Search

Objectives: To investigate the masticatory (masticatory performance, bite force, swallowing threshold, muscle activity, and questionnaires) and nutritional (nutrient intake) impacts of the activation and/or installation of different orthodontic appliances (fixed labial, lingual appliances, and clear aligners)., Materials and Methods: Six electronic databases and gray literature were searched (up to May 2021) for relevant studies evaluating mastication and nutrition after activation/installation of orthodontic appliances. This review followed PRISMA guidelines and was registered at PROSPERO (CRD42020199510). The risk of bias (RoB 2 and ROBINS-I) and evidence quality Grading of Recommendations Assessment, Development, and Evaluation were analyzed., Results: Of 4226 recorded and screened, 15 studies were finally included. Masticatory performance (standardized mean difference [SMD]: 1.069; 95% coefficient interval [CI]: 0.619 to 1.518) and bite force (SMD: -2.542; 95% CI: -4.867 to -0.217) reduced in the first 24 to 48 hours of fixed labial appliance installation/activation, but they were both normalized after 30 days (P > .05). The swallowing threshold remained constant (P > .05). Nutritional intake was rarely reported but showed copper (P = .002) and manganese (P = .016) reductions, with higher calorie and fat intake (P < .05). Lingual appliances impacted chewing more than labial, and clear aligner wearers reported fewer chewing problems (P < .001). Low to very low levels of evidence were found., Conclusions: Based on low to very low levels of evidence, mastication was reduced during the first 24 to 48 hours of fixed labial appliance activation/installation, but it was transitory (up to 30 days). Due to insufficient data, the nutritional impact of orthodontic appliances was not conclusive., (© 2022 by The EH Angle Education and Research Foundation, Inc.)

Objectives: To identify malocclusion characteristics generated after using oral appliances (OAs) for at least 5 years for the management of snoring and obstructive sleep apnea (OSA) in adults., Materials and Methods: PubMed, MEDLINE (Ovid), Scopus, CINAHL, and Informit were searched without language restrictions through January 20, 2021. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and the Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Risk of bias was assessed through the revised Cochrane Risk of Bias tool for randomized controlled trials (RoB2) and Non-Randomized Studies of Interventions for non-RCTs and uncontrolled before-after studies (ROBINS-I). A random-effects meta-analysis was conducted only on studies that used the same OAs to exclude biomechanical differences. Risk of bias across studies was assessed with the Grading of Recommendations, Assessment, Development and Evaluation tool., Results: A total of 12 studies were included in the final qualitative synthesis. Eight included studies had high, one had moderate, and three had low risks of bias. Significant progressive decreases of overjet (OJ; -1.43 mm; 95% confidence interval [CI], -1.66 to -1.20) and overbite (OB; -1.94 mm; 95% CI, -2.14 to -1.74) associated with maxillary incisor retroclination and mandibular incisor proclination were reported long term. Although most studies showed no sagittal skeletal changes, some degree of vertical skeletal changes were noted., Conclusions: Based on a very low evidence level, inevitable anterior teeth positional changes seem to be a common long-term adverse effect of OAs. The magnitude of those changes could be considered clinically irrelevant for most pretreatment occlusions, but in occlusions with limited OJ and OB, it may be worth clinical consideration., (© 2022 by The EH Angle Education and Research Foundation, Inc.)

Objectives: To evaluate the effects of orthodontic force on histomorphology and tissue factor expression in the dental pulp., Materials and Methods: Two reviewers comprehensively and systematically searched the literature in the following databases: Latin American and Caribbean Health Sciences, Embase, Cochrane, PubMed, Scopus, Web of Science, and Grey literature (Google Scholar, OpenGrey, and ProQuest) up to September 2020. According to the Population, Intervention, Comparison, Outcomes, Studies criteria, randomized clinical trials (RCTs) and observational studies that evaluated the effects of orthodontic force on dental pulp were included. Case series/reports, laboratory-based or animal studies, reviews, and studies that did not investigate the association between orthodontic force and pulpal changes were excluded. Newcastle-Ottawa Scale and Cochrane risk-of-bias tool were used to assess the risk of bias. The overall certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation tool., Results: 26 observational studies and five RCTs were included. A detailed qualitative analysis of articles showed a wide range of samples and applied methodologies concerning impact of orthodontic force on the dental pulp. The application of orthodontic force seems to promote several pulpal histomorphological changes, including tissue architecture, cell pattern, angiogenesis, hard tissue deposition, inflammation, and alteration of the expression levels of 14 tissue factors., Conclusions: Although the included articles suggest that orthodontic forces may promote histomorphological changes in the dental pulp, due to the very low-level of evidence obtained, there could be no well-supported conclusion that these effects are actually due to orthodontic movement. Further studies with larger samples and improved methods are needed to support more robust conclusions., (© 2021 by the EH Angle Education and Research Foundation, Inc.)

Objective: To evaluate the esthetic perceptions of orthodontists and laypersons for facial profile changes after orthodontic treatment using Herbst or Forsus appliances., Materials and Methods: Pre- and posttreatment facial profile contour images of 20 Class II patients treated with Herbst (group H; n = 10) and Forsus (group F; n = 10) appliances were analyzed by 30 orthodontists and 30 laypersons, who graded them from 1 (unattractive) to 10 (very attractive) using a visual analog scale. Two assessments were carried out with a 15 day-interval. In the first evaluation, 40 images were presented in a random sequence. In the second evaluation, initial and final facial profile images of each patient were randomly presented side by side. To compare groups in relation to treatment method, Mann-Whitney tests were used. To evaluate differences between time points, Wilcoxon tests were used., Results: In the first evaluation, there was a significant difference between initial and final images only for group H, for both laypersons (P = .017) and orthodontists (P = .037). There was also a significant difference between laypersons and orthodontists in their ratings of posttreatment Herbst appliance profiles (P = .028). There was no significant difference between initial and final facial profile images for group F and no significant differences between or within evaluator groups in their ratings of initial or final Forsus appliance profiles. In the second evaluation, there was a significant difference between appliance groups only for laypersons, who considered cases treated with the Herbst appliance more attractive than those treated with the Forsus (P = .031). Laypersons also considered Herbst profiles more attractive than did orthodontists (P = .047)., Conclusions: Class II malocclusion treatment using the Herbst appliance may produce a more esthetically improved facial profile silhouette compared with Forsus appliances. The magnitude of perceived changes may not be considered clinically relevant., (© 2020 by The EH Angle Education and Research Foundation, Inc.)

Objectives: Conventional two-dimensional (2D) cephalometric radiography is an integral part of orthodontic patient diagnosis and treatment planning. One must be mindful of its limitations as it indeed is a 2D representation of a vaster three-dimensional (3D) object. Issues with projection errors, landmark identification, and measurement inaccuracies impose significant limitations, which may now be overcome with the advent of cone-beam computed tomography (CBCT). A systematic review of the reliability of different 3D cephalometric landmarks in CBCT imaging was conducted., Materials and Methods: Electronic database searches were administered until October 2017 using PubMed, MEDLINE via OvidSP, EBMR and EMBASE via OvidSP, Scopus, and Web of Science. Google Scholar was used as an adjunctive search tool., Results: Thirteen articles considering CBCT scans of human subjects from preexisting data sets were selected and reviewed. Most of the studies had methodological limitations and were of moderate quality. Because of their heterogeneity, key data from each could not be combined and were reported qualitatively. Overall, in 3D, midsagittal plane landmarks demonstrated greater reliability compared with bilateral landmarks. A minimum number of dental landmarks were reported, although most were recommended for use., Conclusions: Further research is required to evaluate the reliability of 3D cephalometric landmarks when evaluating 3D craniofacial complexes.

