Dental Research Waste in Design, Analysis, and Reporting: A Scoping Review.

Research waste is highly prevalent across biomedical investigations. We aimed to assess the evidence on the extent of research waste in dental research. We performed a scoping review of empirical evaluations of dental studies assessing the prevalence and impact of limitations in design, conduct, analysis, and reporting of research. PubMed was searched using specific terms to retrieve studies dealing with design, conduct, analysis, and reporting of studies in dentistry, with no year or language restrictions. Of the 1,807 publications identified from the search and from manual searches, 71 were included in this review. The topic and article selection was based on the expert opinion of the authors. The existing evidence suggests that, although there are improvements over time, substantial deficiencies in all areas (design, conduct, analysis, reporting) were prevalent in dental research publications. Waste in research is a multifaceted problem without a simple solution. However, an appreciation of optimal research design and execution is a prerequisite and should be underpinned by policies that include appropriate training in research methods and properly aligned incentives.

Enamel Remineralization with Novel Bioactive Glass Air Abrasion.

Enamel demineralization or white spot lesions (WSLs) are a frequent complication associated with fixed appliance-based orthodontic treatment. The remineralization potential of a novel fluoride-containing bioactive glass (QMAT3) propelled via an air abrasion system was compared with Sylc glass and artificial saliva on artificially induced WSLs. Thirty extracted human premolars were randomly assigned into 3 groups ( n = 10) per method of treatment and scanned with optical coherence tomography and noncontact profilometer in the 4 enamel states: sound, demineralized, after glass propulsion, and after immersion in artificial saliva. Knoop hardness testing was also performed. Twenty additional prepared teeth samples were also randomly selected for examination by scanning electron microscopy and energy-dispersive X-ray spectroscopy (2 teeth per technique) under each of the 4 enamel conditions. 19F MAS-NMR (magic angle spinning-nuclear magnetic resonance) was also used to detect the type of apatite formed on the enamel surface. Significant enamel remineralization with surface roughness and intensity of light backscattering similar to that of sound enamel was observed following treatment with QMAT3. In addition, mineral deposits were detected on the remineralized enamel surfaces, forming a protective layer and improving its hardness. This layer was rich in calcium, phosphate, and fluoride; 19F MAS-NMR confirmed the formation of fluorapatite. This finding is particularly beneficial since fluorapatite is more chemically stable than hydroxyapatite and has greater resistance to acid attack. Hence, a promising fluoride-containing bioactive glass for enamel remineralization has been developed, although further clinical evaluation and refinement is required.

Collaboration in orthodontic clinical trials: prevalence and association with sample size and funding.

BACKGROUND: To assess patterns of research collaboration in orthodontics and possible relationships with sample size and funding status. METHODS: Orthodontic randomised and non-randomised controlled clinical trials published between 2013 and 2017 were identified through electronic searching. The nature of collaboration, author institutions, study setting, sample size, and funding status were assessed. Linear and logistic regression analyses were applied. RESULTS: Of 1153 studies, 217 met the selection criteria. The majority of studies were authored by university academics (86%), were conducted in a single centre (71.9%) and in at least one university hospital (68.2%). The number of practice-based trials (10.1%), as well as the involvement of specialist practitioners (5.2%) in co-authorship, was limited. Multi-centred studies within a single country were associated with a significantly larger sample size compared to single-centred trials (P = 0.00; 95% confidence interval [CI] 33.59, 106.93). However, authorship collaboration either nationally (odds ratio [OR] 2.37; 95% CI 0.85, 6.57) or internationally across different continents (OR 5.54; 95% CI 0.62, 49.52) did not translate into increased funding. CONCLUSIONS: Most orthodontic studies were undertaken in university hospital settings within a single country. Collaboration is common in orthodontics but involvement of practice settings remains limited, suggesting a need for stimulation of practice-based research and research partnerships.

A cross-sectional analysis of Wits and Riedel in adults with skeletal III malocclusion: How informative are they?

