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BACKGROUND: The objective of this systematic review was to systematically investigate whether there is an association between inflammatory bowel disease (IBD) and oral health. METHODS: Literature searches for randomized and non-randomized studies were performed up to January 2017. Risk of bias within studies was assessed with the Downs and Black checklist. Across-studies risk of bias was assessed with the GRADE framework. Quantitative synthesis was conducted with random-effects meta-analyses. RESULTS: A total of 9 cross-sectional studies including 1297 patients were included. IBD was associated with increased risk of periodontitis (332 more patients per 1000 patients; 95% confidence interval (CI): 257-388 patients; p

DNMT1 is the maintenance DNA methyltransferase shown to be essential for embryonic development and cellular growth and differentiation in many somatic tissues in mammals. Increasing evidence has also suggested a role for DNMT1 in repressing gene expression through interactions with specific transcription factors. Previously, we identified DNMT1 as an interacting partner of the TR2/TR4 nuclear receptor heterodimer in erythroid cells, implicated in the developmental silencing of fetal β-type globin genes in the adult stage of human erythropoiesis. Here, we extended this work by using a biotinylation tagging approach to characterize DNMT1 protein complexes in mouse erythroleukemic cells. We identified novel DNMT1 interactions with several hematopoietic transcription factors with essential roles in erythroid differentiation, including GATA1, GFI-1b and FOG-1. We provide evidence for DNMT1 forming distinct protein subcomplexes with specific transcription factors and propose the existence of a "core" DNMT1 complex with the transcription factors ZBP-89 and ZNF143, which is also present in non-hematopoietic cells. Furthermore, we identified the short (17a.a.) PCNA Binding Domain (PBD) located near the N-terminus of DNMT1 as being necessary for mediating interactions with the transcription factors described herein. Lastly, we provide evidence for DNMT1 serving as a co-repressor of ZBP-89 and GATA1 acting through upstream regulatory elements of the PU.1 and GATA1 gene loci.

Summary Background The use of orthodontic aligners to treat a variety of malocclusions has seen considerable increase in the last years, yet evidence about their efficacy and adverse effects relative to conventional fixed orthodontic appliances remains unclear. Objective This systematic review assesses the efficacy of aligners and fixed appliances for comprehensive orthodontic treatment. Search methods Eight databases were searched without limitations in April 2019. Selection criteria Randomized or matched non-randomized studies. Data collection and analysis Study selection, data extraction, and risk of bias assessment was done independently in triplicate. Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality. Results A total of 11 studies (4 randomized/7 non-randomized) were included comparing aligners with braces (887 patients; mean age 28.0 years; 33% male). Moderate quality evidence indicated that treatment with orthodontic aligners is associated with worse occlusal outcome with the American Board of Orthodontics Objective Grading System (3 studies; MD = 9.9; 95% CI = 3.6–16.2) and more patients with unacceptable results (3 studies; RR = 1.6; 95% CI = 1.2–2.0). No significant differences were seen for treatment duration. The main limitations of existing evidence pertained to risk of bias, inconsistency, and imprecision of included studies. Conclusions Orthodontic treatment with aligners is associated with worse treatment outcome compared to fixed appliances in adult patients. Current evidence does not support the clinical use of aligners as a treatment modality that is equally effective to the gold standard of braces. Registration PROSPERO (CRD42019131589).

Objective: The aims of this longitudinal analysis of untreated monozygotic and dizygotic twins were to investigate vertical changes of the craniofacial structures during growth, to determine the concordance between genetically twins and to assess the genetic component for the various aspects of vertical growth. Settings and sample population: The sample consisted of 34 pairs of untreated monozygotic twins (23 male, 11 female) and 30 untreated dizygotic siblings of multiple birth (8 male, 8 female and 14 mixed) from the Forsyth Moorrees Twin Study (1959-1975); lateral cephalograms taken from 6 to 18 years of age were analysed at 3-year intervals. Materials and methods: Cephalograms were traced, and longitudinal changes between twins in six angular and proportional vertical cephalometric variables (SN-NL, ML-NL, SN-ML, y-axis, PFH/AFH and LAFH/AFH) were analysed with intraclass correlation coefficients and linear regression modelling. Results: The concordance between monozygotic/dizygotic twins at 18 years of age was moderate to high with intraclass correlation coefficient values between 0.51 and 0.66. Additionally, sex differences in concordance at 18 years of age were found for three variables. High heritability (66%-79%) was observed for 5 of the 6 variables (LAFH/AFH, ML-NL, y-axis, SN-ML, PFH/AFH), while SN-NL showed limited heritability (34%). Conclusions: Although monozygotic/dizygotic twins share at least part of their genetic material, differences in the vertical dimension were found. This supports the complex developmental mechanism of the human face and the varying influence of genetic and environmental factors. Keywords: cephalometrics; cohort study; craniofacial growth; genetics; mandibular growth; twins.

OBJECTIVES To evaluate the biological and mechanical complications of angulated abutments on full-arch and partial jaw rehabilitations with a follow-up for at least 1 year. METHODS Electronic search was carried out in MEDLINE, EMBASE and Web of Science. Studies published between January 2000 and January 2019 were included. The quality of the included studies was assessed. The data extraction was focused on implant loss, marginal bone loss and mechanical complications, and meta-analyses were performed for marginal bone loss, mechanical complications and implant failure. RESULTS Nine studies, three prospective and six retrospective cohort studies were included. They reported on 797 patients that received 4127 implants. The total number of abutments was 4079 of which 1673 were angulated, and 2406 were straight. All abutments were prefabricated. Angulated abutments were associated with increased implant failure rates (two studies; RR = 7.30; 95% CI = 2.79-19.08) and an effect that was both statistically significant (P

Objective: The aim of this study was to explore the methods, reporting and transparency of clinical trials in orthodontics and compare them to the field of periodontics, as a standard within dentistry. Design/setting: Cross-sectional bibliographic study Methods: A total of 300 trials published in 2017–2018 and evenly distributed in orthodontics and periodontics were selected, assessed and analysed statistically to explore key aspects of the conduct and reporting of orthodontic clinical trials compared to trials in periodontics. Results: Several aspects are often neglected in orthodontic and periodontic trials and could be improved upon, including use of statistical expertise (22.3% of assessed trials), blinding of outcome assessors (62.3%), prospective trial registration (12.0%), adequate sample size calculation (35.7%), adherence to CONSORT (14.3%) and open data sharing (4.3%). The prevalence of statistically significant findings among orthodontic and periodontic trials was 62.3%, which was significantly associated with several methodological traits like statistician involvement (odds ratio [OR] = 0.5; 95% confidence interval [CI] = 0.3–0.9), blind outcome assessor (OR = 0.5; 95% CI = 0.2–1.0), lack of prospective trial registration (OR = 2.8; 95% CI = 1.3–5.9) and non-adherence to CONSORT (OR = 4.5; 95% CI = 1.3–15.8). Conclusions: Although trials in orthodontics seem to be significantly worse compared to periodontics in aspects like trial registration, adherence to CONSORT and declaration of competing interests or financial support, their methods do seem to have improved considerably in recent years.

