The effect of facemask in patients with unilateral cleft lip and palate: a systematic review and meta-analysis.

BACKGROUND: Patients with cleft lip and palate usually present a Class III skeletal pattern. Facemask (FM) is one of the conventional orthodontic treatment modalities used to address the skeletal discrepancy in cleft patients. OBJECTIVE: To investigate the potential effectiveness of FM in unilateral cleft lip and palate (UCLP) patients. SEARCH METHODS: Search without restrictions except language in seven databases since inception and hand searching until January 2019 was conducted. Detailed search strategies were developed for each database which were based on the PubMed strategy and adapted accordingly. SELECTION CRITERIA: Controlled studies assessing the effect of FM in UCLP patients were to be included. DATA COLLECTION AND ANALYSIS: After retrieval and selection of the studies, data extraction was performed. Both angular and linear cephalometric measurements were collected. Weighted mean differences (WMDs) and 95% confidence intervals (CΙs) between treated and untreated UCLP patients concerning the pre- and post-treatment angular measurements of each group were calculated using a random-effects meta-analysis model. The risk of bias in individual studies was assessed using the ROBINS-I tool. RESULTS: From nine eligible studies, five were included in the meta-analysis investigating the use of FM in patients and controls with UCLP (with and without maxillary expansion). Statistically significant differences were evident for SNA/S-N-ss, SNB/S-N-sm, ANB/ss-N-sm, and SN-MP. FM was found to induce an increase of SNA (WMD = 2.12 degrees, 95% CI: 1.58 to 2.66), ANB (WMD = 4.17 degrees, 95% CI: 3.60 to 4.74), and SN-MP angles (WMD = 2.60 degrees, 95% CI: 1.10 to 4.10) and a decrease of SNB angle (WMD = -1.94 degrees, 95% CI: -2.48 to -1.40) in UCLP patients. Low to moderate heterogeneity was observed. LIMITATIONS: They emerge due to risk of bias, exclusion of non-English papers and methodological characteristics of the included papers. CONCLUSIONS: According to the available data, FM seems to improve the sagittal skeletal relationships in UCLP patients, increasing the SNA and ANB angles and decreasing the SNB angle. Moreover, in the vertical dimension, FM increases the SN-MP angle. Regarding dental measurements, there are controversial results. More high-quality studies need to be conducted in order to further clarify the impact of FM on UCLP patients. REGISTRATION NUMBER: PROSPERO: CRD42019131619.

NAM Therapy-Evidence-Based Results.

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

In vivo evaluation of tooth colour alterations during orthodontic retention: A split-mouth cohort study.

OBJECTIVES: To assess in vivo colour alterations of teeth following removal of fixed orthodontic appliances during retention. SETTING AND SAMPLE POPULATION: The Department of Orthodontics at the Aristotle University of Thessaloniki. Forty-eight patients after orthodontic treatment. MATERIAL AND METHODS: Debonding and cleaning procedures after orthodontic treatment were performed using two different carbide burs attached to a low or high-speed handpiece, respectively, in a non-blinded cohort study with split-mouth design. Spectrophotometric colour data of teeth were recorded: (a) after debonding, (b) three months later, prior to and following finishing with Soflex discs, and (c) after 1 year. The CIE Lab colour parameters were measured for each tooth, and the corresponding ΔΕ differences were calculated. The effect on colour was assessed with 3-way mixed ANOVA and Bonferroni's comparisons test (a < 0.05). RESULTS: Orthodontic debonding and cleaning procedures were found to have statistically significant effects on the CIE colour parameters of treated teeth, since the L* values decreased 0.6 units (P < 0.001), a* values were stable (0.0 units) and b* values increased 1.4 units (P < 0.001), during the first retention year. Finishing temporarily decreased the enamel colour differences. Total ΔΕ differences for all types of teeth measured ranged from 1.4 to 2.1 units. The greatest changes were exhibited during the first 3 months in teeth on which high-speed rotary instruments were used (1.6 units). CONCLUSION: The clinical relevance of this study points out that the colour of natural teeth following removal of fixed orthodontic appliances changes in long-term.

In vitro spectrophotometric evaluation of Vivera clear thermoplastic retainer discolouration.

AIMS: To investigate the in vitro effect of different staining solutions on the colour stability of Vivera retainers. METHODS: Thirty flat specimens fabricated using the Vivera material (Align Technology Inc., CA, USA) were assigned into five Groups (A, B, C, D and E) and immersed at 37 degrees C in solutions of distilled water (control), coffee, tea, red wine, and Coca-Cola. The CIE colour parameters (L*, a*, b*) of each specimen were measured before immersion (T0) and after 12 hours (T1), three days (T2) and seven days (T3) of solution exposure. Colour differences (AE) between the interval groups were calculated. Results: Significant differences were observed concerning (i) L* between T, and T0, Ti and T2 for Group B; (ii) a* between To and T,, T, and T3 for Groups B, C, D and E, as well as between T1 and T2 for Group C; and (iii) b* between To and T,, T2 and T3 for Group B and between T0 and T2 and T1 for Group C. The differences between δE(T1-T0), δE(T2-T0) and δE(T3-T0) were statistically significant for Groups B and C, as well as the difference between δE(T1-T0) and δE(T2-T0) for Group D. CONCLUSIONS: Coffee, tea and red wine caused visible changes in the retainers' colour.

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.