OBJECTIVES: To compare the relationship between Riedel and Wits appraisal in skeletal III malocclusions and to assess the effect of variation in the vertical skeletal measurements. SETTING AND SAMPLE POPULATION: One-hundred and twenty consecutive subjects with Class III malocclusions attending orthognathic clinics were analysed. MATERIALS AND METHODS: Lateral cephalograms were hand-traced under standardized conditions. Cephalometric measurements included Riedel analysis, Wits appraisal, A point/B point to Frankfurt plane (AF-BF) and vertical measurements. RESULTS: The mean ANB and Wits values were -3.22° and -11.39 mm, respectively. A positive correlation was found between ANB and Wits overall (r = -.49; P < .001). However, there was poor agreement between both Wits (r = .087) and Riedel (r = .089) with AF-BF (P > .05). A negative correlation existed between Wits and LAFH% (r = -.64, P-value < .001); however, no relationship was observed between ANB and LAFH% (P > .05) based on linear regression analysis. CONCLUSIONS: There is a positive relationship between ANB and Wits; however, neither correlated well with a purer antero-posterior assessment (AF-BF). Furthermore, variations in the vertical skeletal measurements affect the strength of agreement. Caution is advised in the interpretation of antero-posterior analysis especially in the presence of vertical discrepancy.

A prospective cohort study assessing the appearance of retrieved aesthetic orthodontic archwires.

OBJECTIVES: To investigate the appearance of three esthetic nickel titanium (NiTi) wires after 6 weeks of intra-oral cycling and to determine the association between objective and subjective measures of esthetics. SETTING AND SAMPLE POPULATION: A prospective cohort study was undertaken involving participants undergoing upper fixed orthodontic appliance treatment with ceramic brackets. MATERIALS AND METHODS: Fifty participants were assigned to one of three groups of NiTi esthetic wires (American Orthodontics Ever White™, Forestadent Biocosmetic™ and GAC High Aesthetic™), with wires retrieved after 6 weeks in situ. Participants completed a bespoke questionnaire exploring perceptions of wire esthetics. Objective measurement of coating loss was undertaken using a custom arch wire jig. RESULTS: American Orthodontics Ever White™ had the greatest mean coating loss (50.7%) followed by Forestadent Biocosmetic™ (6%), with GAC High Aesthetic TM undergoing minimal loss (0.07%) (P < .001). The majority of coating loss with the American Orthodontics Ever White™ wires arose in the anterior region while Forestadent Biocosmetic™ wires and GAC High Aesthetic™ wires exhibited coating loss posteriorly (P < .001). These findings were reflected in the subjective assessment with a negative correlation found between coating loss and final Visual Analogue Scale scores (P < .001). CONCLUSIONS: Considerable esthetic variation between arch wires following 6 weeks of intraoral cycling was identified in this prospective cohort study. Intraoral cycling has a negative impact on participant perception of arch wire esthetics, and objective and subjective assessment of wire esthetics appears to be consistent.

A scoping review of outcomes related to orthodontic treatment measured in cleft lip and palate.

The aim of this study was to identify and summarize the outcomes measured in orthodontic studies of children with cleft lip and/or palate. The objectives were to categorize the outcomes into pre-determined domains and to explore whether any domains were under-represented. Electronic databases and grey literature were searched until December 2016 to identify all studies of orthodontic treatment interventions in children and adolescents with cleft lip and palate. Abstracts and subsequently eligible full-text articles were screened independently and in duplicate by two reviewers. All reported outcome measures were identified and categorized into six predetermined outcome domains. The search identified 833 abstracts. The majority of studies did not assess orthodontic interventions and were therefore not eligible for inclusion. Consequently, following screening 71 eligible articles were retrieved in full, of which 40 met the inclusion criteria. Morphological features of malocclusion were measured in 27 studies (68%) and adverse effects of orthodontic treatment in 10 (25%). Functional status (n=4; 10%), physical consequences of malocclusion (n=3; 7.5%), quality of life (n=3; 7.5%) and health resource utilization (n=2; 5%) were rarely considered. Relatively few studies concerning patients with cleft lip and palate focused on orthodontic interventions. Most of the identified outcomes were concerned with measuring morphological treatment-related changes and do not reflect patient perspectives.