An orthodontist attends the scientific orthodontic congress and passing by the company exhibitions receives a free sample of a novel orthodontic archwire introduced in the market for initial alignment/levelling with favourable performance over conventional superelastic nickel-titanium archwires. This novel archwire should increase according to the manufacturer’s claims alignment efficacy and halve the pain for the patient. After using the free sample wire on a patient and observing that the patient felt little to no pain during the alignment/levelling phase, the orthodontist decides to venture into unknown territory and find out if this holds true for most of her patients by doing a randomised clinical trial in her practice.

Why are there so many systematic reviews in orthodontics, and what are the negative consequences of this for our speciality as an academic discipline?

Summary Objective This cross-sectional study aimed to explore the level of knowledge and expectations people deciding on a future orthodontic treatment have about post-orthodontic retention and to investigate the influence of sociocultural characteristics. Material and methods A total of 227 consecutive people involved as legal decision maker (as patient, parent, or legal guardian) for a prospective orthodontic treatment (mean age 37.1 years; 37.3 per cent male) received before their first appointment a questionnaire to assess their knowledge and expectations about post-orthodontic retention. Data were analysed descriptively, whereas predictors were identified with logistic regressions at P value of less than or equal to 0.05. Results Among the 220 responders, 46.3 per cent (n = 99) knew that retention appliances are used after orthodontic treatment and 52.8 per cent (n = 113) believed perfect results can guarantee stability, whereas at the same time, 77.8 per cent (n = 168) knew that teeth can move on their own without any orthodontic appliances. The majority considered stability of the orthodontic result important or extremely important (94.5 per cent; n = 206), preferred bonded over removable retainers (67.2 per cent; n = 133), believed the orthodontist to be primarily responsible for a stable result (73.2 per cent; n = 158), and found it appropriate to charge for recall visits (72.9 per cent; n = 153). Participants’ gender, age, education, nationality, and past orthodontic experiences within the close family significantly influenced answers. Limitations The setting of a single-centred survey conducted in one university moderates the generalizability of the portrayed results. Conclusions Although stability of orthodontic treatment results is very important to people deciding about a prospective orthodontic treatment, knowledge regarding the need for post-orthodontic retention varies and may at times be contradictious. Sociocultural factors seem to influence the level of knowledge and the expectations on post-orthodontic retention.

Posterior fossa A (PFA) ependymomas comprise one out of nine molecular groups of ependymoma. PFA tumors are mainly diagnosed in infants and young children, show a poor prognosis and are characterized by a lack of the repressive histone H3 lysine 27 trimethylation (H3K27me3) mark. Recently, we reported overexpression of CXorf67 as hallmark of PFA ependymoma and that CXorf67 can interact with polycomb repressive complex 2 (PRC2) thereby inhibiting EZH2. However, a detailed description of the functional domains of CXorf67 and the exact mechanism of EZH2 inhibition is still lacking. We now have performed mass spectrometry (MS) analyses of different CXorf67 protein truncates to identify functional domains in the CXorf67 protein involved in the binding of PRC2 core components. Our results show that PRC2 components like EZH2 and SUZ12 specifically bind to the C-terminal part of the CXorf67 protein. Overexpression of this C-terminal part of CXorf67 was sufficient to induce a strong downregulation of H3K27me3 in HEK293 cell lines. Upon inspection of the amino acid sequence in the C-terminus we discovered that a small, highly conserved amino acid sequence is responsible for binding and inhibition of EZH2 resulting in the perturbation of PRC2 function. A synthetic 21 amino acids long peptide containing these conserved amino acids completely abolished PRC2 activity in a methyltransferase assay. Strikingly, in silico analyses showed that the CXorf67 peptide mimics the H3K27M peptide and both can bind to the SET domain of EZH2, suggesting that the mechanism of EZH2 inhibition by CXorf67 was highly similar to the mechanism observed in pediatric high-grade gliomas harboring H3K27M mutations. Taken together, our findings shed light on the functional domains of CXorf67 and reveal a crucial oncogenic mechanism that may be exploited for targeted therapy in PFA ependymoma.

Background Posterior fossa A (PFA) ependymomas are one of 9 molecular groups of ependymoma. PFA tumors are mainly diagnosed in infants and young children, show a poor prognosis, and are characterized by a lack of the repressive histone H3 lysine 27 trimethylation (H3K27me3) mark. Recently, we reported overexpression of chromosome X open reading frame 67 (CXorf67) as a hallmark of PFA ependymoma and showed that CXorf67 can interact with enhancer of zeste homolog 2 (EZH2), thereby inhibiting polycomb repressive complex 2 (PRC2), but the mechanism of action remained unclear. Methods We performed mass spectrometry and peptide modeling analyses to identify the functional domain of CXorf67 responsible for binding and inhibition of EZH2. Our findings were validated by immunocytochemistry, western blot, and methyltransferase assays. Results We find that the inhibitory mechanism of CXorf67 is similar to diffuse midline gliomas harboring H3K27M mutations. A small, highly conserved peptide sequence located in the C-terminal region of CXorf67 mimics the sequence of K27M mutated histones and binds to the SET domain (Su(var)3-9/enhancer-of-zeste/trithorax) of EZH2. This interaction blocks EZH2 methyltransferase activity and inhibits PRC2 function, causing de-repression of PRC2 target genes, including genes involved in neurodevelopment. Conclusions Expression of CXorf67 is an oncogenic mechanism that drives H3K27 hypomethylation in PFA tumors by mimicking K27M mutated histones. Disrupting the interaction between CXorf67 and EZH2 may serve as a novel targeted therapy for PFA tumors but also for other tumors that overexpress CXorf67. Based on its function, we have renamed CXorf67 as “EZH Inhibitory Protein” (EZHIP).

