Gingival Biotype and Its Relation with Malocclusion.

Objective: To systematically review the relationship between gingival biotype (GT) and malocclusion. Methods: The review followed PRISMA standards of quality for systematic reviews and meta-analyses reporting with PROSPERO registration number CRD42020126543. The systematic database search included MEDLINE, Scopus, Embase, PsychINFO, CINAHL, and other key journals; the article search was performed until February 2020. Cochrane's risk of bias in non-randomized studies-of interventions (ROBINS-I) was used to grade the methodological quality of the included studies. Results: The systematic search identified 105 studies, six studies satisfied the inclusion criteria for eligibility. The study participants ranged from 26 to 200 (total n=812), with a mean of 135. Study participants were aged between 14 and 32 years. Five studies were graded as the moderate risk of bias and one study as low risk of bias. Two studies showed thin GT among individuals with severe crowding compared to mild crowding. Three studies showed a thin GT with a narrow zone of the keratinized gingival width compared to a thick GT. No relationship was found between GT and Angle's classification of malocclusion. Conclusion: No relationship was observed between Angle's classification of malocclusion and GT. Thin GT was prevalent among individuals with pro-inclination of incisors. Keratinized gingival width was narrow among individuals with thin GT.

Shear bond strength of orthodontic brackets after adding silver nanoparticles to a nano-bond adhesive at different thermal cycles and cyclic loading- An in vitro study.

OBJECTIVE: To evaluate the effects of silver nano particles (AgNPs) added on Nano-Bond adhesive system (NBA) and its effect on shear bond strength (SBS) of orthodontic brackets attached to enamel at different thermal cycles and cyclic loading. MATERIALS AND METHODS: Forty extracted premolar teeth for orthodontic reasons were divided randomly into two main groups (20 teeth in each group). Group A: the brackets were bonded by NBA without additives. Group B: the brackets were bonded by NBA containing AgNPs with concentration 0.05%. Every group was further subdivided into 4 subgroups according to teeth subjected or not subjected to thermocycling and cyclic loading. SBS was tested using Lloyd universal testing machine. One-way analysis of variance (ANOVA) was used for testing the significance between the means of tested groups. RESULTS: Shear bond strength of Nano-Bond adhesive system with AgNPs showed significantly highest mean SBS (20.25 MPa) than Nano-Bond adhesive system without additives (15.64 MPa, P = 0.001). The SBS increased in Group B with AgNPs compared to Group A in all the conditions tested. Group A1 and B1 with zero thermal cycling and cyclic loading exhibited highest mean SBS. CONCLUSIONS: These results indicate addition of AgNPs significantly increased the shear bond strength of Nano-Bond adhesive system.

Association Between Early Childhood Caries and Obesity among Preschool Children.

PURPOSE: Early childhood caries (ECC) and childhood obesity are among the most prevalent health conditions affecting children. ECC is associated with obesity through the common risk factor of sugar consumption. The present study aimed to assess the association between ECC and obesity in preschool children. MATERIALS AND METHODS: A cross-sectional study was conducted among 1250 preschool children (698 girls, 552 boys; mean age: 4.3 [1.1] years). The children's body mass index was determined (BMI: weight/height in kg/m2). The World Health Organization criteria were used for the diagnosis of caries. Multivariable logistic regression was used to analyse the relationship between ECC prevalence and childhood obesity. RESULTS: ECC was detected in 929 (74.3%) children. The mean dmft and dmfs was 5.91 (1.13) and 8.92 (2.07), respectively. The multiple regression model showed a statistically significant association between ECC prevalence and obesity with an adjusted odds ratio (OR) of 2.59 (95% CI: 1.88 - 3.57; P = 0.001). The logistic regression model showed that in children with a monthly family income > $2666, sugar consumption, preterm low birth-weight/full-term low birth-weight (PTLBW/FTLBW), and toothbrushing frequency ≤ 1 time/day were statistically significantly associated with ECC prevalence. CONCLUSION: ECC was positively associated with obesity.

