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Dentistry Medical European Journal of Orthodontics - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Orthognathic surgery enhances both oral function and aesthetic outcomes for patients with dentofacial disharmony (DFD). However, the influencing factors on oral health-related quality of life (OHRQoL) in patients with varying characteristics remain unclear.<div class="boxTitle">Objective</div>This systematic review aims to comprehensively investigate the factors that influence quality of life (QoL) in patients undergoing orthognathic surgery, and address the gaps of subgroup comparisons in existing reviews, specifically focusing on country development level, type of DFD, type of surgical procedure, and sex.<div class="boxTitle">Search methods</div>PubMed, Embase, Web of Science, CENTRAL, SIGLE, CNKI, CSTJ, and WANFANG Database were searched from 2000 to 2025.<div class="boxTitle">Selection criteria</div>This systematic review included cohort studies that evaluated the impact of orthognathic surgery on QoL and its various influencing factors as measured by Orthognathic Quality of Life Questionnaire-22 (OQLQ-22) or the Oral Health Impact Profile-14 (OHIP-14).<div class="boxTitle">Data collection and analysis</div>The Newcastle-Ottawa Scale (NOS) for Cohort Study was employed to evaluate the quality of included studies. RevMan software was used to perform the meta-analyses.<div class="boxTitle">Results</div>The review included 22 articles with 1482 participants, of which 20 were included in the meta-analyses. Using OQLQ-22, an improvement was noted in the four dimensions of QoL at five months postoperatively compared to the preoperative period. Subgroup analysis indicated that patients undergoing double jaw surgery (MD 22.55, 95% CI [17.00, 28.10]), with skeletal Class III malocclusion (MD 21.91, 95% CI [16.38, 27.45]) and female patients (MD 23.72, 95% CI [11.05, 36.40]) experienced a more significant degree of improvement, suggesting a higher likelihood of achieving greater surgical satisfaction. Notably, the overall QoL improvement was more pronounced in developing countries (MD 21.63, 95% CI [13.82, 29.45]) overall compared with developed countries (MD 18.22, 95% CI [14.22, 22.22]). Similar results were observed in the use of OHIP-14.<div class="boxTitle">Conclusions</div>This study highlights the factors influencing QoL in orthognathic patients, including country development level, type of DFD, surgical procedures, and sex in the QoL. The degree of improvement in patients’ QoL varied according to these characteristics. Given the limited number of studies available, further comprehensive research is warranted.<div class="boxTitle">Registration</div>PROSPERO (CRD42024582409)</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Orthodontic treatment involving tooth extractions typically spans 25–35 months in adult patients. While various methods have been explored to accelerate this process, the outcomes remain inconsistent. This study focuses on evaluating the efficacy of these methods specifically in adult populations.<div class="boxTitle">Objectives</div>This study aimed to evaluate the effects of flapless piezocision combined with low-level laser therapy (LLLT) on the rate of en-masse retraction, comparing it to piezocision alone and conventional.<div class="boxTitle">Materials and methods</div>This single-center, three-arm, parallel-group randomized controlled trial involved adult patients with Class II Division 1 malocclusion who required upper premolar extractions. The study included healthy males and females aged 17–28. Participants were randomly assigned to one of three groups in a 1:1:1 ratio through seven blocks of nine participants each: (1) Piezocision-assisted en-masse retraction with low-level laser therapy (FC + LLLT), (2) Piezocision-assisted en-masse retraction (FC), and (3) Conventional en-masse retraction (CONV). After completing the leveling and alignment phase, piezocision procedures were performed using buccal and palatal vertical incisions made with a piezosurgery microsaw in FC and FC + LLLT groups. Six weeks later, in the FC + LLLT group, low-level laser therapy (LLLT) utilizing a GaAlAs diode laser was administered regularly until en-masse retraction. The primary outcome was the rate of en-masse retraction; secondary outcomes included changes in first molar positions and inter-molar and inter-canine widths.