Mohammed Almuzian

Miniscrews failure rate in orthodontics: systematic review and meta-analysis

BackgroundnMiniscrews in orthodontics have been mainly used for anchorage without patient compliance in orthodontic treatment. The literature has reported changing failure rates.nnnObjectivenThe aim of this review was to provide a precise estimation of miniscrew failure rate and the possible risk factors of the mechanically-retained miniscrews.nnnSearch methodnElectronic search in database was undertaken up to July 2017 through the Cochrane Database of Systematic Reviews, MEDLINE, Scopus, and Ovid. Additional searching for on-going and unpublished data, hand search of relevant journals and grey lietraure were also undertaken, authors were contacted, and reference lists screened.nnnEligibility criterianRandomised controlled trials (RCTs) and prospective cohort studies (PCSs), published in English were obtained, which reported the failure rate of miniscrews, as orthodontic anchorage, with less than 2 mm diameter.nnnData collection and analysisnBlind and induplicate study selection, data extraction, and risk of bias assessment were undertaken in this research. Failure rates and relevant risk factors of miniscrews with the corresponding 95 per cent confidence intervals (CIs) were calculated by using the random-effects model. The heterogeneity across the studies was assessed using the I2 and Chi2 test. The risk of bias was assessed using Cochrane risk of bias and Newcastle-Ottawa Scale. Subgroup and sensitivity analyses were performed in order to test the robustness of the results in meta-analysis.nnnResultsnThe 16 RCTs and 30 PCSs were included in this research. Five studies were not included in the meta-analysis due to a lack of the statistical information needed to compute the effect sizes. About 3250 miniscrews from 41 studies were pooled in a random-effect model. The overall failure rate of miniscrews was 13.5 per cent (95% CI 11.5-15.9). Subgroup analysis showed that miniscrews diameter, length and design, patient age, and jaw of insertion had minimal effect on rate of miniscrews failure while the type of the gingivae and smoking had statistically significant effect.nnnConclusionnMiniscrews have an acceptably low failure rate. The findings should be interpreted with caution due to high-level of heterogeneity and unbalanced groups in the included studies. High quality randomized clinical trial with large sample sizes are required to support the findings of this review.

Effects of Le Fort I Osteotomy on the Nasopharyngeal Airway—6-Month Follow-Up

PURPOSEnThe literature discussing the impact of a single Le Fort I osteotomy on nasopharyngeal airways is limited. This study assessed the volumetric changes in the nasopharyngeal airway after a single Le Fort I osteotomy and explored the correlation between these changes and 3-dimensional surgical movements of the upper jaw.nnnMATERIALS AND METHODSnThis retrospective study was conducted in 40 patients who had undergone a single Le Fort I (maxillary advancement with or without impaction) to correct Class III malocclusion with maxillary hypoplasia. Preoperative (T1) and 6-month postoperative (T2) cone-beam computed tomographic (CBCT) scans of these patients were used for analysis. Maxillary surgical movements and volumetric changes in the nasopharyngeal airway were measured. The reproducibility of the measurements was evaluated using paired t tests and intraclass correlation coefficients. The Wilcoxon test and Pearson correlation coefficient were applied to evaluate the volumetric changes in the nasopharyngeal airway space and assess the correlations of these changes to the maxillary surgical movements.nnnRESULTSnSix patients were excluded from the study owing to major differences (>5°) in their head and neck posture between the T1 and T2 CBCT scans. The errors of the repeated measurements were insignificant (P > .05), with a high level of agreement (r = 0.99; P < .05) between the repeated digitization of the landmarks. There was a statistically significant impact of a Le Fort I osteotomy on the right maxillary sinus (decreased by 17.8%) and the lower retropalatal space (expanded by 17.3%; P < .05). The correlation between the change in airway volume and the magnitude of surgical maxillary movements was moderate (r = .4). Similarly, there was a moderate correlation between changes in the upper nasopharynx and those in the hypopharynx.nnnCONCLUSIONnThe single Le Fort I osteotomy was found to increase the retroglossal airway volume. This could be important for the treatment of obstructive sleep apnea in patients with maxillary deficiency. A long-term follow-up assessment of a larger sample with a functional assessment of airway would be beneficial to confirm these findings.

Does rapid maxillary expansion affect nasopharyngeal airway? A prospective Cone Beam Computerised Tomography (CBCT) based study.

