Ingestion of orthodontic appliances: A literature review.

Ingestion is the entry of a substance into the human organism, which occurs by taking it through the mouth into the gastrointestinal tract. One of the adverse events that may happen during the course of an orthodontic treatment is the ingestion of orthodontic appliances. The present review aims to investigate the literature regarding the ingestion of orthodontic appliances. An electronic search was carried out in order to identify case reports of ingestion of foreign objects related to orthodontic treatment in PubMed, Scopus, and Web of Science until July 2019.Nineteen articles were retrieved. In these articles, ingestion had occurred inadvertently, due to patients' or orthodontists' errors. Some of the most commonly ingested appliances were molar bands, segments of wire, and expansion keys. It is likely that patients with a specific medical background are more prone to ingestion of orthodontic appliances. Special precautions need be taken in order to avoid such incidents. These precautions are analyzed in three categories: general, those related to fixed appliances, and those related to removable appliances.

Intraoral Scanners in Orthodontics: A Critical Review.

BACKGROUND: The use of digital technology has exponentially increased over recent years. Intraoral scanners, especially, have gained traction within orthodontics. The objective of the present review is to investigate the available evidence to create an up-to-date presentation of various clinical aspects of intraoral scanners in orthodontics. METHODS: Search without restrictions in seven databases (Pubmed, CENTRAL, Cochrane Reviews, Scopus, Web of Science, Clinical Trials, Proquest) since inception, and hand searching until October 2020, were conducted. RESULTS: The majority of studies were either cross-over or parallel group studies. The accuracy and reproducibility of intraoral scanners, in comparison to conventional methods, were investigated in several studies, with controversial results. The duration of the procedure did not report any clear outcome in favor of any method. Patients seem to prefer intraoral scanning, even though numerous studies point out the importance of operators' experience and skills. CONCLUSIONS: Despite the innovations that intraoral scanners have brought in orthodontic clinical practice, there are still some challenges and limitations in their use. The majority of existing limitations may be overcome with experience and good clinical skills. More high-quality studies need to be conducted so that clinicians can have a clear image of this new technology.

Patient-reported experiences and preferences with intraoral scanners: a systematic review.

BACKGROUND: Intraoral scanners have become an increasingly popular alternative to conventional impression methods. Although their accuracy and validity have been examined thoroughly, patient-reported information including experiences, preferences, and satisfaction has not yet been investigated in a systematic way. OBJECTIVE: The objective of this systematic review is to investigate the available data and appraise the evidence on patient-reported experiences and preferences following impression taking with intraoral scanners. SEARCH METHODS: Unrestricted search of seven databases (Pubmed, CENTRAL, Cochrane reviews, Scopus, Web of Science, Clinical Trials, and ProQuest) and grey literature were conducted until October 2020. Detailed search strategies were developed for each database. SELECTION CRITERIA: Studies involving individuals of any gender or age, subjected to full arch impression taking with conventional and intraoral scanning methods were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Following the retrieval and selection of the studies, data extraction was performed. Risk of bias assessment was performed using the RoB 2 and ROBINS-I tools. RESULTS: From the initially identified records, nine studies [eight crossover (two of them randomized) and one parallel group] were eventually included in the present systematic review. Randomized studies were shown, overall, to have some concerns regarding bias, whereas the non-randomized studies were found to be at serious risk, mainly because of bias due to confounding. All studies demonstrated some benefit in favour of intraoral scanning compared with conventional techniques. More positive feelings were generally observed with the intraoral scanners regarding smell, taste, sound, vibration, nausea, and queasiness. Overall, comfort assessment mostly favoured digital methods. No differences were found concerning the level of anxiety between the two methods. Among the included studies, time perception was a parameter leading to contradictory results. LIMITATIONS: These emerge due to the nature and characteristics of the information retrieved from the included studies. The validation of the instruments to capture patient-reported outcomes needs to be further elaborated. CONCLUSIONS: Intraoral scanners seem to be a promising new asset in the orthodontic office from the perspective of individuals' experiences and preferences. Nevertheless, to investigate patient-reported outcomes correctly, further high-quality studies are required in the future. REGISTRATION: Open Science Framework (https://osf.io/ayug2/).