Effect of surface treatment on the mechanical stability of orthodontic miniscrews.

OBJECTIVES: To provide collective quantitative evidence about the effect of surface treatments on the mechanical stability of orthodontic miniscrews (MSs). MATERIALS AND METHODS: The study was registered in PROSPERO (No. CRD42020209652). The research question was defined according to the PICO (population, intervention, control, and outcomes) format. Various research databases were searched for animal and human studies on effects of surface treatment on the mechanical stability of MSs. Both prospective and retrospective in vivo clinical studies published in English were included. The risk of bias was assessed using SYRCLE's risk of bias tool for animal studies. The meta-analysis was conducted using RevMan 5.4. RESULTS: A total of 109 articles were identified; 14 were included in the systematic review, and seven studies with sandblasting, acid etching (SLA) methods of surface treatment were included for meta-analysis. The number of study participants ranged from 6 to 24 (total n = 185), with a mean of 13.2. A total of 949 MSs were used with a mean of 67.8. The overall success rate for surface-treated MSs ranged from 47.9% to 100%. Forest plot of removal torque values showed significantly higher values for SLA surface-treated MSs compared with controls with a standard mean difference of 2.61 (95% confidence interval = 1.49-3.72, I2 = 85%). Forest plot of insertion torque showed a standard mean difference of -6.19 (95% confidence interval = -13.63-1.25, I2 = 98%, P = .10). CONCLUSIONS: Surface treatment of MSs improved primary and secondary stability with good osseointegration at the bone-implant surface. However, significant heterogeneity across the studies included in the meta-analysis made it difficult to draw conclusions.

Dental Erosion Prevalence and Its Association With Obesity Among Children With and Without Special Healthcare Needs.

PURPOSE: Dental erosion and childhood obesity are associated with a common risk factor, soft drink consumption. The present study aims to assess the prevalence of dental erosion and its association with obesity among children with and without special healthcare needs. MATERIALS AND METHODS: A cross-sectional study was conducted on 1,200 school children (400 children with special needs (CSHN) and 800 children without special needs) in the age group of 6 to 16 years. Dental erosion was diagnosed according to World Health Organization (WHO) criteria. Body mass index (BMI; weight/height in kg/m2) was recorded for each child. The association of dental erosion and obesity was analysed using multivariate logistic regression analysis. RESULTS: A total of 331 (27.6%) children presented with dental erosion. Dental erosion prevalence among CSHN was 33.5% and among children without special needs was 24.6%. In the final fully adjusted model, children with obesity presented 2.32 times (95%CI 1.17-4.89, P = 0.001) higher odds ratio (OR) of having dental erosion than normal-weight children. Children who consumed soft drinks ≥ 1 time/day and 2-6 times a week presented with an OR of 2.65 (95%CI 1.23-5.21, P = 0.001) times of dental erosion. Children with chronic vomiting and bulimia presented with a 3.27 (95%CI 1.72-6.12, P = 0.001) times higher OR of dental erosion. Children with gastric reflux presented with a 3.21 (95%CI 1.52 - 5.86, P = 0.001) times higher OR of dental erosion. CONCLUSION: The prevalence of dental erosion was slightly higher for special needs children compared to children without special needs. The study outcome suggests that obesity, chronic vomiting, consumption of soft drinks, and gastric reflux are statistically significantly associated with dental erosion.

Frequency of molar incisor hypomineralization and associated factors among children with special health care needs.