Objectives: To test the reliability and usefulness of the midpalatal suture maturation classification and methodology proposed in 2013 by Angelieri et al. for successful prediction of rapid maxillary expansion (RME) treatment results., Materials and Methods: Reliability testing focused on 16 patients aged 9.5-17 years with early mixed to full permanent dentition, representing all proposed palatal maturation stages, from available preexpansion cone-beam computed tomography (CBCT). A retrospective observational longitudinal (cohort) study evaluated 63 preadolescent and adolescent patients aged 11-17 years with full permanent dentition treated with tooth-borne RME appliances who had CBCT records taken at pre- (T 1 ) and postexpansion (T 2 ). CBCT three-dimensional landmarking produced skeletal and dental widths and dental angulations used to evaluate the extent of skeletal and/or dental expansion. A regression model was used to assess the prediction capability of the T1 palatal suture classification of each subject for dental and skeletal changes., Results: There was almost perfect intraexaminer agreement and slight to poor interexaminer agreement, differing from previously reported reliability, affected by necessary operator calibration and the degree of postacquisition image sharpness and clarity. Further exploration of its scientific basis suggested that the proposed classification was ill-founded. Results from the cohort study were also wholly unsupportive of efficacy of the proposed palatal suture maturation classification in predicting the magnitude of portrayed changes., Conclusions: Clinicians should be cautious in applying this classification. Although it has merits, the palatal classification still needs much more research and validation.

Objectives: To evaluate the longitudinal changes in periodontal ligament (PDL) stiffness during orthodontic tooth movement using the Advanced System for Implant Stability Testing (ASIST)., Materials and Methods: ASIST measurements of maxillary canines that were actively retracted into an extraction space were collected approximately once per month for 12 adolescent female patients. The ASIST Stability Coefficient (ASC) values, which are directly related to PDL stiffness, were determined for each visit to examine longitudinal changes for individual canines as they were exposed to different forces (approximately 80 and 150 g) during retraction., Results: The pattern of longitudinal changes in ASC was similar for both canines (regardless of the two force levels applied) in individual patients and across patients. All patients showed some decrease in ASC, with an average maximum reduction in stiffness of 73.4 ± 7.7%. Some recovery was observed for most patients; however, none of the patients had the PDL stiffness return to the pre-treatment value at the final measurement appointment which was some time close after space closure was completed. On average, the ASC value at the final measured visit was 48.1 ± 12.2% of the initial value. No measurements are available after removal of orthodontic appliances and during retention., Conclusions: The ASIST was able to detect changes in PDL stiffness during orthodontic treatment, providing some insight into the mechanical changes that occur at the tooth root interface.

Objectives: The objective of this study was to develop a reproducible method to measure the change of palatal volume and area through superimposition using maxillary expansion digital cast models., Materials and Methods: A total of 10 pre- and 10 postexpansion dental cast models were scanned by the same cone-beam computed tomography machine. Superimposition was performed using a fully automated surface-best fit of the palatal surfaces on the digital cast models. A gingival plane, identified only once on superimposed casts, and a distal plane with the lateral closing border and the palatal surface were used to localize this selection of air. Area and volume were calculated for pre- and postexpansion records. Pre- and postexpansion palatal volume and area were measured by the main investigator and three different observers for inter- and intra-observer reproducibility assessment., Results: The level of intra- and inter-observer agreement was very strong (intraclass correlation coefficients ≥ 0.953; P value < .0001) for all measurements., Conclusions: Palatal volume and area measurements based on the proposed superimposition are reproducible and can be used reliably.

Objective: The purpose of this systematic review was to synthesize the available literature concerning the reliability of three-dimensional superimposition methods when assessing changes in craniofacial hard tissues., Materials and Methods: Four electronic databases were searched. Two authors independently reviewed potentially relevant articles for eligibility. Clinical trials, cohort, case-control, and cross-sectional studies that evaluated the reliability of three-dimensional superimposition methods on the anterior cranial base were included., Results: Six studies fulfilled the inclusion criteria. Four studies used the voxel-based registration method, one used the landmark-based method and one used the surface-based method. Regarding reliability, the voxel-based studies showed on average a difference of 0.5 mm or less between images. The optimized analysis using a six-point correction algorithm in the landmark-based method showed 1.24 mm magnitude of error between images., Conclusions: Although reliability appears to be adequate, the small sample size and high risk of bias among studies make available evidence still insufficient to draw strong conclusions.

Objective: To provide a synthesis of the published studies evaluating the natural growth and development of the human posterior cranial base (S-Ba)., Materials and Methods: The search was performed on MEDLINE, Embase, PubMed, and all EBM Reviews electronic databases. In addition, reference lists of the included studies were hand-searched. Articles were included if they analyzed posterior cranial-base growth in humans specifically. Study selection, data extraction, and risk of bias assessment were completed in duplicate. A meta-analysis was not justified., Results: Finally, 23 published studies were selected: 5 cross-sectional and 18 cohort studies. Articles were published between 1955 and 2015, and all were published in English. The sample sizes varied between 20 and 397 individuals and consisted of craniofacial measurements from either living or deceased human skulls. Validity of the measurements was not determined in any of the studies, while six papers reported some form of reliability assessment. All the articles included multiple time points within the same population or data from multiple age groups. Growth of S-Ba was generally agreed to be from spheno-occipital synchondrosis growth. Basion displaced downward and backward and sella turcica moved downward and backward during craniofacial growth. Timing of cessation of S-Ba growth was not conclusive due to limited identified evidence., Conclusions: Current evidence suggests that S-Ba is not totally stable, as its dimensions change throughout craniofacial growth and a minor dimensional change is observed even in late adulthood.

Objective: To identify which dental and/or cephalometric variables were predictors of postretention mandibular dental arch stability in patients who underwent treatment with transpalatal arch and lip bumper during mixed dentition followed by full fixed appliances in the permanent dentition., Materials and Methods: Thirty-one patients were divided into stable and relapse groups based on the postretention presence or absence of relapse. Intercuspid, interpremolar, and intermolar widths; arch length and perimeter; crowding; and lower incisor proclination were evaluated before treatment (T0), after lip bumper treatment (T1), after fixed appliance treatment (T2), and a minimum of 3 years after removal of the full fixed appliance (T3). Logistic regression analyses were performed to evaluate the effect of changes between T0 and T1, as predictive variables, on the occurrence of relapse at T3., Results: The model explained 53.5 % of the variance in treatment stability and correctly classified 80.6 % of the sample. Of the seven prediction variables, intermolar and interpremolar changes between T0 and T1 (P = .024 and P = .034, respectively) were statistically significant. For every millimeter of increase in intermolar and interpremolar widths there was a 1.52 and 2.70 times increase, respectively, in the odds of having stability. There was also weak evidence for the effect of sex (P = .047)., Conclusions: The best predictors of an average 4-year postretention mandibular dental arch stability after treatment with a lip bumper followed by full fixed appliances were intermolar and interpremolar width increases during lip bumper therapy. The amount of relapse in this crowding could be considered clinically irrelevant.

Objective: To evaluate the effectiveness of the transpalatal arch (TPA) as an anchorage device in preventing maxillary molar mesialization during retraction of the anterior teeth after premolar extraction., Materials and Methods: This systematic review intended to include patients indicated for upper premolar bilateral extraction and subsequent retraction of anterior teeth, considering the use of TPA as an anchorage tool in one of the treatment groups. The search was systematically performed, up to April 2015, in the following electronic databases: Medline, Embase, and all evidence-based medicine reviews via OVID, Cochrane Library, Scopus, PubMed, and Web of Science. Risk of bias assessment was performed using Cochrane's Risk of Bias Tool for randomized clinical trials (RCTs) and Methodological Index for Nonrandomized Studies (MINORS) for non-RCTs., Results: Fourteen articles were finally included. Nine RCTs and five non-RCTs presented moderate to high risk of bias. Only one study investigated the use of TPA in comparison with no anchorage, failing to show significant differences regarding molar anchorage loss. A meta-analysis showed a significant increase in anchorage control when temporary anchorage devices were compared with TPA (mean difference [MD] 2.09 [95% confidence interval {CI} 1.80 to 2.38], seven trials), TPA + headgear (MD 1.71 [95% CI 0.81 to 2.6], four trials), and TPA + utility arch (MD 0.63 [95% CI 0.12 to 1.15], 3 trials)., Conclusion: Based on mostly moderate risk of bias and with some certainty level, TPA alone should not be recommended to provide maximum anchorage during retraction of anterior teeth in extraction cases.

