ABSTRACT
Rapid maxillary expansion (RME) may change speech sound parameters due to the enlargement of oral and nasal cavities. This study aimed to systematically review the current evidence on speech changes as a side effect of RME. An electronic search was conducted in nine databases, and two of them accessed the 'grey literature'. The eligibility criteria included clinical studies assessing orthodontic patients with maxillary transverse deficiency and the relationship with speech alterations without restricting publication year or language. Only interventional studies were included. The JBI Critical Appraisal Tool assessed the risk of bias. The initial search provided 4853 studies. Seven articles (n = 200 patients) met the inclusion criteria and were analysed. The primary source of bias was the absence of a control group in four studies. RME altered speech production by changing vowel fundamental frequency and fricative phoneme formant frequency. Shimmer and jitter rates changed in one and two studies, respectively. Two studies presented deterioration during orthodontic treatment, but speech improved after appliance removal. Despite the limited evidence, RME affects speech during and after treatment.
Subject(s)
Palatal Expansion Technique , Phonetics , Humans , Palatal Expansion Technique/adverse effects , Speech , Maxilla , Nasal CavityABSTRACT
To seek scientific evidence to support the effectiveness of invisible aligners, in the aesthetic and functional aspects, compared with that of conventional braces. An electronic search was performed with a complementary grey literature search for in vivo research. No language restrictions were applied. Scopus, PubMed, Web of Science, Cochrane, ClinicalTrials and GreyLiterature databases were used. Studies were first selected by title and abstract; those potentially eligible were read in full. Non-randomized studies were assessed for risk of bias using the tools Methodological Index for Non-randomized Studies (MINORS) and Cochrane Collaboration Common Scheme for Bias as a function of the presence of randomization. The search found 559 studies, of which 55 were potentially eligible. A total of 4 articles were included in this systematic literature review: three non-randomized controlled studies and one randomized controlled study, three with low risk of bias (RoB) and one with moderate RoB. Three studies showed time of correction of dental crowding shorter or equal to that of the control group and only one study showed less time of correction using conventional braces. Invisible aligners were deficient with respect to anterior/posterior and vertical corrections compared with fixed orthodontic appliances. Invisible aligners are effective in promoting dental alignment, but present clinical limitations in relation to the conventional system.
Subject(s)
Malocclusion , Esthetics , Humans , Orthodontic Appliances, FixedABSTRACT
The presence of fixed orthodontic appliances and its accessories tends to affect bacterial plaque removal, resulting in inadequate cleaning being performed by the patient. Thus, the aim of this systematic review and meta-analysis was to answer the following focal question: are the mechanical methods of oral cleaning effective for the reduction of bacterial dental plaque in patients with a fixed orthodontic appliance? A systematic search of the literature was conducted in the following databases: Scopus, PubMed, Cochrane, Web of Science, Embase, and Medline, in addition to Controlled Trials and Grey Literature, without limitations of language and year of publication. Furthermore, searches were also conducted in the reference lists of the articles selected. Included in the present review were clinical studies with patients undergoing therapy with fixed orthodontic appliances, which would, by means of comparison, evaluate the effectiveness of different mechanical bacterial plaque removal methods. The methodological quality of the articles included was evaluated in accordance with the methodological evaluation protocol, and was classified as high, moderate or low. In order to perform the meta-analysis, articles with high methodological quality were included. Analysis of subgroups was performed according to the type of intervention. The plaque index was defined as the continuous outcome variable, using the fixed effect when there was homogeneity among the articles, and the random effect in cases of heterogeneity. 1815 articles were found, of which only 23 fulfilled the eligibility criteria, with 17 being of high methodological quality and 6 of moderate quality. Of these, 18 included an analysis of the effectiveness of the conventional manual brush, 4 of the manual orthodontic brush,15 of electric brushes, 3 of interdental brushes, 1 of dental floss and 4 or oral irrigation devices, and 1 of Siwak. In the qualitative evaluation of the studies, the use of these mechanical control methods was shown to be effective, with exception of the use of Siwak, which presented an increase in bacterial plaque. Moreover, the results of the meta-analysis indicated a significant reduction of -0.98 (IC 95%) in the plaque index for the use of conventional manual brushes in the period of one month (p<0.001). There is a body of evidence that proves the effectiveness of mechanical bacterial plaque removal in patients using orthodontic appliances and accessories. The findings of the meta-analysis proved the effectiveness of the conventional manual brush. Further studies with better standardization of samples are required to strengthen the evidences.