The effect of facemask in patients with unilateral cleft lip and palate: a systematic review and meta-analysis.

BACKGROUND: Patients with cleft lip and palate usually present a Class III skeletal pattern. Facemask (FM) is one of the conventional orthodontic treatment modalities used to address the skeletal discrepancy in cleft patients. OBJECTIVE: To investigate the potential effectiveness of FM in unilateral cleft lip and palate (UCLP) patients. SEARCH METHODS: Search without restrictions except language in seven databases since inception and hand searching until January 2019 was conducted. Detailed search strategies were developed for each database which were based on the PubMed strategy and adapted accordingly. SELECTION CRITERIA: Controlled studies assessing the effect of FM in UCLP patients were to be included. DATA COLLECTION AND ANALYSIS: After retrieval and selection of the studies, data extraction was performed. Both angular and linear cephalometric measurements were collected. Weighted mean differences (WMDs) and 95% confidence intervals (CΙs) between treated and untreated UCLP patients concerning the pre- and post-treatment angular measurements of each group were calculated using a random-effects meta-analysis model. The risk of bias in individual studies was assessed using the ROBINS-I tool. RESULTS: From nine eligible studies, five were included in the meta-analysis investigating the use of FM in patients and controls with UCLP (with and without maxillary expansion). Statistically significant differences were evident for SNA/S-N-ss, SNB/S-N-sm, ANB/ss-N-sm, and SN-MP. FM was found to induce an increase of SNA (WMD = 2.12 degrees, 95% CI: 1.58 to 2.66), ANB (WMD = 4.17 degrees, 95% CI: 3.60 to 4.74), and SN-MP angles (WMD = 2.60 degrees, 95% CI: 1.10 to 4.10) and a decrease of SNB angle (WMD = -1.94 degrees, 95% CI: -2.48 to -1.40) in UCLP patients. Low to moderate heterogeneity was observed. LIMITATIONS: They emerge due to risk of bias, exclusion of non-English papers and methodological characteristics of the included papers. CONCLUSIONS: According to the available data, FM seems to improve the sagittal skeletal relationships in UCLP patients, increasing the SNA and ANB angles and decreasing the SNB angle. Moreover, in the vertical dimension, FM increases the SN-MP angle. Regarding dental measurements, there are controversial results. More high-quality studies need to be conducted in order to further clarify the impact of FM on UCLP patients. REGISTRATION NUMBER: PROSPERO: CRD42019131619.

Use of Different Cleaning Methods for Removable Orthodontic Appliances: A Questionnaire Study.

OBJECTIVES: The aim of the present study is to assess the means and methods being suggested by Greek orthodontists to their patients for cleaning their removable devices. MATERIALS AND METHODS: A questionnaire survey was conducted among a total of 418 Greek orthodontists found from the registry of orthodontists in Greece. The clinicians were asked about the means and methods of daily cleaning they usually advise their patients for removable appliances. Furthermore, the questionnaire included questions related to possible complications of these devices and data about the use and type of applied devices. RESULTS: From 418 Greek orthodontists, 279 filled the questionnaire and participated in this study. All but one reported that they use removable appliances in their practice for patients of almost any age. All orthodontists recommend routine manual toothbrushing, but the majority of them also suggest at the same time other oral hygiene aids complementary to brushing, such as immersion in denture cleaners (70.06%), in disinfecting solutions (12.73%) and in vinegar (36.94%). Some 15% of all the practitioners advise the use of ultrasonic instruments for cleaning removable orthodontic appliances. At last, clinicians have faced complications from the use of removable devices in the oral cavity at a statistically significant percentage. The most usual is trauma of the mucosa, mycosis and hyperplasia. CONCLUSION: Greek orthodontists use removable orthodontic appliances, active or passive, in their practice. Brushing with a toothbrush and the use of cleaning products for removable prostheses are the preferred methods for cleaning removable orthodontic appliances regardless of the orthodontic specialty programme they had graduated from.

