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Objective: Cervical spine posture is related to craniofacial morphology, airway, gait and body posture. This posture may be influenced by the changes in the mandibular position brought about by functional appliance therapy. Therefore, this systematic review aimed to assess the changes in the cervical spine posture with functional appliance treatment in Skeletal Class II subjects. Methods: A search of studies in six electronic databases - Medline (via Pubmed), the Cochrane Library, OVID, LILACS, Scopus and Web of Science were performed until January 18, 2024 without any restriction in date or language of publication. Eligibility screening, study selection, and data extraction were performed by two reviewers independently. The risk of bias assessment of the included studies was performed with the Newcastle Ottawa scale and Cochrane RoB 2.0. Meta-analysis was performed using random effects model for assessment of changes in the cervical spine with removable and fixed functional appliances. Results: Twelve articles that satisfied the eligibility criteria were included for systematic review and nine articles for meta-analysis. Five studies showed a low risk of bias, one as moderate and six as high risk of bias. GRADE assessment revealed a low quality evidence. Meta-analysis revealed a decrease of the upper cervical inclination by 1.16° (95 % CI of -2.68 to 0.35, I2 = 6 %), an increase of the middle cervical inclination by 2.20° (95 % CI of 0.46-3.94, I2 = 49 %), an increase in cervical curvature angle by 1.60° (95 % CI of 0.12-3.09, I2 = 89 %) and a decrease in cervical lordosis angle by 1.54° (95 % CI of -4.16 to 1.08, I2 = 0 %). Conclusions: Minimal uprighting of the cervical spine was noted with functional appliances. Fixed functional appliances exerted a greater effect than removable functional appliances. Cervical hyperlordosis was reduced with removable functional appliance treatment. Though these changes are minimal, the clinical orthodontist should be aware that functional therapy also influences cervical spine posture. Due to the heterogeneity and low quality of evidence, the results are to be considered critically.
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Objective: To assess the alveolar bone changes and gingival recession following Herbst appliance therapy. Materials and methods: Electronic databases such as PubMed, Ovid, Cochrane Library, Lilacs, Scopus, Web of Science, and Embase were searched until August 2022. Hand-searching of major orthodontic journals was performed to identify all peer-reviewed articles potentially relevant to the review. The quality of the selected studies was ranked using the revised Cochrane risk of bias tool for nonrandomized trials-Risk of Bias In Nonrandomized Studies (ROBINS) 1. Results: Five relevant articles (all nonrandomized studies) were considered for qualitative analysis. The risk of bias was low for four studies and moderate for one. The reduction in the vertical alveolar bone height was 0.13 ± 0.07 mm, with the Herbst appliance. The mean difference in the loss of buccal cortical thickness between the Herbst appliance and untreated control group was 0.22 mm [95% confidence interval (CI) of -0.62-0.18]. Subsequent to Herbst appliance therapy, in the mandibular anterior region 0.1 ± 0.5 mm of gingival recession was observed. Conclusion: Herbst appliance treatment produces a negligible reduction in the buccal cortical thickness, vertical alveolar bone height, and gingival recession. Clinical significance: Though the changes produced by the Herbst appliance were minimal, they are clinically important considering the young age of the patients warranting periodic periodontal assessment. How to cite this article: Kumar MV, Kannan A, Kailasam V. Alveolar Bone and Gingival Changes in Mandibular Anterior Region Following Herbst Appliance Therapy: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2024;17(1):114-120.
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OBJECTIVE: To comparatively evaluate the perception of patients' soft tissue profiles treated with Herbst and Twin Block appliances and correlate the perception with cephalometric parameters. METHODS: The record of 30 patients (15 Herbst and 15 Twin Block) treated for a period of 6 months (±1.1 months) was included in the study. A total of 60 resulting profile silhouettes (from pre- and post-functional profile photographs) were evaluated by 30 examiners and were divided into 3 groups: orthodontists, general dentists, and laypersons. The profiles were arranged in a randomized order, and the examiners rated the profiles using a visual analog scale. Paired t-test and independent t-test were performed to find a significant difference within and between the appliances, respectively. A treatment outcome correlation was done using Pearson's correlation test between the visual analog scale scores and cephalometric parameters. RESULTS: Within the appliances, the orthodontist perceived a difference with only the Twin Block appliance (P = .02). The general dentists perceived a significant difference with both Herbst (P = .02) and Twin Block (P = .001) appliances, whereas the laypersons did not perceive any profile improvement on treatment with functional appliances. However, between the appliances, no statistically significant profile difference was seen with all 3 groups of examiners. The ANB angle had a significant negative correlation (P = .007) to the visual analog scale scores given by the orthodontists for the Herbst appliance. CONCLUSION: No perceptible difference was found in the profile enhancement between Herbst and Twin Block appliances with all 3 groups of examiners. The ANB angle contributed to the difference in profile perception between the appliances for the orthodontists.