BACKGROUND: Molar incisor hypomineralization (MIH) is a frequently encountered oral condition that varies from mild opacities to posteruptive enamel breakdown. No previous published studies have investigated the frequency of MIH and associated risk factors among children with special health care needs (CSHCN) to our awareness. OBJECTIVES: Assess the frequency of MIH and associated risk factors among CSHCN. DESIGN: Cross-sectional. SETTING: Schools in provincial city of Saudi Arabia. PATIENTS AND METHODS: The study was conducted among 400 (180 boys and 220 girls) special needs children. Diagnosis of MIH was according to the European Academy of Paediatric Dentistry criteria. MAIN OUTCOME MEASURE: Result of logistic regression analysis that assessed the association between MIH prevalence and associated prenatal, perinatal, and postnatal factors. SAMPLE SIZE: 400 (180 boys and 220 girls) special needs children. RESULTS: Among 400 CSHCN, 98 (24.5%) presented with MIH. Children with multiple disabilities had a 3.89 times greater risk of MIH (95% CI: 1.91-6.19, P=.002). Children with positive prenatal factors had an adjusted odds ratio (aOR) of 2.31 times for MIH (95% CI: 1.22-4.73, P=.012). Children with a childhood infection history had an aOR of 2.43 times for MIH (95% CI: 1.31-5.85, P=.014). Children with a breastfeeding history >18 months had an aOR of 3.73 for MIH (95% CI: 1.62-8.60, P=.002). Permanent maxillary first molars were the most frequently affected teeth, and demarcated opacity was the most frequent MIH type. CONCLUSION: MIH should be recognized as one of the prevalent oral health problems among CSHCN to prevent tooth mortality. LIMITATIONS: A cross-sectional study cannot establish a causal relationship. CONFLICTS OF INTEREST: None.

Traumatic dental injuries in special health care needs children and association with obesity.

BACKGROUND: Special needs children are at a higher risk of dental trauma because of neurological, physical, mental, and behavioral impairments. They are also at higher risk of developing obesity due to the side effects of medication. OBJECTIVE: Assess the association between traumatic dental injuries (TDIs) and obesity in children with special health care needs. DESIGN: Analytical cross-sectional study. SETTING: Schools for special needs children. STUDY POPULATION AND METHODS: Special needs children with a diagnosis of TDI according to the Andreasen criteria were included in the study. Data on the disability status were obtained from a national demographic survey in 2016. Demographic and dental variables were measured for analysis. Multivariable logistic regression was used to analyse any relationship between TDI prevalence and obesity. MAIN OUTCOME MEASURE: Relationship of body mass index (BMI) to TDI prevalence. SAMPLE SIZE: 350 (131 boys and 219 girls) special needs children with a median (interquartile range) age of 12.0 (2.0) years. RESULTS: Eighty-one (23.1%) children presented with TDIs. The mean (standard deviation) BMI for the entire study population was 24.7 (7.8). Children with obesity had a 30.3% TDI prevalence compared normal-weight children (20.6%) (P=.035), but BMI category was not statistically significant in the regression analysis (P=.541), which showed that children with an overjet of >3 mm were 4.82 times (CI: 2.55-9.09, P=.001) more likely to have TDI than children with an overjet of ≤3 mm. Those with inadequate lip coverage were 2.85 times (CI: 1.49-5.44, P=.002) more likely to have TDI. Children with cerebral palsy were 3.18 times (CI: 1.89-11.32, P=.024) more likely to have TDI than children with other disabilities. CONCLUSION: The study showed a significant association between TDI prevalence and increased overjet, inadequate lip coverage, and cerebral palsy. The prevalence of TDI among obese special needs children was statistically significant according to bivariate analysis, but not in a multivariate analysis that adjusted for other variables. LIMITATIONS: Causal relationship cannot be established with cross-sectional study. CONFLICT OF INTEREST: None.

Association Between Dental Caries and Obesity among Children with Special Health Care Needs.

