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Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis.

ABSTRACT: OBJECTIVES:Adults with fixed orthodontic appliances are increasing nowadays. Compared with adolescents, adults present biological differences that might influence treatment duration. Therefore, the aim of the study was to compare duration of treatment with fixed appliances between adults and adolescents. MATERIALS AND METHODS:Eight databases were searched up to September 2019 for randomized and non-randomized clinical studies comparing treatment duration with fixed appliances in adolescents and adult patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane ROBINS-I tool, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE. RESULTS:A total of 11 unique studies (one prospective and 10 retrospective non-randomized) with 2969 adolescents and 1380 adult patients were finally included. Meta-analysis of 7 studies found no significant difference in the duration of comprehensive treatment with fixed appliances (MD = - 0.8 month; 95% CI = - 4.2 to 2.6 months; P = 0.65; I2 = 92%) between adults and adolescents. Similarly, both distalization of upper first molars with skeletal anchorage for class II correction and the retraction of canines into the premolar extraction spaces lasted similarly long among adults and adolescents. On the other hand, alignment of palatally displaced canines lasted considerably longer in adults compared to adolescents (1 study; MD = 3.8 months; 95% CI = 1.4 to 6.2 months; P = 0.002). The quality of evidence for the meta-analysis was low due to the inclusion of non-randomized studies with considerable risk of bias. CONCLUSIONS:While existing evidence does not indicate a difference in the overall duration of treatment with fixed appliances between adults and adolescents, the alignment of palatally displaced canines lasted significantly longer in adults. However, our confidence in these estimates is low due to the risk of bias in the included studies. TRIAL REGISTRATION:PROSPERO: ( CRD42019148169 ).

SUBMITTER: Abbing A

PROVIDER: S-EPMC7533275 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis.

Abbing Allen A Koretsi Vasiliki V Eliades Theodore T Papageorgiou Spyridon N SN

Progress in orthodontics 20201005 1

<h4>Objectives</h4>Adults with fixed orthodontic appliances are increasing nowadays. Compared with adolescents, adults present biological differences that might influence treatment duration. Therefore, the aim of the study was to compare duration of treatment with fixed appliances between adults and adolescents.<h4>Materials and methods</h4>Eight databases were searched up to September 2019 for randomized and non-randomized clinical studies comparing treatment duration with fixed appliances in a ...[more]

PMID: 33015719

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Project description:BACKGROUND:The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app. OBJECTIVE:The objective of our paper was to describe the systematic development and content of the WhiteTeeth app. METHODS:For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption. RESULTS:On the basis of our literature search, we identified fluoride use and control of dental plaque levels (eg, tooth brushing and proxy brush usage) as target behaviors for preventing caries. Next, we identified important and changeable determinants of oral health behavior that fitted the theoretical concepts of the Health Action Process Approach (HAPA) theory. The HAPA theory, the self-regulation theory, and the results of the semistructured interviews were used to define the program objectives, that is, the performance and change objectives. After defining the objectives, we identified multiple behavior change techniques that could be used to achieve these objectives, such as providing oral health information and feedback, prompting self-monitoring, coaching of set actions and coping plans, and sending reminders. We translated these methods into practical strategies, such as videos and a brushing timer. Next, we combined these strategies into a single program resulting in the WhiteTeeth app (which is available on both iTunes and Google Play stores as "Witgebit"). Adolescents with fixed orthodontic appliances and dental professionals were included in the development process to increase the success of implementation. The pilot test revealed that the app users appreciated and liked the app. The WhiteTeeth app can be integrated into current orthodontic care. CONCLUSIONS:IM allowed us to identify multiple techniques that have been shown to be the most effective in initiating behavior change, but have not yet been incorporated into existing orthodontic apps. The WhiteTeeth app contains all these techniques, which makes it a unique and promising home-based app for promoting oral health in adolescents with fixed orthodontic appliances.

Project description:BackgroundOrthodontic retention aims to maintain optimal teeth positions after active treatment. The stability is affected by numerous factors, including patients' individual features, thus retention should be adjusted in the most optimal way. Bonding a retainer makes retention less dependent on patient's compliance.Questions ariseWhat wire or fiber splint type provides the best treatment stability? What materials should be used to bond the wire or fiber splint? Should be the bonding procedure be direct or indirect? The aim of the study is to assess and synthesize available controlled trials investigating failures of fixed retainers.MethodsLiterature searches of free text and MeSH terms were performed in Scopus, Web of Science, Embase and PubMed Central in order to find studies, referring to failures of fixed retention (12th February 2021). The keywords were: ("orthodontic retainers AND failure AND wire"). The framework of this systematic review according to PICO was: Population: orthodontic patients; Intervention: fixed orthodontic retainer bonding; Comparison: Different protocols of fixed orthodontic retention applied; Outcomes: failure rate, survival rate. Three different specific scales from the Cochrane Collaboration Handbook were used, according to each study type. Additionally, a meta-analysis was conducted to compare the effectiveness of retention using fiber reinforced composite and multistranded steel wire.ResultsThe search identified 177 potential articles: 114 from PubMed, 41 from Scopus, 20 from Web of Science and 2 from Embase. After excluding studies inconsistent with selection criteria, 21 studies were included and subjected to qualitative analysis. The main outcome investigated was failure rate. This systematic review has some potential limitations due to the heterogeneity of design between included studies.ConclusionsNo retainer is proved to guarantee a perfect stability of dental alignment. The retainer should be bonded to all adherent teeth, preferably with additional use of bonding resin. No wire or fiber splint present superior characteristics concerning failure rate. Fiber reinforced composite retention is more sensitive to operator skills, and with imperfect bonding technique, failure rate is much higher. During the first 6 months after bonding retainer the patient should be under frequent control. The study protocol was registered in PROSPERO database with the number CRD42021233406.

