This section is designed to draw the attention of readers to papers that have been recently published in other non-orthodontic journals that may be of interest. The abstracts have been selected and edited by Sara Stephens, Croydon University Hospital, London UK and Howard Moseley, Eastman Dental Hospital, London UK.
Kankam H, Madari S, Sawh-Martinez R, Bruckman KC, Steinbacher DM. 2019. Comparing outcomes in orthognathic surgery using clear aligners versus conventional fixed appliances. The Journal of Craniofacial Surgery. Epub ahead of print. DOI: 10.1097/SCS.0000000000005572
Aims:
This study evaluated post-operative outcomes in Invisalign patients undergoing orthognathic procedures.
Methods:
This retrospective study was carried out in Yale University School of Medicine. This study was not powered and no sample size calculation was carried out. Patients were included if they were treated from January 2015 to August 2017 with orthognathic surgery and orthodontic treatment involving Invisalign. The authors included orthognathic patients undergoing ‘triple-jaw’ surgery which included a Le Fort 1 osteotomy, bilateral sagittal split osteotomy and a genioplasty. Patients were excluded if they were treated with lingual fixed appliances or additional craniofacial procedures. The authors compared the patients using a control group who were treated with conventional labial fixed appliances. The authors stated that the cohorts were matched and details were recorded including age, sex, body mass index and occlusal diagnosis, however no raw data was provided. Pre-surgical active and passive aligners were fitted prior to orthognathic surgery. The authors described the need for the use of surgical splints to facilitate the osteotomies and the placement of bone anchor screws at the mucogingival junction between the central incisors and between the second premolar and molars in each quadrant. No information was provided about the surgical or orthodontic management of the control group. Three-dimensional photographic imaging was obtained for patients’ pre-treatment, 8-14 days post operatively and at 6 months after surgery. Images were superimposed using landmarks, and volume differences were calculated in order to assess post-operative oedema. The researchers mention that a single investigator analysed the photographs in order to minimise inter-operator variability and a repeatability study was carried out with the investigator repeating the analysis 3 weeks later. Unfortunately, the outcome of the repeatability study was not included in the results.
Results:
33 patients were included in the study of which 13 were treated with Invisalign and 20 with fixed appliances. The authors did not include the patient demographics but reported that there was no significant difference in sex, occlusal diagnosis, operating time, extraction of teeth, duration of hospital stay, diet and the use of analgesics. There was no data reporting the severity of skeletal pattern or malocclusion pre-operatively. No information was given regarding the statistical tests used. The researchers concluded there was no significant difference in post-operative oedema between patients treated with fixed appliances and Invisalign cohorts; however they did not indicate whether this was a statistical or clinical difference.
Conclusion:
The authors concluded they were able to demonstrate that orthognathic procedures can be successful for Invisalign patients.
Comments
: This study aimed to assess post-operative outcomes in patients treated with Invisalign and conventional fixed appliances; however they only reported on post-operative oedema and failed to look at other outcomes such as occlusal indices, patient satisfaction or treatment length. This study was not powered and the study failed to consider confounding factors which could have impacted on the patients’ post-operative healing.
Kocsis C, Sommerlath Sohns JM, Graf I, Dreiseidler T, Kreppel M, Rothamel D, Zinser M, Sommerlath Sohns HC, Derlin T, Braumann B, Zöller JE, Ritter L. 2019. Incidental findings on craniomaxillofacial cone beam computed tomography in orthodontic patients. International Journal of Computerized Dentistry. 22:149–162
Aims:
To detect the prevalence of incidental findings on CBCT scans of orthodontic patients.
Methods: This was a retrospective, observational study carried out over a six-year period from 2005 to 2011. Ethical approval was obtained from the University of Cologne and the study adhered to the Declaration of Helsinki. There was no sample size calculation. The researchers did not have an inclusion or exclusion criteria. The justification for the CBCT images were tabulated and included surgery planning, cheilognathouranoschisis, craniofacial malformation, dental anomaly, dysfunction in tooth eruption, anomaly or dysplasia of tooth root, jaw fracture, pathological bone structure and ‘others’. It was not stated how many centres were involved in the study. The CBCT scanner used had a 23cm image intensifier, the reconstruction volume size was 15 x 15 x 15cm and the isotrophic voxel sizes used were 0.3mm. Images were viewed in axial, transverse, sagittal and coronal slices. The researchers’ reported that all images were assessed under standardised conditions at the same examination work station. No reliability study was undertaken. Two dentists reported on the scans independently and any differences were addressed through consensus and a radiologist opinion sought to clarify the findings. It was not clear what level of training the dentists reporting on scans had. The incidental findings were divided up into four groups; dental, sinus and nasal, skeletal and other pathologies. Dental findings were categorized as aplasia, hyperdontia, hypoplasia, oligodontia, missing wisdom tooth, apical blooming, apical calcification, taurodontism, transpositions and close germ position. Skeletal findings were categorised as odontogenic, non-odontogenic cyst, vertical or horizontal bone loss, fracture. Sinus and nasal pathologies were classified into maxillary, odontogenic, suppurative frontal sinusitis, partial or total opacification, chronic or acute sinusitis, nasal septum deviation, deep recess and foreign substances. Other pathologies included carotid artery stenosis, fractures of the cervical spine, sialoliths, calcified tonsils or tonsilloliths.