BACKGROUND AND PURPOSEnThere is limited literature discussing the three dimnesional (3D) impact of rapid maxillary expansion (RME) on upper airway. The purpose of this prospective Cone Beam Computerised Tomography (CBCT) based study is to assess the immediate 3D effects and to correlate the volumteric changes in the upper naspharyngeal airway spaces secondary to RME.nnnMATERIALS AND METHODSnSeventeen participants (8 male, 9 female, with a mean age of 12.6xa0±xa01.8 years), who required RME for the management of narrow maxillary arch, were recruited for this study. The prescribed expansion regimen was quarter turn (0.25xa0mm), twice a day until over-expansion was achieved. The mean period for the active phase was 14 days with a range of 12-21 days. Pretreatment (T1) and immediate post-expansion (T2) CBCT images were obtained and then processed using ITK snap and OnDemand3D softwar packages. Paired t-test and Interclass Correlation Coefficient (ICC) were used to assess the reproducibility of the measurements, student t-test (Pxa0<xa00.05) and Pearson Correlation Coefficient (PCC) were applied to evaluate the volumetric changes in the nasopharyngeal airway spaces, linear dentolaveolar changes and correlate these changes.nnnMAIN FINDINGSnThough, the data of one patient was excluded from the study, owing to major differences (>5 degrees) in the head and neck posture between T1 and T2 CBCT scans, the study findings shows that bonded RME is an effective dentoalveolar expander in growing patients (P= 0.01) with an average expansion of 3.7xa0mm and 2.8xa0mm in males and females respectively. Likewise, the upper nasopharynx (UNP) expanded significantly (15.2% in males and 12% in females). In comparison, the upper retropalatal space (URP) was significantly reduced, by almost one sixth of its original volume, more in males than females, 11.2% and 2.8% respectively. A strong direct correlation between the maxillary sinus volumetric changes, and between appliance expansion and dentoalveolar expansion were evident (PCCxa0=xa00.86, 0.75, respectively). There was also a moderate correlation between changes in the UNP and URP spaces.nnnCONCLUSIONSnRME was found to be an effective dentoalveolar expander and significantly augment the UNP and minimize the URP space. A similar comparative clinical study with long-term follow-up would be beneficial in accurately deteremining the clinical impact of RME on the airway and breathing as well as the stability of these effects.

A novel method for treatment of Class III malocclusion in growing patients

BackgroundManagement of Class III malocclusion is one of the most challenging treatments in orthodontics, and several methods have been advocated for treatment of this condition. A new treatment protocol involves the use of an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol, in conjunction with full-time Class III elastic wear and coupled with the use of temporary anchorage devices (TADs). The aim of this study was to evaluate the dento-skeletal and profile soft tissue effects of this novel protocol in growing participants with retrognathic maxilla.MethodsFourteen growing participants (7 males and 7 females; 12.05u2009±u20091.09xa0years), who displayed Class III malocclusions with retrognathic maxilla, were recruited. Pre-treatment recordsxa0were taken before commencing treatment (T1). All participants had a hybrid mini-implant-supported rapid maxillary expansion (MARME) appliance that was activated by the Alt-RAMEC protocol for 9xa0weeks. Full-time bone-anchored Class III elastics, delivering 400xa0g/side, were then used for maxillary protraction. When positivexa0overjet was achieved, protraction was ceased and post-treatment recordsxa0were taken (T2). Linear and angular cephalometric variables were blindly measured by one investigator and repeated after 1xa0month. An error measurement (Dahlberg’s formula) study was performed to evaluate the intra-examiner reliability. A paired-sample t test (pu2009<u20090.05) was used to compare each variable from T1 to T2.ResultsTreatment objectives were achieved in all participants within 8.5xa0weeks of protraction. The maxilla significantly protracted (SNA 1.87°±xa01.06°; Vert.T-A 3.29±xa01.54xa0mm pu2009<u20090.001), while the mandibular base significantly redirected posteriorly (SNB −2.03°u2009±u20090.85°, Vert.T-B −u20093.43±xa04.47xa0mm, pu2009<u20090.001 and pu2009<u20090.05 respectively), resulting in a significant improvement in the jaw relationship (ANB 3.95°±xa00.57°, pu2009<u20090.001; Wits 5.15±xa01.51xa0mm, pu2009<u20090.001). The Y-axis angle increased significantly (1.95°u2009±u20091.11°, pu2009<u20090.001). The upper incisors were significantly proclined (+u20092.98°±xa02.71°, pu2009<u20090.01), coupled with a significant retroclination of the lower incisors (−u20093.2°±xa03.4°, pu2009<u20090.05). The combined skeletal and dental effects significantly improved the overjet (5.62±xa01.36xa0mm, pu2009<u20090.001) and the soft tissue Harmony angle (2.75°u2009±u20091.8°, pu2009<u20090.001).ConclusionsClass III elastics, combined with the Alt-RAMEC activation protocol of the MARPE appliance, is an efficient treatment method for mild/moderate Class III malocclusions. The long-term stability of these changes needs further evaluation.

