p = 0.009, respectively) whereas there were no significant differences between the groups regarding swelling, eating difficulty, jaw movement restriction, and analgesic consumption. The patients in both groups reported high levels of satisfaction, with no significant differences. The levels of pain, discomfort, swelling, eating difficulty, and jaw movement restriction were dramatically decreased 1 day after flapless corticotomy treatment in both groups (p < 0.05). CONCLUSIONS: Both LAFC and piezocision were associated with high levels of pain, discomfort, swelling, and difficulty in chewing at T1. Laser-assisted flapless corticotomy caused less pain and discomfort than piezocision.

Low-level laser therapy effectiveness in reducing initial orthodontic archwire placement pain in premolars extraction cases: a single-blind, placebo-controlled, randomized clinical trial.

BACKGROUND: The objective of this randomized clinical trial was to evaluate Low-Level Laser Therapy (LLLT) effectiveness in spontaneous and chewing pain reduction following initial orthodontic archwire placement. METHODS: 26 patients (mean age 20.07 ± 3.13 years) with maxillary Little's Irregularity Index (LII) of 7 mm or more that indicates first maxillary premolars extraction and no medications intake were eligible for this trial. Patients were randomly assigned with 1:1 ratio using simple randomization technique to receive either LLL or placebo treatment. Blinding was applicable for patients only. In the laser group, patients received a single LLL dose (wavelength 830 nm, energy 2 J/point) in four points (2 buccal, 2 palatal) for each maxillary anterior tooth root. Patients in the placebo group had the same laser application procedure without emitting the laser beam. Patients were asked to score spontaneous and chewing pain intensity by filling out a questionnaire with a 100-mm Visual Analogue Scale (VAS) after 1, 6, 24, 48, and 72 h of treatment application. Independent t-test was used to compare the mean pain scores between the laser and placebo groups for both spontaneous and chewing pain at each studied time point. RESULTS: No dropout occurred so the results of the 26 patients were statistically analyzed. Despite some clinical differences observed between the two groups, no statistical significance was found for each studied time point (p > 0.05) for both spontaneous and chewing pain except after 72 h for chewing pain with a VAS score of (18.84 ± 13.44) mm for the laser group compared to (38.15 ± 27.06) mm for the placebo group. CONCLUSIONS: LLLT, with the suggested parameters, is not effective in pain reduction following initial orthodontic archwire placement. TRIAL REGISTRATION: Name of the registry: Clinicaltrials.gov Trial registration number: NCT02568436. Date of registration: 26 September 2015 'Retrospectively registered'.

Evaluation of the effectiveness of piezocision-assisted flapless corticotomy in the retraction of four upper incisors: A randomized controlled clinical trial.

BACKGROUND: Comprehensive orthodontic treatment may last for 20-24 months. Reducing the treatment time has become a common demand from both patients and orthodontists. Minimally invasive piezocision is one of the suggested approaches to accelerate the orthodontic tooth movement. OBJECTIVES: The aim of this randomized controlled clinical trial was to assess the effectiveness of the flapless piezocision procedure in accelerating the retraction of upper incisors. MATERIAL AND METHODS: A single-blinded, parallel-group randomized controlled clinical trial was conducted at the Department of Orthodontics at the University of Damascus Dental School, Syria. The study involved 42 patients (11 males, 31 females) at the age of 16-31 years (mean age: 19.15 years). The patients had class II division I malocclusion and were treated with fixed appliances using the two-step retraction technique. With an allocation ratio of 1:1, the participants were randomly assigned to either the experimental group (n = 21) or the control group (n = 21) using a computer-generated list of random numbers. Allocation was concealed due to the use of sequentially numbered, opaque, sealed envelopes. The primary outcomes were the rate of incisor retraction (RIR) and the time required for retraction. The outcome assessor was blinded. RESULTS: The data analysis included 20 patients in each group. The rate of incisor retraction significantly increased in the experimental group by 53%, with a significant shortening of the retraction time in the experimental group by 27% (p < 0.001). The rate of anchorage loss was significantly lesser in the experimental group (p < 0.001). Regarding the cephalometric assessment, incisor tipping was significantly greater in the control group than in the experimental group. Skeletal measurements showed insignificant changes following retraction between the 2 groups. CONCLUSIONS: The piezocision procedure was found to be effective in accelerating the retraction of 4 upper incisors, reducing the retraction time, preserving anchorage and enhancing root torque control during retraction.

En-masse Retraction of Upper Anterior Teeth in Adult Patients with Maxillary or Bimaxillary Dentoalveolar Protrusion: A Systematic Review and Meta-analysis.