PURPOSE: Obesity and dental caries constitute an important public health problem worldwide. Special-needs children are at higher risk of developing dental caries and obesity because of their physical, neurological, or behavioural impairment or due to side effects of the medications they take. The present study was conducted to assess the association between dental caries and obesity among children with special health care needs in Taif City, Saudi Arabia. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among 400 (220 girls and 180 boys) special-needs children. Body mass index (BMI) was determined by using height and weight measurements. Dental caries was recorded according to World Health Organization criteria. The association between caries and obesity was assessed using multivariable logistic regression analysis. RESULTS: 289 (72.3%) children presented with caries with mean dmft and DMFT of 3.9 ± 2.7 and 4.8 ± 2.3, respectively. Regression analysis showed specials needs children were at a greater risk of having dental caries: 1.69 times (CI: 0.18-2.62, p < 0.05) greater with obesity; 2.01 (CI: 0.18-3.09, p < 0.05) times greater with sugar consumption; 2.21 times (CI: 1.27-4.12, p < 0.001) greater with cerebral palsy; and 2.27 (CI: 1.29-5.12, p < 0.001) times greater with intellectual disability. CONCLUSION: The present study showed a positive association between dental caries and obesity among children of special health care needs. Hence, a focused approach towards the common risk factors is essential to prevent both obesity and dental caries in special-needs children.

Self-assembling peptide P11-4 in remineralization of enamel caries - a systematic review of in-vitro studies.

OBJECTIVE: The present systematic review was conducted to investigate the effect of the self-assembling peptide (SAP) - P11-4 in the remineralization of enamel caries. MATERIAL AND METHODS: The systematic search for studies was conducted through CINAHL, EMBASE, MEDLINE, Scopus, PsychINFO, and various key journals. This review was conducted in adherence to PRISMA standards and was registered in PROSPERO with registration number CRD42019110156. The methodological quality of the studies was graded through Cochrane's tool of risk of bias in non-randomized studies - of interventions (ROBINS-I). RESULTS: In total, 91 studies were identified for screening, and 12 studies were eligible. Ten studies showed effective enamel remineralization with P11-4 compared to controls. One study showed a combination of P11-4 with fluoride varnish or Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP-ACPF) leads to significantly higher remineralization compared to P11-4 alone. Quality assessment of study showed 6 (50%) studies as medium risk of bias and 6 (50%) studies as low risk of bias. CONCLUSION: To conclude, the present study results showed SAP- P11-4 is effective in the remineralization of enamel caries.

Changes in Upper Airway Dimensions Following Orthodontic Treatment of Skeletal Class II Malocclusion with Twin Block Appliance: A Systematic Review.

OBJECTIVE: This systematic review intends to evaluate the dimensional changes in upper airway dimensions (UAD) of the respiratory tract subsequent to orthodontic treatment of skeletal Class II malocclusion with Twin Block Appliance (TBA). METHODS: The quality of reporting systematic reviews and meta-analyses was decided by the PRISMA standards with PROSPERO registration number CRD42017060317. The systematic search included EMBASE, MEDLINE, Psych INFO, Scopus, CINAHL, and other reference journals and review articles. The article search was performed from March 2017 until November 2017. Cochrane's risk of bias in non-randomized studies - of interventions (ROBINS-I) was used to grade the methodological quality of the included studies. RESULTS: The screening procedure identified 302 studies, among which seven studies satisfied the inclusion criteria for eligibility. The UAD at the pretreatment time varied from 7.2 mm to 41.9 mm with a mean of 14.16 mm. The post-treatment change in UAD ranged from 8.2 mm to 43.7 mm with a mean of 15.6 mm. CONCLUSION: There was a significant increase in UAD following the TBA treatment in the patient group as compared to the control group.

Enamel matrix derivative (Emdogain) in treatment of replanted teeth - a systematic review.

OBJECTIVE: The main purpose of the present systematic review was to evaluate the efficacy of enamel matrix derivative Emdogain in healing of replanted teeth in humans. MATERIALS AND METHODS: This review conducted in adherence to PRISMA standards and was registered in PROSPERO with registration number CRD42017062736. We graded the methodological quality of the studies by means of Cochrane's tool of risk of bias in non-randomized studies - of interventions (ROBINS-I). RESULTS: In total, 65 studies were identified for screening, and five studies were eligible. The uneventful healing of replanted teeth was varied from 20% to 75%. Two controlled trials found Emdogain treatment significantly reduced resorption of replanted teeth and improved the healing of periodontal ligament compared with controls. Two studies showed high recurrent resorption in Emdogain treated teeth. CONCLUSIONS: To conclude, the number of publications that met all inclusion criteria were limited and did not allow for drawing evidence for Emdogain being effective in supporting healing of replanted teeth.