Does systemic administration of casein phosphopeptides affect orthodontic movement and root resorption in rats

ObjectivesnTo assess the potential effects of casein phosphopeptides (CPPs) on orthodontically induced iatrogenic root resorption (OIIRR) and orthodontic teeth movement.nnnMaterials and methodsnForty Wistar rats (aged 11 weeks) were randomly divided into experimental group (EG; n = 20) that received a diet supplemented with CPP and control group (CG; n = 20) devoid of diet supplement. A 150 g force was applied using nickel titanium (NiTi) coil that was bonded on maxillary incisors and extended unilaterally to a maxillary first molar. At Day 28, animals in both groups were euthanized. Volumetric assessment of root resorption craters and linear measurement of maxillary first molars movement were blindly examined using a micro-computed tomography scan.nnnResultsnNine rats were excluded from the experiment due to loss during general anesthesia or appliances failure. Intra-operator reproducibility was high in both volumetric and linear measurements, 92.8 per cent and 98.5-97.6 per cent, respectively. The results reveal that dietary CPP has statistically insignificant effect on the overall OIIRR and orthodontic movement.nnnConclusionsnCPP seems to have statistically insignificant effect on the volume of OIIRR and orthodontic movement in rats. A long-term study with larger sample size using a different concentration of CPP is required to clarify the dentoalveolar effect of CPP.

The extent of root resorption and tooth movement following the application of ascending and descending magnetic forces: a prospective split mouth, microcomputed-tomography study

ObjectivenVarious factors have been examined in the literature in an attempt to reduce the incidence and severity of root resorption. The purpose of the present investigation is to test the null hypothesis that there is no difference in relation to force level using gradually increasing (ascending) and decreasing (descending) orthodontic force generated by magnets on the severity of Orthodontically Induced Inflammatory Iatrogenic Root Resorption (OIIRR) and amount of tooth movement.nnnMethodsnTwenty maxillary first premolars from 10 patients were subjected to ascending (25-225 g, magnets in attraction) and descending (225 to 25 g, magnets in repulsion) buccal forces using a split mouth design over an 8-week period. Polyvinyl siloxane impressions were taken at week 0, 4, and 8 to record the tooth movement. After 8 weeks, the teeth were extracted, scanned, with micro-CT in 16.9 µm resolution, and the root resorption craters were localized circumferentially and quantified at each level of the root.nnnResultsnThe total volume of OIIRR with ascending force was 1.20 mm3, and with descending force was 1.25 mm3, and there was no statistically significant difference between them. OIIRR on the palatal surface (0.012 mm3) was significantly less than on the buccal surface (0.057 mm3) and than on the mesial surface (0.035 mm3). There is no statistically significant difference in the degree of OIIRR between different level of the root (cervical, middle, and apical) at different surfaces. Moreover, the amount of tooth movement, at 0-, 4-, and 8-week interval, secondary to an ascending and descending force application was not statistically significant.nnnConclusionsnThere is no short-term (8 weeks) statistically significant difference between orthodontic ascending and descending forces, from 25 to 225 g and from 225 to 25 g, respectively, in term of severity and location of OIIRR as well as the amount of tooth movement. The buccal surface of the root showed highest degree of OIIRR compared to other roots surfaces.

The William Houston Gold Medal of the Royal College of Surgeons of Edinburgh 2014, orthodontic cases

The William Houston Medal is awarded to the individual achieving the highest mark at, the Membership in Orthodontics (MOrth) examination at the Royal College of Surgeons of Edinburgh. As part of the examination the candidate must submit five clinical cases. Details of two cases treated by the winning candidate are presented in this paper.

Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants: a systematic review and meta-analysis

ObjectivesThe aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure.Search methodsAn electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed.Eligibility criteriaRandomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews’ failure rate in that insertion site, were included.Data collection and analysisStudy selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results.ResultsOverall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3–6), 4.8% (95% CI 1.6–13.4) and 5.5% (95% CI 2.8–10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4–11.4), 9.7% (95% CI 5.1–17.6) and 16.4% (95% CI 4.9–42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3–23.6) and 9.9% (95% CI 4.9–19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1–14.7).ConclusionsOrthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies.

