Efficacy of clear aligner wear protocols in orthodontic tooth movement-a systematic review.

BACKGROUND AND OBJECTIVES: Different expedited aligner wear protocols are currently in practice. This review was undertaken to systematically appraise the available evidence on the comparative efficacy of orthodontic tooth movement (OTM) across the different wear protocols. SEARCH METHODS: Two assessors conducted comprehensive searches of electronic databases, including MEDLINE (via PubMed), Scopus, Embase, Web of Science, Google Scholar, Directory of Open Access Journals, Cochrane Library, OpenGrey, and Clinical Trial Registry, till 18 February 2024. Titles and abstracts were independently screened. SELECTION CRITERIA: Prospective or retrospective studies comparing expedited wear protocols with the conventional 14-day protocol were included. DATA COLLECTION AND ANALYSIS: A pre-piloted data extraction form was used. Risk of bias (RoB) assessment employed the Cochrane RoB 2.0 tool for randomized-controlled trials (RCTs) and the Newcastle-Ottawa scale for non-RCTs. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation Pro tool. RESULTS: Six studies, including 3 RCTs and 3 non-RCTs, were selected from 9076 records. Four studies (two RCTs and two retrospective cohort) found no statistically significant difference (P > 0.05) in the OTM efficacy between expedited and conventional protocols. Two studies (one RCT and one prospective cohort) found greater efficacy (P < 0.05) with the 14-day protocol, with the RCT reporting greater efficacy for certain movements, such as maxillary posterior intrusion, maxillary posterior distal tipping and buccal torquing, and mandibular posterior intrusion and extrusion. One RCT reported statistically insignificant difference (P > 0.05) in pain perception between the 10-day and 14-day protocols. Two studies demonstrated low RoB, two moderate, and two high RoB. The evidence level was very-low for OTM efficacy and high for pain perception. Meta-analysis was precluded due to significant heterogeneity among the studies. CONCLUSIONS: Within the limitations of the study, the 7-day, 10-day, and 14-day protocols did not show any significant difference in OTM efficacy, except for certain movements that exhibited superior outcomes with the 14-day wear. Hence, a 'hybrid aligner-wear protocol', based on clinical judgement, might serve a better alternative in complex situations. REGISTRATION: PROSPERO CRD42021288179.

Does orthodontic treatment improve the Oral Health-Related Quality of Life when assessed using the Malocclusion Impact Questionnaire-a 3-year prospective longitudinal cohort study.

OBJECTIVES: To assess the change in Oral Health-Related Quality of Life (OHRQoL) following orthodontic treatment using the Malocclusion Impact Questionnaire (MIQ) and to test the responsiveness of MIQ to treatment-associated changes. METHODS: A longitudinal prospective cohort study, in an orthodontic postgraduate centre, Kerala, India. Patients under 18 years were invited to complete the MIQ before the start of treatment (T0) and 1 month after treatment completion (T1). TheIndex of Orthodontic Treatment Need and Peer Assessment Rating (PAR) scores were assessed at both time periods as well as a global transition judgement at T1. RESULTS: Two hundred and ten participants were recruited and 162 completed both questionnaires (45.1% males; 54.9% females; age = 12-18 years, mean = 16.8; SD = 1.7). There was large reduction in MIQ scores from T0 (mean = 28.1, SD = 6.1) to T1 (mean = 3.7, SD = 2.6). 53% reported a large improvement in oral health and related life quality after treatment, 32% minimal change, and 15% no change. None reported worsening in OHRQoL at T1. There was a significant positive correlation between change in MIQ score and change in PAR score (r = 0.358), pretreatment aesthetic component (rho = 0.467) and dental health component (rho = 0.491) of the index of orthodontic treatment (IOTN-DHC), and treatment time (rho = 0.502). Regression analysis revealed the change in PAR score and pretreatment IOTN-DHC to be independent predictors of change in MIQ score. Standardized effect size (4.0) and standardized response mean (2.9) were large and the minimal important difference was 7.7. Receiver operating characteristic analysis reported a high diagnostic accuracy of MIQ. CONCLUSIONS: There was a significant improvement in OHRQoL following orthodontic treatment when assessed using a condition-specific measure for malocclusion. MIQ was found to be responsive to changes associated with orthodontic treatment.