Timing orthodontic treatment: early or late?

The timing of orthodontic interventions has been a contentious topic for many years with early treatment to address or indeed to prevent skeletal discrepancies in all three spatial planes and to alleviate crowding in common practice. In terms of effectiveness, however, broadly speaking early intervention has not been shown to be superior to later intervention. As such, in view of the additional burden and duration of early intervention, the weight of evidence points to reserving early treatment for localized problems and specific situations with definitive treatment typically initiated in the late mixed or early permanent dentition.

Inter-proximal enamel reduction in contemporary orthodontics.

Inter-proximal enamel reduction has gained increasing prominence in recent years being advocated to provide space for orthodontic alignment, to refine contact points and to potentially improve long-term stability. An array of techniques and products are available ranging from hand-held abrasive strips to handpiece mounted burs and discs. The indications for inter-proximal enamel reduction and the importance of formal space analysis, together with the various techniques and armamentarium which may be used to perform it safely in both the labial and buccal segments are outlined.

A survey of undergraduate orthodontic teaching and factors affecting pursuit of postgraduate training.

Background Undergraduate orthodontic teaching has been focused on developing an understanding of occlusal development in an effort to equip practitioners to make appropriate referrals for specialist-delivered care. However, there is a growing interest among general dentists in delivering more specialised treatments, including short-term orthodontic alignment. This study aimed to assess the levels of knowledge of occlusal problems among final year undergraduate dental students, as well as their interest in various orthodontics techniques and training.Methods A 36-item electronic questionnaire was sent to all final year undergraduate students in four dental institutes in the UK (Barts and the London, Kings College London, Cardiff and Dundee). The questionnaire explored satisfaction with undergraduate orthodontic teaching; students' perception of knowledge, based on General Dental Council learning outcomes; perceptions of the need for specialist involvement in the management of dental problems; interest in further training in orthodontics; and potential barriers to undertaking specialist training.Results The overall response rate was 66% (239/362). The majority of students (84.1%) were aware of GDC guidance in terms of undergraduate teaching. Students reported a preference for case-based and practical teaching sessions in orthodontics, with less interest in lectures or problem-based learning approaches. A high percentage were interested in further teaching in interceptive orthodontics (60.3%) and fixed appliance therapy (55.7%). Further training including specialist orthodontic training (36.4%), Invisalign (59%) and Six Month Smiles (41%) courses appealed to undergraduates. Levels of student debt, course fees and geographical issues were seen as potential barriers to formal, specialist training pathways.Conclusions Satisfaction with undergraduate orthodontic teaching is high and interest in further training, including specialist training pathways, continues to be high. While short-term orthodontics is not taught at undergraduate level, there appears to be an appetite to undertake alternatives to conventional orthodontics among dental students.

An assessment of student experiences and learning based on a novel undergraduate e-learning resource.

Purpose/objectives The aims of this study were to describe the development of a novel e-learning resource and to assess its impact on student learning experiences and orthodontic knowledge.Methods Thirty-two 4th year dental undergraduate students at Queen Mary University of London were randomly allocated to receive electronic access to e-learning material covering various undergraduate orthodontic topics over a 6-week period. Thirty-one control students were not given access during the study period. All students were asked to complete electronic quizzes both before (T0) and after (T1) the study period and a general questionnaire concerning familiarity with e-learning. The test group also completed a user satisfaction questionnaire at T1. Two focus groups were also undertaken to explore learners' experiences and suggestions in relation to the resource.Results The mean quiz result improved by 3.9% and 4.5% in the control and test groups, respectively. An independent t-test, however, demonstrated a lack of statistical significance in knowledge gain between control and test groups (P = 0.941). The qualitative feedback indicated that students believed that use of the resource enhanced knowledge and basic understanding with students expressing a wish to ingrain similar resources in other areas of undergraduate teaching.Conclusions Use of the novel orthodontic e-resource by 4th year undergraduate students over a 6-week period did not result in a significant improvement in subject knowledge. However, the e-learning has proven popular among undergraduates and the resources will continue to be refined.