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.

Efficacy of platelet concentrates in pulpotomy - a systematic review.

The main purpose of the present systematic review was to evaluate the efficacy of platelet concentrates in pulpotomy of human teeth. Our systematic search included Medline, Embase, CINAHL, PsycINFO, Scopus, key journals, and review articles; the date of the last search was July 30, 2017. We graded the methodological quality of the studies by Cochrane Risk of Bias tool. Four randomized controlled trails were included in the present systematic review. The number of study participants ranged from 28 to 50, with a mean of 45.5. The age of study participants ranged between 4 and 25 years. In three of the included studies, platelet-rich fibrin (autologous) was used and in one study lyophilized freeze-dried platelet (allogenic) was used as pulpotomy material. Calcium hydroxide and mineral trioxide aggregate were used in control groups. The quality assessment rated three studies as being of fair quality and one study as poor quality. Two of the included studies showed a 100% success of pulpotomy with platelet concentrates and two studies showed more than 80% of success, but the difference between control group and platelet concentrates group was not statistically significant. To conclude, the number of publications that met all inclusion criteria was found to be very limited and no significant difference was reported in the studies comparing platelet concentrates with other materials in pulpotomy. The present results point to the need for high-quality randomized controlled trials in further research.

Pendulum and modified pendulum appliances for maxillary molar distalization in Class II malocclusion - a systematic review.

OBJECTIVE: The main purpose of the present systematic review was to evaluate the quantitative effects of the pendulum appliance and modified pendulum appliances for maxillary molar distalization in Class II malocclusion. MATERIALS AND METHODS: Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus and key journals and review articles; the date of the last search was 30 January 2017. We graded the methodological quality of the studies by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP). RESULTS: In total, 203 studies were identified for screening, and 25 studies were eligible. The quality assessment rated four (16%) of the study as being of strong quality and 21 (84%) of these studies as being of moderate quality. The pendulum appliances showed mean molar distalization of 2-6.4 mm, distal tipping of molars from 6.67° to 14.50° and anchorage loss with mean premolar and incisor mesial movement of 1.63-3.6 mm and 0.9-6.5 mm, respectively. The bone anchored pendulum appliances (BAPAs) showed mean molar distalization of 4.8-6.4 mm, distal tipping of molars from 9° to 11.3° and mean premolar distalization of 2.7-5.4 mm. CONCLUSIONS: Pendulum and modified pendulum appliances are effective in molar distalization. Pendulum appliance with K-loop modification, implant supported pendulum appliance and BAPA significantly reduced anchorage loss of the anterior teeth and distal tipping of the molar teeth.

Torque expression in self-ligating orthodontic brackets and conventionally ligated brackets: A systematic review.

BACKGROUND: To evaluate the torque expression of self ligating (SL) orthodontic brackets and conventionally ligated brackets and the torque expression in active and passive SL brackets. MATERIAL AND METHODS: Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles; the date of the last search was April 4th 2016. We graded the methodological quality of the studies by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP). RESULTS: In total, 87 studies were identified for screening, and 9 studies were eligible. The quality assessment rated one of the study as being of strong quality, 7 (77.78%) of these studies as being of moderate quality. Three out of 7 studies which compared SL and conventionally ligated brackets showed, conventionally ligated brackets with highest torque expression compared to SL brackets. Badawi showed active SL brackets with highest torque expression compared to passive SL brackets. Major and Brauchli showed no significant differences in torque expression of active and passive SL brackets. CONCLUSIONS: Conventionally ligated brackets presented with highest torque expression compared to SL brackets. Minor difference was recorded in a torque expression of active and passive SL brackets. Key words:Systematic review, self ligation, torque expression, conventional ligation.