Aim of this systematic review was to assess the efficacy of preventive interventions against the development of white spot lesions (WSLs) during fixed appliance orthodontic treatment. Nine databases were searched without limitations in September 2018 for randomized trials. Study selection, data extraction and risk of bias assessment were done independently in duplicate. Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality. A total of 24 papers (23 trials) were included, assessing preventive measures applied either around orthodontic brackets (21 trials; 1427 patients; mean age 14.4 years) or molar bands (2 trials; 46 patients; age/sex not reported). Active patient reminders were associated with reduced WSL incidence on patient level compared to no reminder (3 trials; 190 patients; RR: 0.4; 95% CI: 0.31-0.64; Number Needed to Treat [NNT]: 3 patients), flat surface sealants were associated with reduced WSL incidence on tooth level than no sealant (5 trials; 2784 teeth; RR: 0.8; 95% CI: 0.63-0.95; NNT: 33 teeth), and fluoride varnish was associated with reduced WSL severity on tooth level (2 trials; 1160 teeth; MD: -0.32 points; 95% CI: -0.44 to -0.21 points). However, the quality of evidence was low according to GRADE, due to risk of bias. Some evidence indicates that active patient reminders and flat surface sealants or fluoride varnish around orthodontic brackets might be associated with reduced WSL burden, but further research is needed. Keywords: adverse effects; clinical trials; dental caries; evidence-based medicine; fixed appliances; systematic review.

Abnormal uterine bleeding (AUB) observed in a patient on tamoxifen therapy raises concern for primary endometrial abnormalities including atypical endometrial hyperplasia, endometrial polyps, and endometrial cancer 1, while metastatic breast cancer (MBC) is often overlooked as part of the differential diagnoses workup due to its rare incidence 2. While there have been previously reported cases of uterine metastasis from the breast, its pathogenesis has not yet been elucidated. We present a similar case of this uncommon presentation; however, with unique features that have allowed us to exclusively shed light on the possible link between tamoxifen exposure in the uterus and hormonal‐growth receptor pathway cross talk that contribute to increased tumor aggressiveness and invasiveness favoring uterine metastasis.

Aim: The validity of meta-analysis is dependent upon the quality of included studies. Here, we investigated whether the design of untreated control groups (i.e. source and timing of data collection) influences the results of clinical trials in orthodontic research. Materials and methods: This meta-epidemiological study used unrestricted literature searching for meta-analyses in orthodontics including clinical trials with untreated control groups. Differences in standardized mean differences (ΔSMD) and their 95% confidence intervals (CIs) were calculated according to the untreated control group through multivariable random-effects meta-regression controlling for nature of the interventional group and study sample size. Effects were pooled with random-effects synthesis, followed by mixed-effect subgroup and sensitivity analyses. Results: Studies with historical control groups reported deflated treatment effects compared to studies with concurrent control groups (13 meta-analyses; ΔSMD = −0.31; 95% CI = −0.53, −0.10; P = 0.004). Significant differences were found according to the type of historical control group (based either on growth study or clinical archive; 11 meta-analyses; ΔSMD = 0.40; 95% CI = 0.21, 0.59; P < 0.001). Conclusions: The use of historical control groups in orthodontic clinical research was associated with deflation of treatment effects, which was independent from whether the interventional group was prospective or retrospective and from the study’s sample size. Caution is warranted when interpreting clinical studies with historical untreated control groups or when interpreting systematic reviews that include such studies. Registration: PROSPERO (CRD42015024179). Conflict of interest: None.

The purpose of this study was to investigate the corrosion behavior of 10 different high noble gold-based dental alloys, used for prosthodontic retention elements, according to ISO 10271. Samples of 10 high-noble and noble gold-based dental alloys were subjected to: (i) static immersion tests with subsequent analysis of ion release for eight different elements using mass spectrometry; (ii) electrochemical tests, including open-circuit potential and potentiodynamic scans; and (iii) scanning electron microscopy, followed by energy-dispersive X-ray microscopy. The results were analyzed using one-way ANOVA and Sidak multiple-comparisons post-hoc test at a level of significance of α = 0.05. Significant differences were found among the 10 alloys studied for all ions (P < 0.001). The potentiodynamic analysis showed values from -82.5 to 102.8 mV for the open-circuit potential and from 566.7 to 1367.5 mV for the breakdown potential. Both the open-circuit and the breakdown potential varied considerably among these alloys. Scanning electron microscopy analysis confirmed the existence of typically small-diameter corrosion defects, whilst the energy-dispersive X-ray analysis found no significant alteration in the elemental composition of the alloys. The results of this study reveal the variability in the corrosive resistance among the materials used for retention elements in prosthodontics.

Objectives Meta-analysis is the gold standard for synthesizing evidence on the effectiveness of health care interventions. However, its validity is dependent on the quality of included studies. Here, we investigated whether basic study design (i.e., randomization and timing of data collection) in orthodontic research influences the results of clinical trials. Study Design and Setting This meta-epidemiologic study used unrestricted electronic and manual searching for meta-analyses in orthodontics. Differences in standardized mean differences (ΔSMD) between interventions and their 95% confidence intervals (CIs) were calculated according to study design through random-effects meta-regression. Effects were then pooled with random-effects meta-analyses. Results No difference was found between randomized and nonrandomized trials (25 meta-analyses; ΔSMD = 0.07; 95% CI = −0.21, 0.34; P = 0.630). However, retrospective nonrandomized trials reported inflated treatment effects compared with prospective (40 meta-analyses; ΔSMD = −0.30; 95% CI = −0.53, −0.06; P = 0.018). No difference was found between randomized trials with adequate and those with unclear/inadequate generation (25 meta-analyses; ΔSMD = 0.01; 95% CI = −0.25, 0.26; P = 0.957). Finally, subgroup analyses indicated that the results of randomized and nonrandomized trials differed significantly according to scope of the trial (effectiveness or adverse effects; P = 0.005). Conclusion Caution is warranted when interpreting systematic reviews investigating clinical orthodontic interventions when nonrandomized and especially retrospective nonrandomized studies are included in the meta-analysis.

Objectives: To investigate, using a split-mouth randomized clinical design, the effect of micro-osteoperforation (MOP) on mini-implant supported canine retraction using fixed appliances. Materials and Methods: Thirty subjects (seven males and 23 females) with a mean age of 22.2 (3.72) years were randomized into three canine retraction groups: Group 1 (MOP 4-weekly maxilla/8-weekly mandible; n = 10); Group 2 (MOP 8-weekly maxilla/12-weekly mandible; n = 10) and Group 3 (MOP 12-weekly maxilla/4-weekly mandible; n = 10) measured at 4-week intervals over 16 weeks. Subjects also completed pain (5-point Likert scale) and pain impact (Visual Analogue Scale) questionnaires. The primary outcome was the amount of canine retraction over 16 weeks at MOP (experimental) and non-MOP (control) sites. Results: Mean overall canine retraction was 4.16 (1.62) mm with MOP and 3.06 (1.64) mm without. After adjusting for differences between jaws, all MOP groups exhibited significantly higher canine distalization than the control group: 0.89 mm more (95% confidence interval [CI] = 0.19 to 1.59 mm; P = .01) in the MOP-4 group, 1.08 mm more (95% CI = 0.49 to 1.68 mm; P = .001) in the MOP-8 group and 1.33 mm more (95% CI = 0.55 to 2.10 mm; P = .002) in the MOP-12 group. All subjects reported pain associated with MOP with 60% classifying it as moderate and 15% severe. The main impact of this reported pain was related to chewing and speech. Conclusions: MOP can increase overall mini-implant supported canine retraction over a 16-week period of observation but this difference is unlikely to be clinically significant.