Project description:BackgroundOrthodontic patients wearing fixed appliances are susceptible to traumatic dental injuries during a wide range of sporting activities. This randomized clinical trial investigated wearability and preference of mouthguards during sporting activities in patients undergoing orthodontic treatment with fixed appliances.MethodsA prospective three-arm crossover randomized clinical trial conducted in the UK. Thirty patients in active orthodontic treatment with fixed appliances undertaking at least 120 minutes of contact sport per 6-8-week observation period were randomly assigned to one of six mouthguard allocation sequences consisting of three mouthguard types: (MG1) custom-made laboratory constructed, (MG2) mouth-formed OPRO® Gold Braces, and (MG3) pre-fabricated Shock Doctor® Single Brace. Patients completed a nine-outcome 100-mm visual analogue scale (VAS) questionnaire relating to mouthguard wearability during sport. Once feedback was completed, subjects were allocated the next mouthguard in the sequence. At study-end, subjects were asked to identify their preferred mouthguard.ResultsTwenty-four patients (median age = 13; inter-quartile range 12-14.5 years) completed n = 72 follow-up questionnaires with most playing rugby union or field hockey. Considering VAS score as a continuous variable, for comfort, stability, hardness, ability to breathe, ability to not cause nausea, and inclination to chew, MG2 performed better than MG3. For categorization of VAS score into low (less than 80 mm) or high (at least 80 mm) wearability, for comfort, stability, ability to not cause nausea, and inclination to chew, MG1 and MG2 also rated superior to MG3. Patients preferred MG1 overall.ConclusionsThis randomized clinical trial found that during contact sport patients in fixed appliances reported superior wearability for custom-made and mouth-formed mouthguards in comparison to pre-fabricated. Overall, patients preferred custom-made mouthguards.Clinical trials registrationClinicalTrials.gov: NCT04588831.

Project description:It is known that the presence of orthodontic brackets predisposes for a change in the biofilm, facilitating the development of gingivits. The sites are difficult to access with a toothbrush and periodontal curette, worsening inflammation, in addition, a gingival hyperplasia is associated with poor hygiene. The objective of this study is to evaluate the impact of photodinamyc therapy (PDT) as an adjuvant treatment, considering clinical immunoregulatory and microbiological parameters. This randomized, controlled, double-blind clinical study will include 34 patients, both genders, having used fixed appliance for more than 12 months, with gingivitis. Participants will be divided into two groups: G1 (n = 17)- Scaling and Root Planing + PDT placebo and G2 (n = 17)- Scaling and Root Planing + PDT. In G2 the following dosimetric parameters will be used: methylene blue 0.005%, λ= 660 nanometers (nm), 9 Joules (J) per site, irradiance= 3.5Watts (W)/ centimeters (cm), radiant exposure= 318J/cm. All participants will receive oral hygiene guidance prior the curetes scaling. The clinical periodontal data to be analyzed are plaque index, gingival index and probing depth. Crevicular fluid, from 4 pre-determined sites and saliva, will be collected and analysed for IL-6, IL-1β, IL-8, TNF-α and IL-10 cytokines using ELISA (Enzyme immunoabsorption assay) method. Total Bacteria count will also be performed, by qPCR and Universal16SrRNA gene. All analysis will be realized using in the baseline (T0), 7 (T1) and 21 (T2) days after treatment. Oral health-related quality of life will be assessed using the OHIP-14 questionnaire at times T0 and T2. If sample distribution is normal, the Student T-test will be applied if it is not normal, the Mann-Whitney test will be used. The data will be presented in terms of ± PD and The significance level will be set at p < 0.05. Our results may improve quality of life and add data to establish a therapeutic alternative for gingivitis during the orthodontic treatment. Registration: clinicaltrials.gov NCT04037709. https://clinicaltrials.gov/ct2/show/NCT04037709 - Registered in July 2019.

Dataset Information

Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis.

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Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis.

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