Murilo Fernando Neuppmann Feres

Effectiveness of the open bite treatment in growing children and adolescents. A systematic review

BACKGROUND The extensive literature concerning the early treatment of anterior open bite (AOB) is still controversial and covers a wide variety of therapeutic approaches. OBJECTIVES The objective of this study was to provide a comprehensive review evaluating the effectiveness of the orthodontic correction of AOB in growing individuals. SEARCH METHODS Search was conducted on PubMed, Embase, Cochrane Library, Web of Science, Scopus, Google Scholar, Scielo, and Lilacs databases. Trials registries were consulted for ongoing trials, and grey literature was also contemplated. SELECTION CRITERIA Selection process was performed to include controlled trials enrolling growing subjects who underwent orthodontic treatment to correct AOB and/or hyperdivergent facial pattern. DATA COLLECTION AND ANALYSIS Data were grouped and analysed descriptively. Qualitative appraisal was performed according to the Cochrane risk of bias tool, for randomized clinical trials (RCTs), and MINORS tool for non-RCTs. RESULTS The 22 studies included in this review mostly considered mixed dentition subjects, and there was a considerable variation regarding therapeutic approaches. Because of poor-quality and/or insufficient evidence, consistent results were not found. However, some useful clinical inferences and suggestions for future studies were provided for each therapeutic modality considered here. CONCLUSIONS Additional efforts must still be directed to perform, whenever possible, RCTs; or to conduct prospective controlled trials with adequate sample sizes, consecutively assembled subjects, with the comparison of contemporary and equivalent groups.

Effectiveness of open bite correction when managing deleterious oral habits in growing children and adolescents: a systematic review and meta-analysis.

Background/objectives: Oral habits are common etiological factors for anterior open bites (AOBs) in growing children and adolescents. The objective of this review was to provide a literature synthesis evaluating the effectiveness of open bite correction in growing individuals with the use of habit-interception appliances. Search methods: Electronic searches were conducted on PubMed, Embase, Cochrane Library, Web of Sciences, Scopus, Google Scholar, Scielo, and Lilacs databases. Trials registries were consulted for ongoing trials, and a partial grey literature search was also conducted. Selection criteria: The selection criteria included controlled clinical trials enrolling growing subjects who underwent habit-interception orthodontic treatment to correct dental and/or skeletal AOB. Data collection analysis: Data was grouped and analysed descriptively. A meta-analysis was only possible regarding crib therapy effectiveness. Qualitative appraisal was performed according to Cochrane Risk of Bias tool for randomized clinical trials (RCTs) and the MINORS tool for non-randomized clinical trials (nRCTs). Results: Two RCTs and nine nRCTs were identified. Most of them presented relevant limitations. Crib therapy demonstrated to be effective (+3.1mm overbite correction). However, most of the dental effects are seemingly lost with time; and the skeletal effects are still controversial. Other habit-interception appliances, such as spurs, were not sufficiently investigated. Conclusions: Crib therapy appears to be effective on a short time basis. As for other habit-interception appliances, insufficient evidence could not provide reliable conclusions.

Rapid maxillary expansion effects in Class II malocclusion: A systematic review

OBJECTIVE To evaluate the effectiveness of rapid maxillary expansion (RME) on the sagittal dental or skeletal parameters of growing children with Class II malocclusion. MATERIALS AND METHODS A systematic review intended to identify relevant literature was conducted. The search was performed on Medline, Embase, Cochrane Library, and Scopus databases. Reference lists of the included articles were also screened for relevant documents. The qualitative assessment was performed according to the Methodological Index for Non-Randomized Studies (MINORS) tool, and the resultant data were grouped and analyzed concerning dental and skeletal sagittal effects of RME. RESULTS Of 25 screened studies, seven articles met eligibility criteria and were included. Study samples were observed during mixed dentition stage and characterized as having either Class II dental malocclusion or skeletal discrepancy. None of the included studies was a randomized clinical trial. Included controlled studies presented several inadequacies related to control group or lacked appropriate comparative statistical analysis. Besides being frequently based on deficient methodology, dental and skeletal sagittal effects of RME were either controversial or lacked clinical relevance. CONCLUSION The effect of RME on the sagittal dimension of Class II malocclusions has not been proved yet. Future randomized controlled clinical trials are still needed to definitely address this question.

