Tele-orthodontics and sensor-based technologies: a systematic review of interventions that monitor and improve compliance of orthodontic patients.

BACKGROUND: Recent advances in orthodontics offer appealing tools to monitor compliance and designate protocols to enhance it. OBJECTIVE: This systematic review of systematic reviews (SRs) aimed to assess the effectiveness of digitized communication methods and sensor-based devices that track compliance in orthodontic patients. SEARCH METHODS: Five electronic databases (PubMed, Web of Science, MEDLINE, PsycINFO, and EMBASE) were searched from database inception up to 4 December 2022. SELECTION CRITERIA: SRs using digitized systems and sensor-based technologies to monitor and/or improve compliance with orthodontic treatment or during an active retention phase were included. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and risk of bias assessment using the AMSTAR 2 tool were performed independently by two review authors. A qualitative synthesis of outcomes from moderate- and high-quality SRs was provided, and evidence was graded in accordance with a scale of statements. RESULTS: A total of 846 unique citations were retrieved. After study selection, 18 SRs met the inclusion criteria, and 9 moderate- and high-quality reviews were further integrated into the qualitative synthesis. Digitized communication methods were found to be effective in improving compliance with oral hygiene practices and adherence to orthodontic appointments. Monitoring removable appliance wear with microsensors revealed sub-optimal levels of compliance with wear instructions of intra-oral and extra-oral appliances. One review discussed the informational value of social media platforms and their importance in guiding the decision-making process to seek orthodontic treatment and compliance-related experiences. LIMITATIONS: The variability in the quality of included SRs and the limited number of primary studies on certain outcomes present as limitations within this overview. CONCLUSIONS: The integration of tele-orthodontics and sensor-based technologies to improve and monitor compliance within orthodontic practices is promising. There is sufficient evidence that establishing communication channels with orthodontic patients through reminders and audiovisual systems positively impact their oral hygiene practices throughout orthodontic treatment. However, understanding the informational value of social media as communication channels between clinicians and their patients, and their overall effect on modulating compliance is still insufficient. REGISTRATION: CRD42022331346.

Stability of single-jaw vs two-jaw surgery following the correction of skeletal class III malocclusion: A systematic review and meta-analysis.

This review aims to compare the stability of sagittal skeletal and overjet anteroposterior correction of skeletal class III malocclusion in single-jaw and two-jaw orthognathic procedures. An unrestricted comprehensive electronic search was undertaken on Embase, Cochrane's CENTRAL, Web of Science, Medline, Scopus and LILACs databases up to October 2020. The bibliographies of relevant studies, ongoing, unpublished and grey literature were screened. Two independent reviewers performed study selection, bias assessment and data extraction; a third reviewer mediated inconsistencies. Randomized clinical trials, prospective cohort, retrospective cohort and series with a minimum of 1 year follow-up were eligible for inclusion. Additional subgroup analyses were undertaken. The generated effects were scored using the GRADE approach. Nine articles met the inclusion criteria and eight studies were subsequently analysed quantitatively. No significant difference in sagittal stability at the ANB angle, A-point or B-point on a short-term was detected. However, a statistically significant difference, indicating a greater short-term relapse in overjet with mandibular setbacks alone, was found (MD: -0.40 mm; 95% CI -0.77 to -0.04; I2 : 0%; P = .03). Long-term follow-up (≥5 years) revealed a statistically non-significant difference in stability of sagittal skeletal and overjet corrections. Within the limitations of this review, both procedures seem to offer comparable skeletal and overjet stability outcomes; however, further high-quality research is required to confirm these findings.

Effectiveness of prefabricated myofunctional appliances in the treatment of Class II division 1 malocclusion: a systematic review.

BACKGROUND: Prefabricated myofunctional appliances (PMAs) are widely advocated for correcting Class II division I malocclusion. However, their effectiveness is associated with a high amount of uncertainty within contemporary literature. OBJECTIVES: The aim of this review was to systematically examine the available literature regarding the effectiveness of PMAs in treating Class II division 1 malocclusion in children and adolescents. SEARCH METHODS: Comprehensive unrestricted electronic searches in multiple databases as well as manual searches were conducted up to August 2018. SELECTION CRITERIA: Randomized controlled trials (RCTs) and non-randomized studies (NRS) matching the eligibility criteria. DATA COLLECTION AND ANALYSIS: Two independent review authors were directly involved in study selection, data extraction, and bias assessment. The Cochrane risk of bias tool and the ROBINS-I tool were used for assessing the risk of bias. Quantitative pooling of the data was undertaken with a random-effects model with its 95% confidence interval (CI). RESULTS: Three RCTs comparing PMAs to activators and three NRS comparing PMAs to untreated controls met the inclusion criteria. On a short-term basis, exploratory quantitative synthesis indicated that the activators were more effective than the PMAs in correcting overjet with a mean difference of (1.1 mm; 95% CI: 0.44 to 1.77). On a long-term basis, there were no significant differences between the two appliances. Qualitative synthesis indicated less favorable soft tissue changes as well as patient experiences and compliance with the PMAs when compared to the activators. However, PMAs were associated with reduced costs compared to customized activators and modest changes when compared to untreated controls. CONCLUSIONS: On a short-term basis, low quality of evidence suggests that PMAs were generally less effective than the activators in treating Class II division 1 malocclusion. The main advantage of PMAs seems to be their reduced costs. These results should be viewed with caution, as a definitive need for high-quality long-term research into this area is required. REGISTRATION: PROSPERO (CRD42018108564).