AIM: To evaluate the efficacy of accelerated and non-accelerated methods of en-masse retraction of the upper anterior teeth in terms of skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment. MATERIALS AND METHODS: An electronic search of PubMed and nine other major databases for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was performed between January 1990 and April 2018. The bibliography in each identified article was reviewed. In addition, manual searching was performed in the same time frame in five major orthodontic journals.The participants were patients over 14 years old undergoing fixed orthodontic treatment with extraction of maxillary or bimaxillary premolars followed by en-masse retraction of maxillary anterior teeth in both groups. Cochrane's risk of bias tool for RCTs and methodological index for non-randomized studies (MINORS) for CCTs were used. RESULTS: Eight articles (six RCTs and two CCTs) were included in this review, and only five articles were suitable for quantitative synthesis. The en-masse retraction caused a decrease in the SNA and ANB angles with no significant differences between the different en-masse retraction methods. Using temporary skeletal anchorage devices (TSADs) gave significantly better results in terms of posterior anchorage in comparison with conventional anchorage(standardized mean difference (SMD) = -3.03 mm, p < 0.001). No significant difference was found between en-masse/flapless corticotomy and en-masse/control groups in terms of anterior teeth retraction (p = 0.661); while there was a significantly greater anterior teeth retraction in corticotomy with flap elevation group compared to control group (p < 0.001). CONCLUSION: There is a weak to moderate evidence that using accelerated and non-accelerated methods would improve the facial profile and lead to similar skeletal corrections. There is weak to moderate evidence that using TSADs would lead to better posterior anchorage than using conventional anchor-age.Moderate evidence was found regarding the benefit of using piezosurgery in achieving good incisors' inclination. Contradictory results were found regarding the amount of achieved anterior retraction and the retraction time in the studies that evaluated acceleration methods versus the traditional methods of retraction. According to the quality of evidence, there is a need for more well-conducted RCTs, and more work to be oriented towards en-masse retraction with the use of other acceleration methods. CLINICAL SIGNIFICANCE: The correction of the maxillary or bimaxillary dentoalveolar protrusion by en-masse retraction of the upper anterior teeth with/without acceleration is accompanied by aesthetic results in the facial soft tissues as well as in the underlying skeletal and dental structures. The traditional corticotomy-assisted retraction is expected to reduce the retraction time significantly. However, the strength of evidence is not strong and requires additional research work.

Evaluation of piezocision and laser-assisted flapless corticotomy in the acceleration of canine retraction: a randomized controlled trial.

BACKGROUND: To evaluate the effectiveness of two minimally invasive surgical procedures in the acceleration of canine retraction: piezocision and laser-assisted flapless corticotomy (LAFC). METHODS: Trial design: A single-centre randomized controlled trial with a compound design (two-arm parallel-group design and a split-mouth design for each arm). PARTICIPANTS: 36 Class II division I patients (12 males, 24 females; age range: 15 to 27 years) requiring first upper premolars extraction followed by canine retraction. INTERVENTIONS: piezocision group (PG; n = 18) and laser-assisted flapless corticotomy group (LG; n = 18). A split-mouth design was applied for each group where the flapless surgical intervention was randomly allocated to one side and the other side served as a control side. OUTCOMES: the rate of canine retraction (primary outcome), anchorage loss and canine rotation, which were assessed at 1, 2, 3 and 4 months following the onset of canine retraction. Also the duration of canine retraction was recorded. Random sequence: Computer-generated random numbers. Allocation concealment: sequentially numbered, opaque, sealed envelopes. Blinding: Single blinded (outcomes' assessor). RESULTS: Seventeen patients in each group were enrolled in the statistical analysis. The rate of canine retraction was significantly greater in the experimental side than in the control side in both groups by two-fold in the first month and 1.5-fold in the second month (p < 0.001). Also the overall canine retraction duration was significantly reduced in the experimental side as compared with control side in both groups about 25% (p ≤ 0.001). There were no significant differences between the experimental and the control sides regarding loss of anchorage and upper canine rotation in both groups (p > 0.05). There were no significant differences between the two flapless techniques regarding the studied variables during all evaluation times (p > 0.05). CONCLUSIONS: Piezocision and laser-assisted flapless corticotomy appeared to be effective treatment methods for accelerating canine retraction without any significant untoward effect on anchorage or canine rotation during rapid retraction. TRIALS REGISTRATION: ClinicalTrials.gov (Identifier: NCT02606331 ).