Myths and realities in orthodontics.

Comprehensive orthodontic treatment typically comprises an initial phase of alignment over a period of four to six months, followed by vertical, transverse and antero-posterior corrections, space closure, finishing and detailing to enhance dental and facial aesthetics and function. Each course of treatment involves a series of decisions and alternatives relating to objectives, appliance design and treatment mechanics. In recent years there has been increasing interest in short-term approaches to treatment with more limited objectives and the avoidance of phases traditionally considered integral to successful treatment. In this review the veracity of accepted truths in orthodontics are discussed; specifically, the importance of initial molar relationship, final incisor relationship, the merits of orthodontic extractions, anticipated treatment times, the value of modern fixed appliance systems, the importance of torque expression and the relative merits of bonded retainers and inter-proximal reduction are considered.

Is orthodontics prior to 11 years of age evidence-based? A systematic review and meta-analysis.

OBJECTIVES: To determine whether interceptive orthodontics prior to the age of 11 years is more effective than later treatment in the short- and long-term. DATA AND SOURCES: Multiple electronic databases were searched, authors were contacted as required and reference lists of included studies were screened. STUDY SELECTION: Randomised and quasi-randomised controlled trials were included, comparing children under the age of 11 years requiring interceptive orthodontic correction for a range of occlusal problems, to an untreated or positive control group. Data extraction and quality assessment were performed independently and in duplicate. RESULTS: Twenty-two studies were potentially eligible for meta-analysis, the majority related to growth modification. Other outcomes considered included correction of unilateral posterior crossbite, anterior openbite, extractions and ectopic maxillary canines. Meta-analysis was possible for 11 comparisons. For Class II correction in the short-term, meta-analyses demonstrated a statistically significant reduction in ANB (-1.4 degrees, 95 CI: -2.17, -0.64) and overjet (-5.81mm, 95 CI: -6.37, -5.25) with both functional appliances and headgear versus control. In the long-term, however, statistical significance was not found for the same outcomes. Treatment duration was prolonged with both functional appliances (6.85 months, 95 CI: 3.24, 10.45) and headgear (12.47 months, 95 CI: 8.67, 16.26) compared to adolescent treatments. Meta-analyses were not possible for comparisons of other interceptive treatments due to heterogeneity and methodological limitations. CONCLUSIONS: The results suggest a lack of evidence to prove that early treatment carries additional benefit over and above that achieved with treatment commencing later; however, this does not necessarily imply that early treatment is ineffective. Further high quality trials are required to assess the effectiveness of early treatment compared to later intervention. CLINICAL SIGNIFICANCE: Interceptive orthodontics is variously recommended for a range of malocclusions both of skeletal and dental aetiology. The merits of interceptive treatment, however, are often disputed. Further high quality trials are required to assess the effectiveness of early treatment compared to later intervention.

A prospective longitudinal controlled assessment of pain experience and oral health-related quality of life in adolescents undergoing fixed appliance treatment.

OBJECTIVE: To compare subjective pain experience and oral health-related quality of life (OH-QoL) in treated and untreated subjects over the first 3 months of fixed appliance therapy. SETTING AND SAMPLE POPULATION: The Department of Orthodontics, School of Medicine and Dentistry. One hundred and twenty-four subjects aged between 11 and 14 years either commencing or awaiting fixed appliance treatment. MATERIAL & METHODS: A prospective controlled longitudinal study design was applied to subjects, over a 3-month observation period, following the placement of fixed appliances. Socio-economic status, OH-QoL, pain experience and analgesic consumption were recorded on questionnaires at baseline (T0), 6 weeks (T1) and 3 months (T2). RESULTS: Oral symptoms and functional limitation domains of OH-QoL were found to worsen, during the follow-up period, in the test group (p = 0.001 and p = 0.002, respectively). In the treated group, pain intensity declined significantly on days 3 and 2 at T1 and T2, respectively (p < 0.001). Analgesia was required during both periods in a total of 13 participants (24.5%) undergoing orthodontic treatment. CONCLUSION: Based on this prospective controlled study, the initial stages of fixed appliance treatment results in subjective pain experience, with subsequent reduction, and a significant impact on oral symptoms and functional limitation domains of OH-QoL.

