Evaluation of orthodontically induced external root resorption following orthodontic treatment using cone beam computed tomography (CBCT): a systematic review and meta-analysis.

Background: Orthodontically induced external root resorption (OIRR) is a pathologic consequence of orthodontic tooth movement. However, the limitations of two-dimensional radiography suggest that cone beam computed tomography (CBCT) with its three-dimensional capabilities might be more suitable to assess OIRR. Objective: The aim of this study was to assess in an evidence-based manner data on linear or volumetric OIRR measurements of permanent teeth by means of CBCT, during and/or after the end of orthodontic treatment. Search methods: Unrestricted electronic and hand searches were performed up to January 2017 in 15 databases. Selection criteria methods: Randomized clinical trials, prospective, and retrospective non-randomized studies assessing OIRR during and/or after orthodontic treatment using CBCT in human patients were included. Data collection and analysis: After duplicate study selection, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses, followed by subgroup, meta-regression, and sensitivity analyses were also performed in order to evaluate factors that affect OIRR. Results: A total of 33 studies (30 datasets) were included in the qualitative analysis while data from 27 of them were included in the quantitative analysis. Direct comparisons from randomized trials found little to no influence of appliance-related factors on OIRR. Explorative analyses including non-randomized studies found a pooled OIRR of 0.79 mm based on all included studies and 0.86 mm when OIRR was assessed at the end of orthodontic treatment. Statistically significant differences in OIRR were found according to tooth type or jaw, inclusion of extractions, treatment duration, and diagnostic accuracy of the CBCT. Conclusions: Based on the results of this study, CBCT seems to be a reliable tool to examine OIRR during or at the end of orthodontic treatment. Although the average OIRR measured with CBCT seems to lack clinical relevance, there are certain factors that may affect OIRR following orthodontic treatment. Nevertheless, due to data heterogeneity and low quality of the included studies, the corresponding results should be interpreted with some caution. Registration: PROSPERO (CRD42016030131).

Dental calcification stages as determinants of the peak growth period.

OBJECTIVE: The objective of this study was to investigate the diagnostic accuracy of dental maturation stages for identifying individual-specific skeletal maturation phases. SUBJECTS AND METHODS: Prior to initiating this study, 255 orthodontic patients comprising 145 girls and 110 boys from the Department of Orthodontics, Aristotle University of Thessaloniki, Greece were identified. Lateral cephalometric and panoramic radiographs were evaluated. Dental calcification stages were assessed according to the Demirjian method and skeletal maturation according to the cervical vertebral maturation stage (CVMS) method. Statistical assessments included Spearman Brown formula, descriptive statistics, Spearman's rho correlation coefficient, and positive likelihood ratios (LHRs). RESULTS: The highest (r = 0.725) correlations were found for second molars and the lowest correlation for canines (r = 0.463, p < 0.001). Positive LHR values exceeding ten were found to identify the pre-peak growth phase in conjunction with the second molar (stage D), second premolar (stage E), and first premolar (stages D and E). Only the second molar (stage F) yielded positive LHR values for identifying the peak growth phase. The positive LHR values for the second molar also facilitated identification of the post-peak growth phase (stage H). Taking the clinical diagnostic efficacy of the second molar into account in identifying these growth phases, we calculated the positive LHRs of the second molar to determine dental maturation stages for diagnosing CVMS II and III. Positive LHR values greater than 10 identified CVMS II (stage D). CONCLUSION: Evaluating dental maturation is a useful initial diagnostic step when assessing skeletal growth. The calcification stages of the second molar provide reliable diagnostic information with which to determine the pubertal growth spurt.

Clinical effectiveness of chin cup treatment for the management of Class III malocclusion in pre-pubertal patients: a systematic review and meta-analysis.

