A novel method for testing accuracy of bite registration using intraoral scanners.

Objective: The evidence on the accuracy of bite registration using intraoral scanners is sparse. This study aimed to develop a new method for evaluating bite registration accuracy using intraoral scanners. Methods: Two different types of models were used; 10 stone models and 10 with acrylic resin teeth. A triangular frame with cylindrical posts at each apex (one anterior and two posteriors) was digitally designed and manufactured using three-dimensional (3D) printing. Such a structure was fitted in the lingual space of each maxillary and mandibular model so that, in occlusion, the posts would contact their opposing counterparts, enforcing a small interocclusal gap between the two arches. This ensured no tooth interference and full contact between opposing posts. Bite registration accuracy was evaluated by measuring the distance between opposing posts, with small values indicating high-accuracy. Three intraoral scanners were used: Medit i500, Primescan, and Trios 4. Viewbox software was used to measure the distance between opposing posts and compute roll and pitch. Results: The average maximum error in interocclusal registration exceeded 50 µm. Roll and pitch orientation errors ranged above 0.1 degrees, implying an additional interocclusal error of around 40 µm or more. The models with acrylic teeth exhibited higher errors. Conclusions: A method that avoids the need for reference hardware and the imprecision of locating reference points on tooth surfaces, and offers simplicity in the assessment of bite registration with an intraoral scanner, was developed. These results suggest that intraoral scanners may exhibit clinically significant errors in reproducing the interocclusal relationships.

Effect of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis: A systematic review with meta-analysis.

AIM: To assess the beneficial and adverse effects on the dental and periodontal issues of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis. MATERIALS AND METHODS: Nine databases were searched in April 2020 for randomized/non-randomized clinical studies. After duplicate study selection, data extraction, and risk-of-bias assessment, random-effect meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression analyses. RESULTS: A total of 30 randomized and non-randomized clinical studies including 914 patients (29.7% male; mean age 43.4 years) were identified. Orthodontic treatment of pathologically migrated teeth was associated with clinical attachment gain (-0.24 mm; seven studies), pocket probing depth reduction (-0.23 mm; seven studies), marginal bone gain (-0.36 mm; seven studies), and papilla height gain (-1.42 mm; two studies) without considerable adverse effects, while patient sex, gingival phenotype, baseline disease severity, interval between periodontal and orthodontic treatment, and orthodontic treatment duration affected the results. Greater marginal bone level gains were seen by additional circumferential fiberotomy (two studies; MD = -0.98 mm; 95% CI = -1.87 to -0.10 mm; p = .03), but the quality of evidence was low. CONCLUSIONS: Limited evidence of poor quality indicates that orthodontic treatment might be associated with small improvements of periodontal parameters, which do not seem to affect prognosis, but more research is needed.

Mid-term follow up effectiveness of facemask treatment in class III malocclusion: A systematic review.

OBJECTIVE: This systematic review aims to investigate and summarize the mid-term effects and stability of the treatment with facemask appliance. METHODS: Search without restrictions in five databases (Pubmed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials) since inception and hand searching until March 2021 was conducted. Detailed search strategies were based on the PubMed strategy and adapted accordingly. Studies assessing the mid-term effects of facemask appliance, with a follow-up post-treatment period of more than 6 years or after the peak of pubertal growth, were to be included. The risk of bias in individual studies was assessed using the Cochrane guidelines for the RCT and the ROBINS-I tool for the non-RCT studies. RESULTS: Five studies were finally considered eligible for inclusion (one RCT and four CCTs). According to the reported evidence, the mid-term success rate ranged from 62.7% to 100%. Mid-term success was identified with positive overjet as well as acceptable aesthetic and functional characteristics. CONCLUSIONS: Class III malocclusion treated with facemask presents a high percentage of success in the mid-term follow-up period. The mid-term effects of facemask were stable for the maxilla, in terms of sagittal and anteroposterior dentoskeletal dimensions, and any kind of relapse is attributed to uncontainable residual growth of the mandible. However, considering the high risk of bias and the follow-up period limitations, more high-quality studies are necessary in order to achieve further clarification. Future research should be based also on identifying biomarkers to indicate likely treatment responses. REGISTRATION NUMBER: PROSPERO: CRD42020179402.

Gingival Thickness Assessment at Mandibular Incisors of Orthodontic Patients with Ultrasound and Cone-beam CT. A Cross-sectional Study.

PURPOSE: To use and evaluate two methods for measuring gingival thickness (GT) at mandibular incisors of orthodontic patients and compare their performance in assessing periodontal anatomy through soft tissue thickness. MATERIALS AND METHODS: The sample consisted of 40 consecutive adult orthodontic patients. GT was measured just before bracket placement at both central mandibular incisors, mid-facially on the buccal aspect, 2 mm apically to the free gingival margin with two methods: clinically with an ultrasound device (USD) and radiographically with cone-beam computed tomography (CBCT). RESULTS: CBCT measurements were consistently higher than USD measurements, with the difference ranging from 0.13 mm to 0.21 mm. No statistically significant difference was noted between the repeated CBCT measurements at the right central incisor (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.104). Although the respective results for the left incisor statistically indicated that the measurements were not exactly replicated, the magnitude of the point estimate was small and not clinically significant (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014). Small differences between CBCT measurements made by the 2 examiners at the left central incisor (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014) were detected. However, this difference was minor and also not clinically significant. The respective analysis on the right incisor showed no statistically significant difference (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.246). CONCLUSIONS: Based on reproducibility, CBCT imaging for gingival thickness assessment proved to be as reliable as ultrasound determination. However, CBCT consistently yielded higher values, albeit at a marginal level, than did the ultrasound device.