Objective: To determine whether orthodontic treatment with removable aligners vs fixed orthodontic appliances is associated with a different frequency of orthodontically induced external apical root resorption (OIEARR) when genetic, radiographic, and clinical factors are accounted for., Materials and Methods: Three hundred seventy-two orthodontic patients treated with removable aligners (Invisalign) or fixed appliances were genetically screened for interleukin 1B gene (IL1B) (rs1143634), interleukin 1 receptor antagonist gene (IL1RN) (rs419598), and osteopontin gene (SPP1) (rs9138/rs11730582). Twelve clinical variables, potentially associated with OIEARR, were also considered. Subjects were divided according to the presence of radiographically determined OIEARR (>2 mm). The association between OIEARR and appliance type, and radiographic, clinical and genetic factors, was assessed using backward stepwise conditional logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported., Results: Reliability of the methods was adequate. Clinical case complexity (American Board of Orthodontics [ABO] Discrepancy Index) (OR: 1.032; 95% CI: 1.005-1.061; P = .021) and extent of incisor apical displacement in the sagittal plane (OR: 1.478; 95% CI: 1.285-1.699; P = .001) were associated with an increased OIEARR risk. After adjusting for associations between clinical/radiographic/genetic factors, there were no statistically significant differences with respect to OIEARR or type of orthodontic appliance used, whether removable aligners or fixed appliances (OR: 1.662; 95% CI: 0.945-2.924; P = .078). Only subjects homozygous for the T allele of IL1RN (rs419598) were more prone to OIEARR during orthodontic treatment (OR: 3.121; CI: 1.93-5.03; P < .001)., Conclusions: A similar OIEARR predisposition was identified using either removable aligners (Invisalign) or fixed appliances.

Objective: To evaluate the dentoskeletal effects of different anterior open bite treatment modalities in children., Materials and Methods: This cephalometric study assessed changes resulting from different treatment approaches on 77 growing children with anterior open bite. A control group (n = 30) was used for comparison. Lateral cephalograms were available before treatment and after 12 months. The sample was divided into four groups: removable palatal crib associated with a chincup (G1), bonded spurs associated with a chincup (G2), chincup (G3), and nontreated control (G4). Statistical comparisons among the four groups were performed on T1 and the treatment changes using analysis of variance with Tukey's post hoc tests., Results: No statistically significant changes in skeletal variables were found among the groups, except for lower anterior face height (LAFH) increase in G1. Overall, effects in all of the treated groups were exclusively dentoalveolar. A larger overbite (OB) increase was observed in G1 and G2 when compared with G3 and G4. The maxillary incisors in G1 showed increased palatal tipping, retrusion, and more vertical dentoalveolar development as well as increased lingual tipping among mandibular incisors. There was less vertical development of maxillary and mandibular molars in G3., Conclusions: A removable palatal crib provided an improvement in OB (97.5%), followed by the bonded spurs (84.5%). Conversely, the chincup-only group did not have positive OB effects.

Objective: To evaluate short- and long-term mandibular dental arch changes in patients treated with a lip bumper during the mixed dentition followed by fixed appliances, compared with a matched control sample., Materials and Methods: Dental casts and lateral cephalograms obtained from 31 consecutively treated patients before (T0) and after (T1) lip bumper, after fixed appliances (T2), and a minimum of 3 years after fixed appliances (T3) were analyzed. The control group was matched as closely as possible. Arch width, arch perimeter, arch length, and incisor proclination were evaluated. Repeated measures ANOVA was used to analyze changes in measurements over all four time points between treatment and control groups., Results: Arch widths and crowding were always significantly different except at T2-T1. At T1-T0, only crowding decreased 3.2 mm while intercanine, interpremolar, and intermolar widths increased by 3.8, 3.3, and 3.9 mm, respectively. Changes at T3-T2 showed a significant decrease of 2.1 mm for crowding and an increase of 3.5, 2.9, 2.7, and 0.8 mm for intercanine, interpremolar, and intermolar widths and arch perimeter, respectively. Finally, at T3-T0, the reduction in crowding of 5.03 mm was significant and clinically important in the treated group. The differences between intercanine, interpremolar, and intermolar widths were also significant (2.1, 3.8, and 3.6 mm, respectively). All those differences favored the treated group., Conclusions: Mandibular dental arch dimensions were significantly changed after lip bumper treatment. At follow-up, all arch widths were slightly decreased, generating an increase of 0.4 mm in crowding, considered clinically irrelevant. Overall changes remained stable after an average 6.3-year follow-up.

Objective: To synthesize available evidence about factors associated with patients' satisfaction after orthodontic treatment combined with orthognathic surgery., Materials and Methods: Studies that evaluated any factor associated with patients' satisfaction after the conclusion of an orthodontic treatment combined with an orthognathic surgery were identified. Orthognathic surgical procedures should have been undertaken after completion of craniofacial growth. Any satisfaction psychometric tool was considered. No language limitation was set. A detailed individual search strategy for each of the following bibliographic databases was crafted: MEDLINE, PubMed, EBM Reviews, Web of Science, EMBASE, LILACS, and Scopus. The references cited in the identified articles were also cross-checked, and a partial gray-literature search was undertaken using Google Scholar., Results: Eight articles satisfied the inclusion criteria of this systematic review and accounted for 998 patients. The included studies showed large variation in sample size (range  =  44 to 505 patients), age (range  =  15 to 72 years old), distinct psychological evaluation tools, and time elapsed between the assessment and the completion of surgery and postorthodontic treatment. Most of the studies (five of eight) were classified as having high risk of bias., Conclusion: Factors associated with satisfaction were final esthetic outcome, perceived social benefits from the outcome, type of orthognathic surgery, sex, and changes in patient self-concept during treatment. Factors associated with dissatisfaction were treatment length; sensation of functional impairment and/or dysfunction after surgery, and perceived omitted information about surgical risks.

Objective: To compare the short-term skeletal and dental effects of two-phase orthodontic treatment including either a Twin-block or an XBow appliance., Materials and Methods: This was a retrospective clinical trial of 50 consecutive Class II cases treated in a private practice with either a Twin-block (25) or XBow (25) appliance followed by full fixed orthodontic treatment. To factor out growth, an untreated Class II control group (25) was considered., Results: A MANOVA of treatment/observation changes followed by univariate pairwise comparisons showed that the maxilla moved forward less in the treatment groups than in the control group. As for mandibular changes, the corpus length increase was larger in the Twin-block group by 3.9 mm. Dentally, mesial movement of mandibular molars was greater in both treatment groups. Although no distalization of maxillary molars was found in either treatment group, restriction of mesial movement of these teeth was seen in both treatment groups. Both treatment groups demonstrated increased mandibular incisor proclination with larger increases for the XBow group by 3.3°. The Wits value was decreased by 1.6 mm more in the Twin-block group. No sex-related differences were observed., Conclusions: Class II correction using an XBow or Twin-block followed by fixed appliances occurs through a relatively similar combination of dental and skeletal effects. An increase in mandibular incisor inclination for the XBow group and an increased corpus length for the Twin-block group were notable exceptions. No overall treatment length differences were seen.