<div class="boxTitle">Results</div>In this RCT of 80 patients, 63 (16 males and 47 females, mean age: 21.46 ± 3.16 years) were recruited. The FC + LLLT group had the greatest retraction rate at 1.32 ± 0.19 mm/month, significantly greater than the FC (1.09 ± 0.13 mm/month) and CONV groups (0.75 ± 0.06 mm/month). No significant differences were found in first molar distal movement or inter-molar width changes.<div class="boxTitle">Conclusion</div>Combining LLLT with flapless piezocision significantly boosts upper anterior teeth retraction by 43.8%, compared to 31.8% with piezocision alone. This approach remains effective throughout the retraction period, while piezocision benefits were mainly seen in the initial two months. All methods cause slight distal movement of first molars and minor increases in inter-canine and intermolar widths, with no significant differences.<div class="boxTitle">Harms</div>No harms were reported.<div class="boxTitle">Trial registration number</div>This trial protocol was registered in the Clinical Trials database (NCT05655169).</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Issues regarding research transparency have been highlighted in the literature. The aim of this investigation was to assess the trend of adhering to the reporting of key transparency practices (data sharing, code sharing, COI disclosure, funding disclosure, and protocol registration) by articles published in three leading orthodontic journals.<div class="boxTitle">Material and methods</div>A Scopus database search was undertaken to identify articles published in 2013, 2018 and 2023 in three orthodontic journals. Independent data extraction was performed. Frequency distributions and cross tabulations (COI not disclosed vs COI disclosed) were calculated. Univariable logistic regression was undertaken to detect associations between COI disclosure and publication characteristics, journal type and reporting of transparency practices.<div class="boxTitle">Results</div>1498 articles were analysed. No data sharing statement (60.7%) was commonly cited. The intention to share data was stated in approx. 15% articles. No article stated a code sharing statement. Almost 70% articles had not registered a protocol. A third of articles disclosed the funder or sponsor (32.7.%), while approximately an equal number of articles disclosed (49.1%) or did not disclose (50.9%) any conflict of interest. Articles published in the EJO had higher odds of reporting protocol registration (OR 7.42; 95% CI: 4.55, 12.10; P < .01) and funding disclosure (OR 3.44; 95% CI: 2.52, 4.69; P < .01) compared to AO and AJODO. A COI disclosure statement was more likely to be in articles published in AJODO. The odds of reporting a data sharing statement were higher in articles published in EJO (OR 8.72; 95% CI: 5.72, 13.29; P < .001). Apart from code sharing, improvements over the 5-year intervals in reporting of transparency indicators were evident.<div class="boxTitle">Limitations</div>Only three journals were assessed which may impact the generalisability of the results.<div class="boxTitle">Conclusions</div>Despite improvements over the 5-year intervals, the reporting of research transparency indicators requires improvement in articles published in orthodontic journals. To encourage transparent research conduct and open science practices, journals and their editors should promote reporting of research transparency indicators.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>To evaluate the amount of bisphenol-A (BPA) released from different orthodontic appliances into saliva and plasma and to compare BPA levels between orthodontic appliance groups.<div class="boxTitle">Methods</div>This non-randomized clinical trial included 78 patients, and they were divided into four groups: fixed appliance, temporary anchorage devices (TADs), removable appliance, and functional appliance groups. Saliva and plasma samples were collected before treatment/appliance wear (T0) and one day (T1), one week (T2), and one month (T3) after treatment/appliance wear. Saliva and plasma BPA levels were analysed using Ultra-performance Liquid Chromatography–Mass Spectrometry (UPLC-MS/MS). Data was analysed using analysis of variance (ANOVA) and Tukey HSD multiple comparison tests with Bonferroni correction. Correlations between saliva and plasma BPA levels at different time points were evaluated using Pearson correlation analysis.