BACKGROUND: Chin cup is regarded as the oldest orthodontic appliance for the management of Class III malocclusion. To assess its clinical effectiveness in pre-pubertal patients, a meta-analysis on specific cephalometric values is attempted. METHODS: Detailed electronic and hand searches with no restrictions were performed up to July 2014. Only randomized controlled trials (RCTs) and cohort studies, i.e. prospective controlled trials (pCCTs) and (retrospective) observational studies (OS), were included. Analyses were performed by calculating the standard difference in means and the corresponding 95% confidence intervals, using the random effects model. Data heterogeneity and risk of bias assessment of the included studies were also performed. Study selection, data extraction and risk of bias assessment were performed twice. The level of significance was set at P ≤ 0.05 for all tests, except for heterogeneity (P ≤ 0.1). RESULTS: Seven treated groups from five studies (no RCTs, four pCCTs, one OS) were eligible for inclusion, assessing only the short-term occipital pull chin cup effects. In total, 120 treated patients (mean age: 8.5 to 11 years) compared with 64 untreated individuals (mean age: 7.3 to 9.89 years) were assessed by means of 13 cephalometric variables. The overall quality of these studies was low to medium. In comparison to untreated individuals, the SNB and gonial angles decreased significantly following chin cup use, whereas ANB, Wits appraisal, SN-ML, N-Me and overjet increased. For the rest of the variables, no statistically significant differences were detected. CONCLUSIONS: Although the occipital chin cup affects significantly a number of skeletal and dentoalveolar cephalometric variables, indicating an overall positive effect for the treatment of Class III malocclusion, data heterogeneity and between-studies variance impose precaution in the interpretation of the results.

Root resorption of endodontically treated teeth following orthodontic treatment: a meta-analysis.

OBJECTIVE: The aim of this meta-analysis was to investigate the effect of orthodontic treatment on root resorption of endodontically treated teeth compared to vital teeth. MATERIALS AND METHODS: A literature search was conducted in 18 electronic databases. Review articles and relevant articles were searched for cross-references. Two independent reviewers screened all articles according to predefined inclusion and exclusion criteria and extracted the corresponding data. The pooled estimate of mean difference of root resorption weighted by the fixed-effect model and the corresponding 95 % confidence intervals (CIs) were used to construct a forest plot by implementing the "RevMan 5.1" software. Quality and heterogeneity assessments as well as publication bias evaluation and sensitivity analyses were performed. Inter-reviewer agreement for data selection, data extraction and quality analysis was evaluated by Cohen's kappa. RESULTS: Six out of 1,942 original papers met the inclusion criteria. Four out of six studies were included in the quantitative analysis. Root resorption was less in endodontically treated teeth than in vital teeth (MD = -0.48 mm; 95 % CI = -0.81 to -0.14 mm). The funnel plot indicated no evidence of publication bias, while no data heterogeneity was present (I(2) = 0 %). However, the overall quality of the included studies was considered as "low." CONCLUSIONS: Following orthodontic treatment, endodontically treated teeth exhibit relatively less root resorption than teeth with vital pulps. CLINICAL RELEVANCE: Clinicians should consider orthodontic movement of endodontically treated teeth as a relatively safe clinical procedure.

Orthodontic management of silver-russell syndrome. A case report.

This case report describes the orthodontic management of a 10-year-old female with Silver-Russell syndrome by means of gradual expansion of the mandibular dental arch using removable appliances and subsequent comprehensive treatment of malocclusion by means of fixed appliances.

Presence of third molars in orthodontic patients from northern Greece.

OBJECTIVE: The purpose of the present study was to investigate the frequency of presence of third molar teeth and their distribution in each jaw and each side, according to sex, in a group of orthodontic patients with permanent dentition from northern Greece. METHODS: The sample included panoramic radiographs from 220 patients with permanent dentition (mean age 13.62 ± 1.81). The χ(2) test was used to assess the relationships between the variables, and the Fisher's exact test was used in cases where the expected frequencies in each cell were <5. RESULTS: The frequency of third molar presence was 79.1%, and 20.9% was the frequency of third molar agenesis. Intersexual differences in the number of third molars was not statistically significant. There was a correlation between the distribution of third molars on the right and the left side (Fisher's exact test = 100.788; P = 0). The two sides showed the same tendency toward the presence or absence of third molars. A correlation was also found between the distribution of maxillary and mandibular third molars (Fisher's exact test = 24.372; P = 0). In each jaw, the presence or absence of third molars was highly related to the number of third molars found in the other jaw. CONCLUSION: The present results showed that in this orthodontic group of northern Greek patients, presence accounted for 79.1% and agenesis for 20.9%. No significant difference was found between the frequencies of third molar presence on the left and right sides in either the maxilla or mandible.

The contribution of orthodontics to the prosthodontic treatment of ectodermal dysplasia: a long-term clinical report.