Effectiveness of the transpalatal arch in controlling orthodontic anchorage in maxillary premolar extraction cases: A systematic review and meta-analysis.

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 Cochranes 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.

Effect of low-intensity pulsed ultrasound on the activity of osteoclasts: An in vitro study

OBJECTIVE The objective of this in vitro study was to evaluate the effect of low-intensity pulsed ultrasound on the resorption activity of osteoclast cell cultures. DESIGN RAW 264.7 cells were cultured and seeded over plates that were pre-coated with a synthetic carbonate apatite, and marked with fluoresceinamine-labeled sodium chondroitin polysulfate. Plates were randomly divided into 4 groups according to the treatment assigned to each one of them: NO RANKL (no RANK-L addition and no ultrasound application), NO LIPUS (addition of RANK-L and no ultrasound application), LIPUS 10 (addition of RANK-L and 10min of ultrasound application per day), and LIPUS 20 (addition of RANK-L and 20min of ultrasound application per day). The ultrasound device produced 1.5MHz pulses with a repetition rate of 1kHz and intensity of 30mW/cm2. The experiment extended for one week and afterwards, resorption activity was evaluated according to the fluorescence intensity analysis and pit resorption measurements (number of pits and mean area). RESULTS Our experiment consistently demonstrated that low-intensity pulsed ultrasound application enhanced osteoclasts resorptive activity. In addition, it was demonstrated that when daily ultrasound application lasted longer (20min) the resorption was the highest. Results obtained from both evaluation methods were reasonably coherent. CONCLUSIONS Low-intensity pulsed ultrasound increases osteoclast resorptive activity in the absence of osteoblasts. This effect seems to be influenced by ultrasound treatment time. Future research might be directed to investigate osteoclast response to different ultrasound application protocols (frequencies and intensities) and potential cellular mechanisms.

Adjunctive techniques for enhancing mandibular growth in Class II malocclusion

Class II malocclusions are generally characterized by mandible retrusion. For this reason, forward bite jumping appliances, also known as functional appliances were originally designed to enhance mandibular forward projection. However, there is still insufficient evidence to support the effectiveness, predictability and stability of functional appliances in modifying mandibular growth. This article was aimed at presenting evidences and hypotheses that mandibular growth may be enhanced through the use of adjunctive methods in conjunction with functional appliances. In formulating our hypothesis, we considered relevant data, mostly derived from animal studies, concerning alternative methods, such as low-intensity ultrasound and light-emitting diode, as well as their related cellular and molecular mechanisms. According to the evidences covered in this article, we suggest that both methods are potentially effective, and theoretically able to act in synergistic way to enhance functional appliances treatment on mandibular and condylar additional growth. The rationale for the use of these methods as adjunctive therapies for mandibular underdevelopment is attributed to their abilities on stimulating angiogenesis, cell differentiation, proliferation, and hypertrophy, as well as enhancing matrix production and endochondoral bone formation, especially on the condyle of growing animals. This article also proposed a study design which would be able to either prove or refute our hypothesis. If ratified, it would represent a significant scientific accomplishment which provides support for further investigations to be carried out on well-designed clinical trials.

Teledentistry and Orthodontics

Teledentistry can be considered as a valuable tool to assist isolated or disadvantaged populations and to improve access to oral healthcare. The application of teledentistry has demonstrated interesting results in many fields of Dentistry. The objective of this chapter is to review the literature on the attempt to associate teledentistry and orthodontics. Most of the collected studies described and evaluated teledentistry as a means to improve effectiveness of orthodontic referrals and consultancy. Other researches focused on evaluating the use of teledentistry for remote diagnosis, monitoring, and motivation of orthodontic patients. After critically reviewing the collected evidence, it was considered that teledentistry might be used as a helpful tool for referring patients or providing consultancy to general practitioners. The possible benefits included the ability of decreasing the number of inappropriate referrals and encouraging previously trained general practitioners to treat cases. Minor issues, such as the small likelihood of patients being neglected, as well as the lack of standardization during records preparation, are still a concern. There is a clear trend among professionals toward a supportive position of teledentistry use allied with orthodontic practice. Nevertheless, most of the general practitioners still present concerns in relation to workload increase. Literature is still scarce on cost studies of teledentistry. It is therefore suggested that future researchers address that gap in addition to conduct methodologically stronger studies focused not only on the financial aspects of teledentistry, but also on the clinical outcomes of the treatment provided with the aid of this system.