The effect of osteopenia on tooth movement in ovariectomized rats. An experimental study.

OBJECTIVE: The purpose of this experimental study was to investigate in depth the effects of osteopenia related to the rate, as well as to the quality of orthodontic tooth movement, by combining experimental ovariectomy and molar movement in rats. METHODS: Twenty-four six-month-old female Wistar rats were used in this study. The animals were divided into two groups consisting of twelve animals each: Group A (control group) was subjected to orthodontic movement of the upper right first molars. Group B was subjected to orthodontic movement of the upper right first molar following bilateral ovariectomy. Ovariectomy was performed on the first experimental day and the upper right first molars were subjected to orthodontic forces 60 days post-ovariectomy, lasting for 14 days. RESULTS AND CONCLUSION: Direct inspections of the upper jaws, measurements of orthodontic movement of the upper right first molars of Group A and B, as well as histologic examinations of the alveolar bone in the upper right and left first molar regions, showed that osteopenia affects the rate of orthodontic tooth movement, as well as the quality of alveolar bone remodeling, in ovariectomized rats. Specifically, in the ovariectomized animals the alveolar bone of the non-loaded side showed extensive internal resorption, with large marrow cavities, whereas the alveolar bone of the loaded side was dense with almost no marrow cavity and frontal resorption on the surface. It appears that alveolar remodeling after the exertion of orthodontic forces follows the general paradigm of osteoporotic bone remodeling after loading.

Retrieval analysis of immediately loaded orthodontic mini-implants: material and tissue characterization.

OBJECTIVE: To investigate the morphological and compositional alterations of retrieved orthodontic mini-implants and the type of adjacent bone, in relation to loading period and anatomical region. MATERIALS AND METHODS: Seventy orthodontic mini-implants (Aarhus: n = 35 and AbsoAnchor: n = 35) were placed in the maxilla and mandible of 33 orthodontic patients for anchorage purposes. All mini-implants were immediately loaded for a period specified by treatment plan. Fifty-nine mini-implants were retrieved (Aarhus: n = 29 and AbsoAnchor: n = 30) and examined by stereomicroscopy, reflection Fourier transform infrared microspectroscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy. Tissue samples adjacent to the implants were histologically examined to identify the bone type. RESULTS: Changes in surface finish, formation of biological integuments, and compositional alterations mainly due to adsorption of proteinaceous material (rich in C, O, N, OH, NH, CH2/CH3, amide I, II, and III, and CH-OH) were identified in all mini-implants. In some cases, mineralized fragments were identified (rich in Ca, P, and Ca-P). In 25 out of the 59 histological sections examined, woven and lamellar bone types were detected. In 12 sections, only woven bone was detected, whereas in the residual 22, only lamellar bone was identified. A significant correlation was found between histological result and loading time but not between histology and region. CONCLUSION: Morphological and elemental alterations were found for both types of mini-implant surfaces. An increase of the loading period increased the possibility of lamellar bone development around mini-implants.

Distraction-like phenomena in maxillary bone due to application of orthodontic forces in ovariectomized rats.

BACKGROUND: Orthodontic forces may not only influence the dentoalveolar system, but also the adjacent and surrounding cortical bone. AIM: Since there is very limited information on this issue, we aimed to study the possible changes in maxillary cortical bone following the application of heavy orthodontic forces in mature normal and osteoporotic rats. MATERIALS AND METHODS: Twenty-four 6-month-old female rats were selected and divided into an ovariectomized group and a normal group. In both groups, the rats were subjected to a 60 grFNx01 orthodontic force on the upper right first molar for 14 days. RESULTS: In both groups, histological sections showed that the application of this force caused hypertrophy and fatigue failure of the cortical maxillary bone. The osteogenic reaction to distraction is expressed by the formation of subperiosteal callus on the outer bony side, resembling that seen in distracted bones. CONCLUSION: From this study we concluded that heavy experimental orthodontic forces in rats affect the maxillary cortical bone. The osteogenic reaction to these forces, expressed histologically by subperiosteal callus formation, is similar to that seen in distraction osteogenesis models.