Bisphenol-A release from thermoplastic clear aligner materials: A systematic review.

AIM: The aim of the present study was to undertake a systematic review of the available evidence on the release of bisphenol-A (BPA) from thermoplastic materials used in the fabrication of clear aligners (CA). METHODS: Electronic databases, such as MEDLINE (via PubMed), Google Scholar, Scopus, Cochrane Library, Web of Science, OpenGrey, and the U.S. National Institute of Heath-Clinical Trials, were searched up to 27 October 2022. In vivo/in vitro studies that assessed the release of BPA from different thermoplastic CA materials, with or without a control group, were selected. The risk of bias (RoB) in the randomised controlled trials (RCT) and in vitro studies was assessed using the Cochrane RoB tool and the guidelines for the reporting of pre-clinical studies, respectively. The quality of evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Pro tool. RESULTS: Six studies were considered for review from a total of 1926 records. This included one RCT and five in vitro studies. Only two studies found leaching of BPA, while four did not report any traces. The RoB was found to be moderate to high. The GRADE evidence level ranged from low to very low. Five of the included studies were conducted in vitro. Significant heterogeneity among the included studies prevented a quantitative synthesis. CONCLUSION: In light of the available conflicting evidence, BPA release from CAs can neither be confirmed nor denied. Safety remains questionable until high-quality in vivo trials prove otherwise. REGISTRATION: PROSPERO CRD42022310434.

What are the intra-arch risk factors for palatally displaced maxillary canine? - Results of a case-control study.

INTRODUCTION: This study aimed to identify the intra-arch risk factors for palatally displaced canine by comparing the maxillary transverse dimensions, palatal depth (PD), and arch length (AL) of the subjects with and without impacted canine using cone-beam computed tomography (CBCT). METHODS: In this prospective case-control study, 79 CBCT images of gender- and skeletal feature-matched subjects (25 cases and 54 controls) were compared. Based on the CBCT images, maxillary transverse widths at four levels (molar basal, molar alveolar, premolar basal, and premolar alveolar), maxillary PD, and maxillary AL were measured. Group comparisons were assessed using analysis of variance (ANOVA), followed by post-hoc Scheffe's test, and risk factors were identified using univariate and multivariate logistic regression. RESULTS: The impacted canine group showed significantly smaller molar alveolar width, premolar alveolar width, PD, and greater AL compared to the control group (P = 0.046, P < 0.001, P = 0.003, and P = 0.001, respectively). No significant difference was observed in the molar and premolar basal width measurements between the two groups. Multivariate analysis showed that impacted maxillary canine was influenced by premolar alveolar width (odds ratio (OR): 0.669), PD (OR: 0.532), and AL (OR: 1.739). CONCLUSION: Intra-arch risk factors, such as reduced maxillary premolar transverse alveolar width, PD, and greater AL, are associated with palatally displaced canine.

How effective is maxillary expansion as an interceptive treatment in individuals with palatally displaced canines? A systematic review and meta-analysis.

BACKGROUND: The objective was to provide a synthesis of the existing literature on the effectiveness of maxillary expansion in intercepting palatally displaced canines (PDCs). METHODS: Studies that evaluated the effectiveness of maxillary expansion in subjects with PDCs in the mixed dentition period were included. The following electronic databases were searched until November 30, 2021: MEDLINE (via PubMed), Scopus, Google Scholar, Web of Science, and Cochrane library. Grey literature search and manual search were also performed. The risk of bias was assessed using the Cochrane tool for the one randomized controlled trial (RCT) and the ROBINS-I tool for the non-RCTs. The data were extracted and meta-analysis was performed using RevMan 5.4. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of evidence. RESULTS: Four studies were selected from 9,586 records, which included one RCT and three non-RCTs. The former demonstrated a high risk of bias whereas the non-RCTs showed moderate risk. The meta-analysis of three non-RCTs found no significant improvement in the alpha angle of canines after rapid maxillary expansion, with a difference of -4.26 (95% CI -11.41 to 2.89; P = 0.24). The RCT showed an increase in the eruption rate of high-risk canines with rapid maxillary expansion. Slow maxillary expansion did not demonstrate any favorable change. The level of evidence ranged from low to very low. CONCLUSIONS: There is insufficient evidence to recommend the use of maxillary expansion as a stand-alone procedure in intercepting PDCs. Additional well-conducted trials are required.