<div class="boxTitle">Results</div>BPA levels ranged from 0.07–7.28 ng/ml in saliva samples and from 0.17–12.51 ng/ml in plasma samples in all groups. Within-group comparisons showed no significant changes over time (p > 0.0125) in each group. Between-group comparisons showed significantly higher saliva BPA levels in the fixed appliance group compared to the other groups (p < 0.017), with no significant differences in plasma BPA levels between groups (p < 0.0175). Positive correlations were observed between saliva BPA measurements, whereas positive correlation was observed only between T0 and T3 plasma PBA levels.<div class="boxTitle">Conclusion</div>This research obviously demonstrated that the orthodontic appliances we investigated release BPA into the saliva. However, the BPA levels detected in both saliva and plasma are consistently within the acceptable safety limits. However, precautions should be taken to minimize BPA release during orthodontic treatment.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>Clear aligner therapy (CAT) is an aesthetic alternative to fixed appliance therapy (FAT). An understanding of patient experiences with CAT can enable clinicians to educate patients, manage expectations, and identify potential barriers to effective treatment. A scoping review was undertaken to map and synthesise the available evidence on patient experiences with CAT.<div class="boxTitle">Methods</div>The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed (MEDLINE), Embase, Scopus, Web of Science and Dentistry & Oral Sciences Source databases and grey literature were searched. Data collation and synthesis was presented in descriptive and tabular formats.<div class="boxTitle">Results</div>The initial search yielded 541 articles following removal of duplicate studies. 37 studies met the selection criteria and were scoped in the present review. The studies identified included cross-sectional, longitudinal, prospective, and randomised clinical trials reporting on patient experiences with CAT associated with Oral Health-Related Quality of Life (OHRQOL) and satisfaction. The impacts of CAT on OHRQOL with relevance to pain was the most frequently evaluated aspect, followed by speech, satisfaction, eating, anxiety, and sleep.<div class="boxTitle">Conclusions</div>CAT patients report satisfaction with the aesthetics of the appliance however can expect transient negative effects on OHRQOL, pain, anxiety, and speech after commencing treatment. Further longitudinal research using validated qualitative tools focussing on CAT is required.<div class="boxTitle">Registration</div>This review was registered in the Open Science Framework database (DOI: xx)</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Orofacial myofunctional disorders (OMDs) are conditions or behaviors that negatively affect oral postures and functions. These behaviors can interfere with normal orofacial growth and development and related functions.<div class="boxTitle">Objectives</div>Map the available evidence regarding the effectiveness of Orofacial Myofunctional Therapy (OMT) in treating or managing OMDs associated with specific malocclusion traits or orthognathic surgery outcomes.<div class="boxTitle">Search Methods</div>An experienced librarian developed a comprehensive search strategy for six databases and gray literature. The reference lists of included studies were reviewed.<div class="boxTitle">Selection Criteria</div>Randomized controlled trials and non-randomized studies of intervention were included in which individuals with OMDs were treated with OMT, regardless of the healthcare setting or the professional delivering the treatment.<div class="boxTitle">Data Collection and Analysis</div>Two independent reviewers screened the retrieved records in two phases based on predefined eligibility criteria and extracted data. The evidence level was assessed using the Oxford Levels of Evidence.<div class="boxTitle">Results</div>Twenty-four studies were included (18 primary studies and 6 reviews). Seven studies focused on OMDs associated with malocclusion sagittal characteristics (Class I, II, or III), ten examined open-bite-related OMDs, and seven explored OMDs following orthognathic surgery. Only four studies (22%) were randomized controlled trials (RCTs); most studies lacked proper randomization procedures, did not report allocation concealment, and three of the four RCTs were open-label. Among the six comparisons identified, five were deemed plausible (four with a level of evidence 3 and one with a level of evidence 2). No comparisons were rated at level 1 evidence. As a result, the effectiveness of OMT alone or in combination with orthodontic treatment for the conditions of interest could not be conclusively confirmed. Further well-designed RCTs are needed to confirm or refute this finding and to strengthen the overall evidence base.