The Factors Affecting Long-Term Stability in Anterior Open-Bite Correction - A Systematic Review.

OBJECTIVE: The present systemic review was conducted with the main purpose to evaluate the quantitative effects of orthognathic surgeries, extraction versus non-extraction treatment, and the type of malocclusion in the stability of anterior open-bite (AOB) correction over the long-term. METHODS: The systematic search for studies was conducted through MEDLINE, CINAHL, EMBASE, Scopus, PsychINFO, various key journals, and review articles; November 30, 2016, was the last date for the search. The Quality Assessment Tool for Quantitative Studies was used to grade the methodological quality of the studies. RESULTS: The present review included 14 studies. Stability of the corrected AOB ranged from 61.9% to 100%. The studies with orthognathic surgeries showed a stability of 70-100%. The studies without orthognathic surgeries showed the stability of 61.9-96.7%. All of the studies were retrospective. The mean change in AOB before (T1) and after treatment (T2-T1) was 0.1 mm to 6.93 mm and the mean change in overbite from T2 to T3 (T3-T2) was -0.06 mm to 2.5 mm. CONCLUSION: Studies with orthognathic surgeries presented with high amount of long-term stability in corrected AOB. No significant difference was noticed in relation to the type of malocclusion and extraction or non-extraction cases.

Cephalometric craniofacial features of growing patients with chronic renal failure.

INTRODUCTION: Chronic renal failure (CRF) in growing children can affect their physical growth status. The objective of this research was to study the craniofacial morphology of children with CRF as evaluated by cephalometric analysis. METHODS: Twenty-three growing children with CRF were included in this study. They were divided into three groups according to age ranges. The age ranges were >5-11 (group 1); >11-14 (group 2); >14-16 (group 3). Another twenty-three matching controls (in age and gender) were also included. Lateral cephalometric radiographs were taken as part of these children's orthodontic records. Lateral cephalometric radiographs were corrected for magnification distortion, digitized, and cephalometric analysis was performed. Data were analysed using ANOVA test. RESULTS: The results showed that CRF patients in all age groups have statistically significantly decreased posterior cranial base lengths. Posterior facial heights showed a significant decrease in CRF patients in groups 1 and 2. Younger CRF patients (group 1) showed statistically significant increased gonial angle and FH-Mandibular plane angle, SN-Mandibular plane angle and decreased posterior to anterior face height ratio, total anterior facial height (N-Me), Mandibular body length (Go-Me), upper anterior facial height (N-ANS), Y axis length, pterygomaxillary-A point length. CONCLUSION: Younger children (groups 1 and 2) with CRF showed a decrease in posterior facial growth (posterior facial height and posterior cranial base) when compared to matching normal controls. This decrease is not significant in older group (group 3). This finding suggests that children with CRF might catch up in growth with normal subjects and most of the earlier retarded growth features disappear with age.

Accuracy of computer programs in predicting orthognathic surgery hard tissue response.

PURPOSE: The aim of this systematic review was to investigate the accuracy of computer programs in predicting skeletal changes after orthognathic surgery. MATERIALS AND METHODS: A systematic computerized database search was conducted with the help of a health sciences librarian. Specific selection criteria were used to select articles, reference lists of the selected articles were also searched for any potential articles that might have been missed in the electronic search, and additional information not available through the articles was obtained directly from the corresponding author. RESULTS: Of the 79 initially identified articles (abstracts/titles), only 9 fulfilled the final selection criteria. As expected, no dental changes occurred but the computer programs were unable to precisely predict all the skeletal changes. Most of the prediction inaccuracies were within 2 mm or 2 degrees , which can be partially attributed to measurement errors in cephalometric tracing. CONCLUSIONS: This systematic review showed that computer programs cannot consistently predict the skeletal changes occurring after orthognathic surgery but their results may be considered inside a clinically acceptable range. Last-minute changes by the surgeons could also explain the differences. We also conclude that no software program was shown to be superior in prediction accuracy compared with its competitor.