Objective: To evaluate short- and long-term maxillary dental arch dimensional changes in patients treated with a transpalatal arch (TPA) during mixed dentition followed by full fixed appliances in the permanent dentition compared with an untreated sample., Materials and Methods: Dental casts and lateral cephalograms obtained from 36 consecutively treated patients before TPA treatment (T0), after TPA treatment (T1), after fixed appliance treatment (T2), and a minimum of 3 years after fixed appliance treatment (T3) were analyzed. The control group was matched as closely as possible. Arch widths, perimeter, and length, as well as crowding and incisor proclination, were evaluated., Results: In the treated group, intercanine, interpremolar, and intermolar widths and arch perimeter increased significantly at T1. At T2, only the intercanine width increase was still significant. At T3 all arch dimensions decreased, remaining larger than they were at T0. The arch length increased after T1, significantly decreased at T2, and slightly decreased at T3. The crowding decreased significantly at T1, was eliminated at T2, and increased at T3. At T3, 50% of the patients showed relapse with crowding ranging from 0.5 to 2 mm. In the control group at T1, only slight changes were noted but crowding increased. At T2, crowding and upper incisor inclination increased but arch length decreased. At T3, intercuspid width, arch perimeter, and arch length continued to decrease, thereby increasing crowding., Conclusion: Maxillary dental arch dimensions changed significantly after TPA followed by treatment with fixed appliances. Relapse occurred to some extent, especially in intercanine width and arch perimeter, but most of the dental arch changes remained stable.

Objective: To determine in which clinical scenarios digital models are valid as replacements for plaster models during orthodontic treatment decision-making process and treatment planning., Materials and Methods: An attempt to identify all pertinent published information was made. Retained articles were those where a decision-making process leading to differential orthodontic treatment plans based on either method were compared. The search was tailored for PubMed and adapted for EMBASE, MEDLINE, the Cochrane Library, LILACS, and Web of Science. A partial grey literature search was conducted through Google Scholar. References lists of the included articles were screened for potential relevant studies. The methodology of selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS)., Results: Only two studies were finally selected for the qualitative and quantitative synthesis. QUADAS results scores from selected studies ranged from 61% to 83% of 11 items evaluated. In one, the overall treatment plan regarding orthognathic surgery for Class II malocclusion changed in 13% to 22% of the cases. In the other one, 6% of the orthodontic treatment plans changed., Conclusion: Digital models could be used to replace plaster models in Class II malocclusion treatment planning.

Objective: To compare the short-term skeletal and dental effects of two-phase orthodontic treatment including either a Twin-block or an XBow appliance., Materials and Methods: This was a retrospective clinical trial of 50 consecutive Class II cases treated in a private practice with either a Twin-block (25) or XBow (25) appliance followed by full fixed orthodontic treatment. To factor out growth, an untreated Class II control group (25) was considered., Results: A MANOVA of treatment/observation changes followed by univariate pairwise comparisons showed that the maxilla moved forward less in the treatment groups than in the control group. As for mandibular changes, the corpus length increase was larger in the Twin-block group by 3.9 mm. Dentally, mesial movement of mandibular molars was greater in both treatment groups. Although no distalization of maxillary molars was found in either treatment group, restriction of mesial movement of these teeth was seen in both treatment groups. Both treatment groups demonstrated increased mandibular incisor proclination with larger increases for the XBow group by 3.3°. The Wits value was decreased by 1.6 mm more in the Twin-block group. No sex-related differences were observed., Conclusions: Class II correction using an XBow or Twin-block followed by fixed appliances occurs through a relatively similar combination of dental and skeletal effects. An increase in mandibular incisor inclination for the XBow group and an increased corpus length for the Twin-block group were notable exceptions. No overall treatment length differences were seen.

Objective: To compare the clinical complications during treatment with either a removable mandibular acrylic splint (RMS) or with a cantilever (HC) Herbst appliance., Methods: Records from 159 Class II, division 1, consecutively treated patients with a Herbst appliance were examined. The sample was composed of 82 male and 77 female patients with a mean age of 11.8 years. The Herbst appliance was used for a mean of 12 months (standard deviation 2.15 months). Two main Herbst groups were analyzed: group RMS (n  =  125) and group HC (n  =  34). They were further subdivided according to the telescopic system used (Dentaurum type 1 or PMA) and fixation mode (splint with crowns or Grip Tite bands). Patients' clinical records were assessed to identify clinical complications., Results: The incidence of complications during treatment was 85.3% for the HC group and 88.0% for the RMS group, with no statistically significant difference (Mann-Whitney test, P > .05). The fixation mode (crown or band) also did not show a statistically significant difference (P > .05). Regarding the telescopic system used, the Dentaurum group had 2.9 times more susceptibility to complications than the PMA group, regardless of the Herbst type., Conclusions: On average, approximately 2.5 complications per patient were reported. Most patients had a maximum of three complications during Herbst treatment. Herbst appliance type (RMS or HC) and fixation mode (crowns or Grip Tite bands) did not influence the number of complications. The PMA (without screws) telescopic system seemed to be more reliable (regarding the number of complications) than Dentaurum type 1, regardless of the appliance design (RMS or HC).

Objective: To compare the anterior dentoalveolar and skeletal maxillary cephalometric factors involved in excessive upper incisor crown exposure (UICE) in subjects with skeletal open bite Class II (SOBCIIG) and Class III (SOBCIIIG) against an untreated control group (CG)., Materials and Methods: Seventy pretreatment lateral cephalograms of orthodontic young adult patients (34 men, 36 women) were examined. The sample was divided into three groups according to both sagittal and vertical growth pattern and occlusion. The CG group (n  =  25) included Class I, normodivergent cases with adequate overbite, and the SOBCIIG group (n  =  25) and SOBCIIIG group (n  =  20) included skeletal Class II or III malocclusions, respectively, with hyperdivergent pattern and negative overbite. Several cephalometric measurements were considered (skeletal and dental). Analysis of variance, multivariate analysis of covariance, and Tukey HSD post hoc tests were used. Principal component analysis (PCA) was used for reducing the number of cephalometric variables related to UICE. Finally, a multiple linear regression was calculated., Results: Significant differences in UICE were found between the groups (P < .05). UICE was 3.9 mm in SOBCIIG, 2.5 mm in SOBCIIIG, and 0.4 mm in CG. PCA showed that a nondental component-including vertical maxillary height (VMH) and upper lip height (ULH)-was the only component significantly associated with UICE. The regression model had a moderate prediction capability., Conclusions: Although the UICE was statistically different in SOBCIIG, the values were within the esthetic standards. The UICE was mainly influenced by VMH and ULH.

Objective: To compare lower incisor dentoalveolar compensation and mandible symphysis morphology among Class I and Class III malocclusion patients with different facial vertical skeletal patterns., Materials and Methods: Lower incisor extrusion and inclination, as well as buccal (LA) and lingual (LP) cortex depth, and mandibular symphysis height (LH) were measured in 107 lateral cephalometric x-rays of adult patients without prior orthodontic treatment. In addition, malocclusion type (Class I or III) and facial vertical skeletal pattern were considered. Through a principal component analysis (PCA) related variables were reduced. Simple regression equation and multivariate analyses of variance were also used., Results: Incisor mandibular plane angle (P < .001) and extrusion (P  =  .03) values showed significant differences between the sagittal malocclusion groups. Variations in the mandibular plane have a negative correlation with LA (Class I P  =  .03 and Class III P  =  .01) and a positive correlation with LH (Class I P  =  .01 and Class III P  =  .02) in both groups. Within the Class III group, there was a negative correlation between the mandibular plane and LP (P  =  .02). PCA showed that the tendency toward a long face causes the symphysis to elongate and narrow. In Class III, alveolar narrowing is also found in normal faces., Conclusions: Vertical facial pattern is a significant factor in mandibular symphysis alveolar morphology and lower incisor positioning, both for Class I and Class III patients. Short-faced Class III patients have a widened alveolar bone. However, for long-faced and normal-faced Class III, natural compensation elongates the symphysis and influences lower incisor position.