A presença de aparelhos ortodônticos fixos e seus acessórios tende a afetar a remoção da placa bacteriana, resultando em limpeza inadequada realizada pelo paciente. Assim, o objetivo desta revisão sistemática e metaanálise foi responder à seguinte questão norteadora: os métodos mecânicos de limpeza oral são eficazes para a redução da placa bacteriana dental em pacientes com aparelho ortodôntico fixo? Uma pesquisa sistemática da literatura foi realizada nas seguintes bases de dados: Scopus, PubMed, Cochrane, Web of Science, Embase e Medline, além de Ensaios Controlados e Literatura Cinzenta, sem limitações de idioma e ano de publicação. Além disso, as pesquisas também foram realizadas nas listas de referência dos artigos selecionados. Foram incluídos na presente revisão estudos clínicos realizados com pacientes submetidos à terapia com aparelhos ortodônticos fixos, os quais, por meio de comparação, avaliaram a eficácia de diferentes métodos mecânicos de remoção de placas bacterianas. A qualidade metodológica dos artigos incluídos foi avaliada de acordo com o protocolo de avaliação metodológica, e classificada como alta, moderada ou baixa. Para realização da metanálise, foram incluídos artigos de alta qualidade metodológica. A análise dos subgrupos foi realizada de acordo com o tipo de intervenção. O índice de placa foi definido como variável de desfecho contínuo, utilizando o efeito fixo quando houve homogeneidade entre os artigos e o efeito aleatório nos casos de heterogeneidade. 1815 artigos foram encontrados, dos quais apenas 23 preencheram os critérios de elegibilidade, sendo 17 de alta qualidade metodológica e 6 de qualidade moderada. Destes, 18 incluíram uma análise da eficácia da escova manual convencional, 4 da escova ortodôntica manual, 15 de escovas elétricas, 3 de escovas interdentais, 1 de fio dental e 4 de dispositivos de irrigação oral e 1 de Siwak. Na avaliação qualitativa dos estudos, a utilização destes métodos mecânicos de controle mostrou-se efetiva, com exceção do uso de Siwak, que apresentou aumento na placa bacteriana. Além disso, os resultados da meta-análise indicaram uma redução significativa de -0,98 (IC 95%) no índice de placa para o uso de escovas manuais convencionais no período de um mês (p <0,001). Existe um conjunto de provas que comprovam a eficácia da remoção de placas bacterianas mecânicas em pacientes que utilizam aparelhos e acessórios ortodônticos. Os resultados da metanálise provaram a eficácia da escova manual convencional. Outros estudos com melhor padronização de amostras são necessários para fortalecer as evidências.
Subject(s)
Oral Hygiene , Orthodontic Appliances , Dental PlaqueABSTRACT
ABSTRACT Introduction: the treatment of Class III malocclusion in early age is one of the greatest challenges for orthodontists, and the establishment of more effective treatment method is a constant concern for these professionals. Thus, the objective of this systematic review is to verify the effectiveness of the therapy protocol for alternate rapid maxillary expansion and constriction (Alt-RAMEC) in the early treatment of Class III malocclusion. Methods: searches were performed in the following electronic databases: Cochrane Library, Medline (EBSCO and PubMed), SciELO, LILACS and Scopus. The following inclusion criteria were used: in vivo studies conducted with early intervention (patient in craniofacial development phase) with the use of the Alt-RAMEC protocol. Reviews, case reports, editorials, and studies with syndromic patients or under use of systemic drug were excluded. Duplicates were also excluded. The studies were assessed for methodological quality using the Cochrane tool for assessment of risk of bias, and classified as high or low risk of bias. Results: 53 articles were found. Duplicates exclusion was thus performed and 35 articles remained. After inclusion analysis, only 5 matched the criteria. Two articles were classified as low risk of bias and three as high risk of bias. It was observed that the Alt-RAMEC enable protraction in less time and with better results, promoting greater effectiveness in the protraction treatment of Class III malocclusion. Conclusions: Although there is positive evidence of the effectiveness of early treatment with the Alt-RAMEC protocol in patients with Class III malocclusion, further studies are needed to confirm its effectiveness using long-term methodology.
