Padhraig S. Fleming

Orthodontic measurements on digital study models compared with plaster models: a systematic review

The aim of this study is to evaluate the validity of the use of digital models to assess tooth size, arch length, irregularity index, arch width and crowding versus measurements generated on hand-held plaster models with digital callipers in patients with and without malocclusion. Studies comparing linear and angular measurements obtained on digital and standard plaster models were identified by searching multiple databases including MEDLINE, LILACS, BBO, ClinicalTrials.gov, the National Research Register and Pro-Quest Dissertation Abstracts and Thesis database, without restrictions relating to publication status or language of publication. Two authors were involved in study selection, quality assessment and the extraction of data. Items from the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews checklist were used to assess the methodological quality of included studies. No meta-analysis was conducted. Comparisons between measurements of digital and plaster models made directly within studies were reported, and the difference between the (repeated) measurement means for digital and plaster models were considered as estimates. Seventeen relevant studies were included. Where reported, overall, the absolute mean differences between direct and indirect measurements on plaster and digital models were minor and clinically insignificant. Orthodontic measurements with digital models were comparable to those derived from plaster models. The use of digital models as an alternative to conventional measurement on plaster models may be recommended, although the evidence identified in this review is of variable quality.

Self-ligating brackets in orthodontics. A systematic review.

OBJECTIVE To evaluate the clinical differences in relation to the use of self-ligating brackets in orthodontics. MATERIALS AND METHODS Electronic databases were searched; no restrictions relating to publication status or language of publication were applied. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) investigating the influence of bracket type on alignment efficiency, subjective pain experience, bond failure rate, arch dimensional changes, rate of orthodontic space closure, periodontal outcomes, and root resorption were selected. Both authors were involved in study selection, validity assessment, and data extraction. Disagreements were resolved by discussion. RESULTS Six RCTs and 11 CCTs were identified. Meta-analysis of the influence of bracket type on subjective pain experience failed to demonstrate a significant advantage for either type of appliance. Statistical analysis of other outcomes was unfeasible because of inadequate methodological design and heterogenous designs. CONCLUSIONS At this stage there is insufficient high-quality evidence to support the use of self-ligating fixed orthodontic appliances over conventional appliance systems or vice versa.

Bullying in orthodontic patients and its relationship to malocclusion,self-esteem and oral health-related quality of life.

Objectives To measure the self-reported frequency and severity of bullying amongst patients referred for orthodontic treatment and to investigate whether there is a relationship between levels of self-reported bullying, malocclusion and need for orthodontic treatment and an individuals self-esteem and oral health-related quality of life (OHRQoL). Design and setting Cross-sectional study of an adolescent group referred for orthodontic assessment at three UK hospitals. Subjects and methods Three hundred and thirty-six participants aged between 10 and 14 years were recruited. Validated questionnaires were used to measure the self-reported frequency and severity of bullying, self-esteem and OHRQoL. Orthodontic treatment need was assessed using IOTN. Results The prevalence of bullying was 12·8%. Being bullied was significantly associated with Class II Division 1 incisor relationship (P = 0·041), increased overbite (P = 0·023), increased overjet (P = 0·001) and a high need for orthodontic treatment assessed using AC IOTN (P = 0·014). Bullied participants also reported lower levels of social competence (P<0·001), athletic competence (P<0·001), physical appearance related self-esteem (P<0·001) and general self-esteem (P<0·001). Higher levels of oral symptoms (P = 0·032), functional limitations (P<0·001), emotional (P<0·001) and social impact (P<0·001) from their oral condition, resulting in a negative impact on overall OHRQoL (P<0·001), were also reported. Conclusions Significant relationships exist between bullying and certain occlusal traits, self-esteem and OHRQoL.

Efficiency of mandibular arch alignment with 2 preadjusted edgewise appliances.

INTRODUCTION The aim of this study was to compare the efficiency of mandibular arch alignment in 3 dimensions with a self-ligating bracket system (SmartClip, 3M Unitek, Monrovia, Calif) and a conventional preadjusted edgewise twin bracket (Victory, 3M Unitek) in nonextraction patients. This was a prospective, randomized, controlled clinical trial at the Royal London Hospital, School of Dentistry, and Kent and Canterbury Hospital, United Kingdom. Sixty-six consecutive patients satisfying the inclusion criteria were enrolled in the study. They were randomly allocated with a computer-generated system to 1 of the 2 bracket systems. METHODS Pretreatment mandibular arch irregularity was measured by using a coordinate measuring machine (Merlin II, International Metrology Systems, Gloucester, United Kingdom). A 0.016-in round martensitic active nickel-titanium aligning archwire (3M Unitek) was placed in all subjects. Mandibular arch irregularity was remeasured 8 weeks later. RESULTS Sixty-five subjects completed the study. Bracket type had little influence on alignment efficiency overall (P = 0.08), or in the buccal (P = 0.173) or labial segments (P = 0.528) after adjustment for pretreatment differences by analysis of covariance (ANCOVA). Alignment efficiency was highly correlated to pretreatment irregularity overall (P <0.001), both in the buccal (P = 0.001) and labial (P <0.001) segments. Increasing age appeared to have a negative effect on alleviation of irregularity, although this effect did not reach statistical significance (P = 0.053). CONCLUSIONS The null hypothesis that efficiency of alignment in the mandibular arch in nonextraction patients is independent of bracket type was accepted. Alignment efficiency is largely influenced by initial irregularity.