Are clear aligners environment friendly?

Clear aligner therapy has revolutionized orthodontic care delivery over the last 2 decades. With the increase in demand for clear aligner therapy, there is a concern about the plastic burden on the environment. Hence, we initiated research to investigate its environmental impact. This short communication aims to discuss the rationale of our ongoing study.

What has changed in orthodontic patient care between the two surges of the COVID-19 pandemic? A thematic analysis.

BACKGROUND AND AIM: The coronavirus disease 2019 (COVID-19) has brought new challenges to every specialty and orthodontics is no exception. Currently, there seems no way other than to mitigate the risk and proceed with routine orthodontic treatment. The aim of the present study was to conduct a qualitative inquiry into the coping strategies, perceptions and anticipations of orthodontic patients and the challenges faced by orthodontists. METHODS: An in-depth telephone interview of 30 patients and/or their parents and orthodontists belonging to an Academic-based Residency Program and Private Practice was conducted regarding the challenges, opportunities and futuristic ways of coping with COVID-19. Inputs were recorded, transcripts were prepared and anonymised, and a thematic analysis was performed. RESULTS: Six themes and several sub-themes emerged from the detailed interviews and their transcripts. The initial fearful situation due to COVID-19 has gradually transformed into a certain 'new normal' in the lives of patients and caregivers, explaining why patients started seeking orthodontic treatment as usual or even preferring to begin treatment during this period. Orthodontists in the midst of uncertainty are delivering quality care and expecting future innovations and changes to combat such pandemics. CONCLUSION: Humans can adapt to any crisis that runs over a period of time. The new insights obtained will help to plan treatment and set up practice to cope with pandemics and crises that can affect orthodontic treatment in the future.

Maxillary Incisor Intrusion Using Two Conventional Intrusion Arches and Mini Implants: A Prospective Study.

AIM AND OBJECTIVE: This study aimed to compare cephalometrically the rate of maxillary incisor intrusion using mini implants, Connecticut intrusion arches, and segmental intrusion arches. MATERIALS AND METHODS: Thirty-two adult patients with deep bite were divided into three groups: 10 patients in mini implant and Connecticut intrusion arch group each and 12 patients in segmental intrusion arch group. Bilateral mini implants were used for intrusion in Group 1. Connecticut intrusion arch and Burstone's three-piece intrusion arch were used for intrusion in Group 2 and Group 3, respectively. Intrusion was carried out in all the patients for 4 months. Lateral cephalograms were taken just after alignment and leveling (T1) and after 4 months of intrusion (T2). RESULTS: The mean amount of intrusion observed was 1.7 mm (0.425 mm/month) in mini implant group, 1.4 mm (0.35 mm/month) in Connecticut intrusion arch group, and 1.66 mm (0.415 mm/month) in segmental intrusion arch group. No statistically significant difference was found in the extent of incisor intrusion in the three groups (p <0.05). CONCLUSION: The study failed to reject the null hypothesis, and there was no statistically significant difference in the amount and rate of incisor intrusion achieved among the three groups (p >0.05). CLINICAL SIGNIFICANCE: Significant amount of incisor intrusion was carried out by all the three methods. There was no statistically significant difference in the amount and rate of incisor intrusion achieved by the three methods. Clinically, mini implants can be considered superior to the conventional techniques as it provides absolute anchorage which eliminates unwanted effects of incisor intrusion.

Is Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) Valid for the Indian Population?-A Psychometric Study.