OBJECTIVES To evaluate the implant failure, marginal bone loss (MBL), and other biological or technical complications of restorations supported by tilted and straight implants after at least 3 years in function. METHODS Electronic and manual searches were performed in MEDLINE, Embase, Web of Science, and OpenGrey to identify clinical studies published up to December 2017. After duplicate study selection and data extraction, the risk of bias was assessed with the ROBINS-I tool. Random-effects meta-analyses of relative risks (RRs) or mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by subgroup/sensitivity analyses and application of the GRADE approach. RESULTS A total of 17 nonrandomized studies (eight prospective/nine retrospective) were included. The number of implants of the overall systematic review was 7,568 implants placed in 1,849 patients supporting either full-arch or partial implant prostheses. No difference in the failure of tilted and straight implants was seen (eight studies; 4,436 implants; RR = 0.95; 95% CI = 0.70 to 1.28; p = 0.74), with the quality of evidence being very low due to bias and imprecision. Likewise, no difference in MBL was seen between tilted and straight implants (16 studies; 5,293 implants; MD = 0.03 mm; 95% CI = -0.03 to 0.10 mm; p = 0.32), with the quality of evidence being very low due to bias and inconsistency. Contradictory results regarding implant survival were found from prospective and retrospective studies, which could indicate bias from the latter. CONCLUSIONS Within the limitations of the present systematic review, no effect of implant inclination on implant survival or peri-implant bone loss was found.

Aim of this randomised clinical trial was to compare the outcome of direct pulp capping (DPC) versus pulpotomy, both with MTA, for carious primary molars. Healthy, cooperative children aged 3–9 years with at least one deep carious primary molar requiring vital pulp therapy were included. Data on the primary outcome (all-cause failure) and secondary outcomes (clinical or radiographic failure) were collected blindly semi-annually for a minimum of 1 year up to 3 years and analysed with survival analysis and generalised linear regression at alpha = 5%. A total of 74 children were randomly allocated on 1:1 basis to DPC (35 children; 40 teeth) or pulpotomy (39 children; 57 teeth). Survival from all-cause failure was 79.7% [95% confidence interval (CI) 69.3–86.9%] at 12 months and 66.0% (95% CI 53.4–76.0%) at 24 months which remained stable up to 36 months, with no differences between groups (P > 0.05). No significant difference was found in the survival rate of the two groups for all-cause [hazard ratio (HR) = 0.95; 95% CI 0.45–2.01; P = 0.88], clinical (HR = 0.74; 95% CI 0.0.19–2.92; P = 0.66), or radiographic failure (HR = 0.80; 95% CI 0.0.36–1.82; P = 0.60) throughout the 3-year follow-up. Regression analysis indicated that needing a second attempt for haemorrhage control was associated with higher clinical failure rate. All-case failure was significantly different for class II versus occlusal cavities and in the latter cavities pulpotomy performed better (P

Background Fixed orthodontic appliances might be associated with intraoral adverse effects on enamel, due to plaque accumulation and their colonization by oral microbes. At the same time, the demand for esthetic alternatives to orthodontic treatment, like thermoplastic aligners, is growing. However, thermoplastic aligners may behave differently intraorally than fixed appliances in terms of bacterial colonization and biofilm formation. Therefore, the aim of this prospective cohort study was to assess the salivary prevalence of the cariogenic bacteria Streptococcus mutans, Lactobacillus acidophilus, and Streptococcus sanguinis among adolescents treated orthodontically with thermoplastic aligners or fixed appliances. Methods Thirty adolescent patients (17 girls/13 boys; mean age 13.8 years old) were assigned to treatment with either (i) self-ligating fixed appliances with nickel-titanium archwires or (ii) aligners constructed from clear transparent polyethylenterephthalat-glycol copolyester (PET-G) thermoplastic sheets. Whole stimulated saliva was collected from each patient at three time points: at baseline (before bonding and initiation of orthodontic therapy or before insertion of the thermoplastic aligners), after 2 weeks, and after 1 month. A simplified plaque index, a simplified gingival index, and the decayed, missing, and filled teeth (DMFT) index were assessed from the clinical examination of the patients. Microbiological analysis of salivary bacteria was performed by quantitative polymerase chain reaction, followed by descriptive and inferential statistics at the 5% level. Results Although patients treated with aligners had significantly lower plaque and gingivitis scores throughout treatment compared to patients treated with fixed appliances, no significant difference could be found between the S. mutans counts of the two groups at any time through treatment (P > 0.05). On the other hand, patients treated with aligners had significantly lower salivary S. sanguinis counts at all time points than patients treated with fixed appliances (P

Clinical trials using categorical outcomes often express their results as risk, which is the probability with which a health outcome (usually an adverse event) will occur. For this article, two sce...

Background: Orthodontically induced external root resorption (OIRR) is a pathologic consequence of orthodontic tooth movement. However, the limitations of two-dimensional radiography suggest that cone beam computed tomography (CBCT) with its three-dimensional capabilities might be more suitable to assess OIRR. Objective: The aim of this study was to assess in an evidence-based manner data on linear or volumetric OIRR measurements of permanent teeth by means of CBCT, during and/or after the end of orthodontic treatment. Search methods: Unrestricted electronic and hand searches were performed up to January 2017 in 15 databases. Selection criteria methods: Randomized clinical trials, prospective, and retrospective non-randomized studies assessing OIRR during and/or after orthodontic treatment using CBCT in human patients were included. Data collection and analysis: After duplicate study selection, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses, followed by subgroup, meta-regression, and sensitivity analyses were also performed in order to evaluate factors that affect OIRR. Results: A total of 33 studies (30 datasets) were included in the qualitative analysis while data from 27 of them were included in the quantitative analysis. Direct comparisons from randomized trials found little to no influence of appliance-related factors on OIRR. Explorative analyses including non-randomized studies found a pooled OIRR of 0.79 mm based on all included studies and 0.86 mm when OIRR was assessed at the end of orthodontic treatment. Statistically significant differences in OIRR were found according to tooth type or jaw, inclusion of extractions, treatment duration, and diagnostic accuracy of the CBCT. Conclusions: Based on the results of this study, CBCT seems to be a reliable tool to examine OIRR during or at the end of orthodontic treatment. Although the average OIRR measured with CBCT seems to lack clinical relevance, there are certain factors that may affect OIRR following orthodontic treatment. Nevertheless, due to data heterogeneity and low quality of the included studies, the corresponding results should be interpreted with some caution.