Social media and orthodontic treatment from the patient's perspective: a systematic review.

BACKGROUND: Social media are one of the most common and easily accessible ways of gaining information about orthodontic treatment. OBJECTIVE: The main objective of this study was to systematically search the literature and determine the various aspects of the interrelationship between social media and orthodontics from the patient's perspective. SEARCH METHODS: Electronic database searches of published and unpublished literature were performed. The reference lists of all eligible articles were hand-searched for additional studies. SELECTION CRITERIA: Randomized clinical trials (RCTs), prospective, retrospective, and cross-sectional studies were included. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate by the first two authors. RESULTS: One RCT, three retrospective, and four cross-sectional studies were deemed as eligible for inclusion in this review. The studies included patient's statements in social media or results from questionnaires given to patients. The social media reported were with order of frequency: Twitter, YouTube, Facebook, Google+, Pinterest, and Instagram. The feelings the patients expressed seemed to be more positive than negative: enthusiasm, self-esteem and pleasure, excitement about the aesthetic result, excitement after braces removal but also antipathy, annoyances, reduced self-esteem, and impatience for removing mechanisms. In addition, one study referred to bullying through Twitter. LIMITATIONS: The high amount of heterogeneity precluded a valid interpretation of the results through pooled estimates. CONCLUSIONS AND IMPLICATIONS: This systematic review demonstrated that information about orthodontics, how the patient feels, and other psychosocial facets are spread through social media. It is intuitive that research relating to the effects and impact of orthodontic interventions should account not only for the physical impacts of treatment but also to encompass patient-centered outcomes. REGISTRATION: The protocol of this study was not registered in publicly assessable database. CONFLICTS OF INTEREST: None to declare.

Use of Different Cleaning Methods for Removable Orthodontic Appliances: A Questionnaire Study.

OBJECTIVES: The aim of the present study is to assess the means and methods being suggested by Greek orthodontists to their patients for cleaning their removable devices. MATERIALS AND METHODS: A questionnaire survey was conducted among a total of 418 Greek orthodontists found from the registry of orthodontists in Greece. The clinicians were asked about the means and methods of daily cleaning they usually advise their patients for removable appliances. Furthermore, the questionnaire included questions related to possible complications of these devices and data about the use and type of applied devices. RESULTS: From 418 Greek orthodontists, 279 filled the questionnaire and participated in this study. All but one reported that they use removable appliances in their practice for patients of almost any age. All orthodontists recommend routine manual toothbrushing, but the majority of them also suggest at the same time other oral hygiene aids complementary to brushing, such as immersion in denture cleaners (70.06%), in disinfecting solutions (12.73%) and in vinegar (36.94%). Some 15% of all the practitioners advise the use of ultrasonic instruments for cleaning removable orthodontic appliances. At last, clinicians have faced complications from the use of removable devices in the oral cavity at a statistically significant percentage. The most usual is trauma of the mucosa, mycosis and hyperplasia. CONCLUSION: Greek orthodontists use removable orthodontic appliances, active or passive, in their practice. Brushing with a toothbrush and the use of cleaning products for removable prostheses are the preferred methods for cleaning removable orthodontic appliances regardless of the orthodontic specialty programme they had graduated from.

Success of palatal implants or mini-screws placed median or paramedian for the reinforcement of anchorage during orthodontic treatment: a systematic review.

Objectives: To assess the failure rates of palatal implants and palatal mini-screws, independently and comparatively, used for supplementing anchorage during orthodontic treatment. Protocol and registration: The protocol was not registered prior to the study. This study was not registered in any publicly assessable database. Materials and methods: Screening for inclusion eligibility, quality assessment of studies, and data extraction was performed independently by two authors. The electronic databases MEDLINE, EMBASE, and CENTRAL, as well as unpublished literature, were searched with no restrictions on publication date or language using detailed strategies. The main outcome assessed was palatal implant or mini-screw failure. Randomized controlled trials were evaluated according to the Cochrane risk of bias tool. Prospective and retrospective studies were graded employing the adjusted predetermined criteria of Bondemark. Results: Twenty-seven studies satisfied the inclusion criteria. Four were RCTs of low risk of bias, 12 were prospective (2 low, 7 unclear, 3 high risk of bias) and 11 were retrospective studies (6 unclear, 5 high risk of bias). Only one retrospective study assessed both palatal implants and mini-screws. Seventeen studies, including the four RCTs, assessed solely palatal implants and nine studies palatal mini-screws. The median failure risk of palatal implants was 6.0 per cent (range: 0.0-26.1%) and of mini-screws 6.1 per cent (range: 0.0-33.3%). The median follow-up period was 17.9 months for palatal implants and 6 months for mini-screws. Limitations: Significant clinical and methodological heterogeneity among studies and highly variable outcomes. Conclusions: Both palatal implants and mini-screws have quite low failure rates that are also comparable, though the median follow-up period of palatal implants was quite larger. Therefore, in regular orthodontic cases, the choice between anchoring devices may rely on other factors, such as costs, patient comfort, personal preferences, familiarity with the device, and insertion procedures.