OBJECTIVES: A culturally adapted and validated Oral Health-Related Quality of Life (OHRQoL) inventory helps to reliably compare patient perceptions among different populations. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) evaluates the impact of dental aesthetics on OHRQoL. This study aimed to develop a regional version of PIDAQ (PIDAQMal) for the Indian population and to assess differences in perceptions due to malocclusion in different population groups. MATERIALS AND METHODS: PIDAQMal was derived through the translation process and pilot-tested to assess test-retest reliability. Psychometric properties were tested on 285 subjects (31.2% males, 68.8% females; age range 18-25 years). Normative treatment need was assessed using Index of Orthodontic Treatment Need (IOTN)-Dental Health Component and subjective assessment using IOTN-Aesthetic Component (AC) and Perception of Occlusion Scale (POS). PIDAQMal mean domain scores were compared with those of the previously validated versions to assess difference in perceptions. RESULTS: Internal consistency and test-retest reliability were good (Cronbach's α = 0.83-0.88; Intraclass Correlation Coefficient = 0.74-0.91). IOTN-AC and POS scores showed significant correlation with PIDAQMal scores ensuring convergent validity (P < 0.001). Discriminant validity was confirmed by statistically significant differences (P < 0.001) in PIDAQMal scores between subjects with no treatment need and moderate/definite need. Factor analysis derived four domains with one item showing cross-loading. Difference in mean domain scores among the previously validated versions of PIDAQ confirmed socio-cultural differences in perceptions due to malocclusion. CONCLUSION: PIDAQMal was found to be reliable and valid for the Indian subjects and can be used as a condition-specific OHRQoL measure. Socio-cultural differences in perceptions were brought to light using the translated scale.

Is There a Need to Increase Palatal Root Torque of Upper Incisors in Lingual Appliance? A Finite Element Analysis.

OBJECTIVES: To understand the effect of the biomechanical differences by assessing pre and post retraction torque, amount of retraction and arch width changes in both techniques. METHODOLOGY: A three-dimensional geometric model of maxilla with all upper teeth except first premolar was generated based on computed tomography radiograph of a dry skull using the computer program Hypermesh. 13.0. Virtual models of 0.022 "Roth labial brackets and 0.018 "ORMCO 7th generation lingual brackets; and for labial brackets 0.019 × 0.025" SS archwire and for lingual brackets 0.016 × 0.024" SS archwire were constructed. Sliding mechanics was used during en-masse retraction by applying a 300 g distal force on both sides of the dentition from canine to the second premolar brackets in the labial and lingual simulation. The finite element program ANSYS 12.1 was used to calculate the torque and displacement. RESULTS: The results stipulated that in transverse direction there was lingual tipping of anteriors, mild buccal flaring in second premolars and first molars and lingual tipping in second molar in lingual appliance. In the sagittal plane, the greater distal movement of posteriors and an up-righting tendency of molars were observed in lingual appliance. Extrusion of anterior teeth were observed in both appliances. Regarding the premolars and first molars, labial movements and relative intrusion were observed in lingual appliance compared to labial appliance. CONCLUSION: In lingual treatment, it is crucial to increase the lingual root torque. The amount of retraction and arch widening were more in lingual appliance compared to labial technique.

Malocclusion-Related Quality of Life Questionnaire (MRQoLQ): Development and validation of a new psychometric tool for older adolescents with malocclusion

ABSTRACT Objective: To develop and validate a new psychometric tool for assessing malocclusion-related quality of life among older Indian adolescents. Methods: Item generation involved analysis of existing validated tools, followed by development of new items using various qualitative steps. A draft item pool of 41 questions was initially generated and subjected to item reduction through sequential steps involving two clinical studies to ensure reliability and validity. 431 subjects aged between 15 to 18 years took part in the validation study. Principal component analysis with varimax rotation was performed to get a psychometric tool with good factorial structure and maximum variance. Results: Rotated component matrix resulted in a 20 item psychometric tool containing 4 domains with a total variance of 61.57%. Inter item, item total correlation and Cronbach α (α = 0.88) ensured good reliability. A positive correlation of the scale with global question ensured convergent validity. Independent t test showed statistically significant difference (p< 0.05) between mean score of IOTN-DHC and DAI with MRQoLQ, ensuring good construct validity. Conclusions: The newly developed psychometric tool is named as Malocclusion-Related Quality of Life Questionnaire (MRQoLQ) having 20 questions, including 2 socioeconomic items. The scale showed good reliability and initial validity, hence can be used among older adolescents with malocclusion to assess their malocclusion-related quality of life.