<div class="boxTitle">Conclusion</div>Although no high-level evidence currently supports the effectiveness of OMT for managing OMDs associated with malocclusion traits, its potential effectiveness remains plausible. Level 2 evidence suggests that OMT may effectively manage OMDs following orthognathic surgery.<div class="boxTitle">Registration</div>Open Science Framework (DOI 10.17605/OSF.IO/M6HNS).</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background/Objectives</div>The inclusion of a participant flow diagram in randomized clinical trials (RCTs) is a requirement of the CONSORT guidelines. The aim of this study was to assess the reporting quality of flow diagrams of RCTs published in orthodontic journals in relation to the CONSORT Flow Diagram for Parallel Group RCTs.<div class="boxTitle">Materials/Methods</div>RCTs published between January 2011 and December 2023 in five orthodontic journals were identified and trial characteristics were extracted. The reporting of the flow diagram (if included) was assessed for completeness in relation to the CONSORT flow diagram template. Descriptive statistics and cross tabulations between RCT characteristics and presence/no presence of a flow diagram were performed. On an exploratory basis, univariable associations between RCT characteristics and presence/no presence of a flow diagram were performed and univariable logistic regression to examine the effect of publication year on flow diagram reporting.<div class="boxTitle">Results</div>Three hundred and thirty-four RCTs met the inclusion criteria. The majority were published in 2021 (n = 39, 11.7%), and had 2 arms (n = 279, 83.5%). Three-hundred and seven (92.0%) RCTs were published in journals endorsing the CONSORT guidelines. Two hundred and thirty-three (69.8%) RCTs included a flow diagram and from these, 48.1% (n = 112) were fully compliant with flow diagram reporting. 121 (51.9%) omitted at least one item of the CONSORT reporting template. Significant associations between journal type, CONSORT endorsement by authors, ethical approval status, presence of a published protocol, significance of the primary outcome, involvement of a statistician, presence of conflict of interest, center type, type of analysis undertaken and the presence/ no presence of a flow diagram were present. Across the study timeframe, the odds of inclusion of RCT flow diagram increased per additional year (OR:1.47; 95%CI:1.34,1.61; p < .001).<div class="boxTitle">Limitations</div>Only five orthodontic journals.<div class="boxTitle">Conclusions/Implications</div>Despite improvements over time, the inclusion and reporting of CONSORT flow diagram for parallel group RCTs in trials published in orthodontic journals requires improvement. To mitigate potential biased interpretation of trial results, journal editors should ensure a complete CONSORT flow diagram is submitted by researchers.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background/Objectives</div>To assess Dutch dentists’ experience, competence and opinions on various aspects of orthodontic retention with bonded retainers and identify any gaps that may exist in practice and communication.<div class="boxTitle">Materials/Methods</div>A web-based questionnaire was sent to 1000 randomly selected general dentists, covering their (i) experience, competence and opinion in bonded retainer monitoring and maintenance, (ii) knowledge of unintentional active bonded retainers, (iii) responsibility for bonded retainers, and (iv) orthodontic practitioners’ communication.<div class="boxTitle">Results</div>The response rate was 23.6% (n = 236). Orthodontic treatment was performed by 24% of dentists. Dentists were familiar with follow-up (98%), repairs (95%) and placement (77%) of bonded retainers. The more hours involved in treatment, the more competent they felt in repairing BRs (P = .025). However, over a quarter felt insufficiently competent in repairing (26%) and placement (33%) of bonded retainers. When patients requested their dentist to remove their bonded retainer, 89% informed them about possible consequences, and 41% referred them to their orthodontic practitioner. Awareness of torsional movements of anterior teeth due to unintentionally active bonded retainers was high (77%). Almost two thirds (64%) believed that dentists should check bonded retainers one year after placement. Respondents felt insufficiently informed by orthodontic practitioners regarding several aspects of the retention phase. One-third (34%) would appreciate additional training.