Objective: To evaluate the efficiency of molar distalization associated with the second and third molar eruption stage., Materials and Methods: A systematic computerized database search was conducted using several databases. Adaptations of the terms molar distalization and distalizing appliances were used. The reference lists of all the selected articles were also searched for any potential articles that might have been missed in the electronic search. The data provided in the selected publications were grouped and analyzed in terms of molar distalization with respect to various eruption stages of maxillary second and third molars., Results: Out of the 13 initially identified articles only four fulfilled the final selection criteria. Three of the four studies showed no statistical significance in linear molar distalization based on the eruptive stage of the second and/or third molars, while one study found that the amount of distal movement of the first molars was significantly greater in the group with unerupted second molars. Only one study found that the amount of molar tipping that occurred as a result of distalization was related to the eruption stage of the maxillary molars. Similarly, three of the four studies found that molar distalization time was not significantly affected by eruption of the second or third molars., Conclusion: The effect of maxillary second and third molar eruption stage on molar distalization-both linear and angular distalization-appears to be minimal. This conclusion is only based on low-level of evidence clinical trials. The large variability in the outcomes should be considered clinically.

Objective: To compare the changes in incisor inclination between two compliance-free Class II correction protocols for the treatment of mild to moderate Class II malocclusions., Materials and Methods: Among Class II malocclusion patients a total of 38 consecutive patients treated with the Xbow appliance and later with full brackets (XB) were compared to 36 consecutive patients treated with Forsus connected to the archwire while on full brackets (FO). Evaluated cephalometric variables were overjet, overbite, skeletal Class II, lower incisor inclination, and upper incisor inclination. Factors that were analyzed were gender, treatment type, age at start of treatment (T1), and treatment length. Independent t-tests, χ(2), multiple analysis of variance, and Pearson correlations were applied., Results: No differences in incisor inclination between both treatment protocols were identified. At T1 no statistical difference for any cephalometric variable was demonstrated with regard to gender and treatment type. Gender was also not associated with a different treatment time or age at T1. The mean treatment time was 24.2 months for XB and 30.2 months for the FO group (P  =  .037). XB patients averaged 10 fewer months of fixed edgewise appliances compared to FO patients. Neither gender nor treatment type had any influence on the changes of the evaluated dependent variables between T1 and the end of treatment. Lower incisors proclined more the longer the treatment (P  =  .005). Both overjet and upper incisor inclination were affected by age at T1 (P  =  .001 and P  =  .014, respectively)., Conclusions: Both compliance-free Class II correction protocols for the treatment of mild to moderate Class II malocclusions appear to generate the same amount of incisor inclination. Large variability was identified.

Objective: To investigate patients' experiences with the Forsus Fatigue Resistant Device (FFRD)., Methods: This was a survey focused on patient's comprehensive experience with FFRD, both initially and after several months of wear, including the patient's overall impression of the appliance. The survey was administered to 70 patients wearing FFRD in both university and private practice settings., Results: A high percentage (81.5%) reported a neutral to favorable experience with FFRD; 89.8% reported growing accustomed to the appliance within 4 weeks. The majority of those who had previously worn rubber bands found FFRD to be "easier." Cheek irritation was the most serious side effect (about 50%). Cheek irritation and other negative effects generally decreased over time., Conclusions: The FFRD is relatively well accepted by patients. Most patients experience some discomfort and functional limitations; however, the effect generally diminishes with time, and patients adapt to the appliance. Practitioners should be especially vigilant about problems with cheek irritation.

Objective: To perform a systematic review of the literature to assess the reliability and validity of linear measurements using virtual vs plaster study models., Materials and Methods: A search strategy was developed for four online databases, and references were further hand searched for studies additional papers. Three researchers determined the eligibility of papers by applying specific selection criteria and ultimately selected 17 papers. Grouped by virtual model acquisition type and the number of landmarks used in a given measurement, the data were weighted by sample size and analyzed in terms of the reliability and validity of linear measurements., Results: The intrarater reliability was high for two-landmark and >two-landmark linear measurements performed on laser-acquired models or cone-beam computed tomography (CBCT)-acquired models and were similar to measurements on plaster models. Validity was high for two-landmark and >two-landmark linear measurements comparing laser-acquired models or CBCT-acquired models to plaster study models, and the weighted mean differences were clinically insignificant. Agreement of measurements was excellent, with less variability than correlation. Acquisition type had no perceived influences on reliability and validity. More than two-landmark measures tended to have higher mean differences than two-landmark measures., Conclusions: Virtual study models are clinically acceptable compared with plaster study models with regard to intrarater reliability and validity of selected linear measurements.

Objective: To systematically review the long-term skeletal stability after maxillary advancement with distraction osteogenesis (DO) in cleft lip and palate (CLP) patients., Materials and Methods: Electronic databases, grey literature, and reference list searches were conducted. The inclusion criteria were stability of maxillary advancement with distraction osteogenesis assessed at the posttreatment follow-up ≥ 1 year in CLP patients. Full articles were retrieved from abstracts or titles that appear to meet the inclusion criteria or lacked sufficient detail for immediate exclusion. Once full articles were collected, they were again reviewed considering more detailed inclusion criteria for a final selection decision. A methodologic quality assessment tool was utilized., Results: Thirty abstracts/titles met the initial search criteria, and 13 articles were finally selected. Overall, methodologic quality scores were high in only one randomized clinical trial. After maxillary advancement with DO in CLP patients, the long-term horizontal relapse in A-point was less than 15% in eight studies and between 20% and 25% in four studies. The study that was judged as a high-quality study reported 8.2% horizontal relapse in A-point. The relapse rate was higher in DO with external distracter device than DO with internal distracter device., Conclusions: Current evidence suggests maxillary advancement with DO has good stability in CLP patients with moderate and severe maxillary hypoplasia.

Objective: To predict lower incisor proclination from initial cephalometric values in Class II division 1 patients treated in phase I with the Xbow appliance., Materials and Methods: Two hundred forty-nine mild to moderate Class II division 1 patients treated with the Xbow appliance as a phase I treatment were considered. Patients were in late mixed dentition or early permanent dentition. Commonly used cephalometric variables at T1 (before treatment) were used to predict lower incisor proclination after Xbow treatment (T2). A principal component analysis (PCA) was performed. The four extracted PCA components were skeletal component, incisal distance, anterior facial projection, and maxillo-mandibular relation. Thereafter, a multiple linear regression analysis (MLRA) was performed using the four extracted PCA components at T1 as predictor variables, and lower incisor inclination relative to the mandibular plane (L1-MP) at T2 as the dependent variable., Results: The mean L1-MP at T1 was 95.46 degrees and the mean L1-MP at T2 was 98.51 degrees, resulting in a mean difference of 3.04 degrees. Only incisal distance and maxillo-mandibular relation PCA components had significance (P < .05) according to the MLRA. The overall model gave an adjusted R2 value (coefficient of determination) of 0.091., Conclusion: The best prediction model could account for only 9% of the total variability. Using common cephalometric variables at T1, average lower incisor proclination from Xbow treatment cannot be predicted in a clinically meaningful way.

Objective: To evaluate the association between vertical facial morphology and overjet in untreated Class II subjects., Materials and Methods: The lateral cephalograms of 140 untreated Class II subjects (68 males and 72 females) between 8 and 11 years of age were divided into three groups based on their overjet value as measured on study casts: Group I normal overjet (less than 3 mm), Group II increased overjet (more than 3 mm but less than or equal to 6 mm), and Group III extreme overjet (more than 6 mm). Mean values and standard deviations of 28 variables measured on lateral cephalograms were calculated. Differences between the three groups were tested using one-way analysis of variance (ANOVA), followed by Bonferroni tests. Additionally, cephalometric differences between groups and available normal values for the Syrian population were evaluated using an independent t-test., Results: Subjects with normal overjet showed a horizontal facial pattern and posterior inclination of the maxilla, whereas increased overjet subjects exhibited a neutral facial pattern. In contrast, subjects with extreme overjet had a vertical facial pattern and anterior inclination of the maxilla. The mandible was retrognathic and the maxilla was normally positioned in the three groups., Conclusions: A positive association was found between the overjet and the tendency toward a hyperdivergent pattern.