RESUMO Objetivo: desenvolver e validar uma nova ferramenta psicométrica para avaliar o impacto da má oclusão na qualidade de vida em pacientes indianos ao final da adolescência. Método: o delineamento do conjunto de itens desse questionário envolveu a análise de ferramentas existentes já validadas, seguida da criação de novos itens, usando vários passos qualitativos. Um conjunto provisório de itens, com 41 perguntas, foi inicialmente formulado e submetido à redução de itens por meio de passos sequenciais envolvendo dois estudos clínicos, para garantir sua validade e confiabilidade. Nesse estudo de validação, participaram 431 pacientes com idades entre 15 e 18 anos. Foi realizada uma análise do componente principal pelo método Varimax, para se obter uma ferramenta psicométrica com boa estrutura fatorial e variância máxima. Resultados: a matriz, após as rotações dos fatores, resultou em uma ferramenta psicométrica com 20 itens, contendo 4 domínios, com uma variância total de 61,57%. As correlações interitens e item-total e o alfa de Cronbach (α = 0,88) confirmaram uma boa confiabilidade. Uma correlação positiva da escala com a questão global assegurou validade convergente. O teste t independente demonstrou diferença estatisticamente significativa (p< 0,05) entre a pontuação média do IOTN-DHC e do DAI com o MRQoLQ, assegurando uma validade bem construída. Conclusões: essa nova ferramenta psicométrica desenvolvida, denominada Questionário "Impacto da Má Oclusão na Qualidade de Vida" (MRQoLQ, do inglês Malocclusion-Related Quality of Life Questionnaire), com 20 perguntas, incluindo 2 itens socioeconômicos, demonstrou boa confiabilidade e validade inicial. Assim, pode ser utilizado em pacientes no final da adolescência, para avaliar o impacto da má oclusão em sua qualidade de vida.

Prevalence and predictors of early periodontal disease among adolescents.

BACKGROUND: Periodic estimation of periodontal disease burden is essential for formulating new treatment strategies, for evaluating preventive strategies, and for framing of new policies. The previous national-level survey among adolescents was held 15 years ago. The objective of this study was to estimate the prevalence of periodontal disease among older adolescent students and to analyze its predictors as part of an oral health assessment survey conducted in Kerala. MATERIALS AND METHODS: A multistage cluster sampling was employed among five districts of Kerala to examine 1065 students in the age group of 15-18 years from government and private schools of selected urban and rural areas. Sociodemographic and oral health behavioral data, modified Community Periodontal Index, Oral Hygiene Index Simplified, and Dental Aesthetic Index were taken. Descriptive statistics and bivariate and multivariate logistic regression analyses were done to identify the predictors of gingival bleeding and periodontal pockets. RESULTS: The prevalence of gingival bleeding, periodontal pockets, and loss of attachment was 42%, 13.4%, and 2.7%, respectively. In the adjusted multivariate model for predictors of gingival bleeding, rural location of residence, studying in government schools, high mother's education and their working status, orthodontic treatment need, oral hygiene frequency, and poor oral hygiene status emerged as significant predictors of gingival bleeding. In the multivariate model for periodontal pockets, bleeding on probing emerged as the strongest predictor with an odds ratio of 12.85 when adjusted to poor oral hygiene. CONCLUSION: The prevalence of early periodontal disease among adolescents is significant. Sociodemographic factors, poor oral hygiene, and malocclusion are significant predictors for periodontal disease among adolescents.

Malocclusion-Related Quality of Life Questionnaire (MRQoLQ): Development and validation of a new psychometric tool for older adolescents with malocclusion.

