Publications by authors named "Eleftherios G Kaklamanos"

42 Publications

Effect of ovariectomy-induced osteoporosis on the amount of orthodontic tooth movement: a systematic review of animal studies.

Eur J Orthod 2021 Apr 18. Epub 2021 Apr 18.

Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: Understanding the impact of osteopenia and osteoporosis on orthodontic tooth movement could be of benefit to the orthodontist, but research in humans presents practical and ethical problems. The ovariectomized animal model could provide useful information on osteoporosis.

Objective: To compare the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects.

Search Methods: Unrestricted searches in seven databases and manual searching of the reference lists in relevant studies were performed up to February 2021 (PubMed, Central, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Arab World Research Source, ProQuest Dissertations, and Theses Global).

Selection Criteria: We searched for studies quantitatively comparing the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects.

Data Collection And Analysis: Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model.

Results: Thirteen studies were finally selected and no specific concerns regarding bias were identified. During the active period, ovariectomy was associated with a statistically significant acceleratory effect on the rate of orthodontic tooth movement compared to non-treated rats (3 weeks; 4 studies, 0.15 mm more movement in the ovariectomized rats; 95 per cent confidence interval: 0.10-0.19; P = 0.000). Exploratory meta-regression showed that this difference could increase over time. Following force discontinuation, no statistically significant differences were observed [3 weeks; 1 study (median ± SE), Ovariectomy group: 0.30 ± 0.04 mm; Sham operation group: 0.18 ± 0.03; P = 0.1558].

Conclusions: Ovariectomy-induced osteoporosis may affect the rate of orthodontic tooth movement. Although animal studies should be approached with caution regarding their translational potential, the safe practice would suggest that one should consider potential implications.

Registration: PROSPERO (CRD42018118003).
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http://dx.doi.org/10.1093/ejo/cjab013DOI Listing
April 2021

Effect of nicotine exposure on the rate of orthodontic tooth movement: A meta-analysis based on animal studies.

PLoS One 2021 17;16(2):e0247011. Epub 2021 Feb 17.

Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: Nicotine exposure has been reported to modify bone cell function and the osseous metabolism with potential effects on the rate of orthodontic tooth movement.

Objectives: To systematically investigate and quantitively synthesize the most recent available evidence from animal studies regarding the effect of nicotine exposure on the rate of orthodontic tooth movement.

Search Methods: Unrestricted searches in 7 databases and hand searching were performed until July 2020 (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ProQuest Dissertations and Theses Global).

Selection Criteria: We searched for controlled studies on healthy animals investigating the effect of nicotine on the rate of orthodontic tooth movement.

Data Collection And Analysis: Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model.

Results: From the initially identified records, 5 articles meeting the inclusion criteria were selected and no specific concerns regarding bias were identified. Quantitative data synthesis showed that the rate of orthodontic tooth movement in the nicotine exposed rats was higher than in the control group animals (2 weeks of force application; 0.317 mm more movement in nicotine exposed rats; 95% Confidence Interval: 0.179-0.454; p = 0.000). No effect of the concentration or the duration force application was demonstrated following exploratory meta-regression.

Conclusion: Rats administered with nicotine showed accelerated rates of orthodontic tooth movement. Although, information from animal studies cannot be fully translated to human clinical scenarios, safe practice would suggest that the orthodontist should be able to identify patients exposed to nicotine and consider the possible implications for everyday clinical practice.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247011PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888643PMC
February 2021

Microbial Metabolic Genes Crucial for Biofilms: An Insight From Re-analysis of Publicly Available Microarray Datasets.

Front Microbiol 2020 28;11:607002. Epub 2021 Jan 28.

College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Bacterial biofilms are microbial lifestyles found in all environments. Up to 80% of human infections and 60-70% of hospital-acquired infections have a biofilm origin, with one of the leading causes of these infections. Microorganisms in biofilms exhibit significant antimicrobial resistance which poses important treatment challenges, hence the urgent need to identify novel antibiofilm strategies. Microbes form biofilms in response to various factors, and once these 3-dimentional structures form they are highly recalcitrant to removal. The switch from planktonic lifestyle to the biofilm protected mode of growth results in a phenotypic shift in the behavior of the microorganisms in terms of growth rate and gene expression. Given these changes, investigation of microbial gene expression and their modulation at different stages of biofilm maturation is needed to provide vital insight into the behavior of biofilm cells. In this study, we analyzed publicly available transcriptomic dataset of biofilms at different stages of maturation to identify consistently upregulated genes irrespective of the biofilm maturation stage. Our reanalysis identified a total of 6 differentially expressed genes upregulated in both 48 and 144-h old biofilms. Functional analysis revealed that these genes encode for proteins which play a role in key microbial metabolic pathways. However, these genes, as yet, are unrelated or fully studied in the context of biofilm. Moreover, the findings of this work, suggest that these genes may represent potential novel targets for the development of more effective antibiofilm strategies against biofilm-associated infections.
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http://dx.doi.org/10.3389/fmicb.2020.607002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876462PMC
January 2021

Does the rate of orthodontic tooth movement change during pregnancy and lactation? A systematic review of the evidence from animal studies.