Randomized clinical trial of orthodontic treatment efficiency with self-ligating and conventional fixed orthodontic appliances

INTRODUCTION Our objective was to test the hypotheses that treatment with 2 fixed orthodontic appliances (SmartClip and Victory; 3M Unitek, Monrovia, Calif) would result in no difference in (1) the duration of orthodontic treatment or (2) the number of visits required. METHODS Sixty-six consecutive patients were randomly allocated to treatment with a self-ligating bracket system (SmartClip) or a conventional appliance (Victory). The duration of treatment and the number of visits required in addition to the initial and final peer assessment rating (PAR) scores were recorded. The number of teeth extracted during treatment and the frequency of mechanical eruption of canines were also noted. Analyses of covariance were used to assess the influence of bracket type on treatment durations, visits required, and percentage PAR score reductions. RESULTS Fifty-four (81.8%) participants completed the study. The duration of treatment was 3 months greater in the group treated with SmartClip. However, bracket type had no statistical influence on treatment duration (P = 0.076), total visits required (P = 0.184), or percentage PAR score reduction (P = 0.255). CONCLUSIONS Neither hypothesis could be rejected. Bracket type did not influence the duration of treatment or the number of visits required. The percentages of PAR score reductions were also unaffected by the choice of appliance.

Influence of radiographic position of ectopic canines on the duration of orthodontic treatment.

OBJECTIVE To investigate the influence of radiographic position of palatally impacted canines on the length of treatment for orthodontic alignment. MATERIALS AND METHODS Treatment records of 45 consecutive successfully treated patients (36 unilateral, 9 bilateral) with ectopic palatal canines treated with surgical exposure and orthodontic traction were analyzed. The sample was based on orthodontic referrals over a 3-year period in Kent and Canterbury Hospital, UK. The duration of treatment was related to radiographic parameters including the height of the impacted canine, angulation of the long axis to the upper midline, mesiodistal position of the canine tip relative to the midline and adjacent incisors, and the anteroposterior position of the canine root apex. RESULTS Using multiple stepwise regression analysis, the horizontal position of the canine crown relative to adjacent teeth and maxillary dental midline showed a statistically significant correlation with the duration of treatment (P =.042), explaining 7.7% of the overall variance. However, treatment duration was found to be independent of the initial canine angulation (P = .915), vertical height (P =.065), and position of the canine apex (P = .937). CONCLUSIONS Accurate prediction of treatment duration for orthodontic alignment of palatally impacted maxillary canines is difficult. However, the mesiodistal position of the canine may be a useful predictor of treatment duration.

Systematic reviews published in higher impact clinical journals were of higher quality.

OBJECTIVES To compare the methodological quality of systematic reviews (SRs) published in high- and low-impact factor (IF) Core Clinical Journals. In addition, we aimed to record the implementation of aspects of reporting, including Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram, reasons for study exclusion, and use of recommendations for interventions such as Grading of Recommendations Assessment, Development and Evaluation (GRADE). STUDY DESIGN AND SETTING We searched PubMed for systematic reviews published in Core Clinical Journals between July 1 and December 31, 2012. We evaluated the methodological quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. RESULTS Over the 6-month period, 327 interventional systematic reviews were identified with a mean AMSTAR score of 63.3% (standard deviation, 17.1%), when converted to a percentage scale. We identified deficiencies in relation to a number of quality criteria including delineation of excluded studies and assessment of publication bias. We found that SRs published in higher impact journals were undertaken more rigorously with higher percentage AMSTAR scores (per IF unit: β = 0.68%; 95% confidence interval: 0.32, 1.04; P < 0.001), a discrepancy likely to be particularly relevant when differences in IF are large. CONCLUSION Methodological quality of SRs appears to be better in higher impact journals. The overall quality of SRs published in many Core Clinical Journals remains suboptimal.

