OBJECTIVE: The aim of this systematic review was to assess the occlusal outcome and duration of fixed orthodontic therapy from clinical trials in humans with the Objective Grading System (OGS) proposed by the American Board of Orthodontics.
METHODS: Nine databases were searched up to October 2016 for prospective/retrospective clinical trials assessing the outcomes of orthodontic therapy with fixed appliances. After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of the mean OGS score and treatment duration were performed and 95% confidence intervals (CIs) were calculated.
RESULTS: A total of 34 relevant clinical trials including 6,207 patients (40% male, 60% female; average age, 18.4 years) were identified. The average OGS score after treatment was 27.9 points (95% CI, 25.3-30.6 points), while the average treatment duration was 24.9 months (95% CI, 24.6-25.1 months). There was no significant association between occlusal outcome and treatment duration, while considerable heterogeneity was identified. In addition, orthodontic treatment involving extraction of four premolars appeared to have an important effect on both outcomes and duration of treatment. Finally, only 10 (39%) of the identified studies matched compared groups by initial malocclusion severity, although meta-epidemiological evidence suggested that matching may have significantly influenced their results.
CONCLUSIONS: The findings from this systematic review suggest that the occlusal outcomes of fixed appliance treatment vary considerably, with no significant association between treatment outcomes and duration. Prospective matched clinical studies that use the OGS tool are needed to compare the effectiveness of orthodontic appliances.

/pdf/outcomes-of-comprehensive-fixed-appliance-orthodontic-3xvf5omvxt.pdf

Outcomes of comprehensive fixed appliance orthodontic treatment: A systematic review with meta-analysis and methodological overview.

The purpose of this study was to investigate the most effective treatment timing with the chin cup in the treatment of the skeletal Class III malocclusion. The materials consisted of sixty-one cephalometric roentgenograms of seventeen males and forty-four females treated with the chin cup. Ages of children in the sample ranged from 3 years 11 months to 12 years 8 months at the beginning of active treatment. The A-B differences before and after treatment were measured to analyze the skeletal change that occurred. although the anterior cross-bite was corrected in all cases, the final values of the A-B differences were dependent upon the age treatment was started and the level of disharmony before treatment. The final values showed more improvement in the younger age group in the group with milder disharmony before treatment.

Effective timing for the application of orthopedic force in the skeletal classIII malocclusion

Objective To compare treatment duration between 0.018-inch and 0.022-inch slot systems and determine factors influencing treatment duration. Subjects and methods Eligible participants aged 12 years or over were allocated to the 0.018-inch or 0.022-inch slot MBT appliance (3M-Unitek, Monrovia, California, USA) using block randomization in groups of 10. Outcome measures included duration of: 1. overall treatment, 2. levelling and alignment, 3. working and finishing, and 4. appointment numbers and other treatment-related factors. Parametric tests (independent samples t-test) and non-parametric tests (chi-square with Fisher's exact tests and Mann-Whitney U-test) assessed differences between groups. A multiple linear regression analysis identified factors influencing treatment duration (P Results Of the 187 participants randomized (1:1 ratio), 34 withdrew or were excluded (protocol deviations or poor cooperation). There were 77 patients in the 0.018-inch slot group and 76 patients in the 0.022-inch slot group (overall mean age: 19.1 years). Baseline characteristics were similar between groups (P > 0.05). The mean duration of treatment for the 0.018-inch and 0.022-inch slot groups was 29.3 and 31.2 months, respectively. There were no statistically significant differences between the two treatment groups in terms of treatment duration, duration of the key stages of treatment, and number of appointments (P > 0.05). The regression analysis revealed 33.0 per cent of variance in treatment duration was explained by age at bonding, Class II division 2 malocclusion, number of failed appointments, number of emergency appointments, and transfer to another clinician. There were no adverse events. Limitations It was impossible to blind clinicians or patients to allocation and oral hygiene and periodontal outcomes were not assessed. Conclusions There was no statistically or clinically significant difference in treatment duration between 0.018-inch and 0.022-inch slot bracket systems. Increasing patient age, Class II division 2 malocclusion, number of failed and emergency appointments, and multi-operator treatment all increase orthodontic treatment duration. Registration The trial was registered with ClinicalTrials.gov on 5 March 2014, registration number: NCT02080338. Protocol The protocol was published at DOI: 10.1186/1745-6215-15-389.

