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Treatment effects of various prescriptions and techniques for fixed orthodontic appliances

A systematic review

Therapeutische Effekte unterschiedlicher Systeme und Techniken für festsitzende kieferorthopädische Apparaturen

Ein systematischer Review

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Purpose

Although several prescriptions and techniques exist for comprehensive fixed appliance treatment, their treatment effects have not yet been adequately assessed in an evidence-based manner. The aim of this systematic review was to assess the therapeutic and adverse effects of various prescriptions or techniques for orthodontic appliances from randomized clinical trials on human patients.

Methods

Eight databases were searched up to July 2016 for randomized trials assessing any orthodontic prescriptions or techniques in human patients. After elimination of duplicate studies, data extraction, and risk of bias assessment according to the Cochrane guidelines, random effects meta-analyses with mean differences (MD) and their 95% confidence intervals (CIs) were performed.

Results

Compared to Roth preadjusted appliances, both Begg and modified Begg appliances were associated with statistically significantly worse occlusal outcome assessed with Peer Assessment Review (PAR) scores (1 trial, MD 3.1 points, 95% CI 1.9–4.3 points and 1 trial, MD 2.4 points, 95% CI 1.2–3.6 points, respectively) with low quality of evidence, due to bias and imprecision. Compared to a partially programmed fixed orthodontic appliance, a fully programmed appliance was associated with a statistically significant, but clinically irrelevant increase in treatment duration (1 trial, MD 2.4 months, 95% CI 0.6–4.2 months), supported by high quality of evidence. However, caution is needed in the interpretation of these results as only a limited number of small trials with methodological issues were available.

Conclusions

Based on existing trials, there is limited evidence to support any robust clinical recommendation regarding the prescriptions or techniques for fixed orthodontic appliances.

Registration: PROSPERO (CRD42016042727).

Funding: None.

Zusammenfassung

Zielsetzung

Zwar gibt es etliche Systeme und Techniken für eine umfassende Behandlung mit festsitzenden kieferorthopädischen Apparaturen, doch ihre Effekte sind noch nicht angemessen evidenzbasiert erforscht worden. Ziel dieses systematischen Reviews war die Untersuchung von sowohl therapeutisch erwünschten als auch unerwünschten Auswirkungen unterschiedlicher Systeme bzw. Techniken für kieferorthopädische Apparaturen mittels randomisierter klinischer Studien an menschlichen Patienten.

Methoden

In 8 Datenbanken wurde nach randomisierten klinischen Humanstudien zu kieferorthopädischen Systemen oder Techniken recherchiert. Nach Eliminierung von Duplikaten, Datenextraktion und Einsatz des Risk-of-Bias-Tools der Cochrane Collaboration wurden Metaanalysen unter Anwendung eines random effect model sowie von mittleren Differenzen (mean differences, MDs) und deren 95% Konfidenzintervallen (KI) durchgeführt.

Ergebnisse

Im Vergleich mit den Roth-Apparaturen zeigten sowohl die Begg- als auch die modifizierten Begg-Apparaturen nach PAR(“peer assessement review”)-Scores (eine Studie, MD 3,1 Punkte, 95%-KI 1,9-4,3; eine Studie, MD 2,4 Punkte, 95%-KI 1,2-3,6) ein hinsichtlich der Okklusion statistisch signifikant ungünstigeres Outcome, allerdings mit geringer Evidenzqualität bedingt durch Bias und mangende Präzision. Verglichen mit einer teilweise programmierten festsitzenden kieferorthopädischen Apparatur war eine vollständig programmierte Apparatur assoziiert mit einer statistisch signifikanten, klinisch jedoch weitgehend irrelevanten Verlängerung der Behandlungsdauer (eine Studie, MD 2,4, 95%-KI 0,6-4,2 Monate), unterstützt durch eine hohe Evidenz-Qualität. Da nur eine begrenzte Anzahl kleiner, methodisch nicht unproblematischer Studien zur Verfügung stand, sind diese Ergebnisse allerdings mit Vorsicht zu interpretieren.

Schlussfolgerungen

Auf der Basis verfügbarer Studien besteht nur eine sehr limitierte Datenlage, anhand derer sich klinische Empfehlungen hinsichtlich Systeme bzw. Techniken für festsitzende kieferorthopädische Apparaturen evidenzbasiert unterstützen ließen.

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Acknowledgements

The authors would like to thank J. O’Neil (Kettering General Hospital, UK) for providing unpublished data.

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Authors and Affiliations

  1. Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force General Hospital, Athens, Greece

    Sophia Mousoulea

  2. Clinic of Orthodontics and Pediatric Dentistry, Faculty of Medicine, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland

    Spyridon N. Papageorgiou & Theodore Eliades

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  1. Sophia Mousoulea
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  2. Spyridon N. Papageorgiou
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  3. Theodore Eliades
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Correspondence to Theodore Eliades.

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S Mousoulea, S.N. Papageorgiou, and T. Eliades state that they have no competing interests.

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Mousoulea, S., Papageorgiou, S.N. & Eliades, T. Treatment effects of various prescriptions and techniques for fixed orthodontic appliances. J Orofac Orthop 78, 403–414 (2017). https://doi.org/10.1007/s00056-017-0094-0

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