Objectives Clinical trial registration is widely recommended, since it allows tracking of trials that helps ensure full and unbiased reporting of their results. Aim of the present overview was to provide empirical evidence on bias associated with trial registration via a meta-epidemiological approach. Study Design and Settings Six databases were searched in September 2017 for randomized clinical trials and systematic reviews thereof assessing the effects of orthodontic clinical interventions. After duplicate study selection and data extraction, statistical analysis included a two-step meta-epidemiological approach within- and across-included meta-analyses with a Paule-Mandel random-effects model to calculate Differences in Standardized Mean Differences (ΔSMD) between registered and unregistered trials and their 95% Confidence Intervals (CI), followed by subgroup and sensitivity analyses. Results A total of 16 meta-analyses with 83 trials and 4988 patients collectively were finally included, which indicated that registered trials reported less beneficial treatment effects than unregistered trials (ΔSMD=-0.36; 95% CI=-0.60,-0.12). Although some small-study effects were identified, sensitivity analyses according to precision and risk of bias indicated robustness. Conclusions Signs of bias from lack of trial protocol registration were found with non-registered trials reporting more beneficial intervention effects than registered ones. Caution is warranted by the interpretation of non-registered randomized trials or systematic reviews thereof.

Introduction A multicenter parallel 3-arm randomized clinical trial was carried out in 3 university hospitals in the United Kingdom to investigate the effect of supplemental vibratory force on space closure and treatment outcome with fixed appliances. Methods Eighty-one subjects less than 20 years of age with mandibular incisor irregularity undergoing extraction-based fixed appliance treatment were randomly allocated to supplementary (20 minutes/day) use of an intraoral vibrational device (AcceleDent; OrthoAccel Technologies, Houston, Tex) (n = 29), an identical nonfunctional (sham) device (n = 25), or fixed-appliance only (n = 27). Space closure in the mandibular arch was measured from dental study casts taken at the start of space closure, at the next appointment, and at completion of space closure. Final records were taken at completion of treatment. Data were analyzed blindly on a per-protocol basis with descriptive statistics, 1-way analysis of variance, and linear regression modeling with 95% confidence intervals. Results Sixty-one subjects remained in the trial at start of space closure, with all 3 groups comparable for baseline characteristics. The overall median rate of initial mandibular arch space closure (primary outcome) was 0.89 mm per month with no difference for either the AcceleDent group (difference, −0.09 mm/month; 95% CI, −0.39 to 0.22 mm/month; P = 0.57) or the sham group (difference, −0.02 mm/month; 95% CI, −0.32 to 0.29 mm/month; P = 0.91) compared with the fixed only group. Similarly, no significant differences were identified between groups for secondary outcomes, including overall treatment duration (median, 18.6 months; P >0.05), number of visits (median, 12; P >0.05), and percentage of improvement in the Peer Assessment Rating (median, 90.0%; P >0.05). Conclusions Supplemental vibratory force during orthodontic treatment with fixed appliances does not affect space closure, treatment duration, total number of visits, or final occlusal outcome. Registration NCT02314975. Protocol The protocol was not published before trial commencement. Funding AcceleDent units were donated by OrthoAccel Technologies; no contribution to the conduct or the writing of this study was made by the manufacturer.

OBJECTIVE Dental fluorosis has considerable implications on the patients' quality of life. The present study assesses the comparative effectiveness of the various interventions for the treatment of fluorosed enamel. MATERIALS AND METHODS Nine databases were searched from inception to December 2016 for randomized trials. After duplicate study selection, data extraction, and risk of bias assessment, mean differences (MD) or Relative Risks and the corresponding 95% confidence intervals (CIs) were calculated and assessed with the GRADE approach. RESULTS Six trials with a total of 348 patients (at least 40% male/60% female) with a mean age of 17.7 years treated with bleaching, microabrasion, or resin infiltration were included. Evidence of low quality indicated that microabrasion resulted in smaller esthetic improvement compared to bleaching (MD = -2.9; 95% CI = -3.4 to -2.5). Evidence of moderate quality indicated that compared to bleaching a greater esthetic improvement was seen with resin infiltration (MD = 3.6; 95% CI = 2.7-4.6) or a combination of bleaching with resin infiltration (MD = 3.5; 2.8-3.7). However, all comparisons were supported from single trials and therefore caution is warranted. CONCLUSIONS Based on the existing limited evidence, resin infiltration seems to be the most promising treatment for dental fluorosis, followed by bleaching and microabrasion. CLINICAL SIGNIFICANCE For this systematic review, which was registered beforehand in PROSPERO (CRD42016053492), we synthesized evidence from existing randomized clinical trals on humans to see which treatment is most effective for the esthetic rehabilitation of dental fluorosis, the prevalence of which is seeing a worldwide steady increase. We found that resin infiltration seems to be the most effective treatment approach for lesions of mild to moderate severity, followed by bleaching, and finally microabrasion. Our study's strengths are its a priori registration, wide search, quality check according to Cochrane guidelines, and the use of a new robust analytic method to provide valid clinical recommendations according to the principles of evidence-based medicine.

BACKGROUND The effectiveness of intraoral appliances (IOA), maxillary expansion (ME), and maxillomandibular advancement (MMA) in the treatment of children and adults with obstructive sleep apnea (OSA) has not yet been adequately assessed. METHODS An umbrella review was performed based on established guidelines for evidence-based medicine. Data synthesis was performed only from randomized controlled trials with Paule-Mandel random-effects meta-analyses / meta-regressions using mean differences (MDs) and 95% confidence intervals (CIs) and was followed by the qualitative evaluation of the meta-evidence. RESULTS 29 systematic reviews were included, 7 of which provided quantitative data. IOA were effective in improving apnea hypopnea index (AHI) compared to both, placebo appliances (12 trials; 525 patients; MD = -11.70; 95% CI: [-15.38; -8.01]; p

Lifestyle interventions remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD). This randomised controlled single-blind clinical trial investigated the effect of Mediterranean diet (MD) or Mediterranean lifestyle, along with weight loss, in NAFLD patients. In all, sixty-three overweight/obese patients (50 (sd 11) years, BMI=31·8 (sd 4·5) kg/m2, 68 % men) with ultrasonography-proven NAFLD (and elevated alanine aminotransferase (ALT) and/or γ-glutamyl transpeptidase (GGT) levels) were randomised to the following groups: (A) control group (CG), (B) Mediterranean diet group (MDG) or (C) Mediterranean lifestyle group (MLG). Participants of MDG and MLG attended seven 60-min group sessions for 6 months, aiming at weight loss and increasing adherence to MD. In the MLG, additional guidance for increasing physical activity and improving sleep habits were given. Patients in CG received only written information for a healthy lifestyle. At the end of 6 months, 88·8 % of participants completed the study. On the basis of intention-to-treat analysis, both MDG and MLG showed greater weight reduction and higher adherence to MD compared with the CG (all P