/pdf/a-randomized-clinical-trial-of-the-effectiveness-of-0-018-141k99tgrd.pdf

A randomized clinical trial of the effectiveness of 0.018-inch and 0.022-inch slot orthodontic bracket systems: part 2-quality of treatment.

Objectives The aim of this study was to evaluate the qualitative occlusal changes in individuals with normal occlusion during a period of 47 years. Materials and methods The sample comprised dental models of 20 subjects with normal occlusion (8 males; 12 females) taken at 13.2 years (T1) and 60.9 years of age (T2). The occlusal features were evaluated with the objective grading system (OGS) and with the six keys to normal occlusion (SKNO). The subjects also answered a questionnaire on the aesthetic and occlusal self-perception at T2. Comparisons from T1 to T2 were performed with paired t- and McNemar tests (P less than 0.05). Results OGS analysis showed a significant improvement in the marginal ridge levelling and tooth buccolingual inclination. There was a significant deterioration of the antero-posterior occlusal relationship from T1 to T2. Subjects without tooth loss showed a dental alignment worsening between time points. The marginal ridges, buccolingual inclination, and interproximal contacts improved. The SKNO analysis showed a significant deterioration of the maxillary second molars buccolingual inclination and an improvement of the maxillary second molar angulation. All patients were satisfied with their smiles, and 60 per cent of the subjects had no complaints. Dental crowding caused dissatisfaction in 35 per cent of the sample. Limitations A limitation of this study was the high prevalence of tooth loss in the sample from T1 to T2. Only 30 per cent of the subjects had no tooth loss in T2. Conclusions The aging process slightly deteriorates some occlusal features of individuals with normal occlusion. However, most individuals were satisfied with their aesthetics and occlusal comfort at the sixth decade of life.

Aging of the normal occlusion

Radiographs are considered essential in orthodontics. However, their diagnostic value and indications for use are still uncertain, while exposure to radiation carries health risks. This study aimed to report on the development of a clinical practice guideline on orthodontic radiology. A Guideline Development Taskforce was set up. The GRADE methodology was used for development and the RIGHT Statement for reporting of the guideline. We systematically reviewed articles to address the main clinical question: how different types of radiographs contribute to orthodontic diagnosis, treatment planning and post-treatment outcome evaluation. After a literature search and data extraction, we formulated conclusions and assessed the strength of the evidence according to the GRADE method. Both literature conclusions and the most important considerations, such as patient preferences, organizational matters and expert opinions were taken into account to finally issue recommendations. 7 clinical questions focused on orthopantomograms, lateral cephalograms, hand-wrist radiographs, peri-apical radiographs, bitewings, antero-occlusal radiographs, and cone-beam computer tomographic imaging. The literature search lead to 484 unique studies, of which 17 were included in the analysis. The strength of evidence of the conclusions was graded low or very low. We formulated considerations and took them into account when issuing the 13 clinical recommendations to address the clinical questions. There was a considerable lack of scientific evidence on this topic. Nonetheless, this guideline provides clinicians with a tool for decision-making regarding radiographic records while enhancing patient radiation protection. More research of higher quality is recommended for a future update.

/pdf/orthodontic-radiology-development-of-a-clinical-practice-upe0v1w6dd.pdf

Orthodontic radiology: development of a clinical practice guideline.

Validation of the American Board of Orthodontics Objective Grading System for assessing the treatment outcomes of Chinese patients.

This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13 873 Spearman rs values, ranging from –0.08 to +0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component (R2=0.86, P<0.000 1), while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment (R2=0.96, P<0.000 1). Grading scores for SC+LX and SC+PH were highly significantly correlated with those for SC+LX+PH (r(SC+LX)vs.(SC+LX+PH)=0.96, r(SC+PH)vs.(SC+LX+PH)=0.97), showing that either SC+LX or SC+PH is an excellent substitute for all three combined assessment.

/pdf/reliability-assessment-and-correlation-analysis-of-2264zaou9b.pdf

Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients.

Developing skeletal Class III malocclusion treated nonsurgically with a combination of a protraction facemask and a multiloop edgewise archwire.

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Validation of the American Board of Orthodontics Objective Grading System for assessing the treatment outcomes of Chinese patients.

Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients.

Developing skeletal Class III malocclusion treated nonsurgically with a combination of a protraction facemask and a multiloop edgewise archwire.