<div class="boxTitle">Limitations</div>The main limitations of this study are the low response rate, which could result in non-response bias, and the focus on bonded retainers only.<div class="boxTitle">Conclusions/Implications</div>Dutch dentists are well informed about the possibility of torsional movements due to unintentionally active bonded retainers. Clear communication between orthodontic practitioners and dentists is essential for effective long-term follow-up and shared responsibility. Knowledge and skills regarding monitoring and maintenance of bonded retainers should be integrated into dental curricula and postgraduate courses.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aim</div>To compare directly printed aligners (DPA) and thermoformed aligners (TFA), evaluating the potential release and dispersion of microplastic (MP) and nanoplastic (NP) particles under simulated oral conditions.<div class="boxTitle">Materials and methods</div>DPA samples (Graphy Tera Harz TC-85-DAC resin) and TFA samples (Invisalign® SmartTrack) were subjected to rubs in an ultrapure water bath. The liquid was collected post-friction and analyzed for MPs and NPs using various techniques: optical microscopy (OM), transmission electron microscopy (TEM), and atomic force microscopy (AFM). Also, plastic residues were quantified by weighing after drying within a laminar flow hood. Microscopic image analyses comprised the quantification of the average size of MPs and NPs, their concentration by TEM, and the roughness analysis by AFM.<div class="boxTitle">Results</div>The masses of MPs and NPs separated after rubbing were 0.001 g/200 µl and 0.004 g/200 µl for TFA and DPA samples, respectively. TEM analysis confirmed that DPA samples had larger (203.08 ± 2651.65 μm²) and more numerous particles compared to TFA (0.23 ± 27.53 μm²), even though it was not possible to distinguish the MPs and NPs due to clustering of the plastic residuals. AFM analysis indicated a bigger root mean square grain size for TFA than DPA; similarly, the mean roughness was lesser in the DPA sample than TFA one.<div class="boxTitle">Conclusions</div>DPA generated larger and more numerous plastic particles compared to TFA, though grain-size characterization was challenging due to particle aggregation. This suggests that the manufacturing process and materials used in DPA could impact the creation of MPs and NPs during simulated mastication, highlighting a potential area for process optimization.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>The main objective was to analyse the clinical effectiveness of ramus mini-implant-assisted traction of mandibular second molars with eruption disturbances.<div class="boxTitle">Materials and Methods</div>A prospective study was carried out during a 3-year period. A total of 16 patients with 19 impacted mandibular second molars underwent surgical exposure followed by implant-assisted orthodontic traction. The pre- and post-treatment cone-beam computed tomography, and pre-, in-, and post-treatment panoramic radiographs were collected and measured for the changes in space, angles and alveolar bone at pre-, in-, and post-treatment stages.<div class="boxTitle">Results</div>Mandibular second molars showed progressive uprighting (the angle between MM2 and the mandibular plane increased to 95.70 ± 11.96°, p < .0001) and improved root parallelism (the angles between MM2 and the mandibular second premolar decreased to 8.45 ± 7.06°, p < .0001) after the treatment. While molar crowns exhibited no significant deviation from the standard arch form, roots predominantly shifted lingually (2.29 ± 1.84 mm lingually at post-treatment, p < .05). Regarding alveolar bone changes, there was a significant increase of bone height at the distal side of the mandibular first molar (p < .05), coupled with a decrease of bone height at the mesial side of the second molar (p < .05). Root lengths of all patients indicated no statistical significance before and after treatment (p = .63).<div class="boxTitle">Conclusion</div>Mini-implants placed at the mandibular ramus region are clinically effective in the orthodontic traction of impacted mandibular second molars. The orthodontic traction favours periodontal regeneration between first and second molars and bears no or minimal risk of root resorption of mandibular second molars.</span>
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