The aim of this systematic review was to assess the effect of systematic extraction protocols during orthodontic fixed appliance treatment on the soft tissue profile of human patients. Nine databases were searched until December 2016 for controlled clinical studies including premolar extraction or nonextraction treatment. After elimination of duplicate studies, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MD) or standardized mean differences (SMD) and their 95% CIs were performed, followed by subgroup, meta-regression, and sensitivity analyses. Extraction treatment was associated with increased lower lip retraction (24 studies; 1,456 patients; MD = 1.96 mm), upper lip retraction (21 studies; 1,149 patients; MD = 1.26 mm), nasolabial angle (21 studies; 1,089 patients; MD = 4.21°), soft-tissue profile convexity (six studies; 408 patients; MD = 1.24°), and profile pleasantness (three studies; 249 patients; SMD = 0.41). Patient age, extraction protocol, and amount of upper incisor retraction during treatment were significantly associated with the observed extraction effects, while the quality of evidence was very low in all cases due to risk of bias, baseline confounding, inconsistency, and imprecision. Although tooth extractions seem to affect patient profile, existing studies are heterogenous and no consistent predictions of profile response can be made.

The absolute effectiveness of pit and fissure sealants in preventing the development of new caries lesions or the progress of incipient caries lesions has been proved by randomized clinical trials and systematic reviews thereof. Based on the evidence-based assessment of existing randomized clinical trials performed for this chapter, pit and fissure sealants can be effectively applied on any deciduous or permanent posterior teeth without adverse effects on their clinical performance. However, caries susceptibility varies among different patients and among different teeth within a patient. Therefore, a risk-based assessment on a case-by-case manner by an experienced clinician that takes into account factors like tooth morphology, caries history, fluoride intake, oral hygiene, and patient age needs to be undertaken to maximize the cost-to-benefit value of sealant application.

Secure bonding of orthodontic appliances during fixed appliance treatment is closely related to treatment efficiency, as bond failures lead to increased costs in terms of time and money. Additional...

Background Torque of the maxillary incisors is crucial to occlusal relationship and esthetics and can be influenced by many factors. The aim of this study was to assess the relative influence of the material of the orthodontic appliance (adhesive, bracket, ligature, and wire) on tooth displacements and developed stresses/strains after torque application. Methods A three-dimensional upper right central incisor with its periodontal ligament (PDL) and alveolus was modeled. A 0.018-in. slot discovery® (Dentaurum, Ispringen, Germany) bracket with a rectangular 0.018 x 0.025-in. wire was generated. The orthodontic appliance varied in the material of its components: adhesive (composite resin or resin-modified glass ionomer cement), bracket (titanium, steel, or ceramic), wire (beta-titanium or steel), and ligature (elastomeric or steel). A total of 24 models were generated, and a palatal root torque of 5° was applied. Afterwards, crown and apex displacement, strains in the PDL, and stresses in the bracket were calculated and analyzed. Results The labial crown displacement and the palatal root displacement of the tooth were mainly influenced by the material of the wire (up to 150% variation), followed by the material of the bracket (up to 19% variation). The magnitude of strains developed in the PDL was primarily influenced by the material of the wire (up to 127% variation), followed by the material of the bracket (up to 30% variation) and the ligature (up to 13% variation). Finally, stresses developed at the bracket were mainly influenced by the material of the wire (up to 118% variation) and the bracket (up to 59% variation). Conclusions The material properties of the orthodontic appliance and all its components should be considered during torque application. However, these in silico results need to be validated in vivo before they can be clinically extrapolated. Electronic supplementary material The online version of this article (doi:10.1186/s40510-017-0161-5) contains supplementary material, which is available to authorized users.

PURPOSE The objective of this study was to assess the risk of bias of randomized controlled trials (RCTs) published in prosthodontic and implant dentistry journals. MATERIALS AND METHODS The last 30 issues of 9 journals in the field of prosthodontic and implant dentistry (Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Implant Dentistry, International Journal of Oral & Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, International Journal of Prosthodontics, Journal of Dentistry, Journal of Oral Rehabilitation, and Journal of Prosthetic Dentistry) were hand-searched for RCTs. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool and analyzed descriptively. RESULTS From the 3,667 articles screened, a total of 147 RCTs were identified and included. The number of published RCTs increased with time. The overall distribution of a high risk of bias assessment varied across the domains of the Cochrane risk of bias tool: 8% for random sequence generation, 18% for allocation concealment, 41% for masking, 47% for blinding of outcome assessment, 7% for incomplete outcome data, 12% for selective reporting, and 41% for other biases. CONCLUSION The distribution of high risk of bias for RCTs published in the selected prosthodontic and implant dentistry journals varied among journals and ranged from 8% to 47%, which can be considered as substantial.

OBJECTIVES To assess the hypothesis that there is excessive reporting of statistically significant studies published in prosthodontic and implantology journals, which could indicate selective publication. METHODS The last 30 issues of 9 journals in prosthodontics and implant dentistry were hand-searched for articles with statistical analyses. The percentages of significant and non-significant results were tabulated by parameter of interest. Univariable/multivariable logistic regression analyses were applied to identify possible predictors of reporting statistically significance findings. The results of this study were compared with similar studies in dentistry with random-effects meta-analyses. RESULTS From the 2323 included studies 71% of them reported statistically significant results, with the significant results ranging from 47% to 86%. Multivariable modeling identified that geographical area and involvement of statistician were predictors of statistically significant results. Compared to interventional studies, the odds that in vitro and observational studies would report statistically significant results was increased by 1.20 times (OR: 2.20, 95% CI: 1.66-2.92) and 0.35 times (OR: 1.35, 95% CI: 1.05-1.73), respectively. The probability of statistically significant results from randomized controlled trials was significantly lower compared to various study designs (difference: 30%, 95% CI: 11-49%). Likewise the probability of statistically significant results in prosthodontics and implant dentistry was lower compared to other dental specialties, but this result did not reach statistical significant (P>0.05). CONCLUSIONS The majority of studies identified in the fields of prosthodontics and implant dentistry presented statistically significant results. The same trend existed in publications of other specialties in dentistry.