Objective: To evaluate the magnitude of lower incisor inclination associated with the vertical facial type in adolescent Class II patients treated with the Xbow appliance., Materials and Methods: A total of 172 consecutive Class II patients treated with only the Xbow appliance were used. The sample was divided into three groups based on their vertical facial type (24 short, 122 normal, and 25 long facial types). The mean age was 11.11 years at T1 with a mean active Xbow time of 4.5 months. A mean of 6.4 months passed after the Xbow deactivation before T2 radiograph., Results: No significant association between lower incisor proclination and vertical facial type was found. Actual differences between T1 and T2 did exist. In most cases, these differences may be considered clinically relevant, but when the large interindividual variability is considered, the differences between the groups could not be statistically supported. At T1, a distinct trend to have more proclined lower incisors in the short (100.5 degrees ) compared with the long (91.3 degrees ) facial types was found. During treatment, a trend was identified for more proclination of the lower incisor the shorter the face., Conclusions: Although lower incisors do procline with the use of the Xbow appliance, facial type does not appear to affect the amount of lower incisor inclination. The magnitude of the incisor proclination can be considered not clinically relevant, but a large individual variation in the incisor response was identified.

Objective: To evaluate the quantitative effects on torque expression of varying the slot size of stainless steel orthodontic brackets and the dimension of stainless steel wire, and to analyze the limitations of the experimental methods used., Materials and Methods: In vitro studies measuring torque expression in conventional and self-ligating stainless steel brackets with a torque-measuring device, with the use of straight stainless steel orthodontic wire without second-order mechanics and without loops, coils, or auxiliary wires, were sought through a systematic review process., Results: Eleven articles were selected. Direct comparison of different studies was limited by differences in the measuring devices used and in the parameters measured. On the basis of the selected studies, in a 0.018 inch stainless steel bracket slot, the engagement angle ranges from 31 degrees with a 0.016 x 0.016 inch stainless steel archwire to 4.6 degrees with a 0.018 x 0.025 inch stainless steel archwire. In a 0.022 inch stainless steel bracket slot, the engagement angle ranges from 18 degrees with a 0.018 x 0.025 inch stainless steel archwire to 6 degrees with a 0.021 x 0.025 inch stainless steel archwire. Active stainless steel self-ligating brackets demonstrate an engagement angle of approximately 7.5 degrees, whereas passive stainless steel self-ligating brackets show an engagement angle of approximately 14 degrees with 0.019 x 0.025 inch stainless steel wire in a 0.022 inch slot., Conclusions: The engagement angle depends on archwire dimension and edge shape, as well as on bracket slot dimension, and is variable and larger than published theoretical values. Clinically effective torque can be achieved in a 0.022 inch bracket slot with archwire torsion of 15 to 31 degrees for active self-ligating brackets and of 23 to 35 degrees for passive self-ligating brackets with a 0.019 x 0.025 inch stainless steel wire.

Objective: To evaluate intra-examiner and inter-examiner reliability of 3D CBCT-generated landmarks previously used in traditional 2D cephalometry., Materials and Methods: Twenty-four CBCTs NewTom 3G (Aperio Services, Verona, Italy) were randomly selected from patients participating in a clinical trial involving maxillary expansion treatments. The principal investigator located the landmarks five times, and four other investigators located the same landmarks once. Intra-examiner and inter-examiner reliability values were determined using intraclass correlation coefficients (ICCs). To assist in interpretation of the clinical significance of landmark identification differences, average mean differences for x, y, and z landmark coordinates were determined from the repeated assessments. Landmarks then were separated into groups with respect to the region they represented and then were compared via repeated measures ANOVA and multiple comparisons via Bonferroni corrected alpha., Results: Intra-examiner and inter-examiner reliability for x, y, and z coordinates for all landmarks were acceptable, all being greater than 0.80. Most of the mean measurement differences obtained from trials within the principal investigator in all three axes were less than 1.5 mm. Inter-examiner mean measurement differences generally were larger than the intra-examiner differences., Conclusions: Based on this, the best landmarks for use in verifying expansion treatment results are Ekm, buccal surface, and apexes of upper molars, upper premolars and upper canines, and buccal surfaces of lower molars and lower canines. Foramen Spinosum, ELSA, Auditory External Meatus, and Dorsum Foramen Magnum demonstrated adequate reliability for determining a standardized reference system.

Objective: To evaluate available information on the effects of rapid maxillary expansion on nasal airway minimal cross-sectional area and volume, as measured by acoustic rhinometry., Materials and Methods: An electronic database search was conducted. Based on abstracts/titles, articles were initially selected; then full articles were retrieved and were further sorted according to secondary, more stringent criteria. References from selected articles were hand-searched for potential missed publications. Clinical trials using acoustic rhinometry on subjects undergoing rapid maxillary expansion therapy were included. Syndromic or medically compromised patients and absence of an untreated control group were reasons for exclusion. Selected studies thereafter were evaluated methodologically., Results: Only four articles reached final selection, and their overall methodology scores were low, limiting the applicability of results. After rapid maxillary expansion, three of four studies found statistically significant increases in minimal cross-sectional area, and two of three studies reported statistically significant increases in nasal cavity volume as compared with control groups. It appears that any increase is less stable if a traditional technique is used on patients who have passed their peak growth spurt., Conclusions: Although some increases in nasal dimensions have been reported, the changes in nasal volume were small and should not be presented to patients as a clinically significant indication for therapeutic maxillary expansion.

Objective: To compare the amount of expressed frictional resistance between orthodontic self-ligating brackets and conventionally ligated brackets in vitro as reported in the literature., Methods: Several electronic databases (Medline, PubMed, Embase, Cochrane Library, and Web of Science) were searched without limits. In vitro studies that addressed friction of self-ligating brackets compared with conventionally ligated brackets were selected and reviewed. In addition, a search was performed by going through the reference lists of the selected articles to identify any paper that could have been missed by the electronic searches., Results: A total of 70 papers from the electronic database searches and 3 papers from the secondary search were initially obtained. After applying the selection criteria, only 19 papers were included in this review. A wide range of methods were applied., Conclusions: Compared with conventional brackets, self-ligating brackets produce lower friction when coupled with small round archwires in the absence of tipping and/or torque in an ideally aligned arch. Sufficient evidence was not found to claim that with large rectangular wires, in the presence of tipping and/or torque and in arches with considerable malocclusion, self-ligating brackets produce lower friction compared with conventional brackets.

Objective: To determine the effectiveness of orthodontic extrusion of nonrestorable teeth prior to implant placement for improving the alveolar bone and gingival characteristics of implant recipient sites., Materials and Methods: Electronic database searches of the following databases were conducted with the help of a senior health sciences librarian: Medline, PubMed, EMBASE, Scopus, Web of Science, and CINAHL Plus. Hand searches of the reference lists of selected articles were also conducted. Abstracts that appeared to fulfill the initial selection criteria were selected for full article retrieval. Retrieved articles were then carefully evaluated, and more specific selection criteria were applied. The authors conducted the selection processes independently, and any differences were resolved through discussion. An analysis of timing, type, and magnitude of forces applied was sought., Results: Eighteen articles were considered for review. Most of the selected articles were case reports or case series describing orthodontic extrusion of periodontally hopeless maxillary anterior teeth. The results of the reported cases were evaluated individually and collectively with regard to various hard and soft tissue implant site characteristics. Clinically significant gains in alveolar bone and gingival tissue were reported in all cases, resulting in significant quantitative and qualitative improvements in the implant sites., Conclusions: Based on the available literature, orthodontic extrusion of nonrestorable teeth prior to implant placement appears to be a viable alternative to conventional surgical augmentative procedures in implant site development. No direct comparison to any other method was found, and therefore no conclusion could be made about its relative efficacy.