Effectiveness of nickel‐titanium springs vs elastomeric chains in orthodontic space closure: A systematic review and meta‐analysis

The aim of this study is to explore the effectiveness of nickel titanium closing springs (NiTi-CS) and elastomeric power chains (EPC) in orthodontic space closure and to assess the adverse periodontal effects, cost efficiency and patient-centred outcomes between both of these methods.nnnMETHODSnAn electronic search of online databases (Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Scopus, LILACS and Web of Science), reference lists and grey literature as well as hand search were conducted without language restriction up to November/2017. Two authors blindly and in duplicate were involved in study selection, quality assessment and the extraction of data. Only randomized clinical trials (RCTs) were included. The quality of the studies was assessed using the Cochrane Collaborations risk of bias tool. 95% confidence intervals and mean difference for continuous data were calculated. A meta-analysis that generated a random-effect model for the comparable outcomes was conducted, and heterogeneity was measured using I2 statistic.nnnRESULTSnOf 187 records, 4 RCTs met the criteria and were included in the quantitative synthesis featuring 290 test quadrants. Faster space closure with NiTi-CS was observed with a mean difference of (0.20 mm/month, 95% CI: 0.12 to 0.28). Loss of anchorage appears to be similar within both groups when synthesized qualitatively. With exception to anchorage loss, secondary outcomes could not be investigated in the included trials.nnnCONCLUSIONSnThere is a moderate quality of evidence suggesting a faster orthodontic space closure with the NiTi-CS when compared to EPC. A comparable amount of anchorage loss was observed regardless of the utilized method of space closure. Further high-quality RCTs with parallel-groups, reporting on the adverse effects and patient-centred values, are recommended.

Anchorage effectiveness of orthodontic miniscrews compared to headgear and transpalatal arches: a systematic review and meta-analysis

Abstract Background: Anchorage in orthodontics can be provided through several extra- and intra-oral sources including headgear, teeth, cortical bone and soft tissue. Objective: The aim of this review was to systematically review the effectiveness of miniscrews in reinforcing anchorage during en-masse retraction of anterior teeth in comparison to conventional anchorage appliances. Search method: Comprehensive searching of the electronic databases was undertaken up to March 2018 in the Cochrane Database of Systematic review, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed and Scopus databases. Additional searching for on-going and unpublished data and hand search of relevant journals were also undertaken, authors were contacted, and reference lists screened. Eligibility criteria: Searches were restricted to randomized clinical trials (RCTs) published in English, which compared anchorage reinforcement using mechanically-retained miniscrews (diameter of 2u2009mm or less) to conventional anchorage appliances during en-masse retraction of anterior teeth in participants of any age treated with fixed appliances combined with extraction of maxillary premolars. Data collection and analysis: Blind and induplicate study selection, data extraction and risk of bias assessment were undertaken. The primary outcome was the amount of mesial movement of the upper first permanent molar (anchorage loss) while secondary outcomes included treatment duration, number of visits, adverse effects and patient-centered outcomes. The risk of bias was assessed using Cochrane risk of bias tool. A random-effects model with its corresponding 95% confidence interval (CI) were generated for comparable outcomes. Statistical heterogeneity across the studies were assessed using the I2 and Chi2 test. Additional sensitivity tests were implemented. Results: Seven RCTs met the inclusion criteria, however, data of 241 participants from 6 RCTs (250 miniscrews and 134 conventional anchorage appliances) were meta-analyzed. Qualities of the included RCTs varied from low to high. The standardized mean difference (SMD) of the anchrage loss between the two intervention groups was 2.07u2009mm ((95% CI (–3.05) to (–1.08), pu2009<u2009.001, I2u2009=u200988%, 6 RCTs)) in favour of miniscrews, which was also preserved after excluding the high risk of bias studies (SMD 1.94u2009mm, 95% CI (–2.46) to (–0.42) pu2009<u2009.001, I2u2009=u200993%, 3 RCTs)). Information on overall treatment duration, space closure duration, quality of treatment, patient-reported outcomes, adverse effects and number of visit were limited. Conclusion: The result of the meta-analysis suggested that there is moderate quality of evidence that miniscrews are clinically and statistically more effective in preserving orthodontic anchorage than conventional appliances. However, this conclusion is supported by a small number of studies with variable qualities. High-quality RCTs would give a better understanding of miniscrews effectiveness in providing orthodontic anchorage.