A PRISMA assessment of the reporting quality of systematic reviews in orthodontics

OBJECTIVES To assess the reporting quality of Cochrane and non-Cochrane systematic reviews (SR) in orthodontics and to compare the reporting quality (PRISMA score) with methodological quality (AMSTAR criteria). MATERIALS AND METHODS Systematic reviews (n  =  109) published between January 2000 and July 2011 in five leading orthodontic journals were identified and included. The quality of reporting of the included reviews was assessed by two authors in accordance with the PRISMA guidelines. Each article was assigned a cumulative grade based on fulfillment of the applicable criteria, and an overall percentage score was assigned. Descriptive statistics and simple and multiple linear regression analyses were undertaken. RESULTS The mean overall PRISMA score was 64.1% (95% confidence interval [CI], 62%-65%). The quality of reporting was considerably better in reviews published in the Cochrane Database of Systematic Reviews (P < .001) than in non-Cochrane reviews. Both multivariable and univariable analysis indicated that journal of publication and number of authors was significantly associated with the PRISMA score. The association between AMSTAR score and modified PRISMA score was also found to be highly statistically significant. CONCLUSION Compliance of orthodontic SRs published in orthodontic journals with PRISMA guidelines was deficient in several areas. The quality of reporting assessed using PRISMA guidelines was significantly better in orthodontic SRs published in the Cochrane Database of Systematic Reviews.

Comparison of mandibular arch changes during alignment and leveling with 2 preadjusted edgewise appliances

INTRODUCTION Our objective was to compare the effects of 2 preadjusted appliances on angular and linear changes of the mandibular incisors, and transverse mandibular arch dimensional changes over a minimum of 30 weeks. This was a prospective, randomized, controlled, clinical trial a the Royal London Hospital, School of Dentistry, in London and the Kent and Canterbury Hospital in Canterbury, United Kingdom. METHODS Sixty- six consecutive patients satisfying the inclusion criteria were enrolled and randomly allocated to treatment with a self-ligating bracket system (SmartClip, 3M Unitek, Monrovia, Calif) and conventional preadjusted edgewise brackets (Victory, 3M Unitek). Initial study models and cephalograms were obtained within a month of starting the trial. All subjects received treatment with the following archwire sequence: 0.016-in round, 0.017 x 0.025-in rectangular, 0.019 x 0.025-in rectangular martensitic active nickel-titanium archwires, and 0.019 x 0.025-in stainless steel archwires. Final records, including study models and a lateral cephalogram, were collected a minimum of 30 weeks after initial appliance placement. Lateral cephalograms were assessed for treatment-related changes in mandibular incisor inclination and position. Transverse dimensional changes in intercanine, interpremolar, and intermolar dimensions, and the amount of crowding alleviated during the study period were assessed by comparison of pretreatment and posttreatment models. All measurements were made with a digital caliper (150 mm ISO 9001 electronic caliper, Tesa Technology, Renens, Switzerland). RESULTS Sixty patients completed the study. After adjustment for pretreatment values, duration of treatment, and amount of crowding alleviated during the study period, bracket type had little effect on incisor inclination (P = 0.437) and positional changes (P = 0.35), and intercanine (P = 0.967), inter-first premolar (P = 0.495), and inter-second premolar (P = 0.905) dimensions. However, the self-ligating appliance produced slightly more expansion in the molar region, a difference that was statistically significant (P = 0.009). Pretreatment values for incisor inclination (P = 0.044) and transverse dimensions (P = 0.000) affected inclination and transverse changes, respectively, with proclination less likely when the labial segment was proclined at the outset and expansion unlikely during leveling and alignment in wider arches. Greater alleviation of crowding during the study period resulted in more incisor proclination (P = 0.000) and advancement (P = 0.000). CONCLUSIONS There was little difference overall in the pattern of arch alignment and leveling related to the 2 preadjusted appliances. However, there was a statistically greater increase in intermolar width in the group treated with the self-ligating appliance, although the difference was only 0.91 mm.

Cochrane and non-Cochrane systematic reviews in leading orthodontic journals: a quality paradigm?

The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) using AMSTAR and to compare the prevalence of meta-analysis in both review types. A literature search was undertaken to identify SRs that consisted of hand-searching five major orthodontic journals [American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics and Orthodontics and Craniofacial Research (February 2002 to July 2011)] and the Cochrane Database of Systematic Reviews from January 2000 to July 2011. Methodological quality of the included reviews was gauged using the AMSTAR tool involving 11 key methodological criteria with a score of 0 or 1 given for each criterion. A cumulative grade was given for the paper overall (0-11); an overall score of 4 or less represented poor methodological quality, 5-8 was considered fair and 9 or greater was deemed to be good. In total, 109 SRs were identified in the five major journals and on the CDSR. Of these, 26 (23.9%) were in the CDSR. The mean overall AMSTAR score was 6.2 with 21.1% of reviews satisfying 9 or more of the 11 criteria; a similar prevalence of poor reviews (22%) was also noted. Multiple linear regression indicated that reviews published in the CDSR (P < 0.01); and involving meta-analysis (β = 0.50, 95% confidence interval 0.72, 2.07, P < 0.001) showed greater concordance with AMSTAR.