It has been reported that certain patients with non-small-cell lung cancer (NSCLC) that harbor activating somatic mutations within the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) gene may be effectively treated using targeted therapy. The use of EGFR inhibitors in patient therapy has been demonstrated to improve response and survival rates; therefore, it was suggested that clinical screening for EGFR mutations should be performed for all patients. Numerous clinicopathological factors have been associated with EGFR and Kirsten-rat sarcoma oncogene homolog (KRAS) mutational status including gender, smoking history and histology. In addition, it was reported that EGFR mutation frequency in NSCLC patients was ethnicity-dependent, with an incidence rate of ~30% in Asian populations and ~15% in Caucasian populations. However, limited data has been reported on intra-ethnic differences throughout Europe. The present study aimed to investigate the frequency and spectrum of EGFR mutations in 1,472 Greek NSCLC patients. In addition, KRAS mutation analysis was performed in patients with known smoking history in order to determine the correlation of type and mutation frequency with smoking. High-resolution melting curve (HRM) analysis followed by Sanger sequencing was used to identify mutations in exons 18-21 of the EGFR gene and in exon 2 of the KRAS gene. A sensitive next-generation sequencing (NGS) technology was also employed to classify samples with equivocal results. The use of sensitive mutation detection techniques in a large study population of Greek NSCLC patients in routine diagnostic practice revealed an overall EGFR mutation frequency of 15.83%. This mutation frequency was comparable to that previously reported in other European populations. Of note, there was a 99.8% concordance between the HRM method and Sanger sequencing. NGS was found to be the most sensitive method. In addition, female non-smokers demonstrated a high prevalence of EGFR mutations. Furthermore, KRAS mutation analysis in patients with a known smoking history revealed no difference in mutation frequency according to smoking status; however, a different mutation spectrum was observed.

Objectives The aim of this study was to compare the use of odds ratio (OR), risk ratio (RR), and risk difference (RD) in meta-analyses of dichotomous outcomes and assess their influence on their results. Study Design and Setting Initially, we included meta-analyses from a meta-epidemiologic database and reanalyzed them with OR, RR, and RD as summary metric. The primary outcomes were the effects of metric choice on the (1) statistical significance, (2) heterogeneity, and (3) Egger's test for publication bias. Additionally, meta-analyses that originally used OR were reanalyzed using RR to assess the differences in their results. Results In the 235 meta-analyses (147 reviews) that were included, the conclusions in terms of significance rarely changed. On the other hand, use of OR displayed the lowest I 2 values (median 42%), followed by RR (+5.1%) and RD (+15.0%). The Egger's test was most often significant with RR (32%), followed by RD (29%) and OR (24%). Substitution of RR for OR led to a change of the observed effects in 3%, change of between-study heterogeneity in 6% to 24%, and change in Egger's test results in 7% of the cases, respectively. Conclusion The choice of metric for meta-analyses of dichotomous outcomes might influence the identified between-study heterogeneity and the results of Egger's test.

Nickel-containing alloys are widely used in orthodontic appliances, even though nickel is by far the most common contact allergen. However, the scientific evidence concerning allergic reactions to nickel in orthodontic patients has not been evaluated systematically. The objective of this study was to investigate whether the prevalence of nickel hypersensitivity is affected by orthodontic treatment. Unrestricted electronic and manual searches were performed until July 2013 for human clinical studies assessing orthodontic treatment and nickel hypersensitivity. Methodological limitations were evaluated with the Downs and Black tool. Crude and adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated from random-effects meta-analyses, followed by subgroup and sensitivity analyses. Thirty studies were included in the review, and 24 datasets with 10 184 patients in the meta-analyses. Orthodontic treatment had no significant effect on nickel hypersensitivity (n = 11; crude OR 0.99; 95%CI: 0.78-1.25; p = 0.914). However, when confounding from factors such as sex and piercings was taken into account, orthodontic treatment was associated with a lower risk of hypersensitivity (n = 1; adjusted OR 0.60; 95%CI: 0.40-0.80; p < 0.001). This was even more pronounced when orthodontic treatment was performed prior to piercing (n = 7; crude OR 0.35; 95%CI: 0.24-0.50; p < 0.001). Orthodontic treatment seems to have a protective role against nickel hypersensitivity, especially when it precedes piercings.

Aim: The objective of this study was to investigate whether the response to periodontal treatment differs among obese, overweight or normal-weight patients. Materials & Methods: Both randomized and non-randomized studies were identified from searches up to July 2013. Risk of bias was assessed with the DownsBlack checklist, the Cochrane tool and the GRADE framework. Quantitative synthesis was conducted with random-effects meta-analyses in subgroups for systemically healthy and diabetic patients. Results: A total of 15 studies including 867 patients were included. No significant difference was found for any clinical periodontal parameter between overweight/ obese and normal-weight patients. Periodontal treatment in systemically healthy overweight/obese patients was associated with higher decrease in TNFa levels (1 study) and higher decrease in HbA1c levels (1 study) compared to systemically healthy normal-weight patients. Contrary to diabetic normal-weight patients, periodontal treatment in diabetic overweight/obese patients was associated with an increase in adiponectin levels (2 studies) and a decrease in leptin levels (2 studies). However, the quality of existing evidence is low due to inconsistency, imprecision and lack of studies. Conclusions: Whereas no difference was found in clinical periodontal parameters, significant differences in inflammatory or metabolic parameters were found between overweight/obese and normal-weight patients, but existing evidence is weak.

Systematic reviews ideally provide a comprehensive and unbiased summary of existing evidence from clinical studies, whilst meta-analysis combines the results of these studies to produce an overall estimate. Collectively, this makes them invaluable for clinical decision-making. Although the number of published systematic reviews and meta-analyses in orthodontics has increased, questions are often raised about their methodological soundness. In this primer, the first steps of meta-analysis are discussed, namely the choice of an effect measure to express the results of included studies, and the choice of a statistical model for the meta-analysis. Clinical orthodontic examples are given to explain the various options available, the thought process behind the choice between them and their interpretation.

Aim of this systematic review was to assess the effect of orthodontic treatment with fixed appliances on the tooth color of patients. Nine databases were searched up to May 2017 for clinical cohort studies on the effect of fixed appliance treatment on tooth color. After elimination of duplicate studies, data extraction, and risk of bias assessment according to the Cochrane guidelines, random effects meta-analyses of mean differences (MD) or means and their 95% confidence intervals (CIs) were performed, followed by GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment of the quality of evidence. Three nonrandomized and one randomized study with a total of 138 patients (46% male, 54% female) with average age of 15.7 years were included. Tooth color of treated patients was significantly altered during or after orthodontic treatment (4 studies; average of 3.2 ∆E units; 95% CI = 2.0–4.4 ∆E units), which was more than the variation among controls (1 study; MD = 1.9 ∆E units; 95% CI = 1.7–2.2 ∆E units). However, the quality of evidence was very low, due to the inclusion of nonrandomized studies, bias, and imprecision. Re-analysis of raw study data indicated that significant differences in clinically discernable treatment-induced color changes were seen between chemically and light-cured adhesives and among the various tooth categories. Existing evidence of very low quality indicates that orthodontic treatment might be associated with alterations of tooth color, which are however not consistently clinically discernible. Treatment-induced color alterations might be dependent on bonding material and tooth type, but evidence supporting this is weak.