resumo Introdução: o tratamento da má oclusão de Classe III em idade precoce é um dos maiores desafios para os ortodontistas, e a descoberta de métodos de tratamento mais efetivos é uma preocupação constante para esses profissionais. Assim, o objetivo da presente revisão sistemática é verificar a eficácia do protocolo de expansão rápida da maxila e constrição alternadas (Alt-RAMEC) no tratamento precoce da má oclusão de Classe III. Métodos: foram realizadas buscas nas bases de dados eletrônicas Cochrane Library, Medline (EBSCO e PubMed), SciELO, LILACS e Scopus, obedecendo aos seguintes critérios de inclusão: estudos in vivo em que foi realizada intervenção precoce (pacientes em fase de desenvolvimento craniofacial) com o uso do protocolo Alt-RAMEC. Foram excluídos, além das duplicatas, os relatos de caso, revisões, editoriais e estudos com pacientes sindrômicos ou sob uso de drogas sistêmicas. Os estudos foram avaliados, quanto à qualidade metodológica, por meio da ferramenta Cochrane para Avaliação de Risco de Viés, e classificados como alto ou baixo risco de viés. Resultados: foram encontrados 53 artigos e, após removidas as duplicatas, restaram 35 artigos, dos quais 8 foram lidos na íntegra, mas apenas 5 se enquadraram nos critérios de inclusão. Desses, apenas 2 foram classificados como tendo baixo risco de viés e 3 como tendo alto risco de viés. Observou-se que o Alt-RAMEC promove a protração em menor tempo e com melhores resultados, assim como possui maior efetividade no tratamento da má oclusão de Classe III. Conclusões: apesar das evidências positivas da efetividade do tratamento precoce de pacientes com má oclusão de Classe III usando o protocolo Alt-RAMEC, ainda são necessários mais estudos em longo prazo para confirmar sua efetividade.
Subject(s)
Humans , Palatal Expansion Technique , Malocclusion, Angle Class III/therapy , Treatment Outcome , Systematic Reviews as TopicABSTRACT
INTRODUCTION:: the treatment of Class III malocclusion in early age is one of the greatest challenges for orthodontists, and the establishment of more effective treatment method is a constant concern for these professionals. Thus, the objective of this systematic review is to verify the effectiveness of the therapy protocol for alternate rapid maxillary expansion and constriction (Alt-RAMEC) in the early treatment of Class III malocclusion. METHODS:: searches were performed in the following electronic databases: Cochrane Library, Medline (EBSCO and PubMed), SciELO, LILACS and Scopus. The following inclusion criteria were used: in vivo studies conducted with early intervention (patient in craniofacial development phase) with the use of the Alt-RAMEC protocol. Reviews, case reports, editorials, and studies with syndromic patients or under use of systemic drug were excluded. Duplicates were also excluded. The studies were assessed for methodological quality using the Cochrane tool for assessment of risk of bias, and classified as high or low risk of bias. RESULTS:: 53 articles were found. Duplicates exclusion was thus performed and 35 articles remained. After inclusion analysis, only 5 matched the criteria. Two articles were classified as low risk of bias and three as high risk of bias. It was observed that the Alt-RAMEC enable protraction in less time and with better results, promoting greater effectiveness in the protraction treatment of Class III malocclusion. CONCLUSIONS:: Although there is positive evidence of the effectiveness of early treatment with the Alt-RAMEC protocol in patients with Class III malocclusion, further studies are needed to confirm its effectiveness using long-term methodology.