A comparison of two different techniques for early correction of Class III malocclusion.

OBJECTIVE: To compare the effectiveness of Reverse Twin-Block therapy (RTB) and protraction face mask treatment (PFM) with respect to an untreated control in the correction of developing Class III malocclusion. MATERIALS AND METHODS: A retrospective comparative study of subjects treated cases with either PFM (n  =  9) or RTB (n  =  13) and untreated matched controls (n  =  10) was performed. Both the PFM and control group samples were derived from a previously conducted clinical trial, and the RTB group was formed of consecutively treated cases. The main outcome variables assessed were skeletal and dental changes. Lateral cephalograms were taken at the start and end of treatment or during the observation period. Analysis of variance was used to compare changes in cephalometric variables arising during the study period in the lateral group. Linear regression analysis and an unpaired t-test were used to determine the impacts of treatment duration and gender, respectively. RESULTS: Significantly greater skeletal changes arose with PFM therapy than with RTB therapy or in the control group (SNA, SNB, and ANB; P < .001). The dentoalveolar effects of RTB therapy exceeded those of PFM treatment, with significantly more maxillary incisor proclination (P < .001) and mandibular incisor retroclination (P < .006) arising with treatment. CONCLUSIONS: Both appliances are capable of correction of Class III dental relationships; however, the relative skeletal and dental contributions differ. Skeletal effects, chiefly anterior maxillary translation, predominated with PFM therapy. The RTB appliance induced Class III correction, primarily as a result of dentoalveolar effects.

Orthodontic measurements on digital study models compared with plaster models: a systematic review.

The aim of this study is to evaluate the validity of the use of digital models to assess tooth size, arch length, irregularity index, arch width and crowding versus measurements generated on hand-held plaster models with digital callipers in patients with and without malocclusion. Studies comparing linear and angular measurements obtained on digital and standard plaster models were identified by searching multiple databases including MEDLINE, LILACS, BBO, ClinicalTrials.gov, the National Research Register and Pro-Quest Dissertation Abstracts and Thesis database, without restrictions relating to publication status or language of publication. Two authors were involved in study selection, quality assessment and the extraction of data. Items from the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews checklist were used to assess the methodological quality of included studies. No meta-analysis was conducted. Comparisons between measurements of digital and plaster models made directly within studies were reported, and the difference between the (repeated) measurement means for digital and plaster models were considered as estimates. Seventeen relevant studies were included. Where reported, overall, the absolute mean differences between direct and indirect measurements on plaster and digital models were minor and clinically insignificant. Orthodontic measurements with digital models were comparable to those derived from plaster models. The use of digital models as an alternative to conventional measurement on plaster models may be recommended, although the evidence identified in this review is of variable quality.

Revisiting the supernumerary: the epidemiological and molecular basis of extra teeth.

Supernumerary teeth are a common clinical and radiographic finding and may produce occlusal and dental problems. The aetiological basis of extra teeth is poorly understood in human populations; however, the mouse provides a useful model system to investigate the complex genetics of tooth development. This article describes recent advances in our understanding of the genetic basis of supernumerary teeth. We have reviewed biological evidence that provides insight into why supernumerary tooth formation may occur. Indeed, many of the molecular signalling pathways known to be involved in normal development of the tooth germ can also give rise to additional teeth if inappropriately regulated. These include components of the Hedgehog, FGF, Wnt, TNF and BMP families, which provide a useful resource of candidate genes that may potentially play a role in human supernumerary tooth formation.