Background Insertion of orthodontic fixed appliances has been known to induce a mostly transient qualitative and quantitative alteration of the intraoral microbiota. However, the extent to which treatment with fixed appliances might have a lasting adverse effect on the periodontal attachment of the teeth has not yet been investigated in an evidence-based manner. Objectives Aim of this systematic review was to assess the effect of comprehensive treatment with fixed orthodontic appliances on clinical attachment levels of adolescent and adult periodontally healthy patients. Search methods Seven databases were searched from inception to February 2017. Selection criteria Prospective non-randomized longitudinal clinical studies. Data collection and analysis After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, Paule-Mandel random-effects meta-analyses of the clinical attachment loss and its 95 per cent confidence intervals (CIs) were calculated. Results A total of 9 trials were identified that included 335 treated patients (at least 34 per cent male / 66 per cent female) with an average age of 22.6 years. The average pooled clinical attachment loss was 0.11 mm (9 studies; 335 patients; 95 per cent CI = 0.12 mm gain to 0.34 mm loss; P = 0.338) with high heterogeneity. Furthermore, one study hinted that a small amount of clinical attachment might be gained by intrusion of upper incisors. Additional analyses indicated that the results were robust to addition of untreated patient groups, while patient age and timing of outcome measurement might play an important role. Conclusions According to existing evidence from longitudinal clinical studies orthodontic treatment with fixed appliances has little to no clinically relevant effect on periodontal clinical attachment levels.

Background Permanent canines are amongst the teeth most affected by impaction and ectopic eruption. Although impacted canines are often subjected to surgical exposure and alignment with either the open or the closed technique for many decades, their treatment effects have not yet been systematically asssessed. Objectives The aim of this systematic review was to critically assess whether significant differences exist in the outcomes of the open or closed surgical exposure of impacted canines. Search methods An unrestricted electronic search of nine databases from inception to December 2016 was performed. Selection criteria methods Included were randomized or prospective non-randomized studies comparing open versus closed exposure of impacted canines in human patients. Data collection and analysis After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs) and odds ratios (ORs), including their 95 per cent confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results A total of eight unique studies and a total of 433 (30.1% male/59.9% female) patients were included, with an average age of 15.2 years and a total of 453 impacted canines (48.6% and 51.4% in the open and closed exposure, respectively). Open exposure of impacted canines was associated with reduced duration of canine alignment (two studies; MD = -2.14 months; 95% CI = -4.23 to -0.05 months; P < 0.05; moderate heterogeneity and moderate quality) and lower odds of tooth ankylosis (one study; OR = 0.15; 95% CI = 0.03-0.83; P < 0.05; low quality) compared to closed exposure; both findings being independent of canine localization. However, initial alignment of palatally impacted canines took overall significantly longer than labially impacted canines (8.87 versus 4.17 months). Conclusions Based on existing evidence, open surgical exposure seems to be superior in treatment duration and ankylosis risk over the closed technique. Due to the limited number of small included trials, further research is needed for robust clinical recommendations. Registration PROSPERO (CRD42016051916).

A private orthodontic practitioner wants to make his private practice more clinically efficient in terms of patient output. To this end he looks for ways to reduce the average treatment duration of...

Objectives A priori registration of systematic review protocols in international prospective register of systematic reviews (PROSPERO) can help reduce selective reporting of outcomes. The aim of this study was to assess the association between registration of orthodontic systematic reviews in PROSPERO and review quality with the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Study Design and Setting Seven databases were searched for systematic reviews with/without meta-analysis in orthodontics published between 2012 and 2016. After duplicate study selection and data extraction, the quality of identified reviews was assessed in duplicate with the AMSTAR tool. Descriptive statistics of medians and interquartile ranges (IQRs) and chi-square/Fisher exact tests were calculated. Univariable/multivariable linear regression modeling was implemented to assess the effect of review registration on %AMSTAR score at α of 5%. Results A total of 182 orthodontic systematic reviews were identified, 37 (20.3%) of which were registered. Considerable differences were seen in AMSTAR between registered (median = 86.4%; IQR = 77.3–95.5%) and nonregistered reviews (median = 72.7%; IQR = 59.1–81.8%). After adjustment, registration in PROSPERO was associated with an average increase in %AMSTAR score of 6.6% (95% confidence interval = 1.0–12.3%). Conclusion Although only a small percentage of orthodontic systematic reviews was registered a priori in PROSPERO, registered reviews were of higher quality than nonregistered reviews.

Orthodontic researchers have developed a novel way to enhance comprehensive orthodontic treatment with fixed appliances using supplemental irradiation with infrared light. The rationale is founded ...

Obesity is a widespread chronic inflammatory disorder characterized by an increased overall disease burden and significant association with periodontitis. The aim of this prospective clinical cohort study was to investigate the effect of obesity on orthodontic tooth movement. Fifty-five adolescent patients (27 males, 28 females) with a mean (SD) age of 15.1 (1.7) years and mean (SD) body mass index (BMI) of 30.2 (3.5) kg/m2 in obese and 19.4 (2.2) kg/m2 in normal-weight groups were followed from start of treatment to completion of tooth alignment with fixed orthodontic appliances. Primary outcome was time taken to complete tooth alignment, while secondary outcomes included rate of tooth movement and change in clinical parameters (plaque/gingival indices, unstimulated whole-mouth salivary flow rate, gingival crevicular fluid biomarkers). Data collection took place at baseline (start of treatment: appliance placement), 1 h and 1 wk following appliance placement, and completion of alignment. Results were analyzed by descriptive statistics followed by generalized estimating equation regression modeling. There were no significant differences between groups in time taken to achieve tooth alignment (mean [SD] 158.7 [75.3] d; P = 0.486). However, at 1 wk, initial tooth displacement was significantly increased in the obese group ( P < 0.001), and after adjusting for confounders, obese patients had a significantly higher rate of tooth movement compared with normal-weight patients (+0.017 mm/d; 95% confidence interval, 0.008–0.025; P < 0.001) over the period of alignment. Explorative analyses indicated that levels of the adipokines leptin and resistin, the inflammatory marker myeloperoxidase (MPO), and the cytokine receptor for nuclear factor kappa-B ligand (RANKL) were significantly different between obese- and normal-weight patients and associated with observed rates of tooth movement. This represents the first prospective data demonstrating a different response in obese patients compared with normal-weight patients during early orthodontic treatment. These differences in the response of periodontal tissues to orthodontic force in the presence of obesity have potential short- and long-term clinical implications.