Objective: To evaluate the relative skeletal and dental changes produced by the crown- or banded-type Herbst appliance in growing Class II division 1 malocclusion cases., Materials and Methods: Several electronic databases were searched with the help of a health sciences librarian, without language limitation. Abstracts that appeared to fulfill the initial selection criteria (Herbst use and clinical trial) were selected by consensus, and their original articles were then retrieved. Clinical trials were selected that used lateral cephalograms to assess immediate skeletal and dental changes from the use of either crown or banded Herbst appliances. Clinical trials that employed other simultaneous potentially growth-modifying appliances or surgery were excluded. A comparable untreated Class II division 1 malocclusion control group was required to factor out normal growth changes. References from the selected articles were also hand searched., Results: Only three articles meet the selection criteria. Proclination and anterior movement of the lower incisors, overjet reduction, and improvement of first molar relationship thorough mesial movement of the first molars, reduction of ANB angle, and an increase in the mandibular plane angle were reported. There were mixed findings as to mandibular sagittal length and position and increases in lower face height, both anteriorly and posteriorly. No statistically significant changes were noted in the sagittal length or position of the skeletal maxilla., Conclusions: Dental changes have more impact than skeletal changes in the correction of Class II division 1 malocclusions with the crown or banded Herbst appliance.

Objective: To determine the individual and combined influence of some anterior occlusal characteristics on self-perceived dental appearance in a sample of young adults., Materials and Methods: This cross-sectional study was conducted at a dental clinic of a private university in Lima, Peru. A total of 267 first-year students (16 to 25 years old) were randomly selected. A visual analog scale (VAS) was used to determine the self-perceived dental appearance. Clinical examinations were conducted to determine incisal irregularity, anterior dentoalveolar spacing, midline diastema, anterior missing teeth, overjet, and overbite. Simple and multiple linear regression analyses were performed to determine the individual and combined influence of each anterior occlusal characteristic on self-perceived dental appearance., Results: From the eight occlusal characteristics and two covariables evaluated, only maxillary and mandible incisal irregularity (P=.001 and .002 respectively), presence of anterosuperior spacing (P<.001), and number of missing anterior teeth (P=.003) were inversely associated with self-perceived dental appearance, whereas gender (male) was directly associated to the dependent variable (P=.021). Specifically, anterior maxillary spacing, maxillary incisal irregularity, mandible incisal irregularity, and the number of missing teeth were, in that order, the anterior occlusal characteristics with the most negative influence on self-perceived dental appearance., Conclusions: This study confirmed that occlusal characteristics in the anterior portion of the mouth play a role on dental esthetics. However, it should be emphasized that their grouped influence is minimal (less than 20%).

Objective: To evaluate skeletal and dental changes in growing individuals through lateral cephalograms obtained after the sole use of the splint-type Herbst appliances in Class II division 1 malocclusions., Methods: Several electronic databases (Pubmed, Medline, Medline In-Process & Other Non-Indexed Citations, Cochrane Library Database, Embase, Web of Sciences, Scopus, and Lilacs) were searched with the help of a health sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus. The original articles were then retrieved. Their references were also hand-searched for possible missing articles. Clinical trials that assessed, through lateral cephalograms, immediate skeletal and dental changes with the use of splint-type Herbst appliances without any concurrent orthodontic appliances, surgical intervention, or syndromic characteristics were considered. A comparable untreated Class II division 1 malocclusion control group was required to factor out normal growth changes., Results: Three articles were finally selected and analyzed. An individual analysis of these articles was made and some methodological flaws were identified. The selected studies all showed statistically significant changes in the anteroposterior length of the mandible, vertical height of the ramus, lower facial height, mandibular incisor proclination, mesial movement of the lower molars, and distal movement of the upper molars. Posttreatment relapse in overjet and molar relationship was also observed., Conclusions: Dental changes are as important as skeletal changes to attaining the final occlusal results. Long-term, prospective, double-blinded, randomized clinical trials are needed to support these conclusions.

Objective: To evaluate facial soft tissue changes after the use of the twin block appliance in Class II division 1 malocclusion patients., Materials and Methods: Several electronic databases (PubMed, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cochrane databases, EMBASE, Web of Science, and LILACS) were searched with the help of a senior health-sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus, and the original articles were retrieved. The article references were hand-searched for possible missing articles. Clinical trials that assessed facial soft tissue changes with the use of the twin block appliance without any surgical intervention or syndromic characteristics were considered. A comparable untreated control group was required to factor out normal growth changes., Results: Two articles fulfilled the selection criteria and quantified facial soft tissue changes. Although some statistically significant changes in the soft tissue profile were found, the magnitude of the changes may not be perceived as clinically significant. Changes produced in the upper lip seem to be controversial, although the study with sounder methodological quality did not report significant changes. No change in the anteroposterior position of the lower lip and the soft tissue menton or improvement of the facial convexity was found., Conclusions: Three-dimensional quantification of the soft tissue changes is required to overcome current limitations in our understanding of the soft tissue changes obtained after the use of the twin block appliance in Class II division 1 malocclusion patients.

Objective: To evaluate facial soft tissue changes after the use of fixed functional appliances in Class II division 1 malocclusion cases using a systematic review of the literature., Materials and Methods: Several electronic databases (PubMed, Medline, Medline In-Process & Other Non-Indexed Citations, Cochrane Database, Embase, Web of Sciences, and Lilacs) were searched with the help of a senior Health Sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus. The original articles were then retrieved. Their references were also hand-searched for possible missing articles. Clinical trials assessing facial soft tissue changes with the use of fixed functional appliances without any surgical intervention or syndromic characteristics were considered. A comparable untreated control group was required to factor out normal growth changes. Four articles using Herbst and one using Jasper Jumper fulfilled the selection criteria. An individual analysis of these articles was made and some methodological flaws were identified., Results: Although fixed functional appliances produce some significant statistical changes in the soft tissue profile, the magnitude of the changes may not be perceived as clinically significant., Conclusions: The conclusions from this systematic review should be considered with caution because only a secondary level of evidence was found. Long-term double-blinded prospective randomized clinical trials are needed. Three-dimensional quantification of the soft tissue changes is required to overcome current limitations in our understanding of the soft tissue changes obtained with the use of fixed functional appliances.

The aim of this study was to determine which dental esthetic self-perception evaluation tool discriminated better between orthodontically treated or untreated Peruvian young adults. A total of 630 students were randomly chosen from the 2000 admitted in 2002 to a private university in Peru. Students undergoing active orthodontic treatment at the time of examination were excluded. Self-perceived dental esthetic appearance was evaluated through Standardized Continuum of Aesthetic Need, Oral Aesthetic Subjective Index Scale, and Visual Analogue Scale (VAS). A stepwise multivariate discriminant analysis was developed to classify orthodontic treatment according to the three evaluation tools. A total of 199 students (31.6%) reported a history of orthodontic treatment. Differences between orthodontically treated and untreated groups were found only for the mean VAS score (P < .001). Although three different approaches were used to evaluate dental esthetic self-perception, only VAS allowed the discrimination of the self-perceived dental appearance between orthodontically treated and untreated Peruvian university young adults. Similarities in the self-perceived dental appearance of treated and untreated groups reported in previous epidemiological studies could be explained because different evaluation instruments were used. Further studies are required to support current findings.