Subject(s)
Malocclusion, Angle Class III/therapy , Palatal Expansion Technique , Humans , Systematic Reviews as Topic , Treatment OutcomeABSTRACT
OBJECTIVES: The use of fixed orthodontic appliances makes it difficult to clean the teeth and accessories associated with it. For this reason, orthodontic patients have used oral antiseptics as coadjuvent means to reduce cariogenic plaque. The aim of this systematic review was to evaluate the effectiveness of oral antiseptics on the reduction of cariogenic plaque on orthodontic patients. DATA: This review has been registered at PROSPERO--international prospective register of systematic reviews under the number CRD42013006857. SOURCES: A systematic review of the literature was conducted in the following electronic databases: Scopus, PubMed, Web of Science, Medline, Embase and Cochrane, Grey literature and Clinical Trials, without limitations on the year of publication or language. Clinical studies in patients with fixed orthodontic appliances, who were making use of oral mouthwashes in order to reduce cariogenic plaque, were included. Articles with patients using systemic drugs, syndromic patients, those using mouthwashes for other purposes and/or using different cleaning techniques, and clinical cases were excluded. After selection by title and abstract, potentially eligible articles were read in full. The methodological quality and risk of biases of articles included were evaluated according to the characteristics of the study, measurements and statistical analyses of the study. The methodological quality was classified as high, moderate or low. STUDY SELECTION: The search identified 2716 articles, of which 15 met the inclusion criteria. Of these, 8 analyzed chlorhexidine-based mouthwashes, while in 1 article Cetylpyridinium was used; 1 analyzed the mouthwash containing sanguinaria; 1 the use of NaF; 2 articles the use of AmF/SnF2; 2 the use of Listerine(®), 1 also analyzed the association between mouthwashes with octenidine and with PVP-I. Of the articles analyzed, 11 were classified as having high and 4 as having moderate methodological quality. CONCLUSION: There is evidence of effectiveness of the use of oral mouthwashes in the control of cariogenic plaque in patients with fixed orthodontic appliances. The orthodontists may suggest the use of oral antiseptics in the oral hygiene of their patients as coadjuvent means to reduce cariogenic plaque. CLINICAL SIGNIFICANCE: Given current evidence, orthodontists may prescribe mouthwash as an auxiliary method in the control of cariogenic biofilm in orthodontic patients.
Subject(s)
Anti-Infective Agents, Local/therapeutic use , Biofilms/drug effects , Mouthwashes/therapeutic use , Orthodontic Appliances , Dental Plaque/drug therapy , Humans , Oral HygieneABSTRACT
Objetivo / Avaliar a influência da cor na percepção estética de aparelhos extrabucais em crianças na faixa etária entre 10 a 14 anos de escolas públicas e privadas, de ambos os sexos. / Métodos / Um questionário específico foi confeccionado contendo anexas imagens de uma paciente utilizando aparelho ortodôntico extrabucal em diferentes cores, sendo posteriormente aplicado a 200 crianças. As frequências das respostas obtidas e as comparações entre tipo de escola e sexo foram feitas por meio do teste qui-quadrado. Os escores das notas para cada imagem foram comparados utilizando-se o teste U de Mann-Whitney. As médias das notas para cada imagem foram calculadas em cada grupo, a fim de determinar os coeficientes de correlação de Spearman para avaliar a similaridade entre as percepções dos estudantes por tipo de escola e sexo. O nível de significância adotado foi de 5%. / Resultados / A imagem do aparelho extrabucal na cor preta foi ranqueada como a mais atraente pelas crianças. As comparações entre pares mostraram que os estudantes de escola pública pontuaram melhor todas as imagens, comparados com os de escola particular. Com relação ao sexo, não foram encontradas diferenças significativas entre grupos nas imagens com aparelho extrabucal. / Conclusão / A cor apresentada pelo aparelho ortodôntico extrabucal influencia diretamente em sua aceitação e percepção estética, assim como o tipo de escola