Effectiveness of miniscrew-supported maxillary incisor intrusion in deep-bite correction: A systematic review and meta-analysis.

OBJECTIVES: To evaluate systematically the effectiveness of miniscrew-supported maxillary incisor intrusion compared with other nonsurgical intrusive mechanics for deep-bite correction. MATERIALS AND METHODS: Unrestricted electronic searches in Embase, Web of Science, MEDLINE, LILACS, and Cochrane's CENTRAL as well as manual searches were conducted up to August 2019. Only randomized clinical trials (RCTs) were included. Study selection, data extraction, and bias assessment were done by two independent reviewers. The Cochrane risk-of-bias tool was used, and the quality of evidence was graded using the GRADE approach. A random-effects meta-analysis of continuous data, with its 95% confidence intervals (CIs), was used. RESULTS: Seven RCTs were included in the quantitative synthesis, and the overall quality of evidence was very low to low. When compared with intrusion arches, miniscrews resulted in a more efficient deep-bite reduction with a standardized mean difference (SMD) of -0.48 (95% CI, -0.89 to -0.07). When miniscrews were used, a statistically significant difference was observed favoring less maxillary molar extrusion (SMD, -0.86; 95% CI, -1.46 to -0.27) and more incisor intrusion as measured from centroid to palatal plane (SMD, -0.95; 95% CI, -1.41 to -0.49). Results also showed a statistically nonsignificant difference regarding the amount of resultant root resorption between miniscrews and intrusion arches. CONCLUSIONS: There is weak evidence indicating efficient deep-bite correction using miniscrews. Root resorption seems to be an associated adverse effect that occurs regardless of the intrusive mechanics used. These conclusions should be viewed with great caution as further well-designed long-term research is recommended.

Effectiveness of different debonding techniques and adjunctive methods on pain and discomfort perception during debonding fixed orthodontic appliances: a systematic review.

BACKGROUND: Pain is an unpleasant side-effect that can be experienced during orthodontic procedures including debonding of fixed appliances. Pain experience can vary depending on the appliance, debonding technique, as well as adjunctive measures used. OBJECTIVES: The primary objective of this systematic review was to assess the effectiveness of different debonding techniques and adjunctive methods on pain/discomfort perception during debonding procedure (PDP) of fixed orthodontic appliances. The secondary objective was to assess the effects of anatomic location and gender on PDP of fixed orthodontic appliances. SEARCH METHODS: Multiple electronic databases were searched from inception to August 2018. Reference lists of the included articles were manually screened. SELECTION CRITERIA: Randomized clinical trials (RCTs) and controlled clinical trials were included. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers according to Cochrane guidelines, with disputes resolved by a third reviewer. Clinical heterogeneity in study design and methodology prevented quantitative synthesis of the data. RESULTS: The search yielded 198 articles after the removal of duplicates. Seven studies were included in the final review with a total of 307 participants aged 12-60 years. Of the four studies comparing different debonding instruments of labial fixed appliances, two studies showed that the lift-off debonding instrument (LODI) produced lower PDP levels than ligature cutting pliers. Three studies compared adjunctive measures to reduce PDP of labial fixed appliances. Finger pressure and bite wafers significantly reduced PDP levels. Analgesics administration (ibuprofen + paracetamol tablets) 1 hour prior to debonding also reduced PDP. PDP was significantly higher in anterior segments and in females. LIMITATIONS: The authors acknowledge that there was clinical heterogeneity among the included studies and that the potential effect of diurnal variation on pain during debonding was not considered in any of the included trials. CONCLUSIONS AND IMPLICATIONS: There is weak evidence indicating that using the LODI may reduce PDP of labial fixed appliances. Adjunctive measures such as an intrusive force with finger pressure, bite wafers, and preoperative analgesia may further aid PDP control. Further well-designed parallel-group RCTs taking into consideration the diurnal variation in pain are required. REGISTRATION: PROSPERO (CRD42017084474). FUNDING: None. CONFLICT OF INTEREST: The authors declare that there is no conflict of interest.

Reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis.

BACKGROUND: Reminders are implemented in healthcare services to increase compliance with treatment and to decrease the rate of failed appointments. Their effects in the provision of orthodontic care are not yet fully understood. OBJECTIVES: The main objectives of this review were to assess the effectiveness of reminder systems in improving oral hygiene (OH) and adherence to appointments in orthodontic patients. SEARCH METHODS: An unrestricted search was conducted in six electronic databases and was supplemented by an extensive manual search up to January 2018. SELECTION CRITERIA: Only randomized controlled trials (RCTs) evaluating the effectiveness of reminders in orthodontics were included. DATA COLLECTION AND ANALYSIS: Two authors were independently involved in study selection, data extraction, and bias assessment. A random-effects model with its corresponding 95% confidence interval (CI) was generated for comparable outcomes. Periodontal parameters were evaluated in the short term (1-3 months) and in the long term (>3 months). Cochrane risk of bias tool was utilized for bias assessment and the quality of the resultant evidence was graded. Additional subgroup and sensitivity analyses were implemented. RESULTS: Fourteen RCTs involving 2078 participants met the inclusion criteria; five studies were excluded from the quantitative synthesis due to high risk of bias. Small but statistically significant standardized mean differences in the plaque index scores were recorded favoring patients receiving reminders in the short-term (-0.38; 95% CI: -0.65 to -0.10) and in the long-term (-1.51; 95% CI: -2.72 to -0.30). Patients receiving reminders were less likely to miss their appointments with a relative risk of (0.39; 95% CI: 0.22 to 0.70) and less likely to develop white spot lesions (0.45; 95% CI: 0.31 to 0.65). CONCLUSIONS: There is moderate-to-high quality of evidence that reminders have a positive effect on OH and adherence to appointments in orthodontic patients. These effects were demonstrated in the short- and long-term. Future high-quality RCTs should be designed with longer follow-up periods. REGISTRATION: PROSPERO (CRD42017084479). CONFLICT OF INTEREST: None.

Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants: a systematic review and meta-analysis.

OBJECTIVES: The aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure. SEARCH METHODS: An electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed. ELIGIBILITY CRITERIA: Randomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews' failure rate in that insertion site, were included. DATA COLLECTION AND ANALYSIS: Study selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results. RESULTS: Overall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3-6), 4.8% (95% CI 1.6-13.4) and 5.5% (95% CI 2.8-10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4-11.4), 9.7% (95% CI 5.1-17.6) and 16.4% (95% CI 4.9-42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3-23.6) and 9.9% (95% CI 4.9-19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1-14.7). CONCLUSIONS: Orthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies.

Effectiveness of en masse versus two-step retraction: a systematic review and meta-analysis.

BACKGROUND: This review aims to compare the effectiveness of en masse and two-step retraction methods during orthodontic space closure regarding anchorage preservation and anterior segment retraction and to assess their effect on the duration of treatment and root resorption. METHODS: An electronic search for potentially eligible randomized controlled trials and prospective controlled trials was performed in five electronic databases up to July 2017. The process of study selection, data extraction, and quality assessment was performed by two reviewers independently. A narrative review is presented in addition to a quantitative synthesis of the pooled results where possible. The Cochrane risk of bias tool and the Newcastle-Ottawa Scale were used for the methodological quality assessment of the included studies. RESULTS: Eight studies were included in the qualitative synthesis in this review. Four studies were included in the quantitative synthesis. En masse/miniscrew combination showed a statistically significant standard mean difference regarding anchorage preservation - 2.55 mm (95% CI - 2.99 to - 2.11) and the amount of upper incisor retraction - 0.38 mm (95% CI - 0.70 to - 0.06) when compared to a two-step/conventional anchorage combination. Qualitative synthesis suggested that en masse retraction requires less time than two-step retraction with no difference in the amount of root resorption. CONCLUSIONS: Both en masse and two-step retraction methods are effective during the space closure phase. The en masse/miniscrew combination is superior to the two-step/conventional anchorage combination with regard to anchorage preservation and amount of retraction. Limited evidence suggests that anchorage reinforcement with a headgear produces similar results with both retraction methods. Limited evidence also suggests that en masse retraction may require less time and that no significant differences exist in the amount of root resorption between the two methods.