The objectives of this study were to evaluate the frequency and severity of the malocclusion and treatment needs in Peruvian young adults. The second aim was to compare the orthodontic treatment needs according to sex and socio-economic status (SES). This cross-sectional study was conducted at the University Dental Clinic of a private university in Lima, Peru. A total of 267 freshmen (from 16 to 25 years old) were randomly selected from a pool of 780 students. Students wearing an orthodontic appliance or reporting a history of orthodontic treatment were excluded from the study. Clinical examinations were conducted using the Dental Aesthetic Index (DAI). Mann-Whitney and Kruskal-Wallis tests were used to compare the DAI scores according to sex and SES, respectively. The mean DAI score was 28.87 points (IC(95%) 27.77; 29.97, where IC indicates interval of confidence). Around one-third of the sample presented severe or very severe malocclusion, which implies a highly desirable or mandatory orthodontic treatment need. No statistically significant difference was found between the DAI scores according to sex (P = .592) and SES (P = .397). Approximately one-third of the evaluated Peruvian young adults would need orthodontic treatment according to the DAI. In this population, malocclusion was characterized by a relatively high frequency of missing teeth, appreciable dental crowding, and inadequate anteroposterior relationships.

An anonymous, self-administered, mail-out survey of Canadian Orthodontists was conducted to evaluate the characteristics of orthodontic Internet use. The response rate was 45.6% (304 of 667). A total of 76.6% of orthodontists reported having Internet access at work, and an additional 12.4% reported having Internet access from a different location. Statistically significant associations between Internet usage and office staff size (P < .001) and years of practice (P = .046) were observed. Offices with larger staffs had greater Internet access. Number of staffs and number of case starts were positively correlated (P < .001, r = 0.498). The odds ratio for having Internet access on the basis of increased case starts from the less than 100 to 300-399 categories was 5.67. Although not statistically significant, there was a trend for greater Internet access by younger practitioners.

The objective of this study was to compare, combined and individually, the mesiodistal (MD) and buccolingual (BL) tooth sizes as well as their respective crown proportions in the permanent dentition in dental arches with moderate, mild, and no crowding. Dental casts from two-hundred 12 to 16-year-old school children from a typical high school from Lima, Peru, were used. The MD and BL tooth sizes of all permanent teeth except second and third molars were measured, and their crown proportion (MD/BL ratio) was estimated. Each dental arch was classified as presenting moderate (-5.1 mm or more of discrepancy), mild (-0.1 and -5 mm of discrepancy), and no crowding (zero or a positive discrepancy). Combined and tooth-specific comparisons among the crowding groups for the tooth sizes as well as crown proportions were performed with a multivariate analysis of variance (MANOVA, using Wilks lambda). Combined MD tooth sizes and crown proportions differed among crowding groups. Subsequent individual comparisons indicated differences for MD tooth size of all upper teeth and for lower premolars and central incisors. Differences were also detected for crown proportions of the upper second premolar, canine, and both incisors; as well as for the lower first premolar, canine, and central incisor. No differences were found for the BL tooth sizes among crowding groups. MD tooth sizes and crown proportions from specific teeth are significantly different between dental arches with moderate, mild, and noncrowded arches. This study helps to understand the odontometric component of the dental crowding multifactorial origin.

The aim of this study was to assess the correlation between the Fishman maturation prediction method (FMP) and the cervical vertebral maturation (CVM) method for skeletal maturation stage determination. Hand-wrist and lateral cephalograms from 79 subjects (52 females and 27 males) were used. Hand-wrist radiographs were analyzed using the FMP to determine skeletal maturation level (advanced, average, or delayed) and stage (relative position of the individual in the pubertal growth curve). Cervical vertebrae (C2, C3, and C4) outlines obtained from lateral cephalograms were analyzed using the CVM to determine skeletal maturation stage. Intraexaminer reliability (Intraclass correlation coefficient [ICC]) for both methods was calculated from 10 triplicate hand-wrist and lateral cephalograms from the same patients. An ICC coefficient of 0.985 for FMP and an ICC of 0.889 for CVM were obtained. A Spearman correlation value of 0.72 (P < .001) was found between the skeletal maturation stages of both methods. When the sample was subgrouped according to skeletal maturation level, the following correlation values were found: for early mature adolescents 0.73, for average mature adolescents 0.70, and for late mature adolescents 0.87. All these correlation values were statistically different from zero (P < .024). Correlation values between both skeletal maturation methods were moderately high. This may be high enough to use either of the methods indistinctively for research purposes but not for the assessment of individual patients. Skeletal level influences the correlation values and, therefore, it should be considered whenever possible.

The aim of this study was to determine the influence of growth stunting on the maturation stage of the medium phalanx of the third finger (MP3) and the dental development of the left mandibular canine in 280 high school children (140 stunted and 140 normal controls; equally distributed by sex) between 9.5 and 16.5 years of age, from a representative Peruvian school. Periapical radiographs of the MP3 from the left hand were used to determine the skeletal maturity stage, according to an adaptation of the Hägg and Taranger method. Panoramic radiographs were used to determine the dental maturity stage of the lower left canine, according to Demirjian method. Stunting was determined by relating height and age, according to the World Health Organization recommendations. There was no statistically significant difference in the skeletal maturation stage (P = .134) and the dental development stage (P = .497) according to nutritional status, even when considering different age groups (P > .183). A high correlation (r = 0.85) was found between both maturity indicators regardless of the nutritional status (growth stunted, r = 0.855 and normal controls, r = 0.863) or sex (boys, r = 0.809 and girls, r = 0.892). When skeletal level was considered, correlations values were similar between advanced (r = 0.903) and average (r = 0.895) maturers but lower (r = 0.751) for delayed maturers. Growth stunting was not associated with dental development and skeletal maturity stages in Peruvian school children.

The objective was to evaluate long-term transverse, anteroposterior and vertical skeletal changes after rapid maxillary expansion (RME). The data were clinical trials that assessed skeletal changes through cephalometric analysis. No surgical or other simultaneous treatment during the evaluation period was accepted. Electronic databases (PubMed, Medline, Medline In-Process & Other Non-Indexed Citations, Cochrane Database of Systematic Reviews, ASP Journal Club, DARE, CCTR, Embase, Web of Sciences and Lilacs) were searched with the help of a senior Health Sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus. The original articles were then retrieved. A methodological checklist was used to evaluate the quality of the selected articles. Their references were also hand-searched for possible missing articles. Articles without an adequate control group to factor out growth changes were excluded. Only three articles (one measuring transverse and two anteroposterior and vertical changes) measured RME stability after active expansion, all of them had some methodological flaws, which limit the attainable conclusions. An individual analysis of these articles was made. Long-term transverse skeletal maxillary increase is approximately 25% of the total dental expansion for prepubertal adolescents. Better long-term outcomes are expected in transverse changes because of RME in less skeletally mature patients. RME appears not to produce clinically significant anteroposterior or vertical changes in the position of the maxilla and mandible. The conclusions from this systematic review should be considered with caution because only a secondary level of evidence was found. Long-term randomized clinical trials are needed.

This systematic review evaluates long-term dental arch changes after rapid maxillary expansion treatment on orthodontic patients with constricted arches. Clinical trials that assessed dental arch changes through measurements on dental casts or cephalometric radiographs were selected. No patients with surgical or other simultaneous treatment during the active expansion period were accepted. Electronic databases were searched with the help of a senior Health Sciences librarian. Original articles were retrieved from the selected abstracts, and their references were also scanned for possible missing articles. Forty-one articles met the initial inclusion criteria, but 35 were later rejected because they lacked a control group or only evaluated dental changes or used a semirapid technique. Some of them also lacked a reported measurement error. From the remaining articles, two did not report a long-term evaluation. From the final four articles, two measured changes through dental casts and two assessed changes through radiographs (one through lateral cephalometric radiographs and one through posteroanterior radiographs). Similar maxillary molar and cuspid expansion could be found in adolescents and young adults. Significantly less indirect mandibular molar and cuspid expansion was attained in young adults compared with adolescents. A significant overall gain in the maxillary and mandibular arch perimeter was found in adolescents. More transverse dental arch changes were found after puberty as compared with before, but the difference may not be clinically significant. No anteroposterior dental changes were found on lateral cephalometric radiographs.