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PURPOSE: Genioplasty facilitates alteration of the chin position and contour which contributes to aesthetics and function. The response of the hard and soft tissues following genioplasty has not been assessed after a year or more of the surgery being performed. Hence, the aim of this systematic review was to assess the response of the hard and soft tissues occurring at least 1 year after the procedure. MATERIAL AND METHODS: A literature search was conducted in the following electronic databases: PubMed, Ovid, LILACS, and Cochrane Library. Potential articles were identified wherein only studies with genioplasty performed as an isolated procedure and with data at least 12 months after the procedure were included. RESULTS: Five studies were included in this systematic review. Two of the articles included were considered to be of good quality while three were considered to be of moderate quality using a modified Downs and Black tool. The ROBINS-I tool showed a moderate risk of bias for most domains. The study characteristics revealed varying degrees of relapse for the hard and soft tissues. CONCLUSIONS: In the anteroposterior plane, the soft tissue relapsed more than the hard tissues 3 years post genioplasty. However, relapse in the vertical plane showed a wide variation for both the hard and soft tissues. In the anteroposterior plane, the hard tissue to soft tissue response 2 years or more following genioplasty ranged from 1:0.77 to 1:0.91 while in the vertical plane the hard tissue to soft tissue response ranged from 1:0.67 to 1:1.16.
Subject(s)
Genioplasty , Mandible , Cephalometry/methods , Chin/anatomy & histology , Chin/surgery , Esthetics, Dental , Genioplasty/methods , Humans , Mandible/surgery , RecurrenceABSTRACT
In the publication of this article [1], there is an error in the Materials and methods section.
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BACKGROUND: The aim of this trial was to comparatively evaluate Icon® resin infiltration and Clinpro™ XT varnish in restoring aesthetics of white spot lesions (WSLs) present post-orthodontic treatment. MATERIALS AND METHODS: Two hundred forty WSLs were detected in 193 teeth of 12 patients. The participants were analysed-before intervention (T0), immediately after intervention (T1), 3 months later (T2) and 6 months later (T3), with a 1:1 allocation ratio for the application of Icon® resin infiltration and Clinpro™ XT varnish. Using a computer-generated allocation sequence, block randomization was done. A spectrophotometer was used to assess the colour of WSLs and the adjacent enamel, while a DIAGNOdent® was used to assess the fluorescence loss. RESULTS: Immediately after the intervention, Icon® resin infiltration showed statistically significant better improvement than Clinpro™ XT varnish in restoring the colour (p = 0.000); however, at 3 (p = 0.001) and 6 months (p = 0.000), this was reversed. Except at 3 months, the fluorescence loss sequentially reduced more for Icon® resin infiltration (4.48 ± 1.42 at T0 to 1.48 ± 0.81 at T3) and was not statistically significant. CONCLUSIONS: Clinpro™ XT varnish showed significantly better improvement than Icon® resin infiltration in restoring the colour and lightness of the WSLs at 3 and 6 months. The fluorescence loss significantly recovered with both intervention methods between immediate application and at 6 months. However, Clinpro™ XT varnish-treated WSLs showed a statistically significant difference compared to the adjacent sound enamel at 6 months.
Subject(s)
Dental Caries , Orthodontic Brackets , Color , Esthetics, Dental , Humans , PaintABSTRACT
OBJECTIVES: The aim of the present systematic review was to assess the effect of functional appliances on the airway dimensions in patients with skeletal Class II malocclusion. MATERIALS AND METHODS: Articles were identified through a literature survey carried out through the following databases: (1) PUBMED, (2) Google Scholar, (3) The Cochrane Library, (4) Embase, (5) Lilac, and (6) Web of Scholars. The systematic review analyzed 12 articles comprising removable functional appliances, 3 articles with fixed functional appliances, and 2 articles having both fixed and removable functional appliances. RESULTS: Qualitative assessment was done for all the 17 studies. The effect of functional appliances in the dimensions of three airway spaces - nasopharynx, oropharynx, and hypopharynx were analyzed. CONCLUSIONS: Significant increase in the dimensions of nasopharynx and oropharynx was observed with Activator. Significant increase in the nasopharynx and hypopharynx (male patients) was observed with Bionator. Insignificant increase in the oropharynx was observed with the same. Significant increase in the oropharynx and hypopharynx was observed with Twin Block. Insignificant increase in the nasopharynx was observed with the same. Significant increase was observed only in the hypopharynx for Frankel II. Decreased or insignificant change was observed with FMA, MPA IV, and Herbst appliances.