Pain experience during initial alignment with a self-ligating and a conventional fixed orthodontic appliance system. A randomized controlled clinical trial.

OBJECTIVES: To test the hypotheses that (1) there is no difference in the pain experience during the week following initial placement of two orthodontic appliances (SmartClip and Victory; 3M Unitek, Monrovia, Calif); and (2) there is no difference in the pain experience during removal and insertion of orthodontic archwires with these brackets. MATERIALS AND METHODS: Sixty-six consecutive patients were treated with a self-ligating bracket system (SmartClip) or a conventional appliance (Victory) on the basis of computer-generated random allocation. After appliance placement and engagement of a 0.016'' nickel-titanium archwire, pain experience was recorded after 4, 24, and 72 hours and after 7 days with the use of a visual analog system (VAS) questionnaire. At a subsequent visit, participants documented pain experiences during removal and insertion of 0.019 x 0.025'' archwires on an additional 100 mm VAS questionnaire. Independent t-tests and analyses of covariance were used to analyze normally distributed data; the Mann-Whitney U-test was used for skewed distributions. RESULTS: Forty-eight (72.2%) and fifty-one (77.3%) subjects completed the first and second parts of the study, respectively. Bracket type had no influence on pain experience at 4 hours (P = .958), 24 hours (P = .289), 72 hours (P = .569), and 7 days (P = .756) following appliance placement. However, bracket type significantly influenced pain experience during archwire removal (P = .001) and insertion (P = .013). CONCLUSIONS: Hypothesis 1 cannot be rejected. The bracket type had no effect on subjective pain experience during the first week after initial placement of two preadjusted orthodontic appliances. Hypothesis 2 was rejected. Significantly greater discomfort was experienced during archwire insertion and removal with the SmartClip appliance.

I want braces: factors motivating patients and their parents to seek orthodontic treatment.

OBJECTIVE: To determine patients' and parents'/guardians' motivation for orthodontic treatment. BASIC RESEARCH DESIGN: A self-completion postal questionnaire survey of new patients referred for orthodontic assessment. CLINICAL SETTING: Kent and Canterbury Hospital (January 2003-January 2004). PARTICIPANTS: Five hundred patients referred from general dental practice and community dental service within East Kent. RESULTS: Response rate was 66%. Fifty percent of the patients were between 11 and 13-years-old. In 81% of cases referral was initiated by the dentist. Most of the patients (87%) were concerned with the appearance of their teeth, 38% reported teasing related to their dental appearance. Only 20% of patients thought there was nothing wrong with their teeth. CONCLUSIONS: The patients' general dental practitioner initiated referral for orthodontic treatment in the majority of the cases. Most patients and parents appeared to be highly motivated and accepting of appliances for orthodontic treatment. Teasing was a commonly reported consequence of malocclusion with negative psychosocial impact.

Systematic reviews in orthodontics: what have we learned?

UNLABELLED: The literature is becoming replete with systematic reviews of orthodontic-related topics. However, their findings have not been appraised and summarised collectively. METHODS: Systematic reviews related to orthodontics published between 1 January 2000, and 31 January 2007 were identified and reviewed. RESULTS: Fifty-one orthodontic systematic reviews were identified in the defined period. A highly significant percentage of reviews (29%) failed to reach conclusions. Conclusions were made in the remaining reviews although many relied on secondary levels of evidence to do so. In this narrative review the findings from these studies are summarised. CONCLUSIONS: Systematic reviews in orthodontic-related areas have produced some interesting findings. However an unacceptably high number continue to be inconclusive, reflecting methodological inadequacies of the review process and exposing inadequacies in our evidence base.

How to ... manage the transition from functional to fixed appliances.

This paper presents the methods of transfer from functional to fixed appliances. The aim of transition should be maintenance of Class II correction in a time-efficient manner without compromising long-term patient co-operation.