OBJECTIVE: To develop and validate a new psychometric tool for assessing malocclusion-related quality of life among older Indian adolescents. METHODS: Item generation involved analysis of existing validated tools, followed by development of new items using various qualitative steps. A draft item pool of 41 questions was initially generated and subjected to item reduction through sequential steps involving two clinical studies to ensure reliability and validity. 431 subjects aged between 15 to 18 years took part in the validation study. Principal component analysis with varimax rotation was performed to get a psychometric tool with good factorial structure and maximum variance. RESULTS: Rotated component matrix resulted in a 20 item psychometric tool containing 4 domains with a total variance of 61.57%. Inter item, item total correlation and Cronbach α (α = 0.88) ensured good reliability. A positive correlation of the scale with global question ensured convergent validity. Independent t test showed statistically significant difference (p< 0.05) between mean score of IOTN-DHC and DAI with MRQoLQ, ensuring good construct validity. CONCLUSIONS: The newly developed psychometric tool is named as Malocclusion-Related Quality of Life Questionnaire (MRQoLQ) having 20 questions, including 2 socioeconomic items. The scale showed good reliability and initial validity, hence can be used among older adolescents with malocclusion to assess their malocclusion-related quality of life.

Development and initial validation of an oral health-related quality of life scale for older adolescents.

BACKGROUND: Oral health-related quality of life (OHRQoL) perception is age-dependent and therefore different for children, adolescents, and adults. Adolescents are a critical age group with specific oral health needs. Oral health needs assessment is not complete without the estimation of OHRQoL. OBJECTIVE: To develop and validate an OHRQoL scale for older adolescents considering their functional, social, emotional, academic, and economic situation. METHODS: All steps in psychometric tool development including face, content, and translational validity, pretesting, piloting, and factor analysis were followed. Construct validity was further tested using a cross-sectional study on 400 senior secondary students. Sociodemographic data, Decayed Missing Filled Teeth, Dental Aesthetic Index, and Community Periodontal Index were used to test construct validity. RESULTS: A 20-item tool with five domains (intraclass correlation of 0.857, Cronbach's alpha of 0.811, variance of 64.25%) was developed. Convergent validity was established with a single-item global question and discriminant validity with clinical indices. In the multivariate logistic regression model, malocclusion emerged as the most significant predictor for poor OHRQoL adjusting for socioeconomic status, dental caries, gingival bleeding, and last dental visit. Dental caries and last dental visit also significantly predicted poor OHRQoL in the adjusted regression model. CONCLUSION: The new tool has sound psychometric properties, is relatively short, culturally equivalent, age-specific, and can assess both positive and negative aspects of adolescent oral health. Further testing in longitudinal studies is required to determine its usefulness as an outcome measure.

Ready to Use Norms for Arnett Bergman Soft-Tissue Cephalometric Analysis for South Indian Population.

CONTEXT: Variability of the soft-tissue drape in humans has complicated the accuracy of evaluating soft tissue profiles in diagnosis and treatment planning. AIMS: The objective of the present study is to establish soft-tissue cephalometric norms for South Indian population using Arnett Bergman Soft tissue analysis. SETTINGS AND DESIGN: This study was conducted at the Department of Orthodontics and Dentofacial Orthopaedics. SUBJECTS AND METHODS: Lateral cephalograms of 60 individuals (30 males and 30 females), age ranging between 18 and 25 years, with orthognathic facial profiles were obtained in natural head position. True vertical line was drawn through subnasale parallel to the vertical reference plane. Measurements were done according to soft-tissue cephalometric analysis. STATISTICAL ANALYSIS USED: Student's t-test was used to compare the means between two groups. RESULTS: The results of the study showed significant gender dimorphism, with men having thicker soft-tissue structures, larger vertical dimensions, deep-set midface structures, more upright incisors, and deeper inferior labial sulci than women. When compared with the standard norms, the South Indian population had significantly protruded dentition, thinner soft-tissue drape, shorter vertical face heights, prominent forehead and midface with retusive lower facial thirds and convex profiles as compared to Caucasians. CONCLUSIONS: Significant gender dimorphism was evident in the local population suggesting the need for separate set of norms for males and females. Distinct ethnic differences were found between Caucasians and the Indian population that were statistically significant, highlighting the importance of defining separate set of norms for ethnic groups. The norms obtained should be used as reference when planning treatment of a specific ethnic group.