BACKGROUND: The long-term management of hypohidrotic ectodermal dysplasia (HED) from prepuberty to adulthood often necessitates orthodontic and orthopedic treatment in conjunction with prosthodontic care. CASE DESCRIPTION: The authors present a report regarding the combined orthodontic and prosthodontic treatment of a child with HED-associated oligodontia from the ages of 10 to 18 years. The authors fabricated successive maxillary removable partial dentures, equipped with midline jackscrews, at different phases of the treatment and planned treatment to close the patient's midline diastema. After completion of the orthodontic therapy, three-dimensional analysis of the final dental casts showed a measurable increase in the transverse dimensions of the maxillary dental arch, and posttreatment cephalometric analysis revealed the face to have normal vertical dimensions and a mild retroposition of the maxilla. CONCLUSIONS: and CLINICAL IMPLICATIONS: Orthodontic and orthopedic treatment in coordination with prosthetic restoration at the appropriate time may benefit the stomatognathic function, normal growth, esthetics and emotional well-being of young people with HED.

Long term chemoradiotherapy-related dental and skeletal complications in a young female with nasopharyngeal carcinoma.

We describe the long-term complications six years after chemoradiotherapy in a 20-year old woman with nasopharyngeal carcinoma. We wanted to know whether the radiation dose was constant throughout the oral cavity, and thus uniformly affecting the corresponding dental and skeletal structures. Clinical and radiologic findings are described six years after chemoradiotherapy based on a two-dimensional computerized treatment planning system. This revealed radiation caries limited only to posterior teeth, proximal caries in the anterior teeth, limited but continuous salivary flow, mild periodontal infection, mild xerostomia, and a regenerative capacity of bones and the developmental process. The quantitative assessment of radiation delivered to the mandible revealed a high radiation dose in the posterior area and a minimal dose in the anterior area. This explains the differences in caries manifestation between the anterior and posterior teeth. According to the present study, individualized radiation fields, using a two-dimensional treatment planning system, result in restriction of severe damage of the dental and skeletal structures, which usually follows chemoradiotherapy. Orthodontic treatment could be initiated according to individual patient needs.

Digital subtraction radiography of panoramic radiographs to evaluate maxillary central incisor root resorption after orthodontic treatment.

AIM: To quantitatively assess the extent of morphologic changes of the apical root area and root length of maxillary central incisors after orthodontic treatment using digital subtraction radiography (DSR) and to investigate possible contributing parameters. METHODS: The subtracted images of panoramic radiographs of 21 patients before and after orthodontic treatment were evaluated using I/RAS C and Image J software. The retrieved data were analyzed by means of SPSS statistical software, and the method's error was assessed. RESULTS: There was a small but significant decrease of the root dimensions of the maxillary central incisors at the end of orthodontic treatment. The amount of root resorption was not significantly influenced by sex, age, dentition, malocclusion classification, extraction, overjet, overbite, elastic wear, and number of teeth with resorption as measured by DSR. CONCLUSION: DSR of pre- and posttreatment panoramic radiographs was able to confirm minor root resorption of the maxillary central incisors after orthodontic treatment.

Long-term radiotherapy related complications in children with head and neck cancer: Another era for pediatric oncologic pathology.

Long-term radiotherapy-related complications in children with head and neck cancer have been frequently reported, especially facial growth disorders and dental abnormalities. We report on two male children (8 and 14 years old) with head and neck cancer, who were successfully treated with chemoradiotherapy and presented with growth deficiency of middle face and mandible hypoplasia, eight years and one year later, respectively. These severe growth complications attributed to chemoradiotherapy, while the patients survived primary malignancy. Patient age at irradiation was significantly correlated with the severity of disorders. We consider late sequelae in children with head and neck cancer due to chemoradiotherapy another era for pediatric oncologic pathology for prevention, if possible, or to manage them efficiently.

Orthodontics and esthetics of the face: from the "canons" of ancient times to contemporary pluralism. A critical review.

Efforts to define facial esthetics and natural attraction using objective criteria go back in time. Nowadays, the abundance of available information, the evolution in our understanding, the intermeshing of the neurosciences and biology, as well as the potential of digital technology, have provided new elements for the objective definition of esthetics and shaped new perceptions and perspectives. The aim of this paper is to attempt a critical analysis from a clinical orthodontic perspective of the conventional methods assessing facial beauty as well as of the trends and viewpoints that form today's concept of an esthetically ideal face, based on a historical review from ancient times to the 21st century. It appears that the "beauty standards" formulated artificially by the mass media and the internet remain a challenge for the orthodontist, who is called upon to explore the aspirations, motives and expectations of patients in order to be able to contribute in improving their social status and quality of life.