Results:
The majority of the scans were for surgical planning (31.3%) followed by other reasons (23.2%) which included location of nerve exit points, temporo-mandibular joint disease and implant planning. CBCT scans were also carried out for dislocation (8.7%), craniofacial malformation (5.2/%), dental anomaly (4.1%) and jaw fracture (3.5%). 502 incidental findings were found on the 345 patient CBCT scans. Just over 70% of incidental findings were classified as dental followed by skeletal (25.7%), sinus and nasal (2.8%) and other pathologies (0.2%). Other pathological findings included fracture of the cervical spine and calcified tonsil. The most common dental incidental finding was a missing third molar (23.7%) followed by aplasia (18.7%) and dislocation (14.1%). The authors did not describe what they categorised as a dislocation. The most common skeletal incidental findings were vertical bone loss (1.4%) followed by odontogenic cyst (1%) and horizontal bone loss (0.4%). The most common incidental findings within the sinus were partial opacification (6.6%) followed by nasal septum deviation (6.2%) and sinusitis (5.4%).
Conclusion:
The authors concluded that incidental findings on CBCT scans occur frequently and comment that the detection of severe incidental clinical findings is lower than previously published CT studies. The authors have not made recommendations on training requirements for interpreting CBCT images.
Comment:
The use of CBCT imaging is becoming increasingly popular to aid diagnosis and assist with treatment planning for dental patients. This study highlights the need for clinicians to be aware of the likelihood of incidental findings on CBCT images and is a reminder that sufficient training is required to identify anomalies especially if dental CBCT scans include areas outside the dento-alveolar region.
Zotti F, Zotti R, Albanese M, Nocini PF, Paganelli C. 2019. Implementing post-orthodontic compliance among adolescents wearing removable retainers through Whatsapp: a pilot study. Patient Preference and Adherence. 23:609–615. DOI: 10.2147/PPA.S200822
Aims:
To determine whether social media is useful in improving compliance and follow-up attendance among patients wearing retainers after orthodontic treatment.
Methods:
This was a randomised, prospective, observational study carried out in Italy. Ethical approval was not mentioned by the authors and it was not stated how many centres were included in the study. A sample size calculation was carried out and 60 patients were recruited from 2012 to 2014. The researchers outlined inclusion and exclusion criteria. Patients were included if they were caucasian, if they owned a smartphone, if they were able to access the internet on a daily basis, had been treated with fixed orthodontic appliances and had presented with mild or moderate crowded Class I malocclusion. The exclusion criteria included a significant medical history, restrictive dietary regime, habits (nail biting, object biting, cheek/lip biting), difficulties in reading or speaking the national language. The authors did not elaborate on what they classified as a significant medical history or restrictive diet. The study used stratified randomisation taking into account the baseline Little irregularity index value. Both patient groups were given instructions on retainer wear and retainer management following fixed appliance treatment. Patients were advised to wear their retainers for eight hours or more. It was not specified how many clinicians were involved in providing retainer advice or how the information was delivered to the patients. The control group were given review appointments every four months. The intervention group were engaged in a social media chat group called ‘Whatsapp,’ which was moderated by one of the authors. Patients were asked to create a fictional nickname and take part in the “Relapse Game” by sharing a selfie photograph of their teeth on a weekly basis. The moderator assessed the photographs qualitatively and published a ranking of the five best participants of the month. Patients were reviewed at three time points; after 4 months, after 8 months and after 12 months. Impressions were taken at each review and the intercanine width was measured with a digital calliper by the same blinded operator. No reliability study was carried out. The measurements were taken three times at 15-minute intervals and the mean value was recorded.
Results:
The authors included a flow diagram which showed that 88 patients were assessed for study eligibility of which 16 did not meet the study criteria and 12 declined to participate. The follow up attendance was regular in both groups in the first 8 months. Following this, 8 participants in the control group were lost to follow up. There were none lost to follow ups in the intervention group. The authors commented that the high dropout rate in the control group was probably due to lack of motivation in attending follow up appointments. The authors did not comment on the distribution of the data. It is assumed the data was non parametric given that a Mann-Whitney test was carried out to assess the inter-group difference in intercanine width and a Friedman’s test was carried out for intra-group differences in intercanine width at different time points. The authors reported that the intervention group had smaller changes in intercanine width compared to the control group; however it is unclear whether this was clinically significant. There was a statistically significant difference in intercanine width between the different time points in both groups; however no comment was made with regards to clinical significance.
Conclusion:
The authors concluded that engaging adolescent patients directly through WhatsApp activity increased retainer wear and attendance to retainer review appointments, which could lead to improved orthodontic stability and compliance.
Comment:
This study suggests that engaging patients with social media in the retention phase has the potential to increase patient compliance in attending retainer review appointments; however it is questionable whether this directly impacts on retainer wear and preventing orthodontic relapse.