BMC Oral Health 2020 08 27;20(1):237. Epub 2020 Aug 27.

Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Building 34, Dubai Healthcare City, Dubai, United Arab Emirates.

Background: The changes in bone homeostasis observed during pregnancy and lactation could result in alterations in the rate of orthodontic tooth movement, but research in human subjects presents significant ethical and practical limitations. Our aim was to compare the amount of orthodontic tooth movement between pregnant/lactating or not animals.

Methods: We searched without restrictions 8 databases and performed hand searching until July 2019 (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ClinicalTrials.gov , ProQuest Dissertations and Theses Global). We searched for studies comparing quantitatively the amount of orthodontic tooth movement between pregnant/lactating or not animals. Following retrieval and selection of studies, the collection of related data was performed and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis was carried out using the random effects model.

Results: Four studies were finally identified raising no specific concerns regarding bias. One study showed that lactation increased the rate of tooth movement by 50 % [p < 0.05]. Although an overall increase was noted in the pregnancy group as well, it did not reach statistical significance [3 studies, Weighted Mean Difference: 0.10; 95% Confidence Interval: - 0.04 - 0.24; p = 0.165].

Conclusions: The metabolic changes occurring during pregnancy and lactation may have an impact on the rate of tooth movement in animals. Although these animal experimental results should be approached cautiously, it could be safe practice to consider the impact of these physiological changes in the clinical setting.

Registration: PROSPERO (CRD42018118003).
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http://dx.doi.org/10.1186/s12903-020-01223-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450973PMC
August 2020

Orthodontic Procedures, With or Without Extracting Primary Canines, for the Interceptive Management of Palatally Displaced Permanent Canines: A Systematic Review.

J Dent Child (Chic) 2020 May;87(2):60-68

Dr. Athanasiou is a professor and an executive dean, Department of Dentistry, European University Cyprus, Nicosia, Cyprus.

Although rapid maxillary expansion (RME), transpalatal arch (TPA) and cervical-pull headgear (HG) have been suggested for the interception of palatally displaced permanent canines (PDCs), existing knowledge remains inconclusive. The purpose of this study was to assess these practices in an evidence-based manner.
Randomized controlled trials (RCTs) investigating the prevalence of physiologic PDC eruption after using RME, TPA and HG, with or without the extraction of the primary canines, were searched, and the risk of bias was assessed.
Data from five RCTs were included. RME, TPA and HG, with or without extracting primary canines, can significantly increase the rate of normal eruption of PDCs compared to no intervention (risk ratio [RR] = 2.5 to 4.5). In comparison to extraction, no difference was observed, except for HG combined with primary canine extraction (RR = 1.413; 95 percent confidence interval = 1.062 to 1.880).
RME, TPA and HG can significantly increase the rate of normal eruption of PDC compared to no intervention. However, when compared to extraction, no differences were noted, except for HG combined with primary canine extraction.
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May 2020

Could medications and biologic factors affect post-orthodontic tooth movement changes? A systematic review of animal studies.

Orthod Craniofac Res 2021 Feb 5;24(1):39-51. Epub 2020 Aug 5.

Department of Dentistry, European University Cyprus, Nicosia, Cyprus.

Immediately after the removal of orthodontic appliances, the teeth might start to drift away from their corrected position in an attempt to reach a new equilibrium. Medications and biologic factors could potentially modulate these processes. The objective of the present systematic review is to systematically investigate and appraise the quality of the evidence regarding the effect of various medications and biologic factors on the rate of relapse following active tooth movement. Search without restrictions in eight databases and hand searching until April 2020 were conducted. Studies performed on animal models investigating the effects of medication and biologic factors on the rate of relapse following orthodontic tooth movement were considered. Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed. Seventeen studies were finally identified, mostly at either high or unclear risk of bias. Ketorolac did not show any significant effects on relapse, while the administration of tetracycline, atorvastatin, psoralen and raloxifene decreased it. Overall, the same result was observed with bisphosphonates with the exception of low dosage of risedronate, which did not have an effect. Osteoprotegerin and strontium resulted in reduced relapse, but not in the immediate post-administration period. Inconsistent or conflicting effects were noted after the use of simvastatin and relaxin. The quality of the available evidence was considered at best as low. It can be concluded that specific medications and biologic factors may have an effect on the rate of relapse following tooth movement. The orthodontist should be knowledgeable about the substances potentially affecting retention.
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http://dx.doi.org/10.1111/ocr.12411DOI Listing
February 2021

Effects of orthodontic forces on bone turnover biomarkers in peri-miniscrew crevicular fluid: A systematic review.

Int Orthod 2020 Sep 22;18(3):403-411. Epub 2020 Apr 22.

Aristotle University of Thessaloniki, Department of Preventive Dentistry, Periodontology and Implant Biology, Thessaloniki, Greece.

Objective: Peri-miniscrew crevicular fluid (PMCF) analysis of biomarkers representing bone formation or resorption could provide a non-invasive way to monitor bone turnover around miniscrews and the response to force loading. Our objective was to systematically investigate the relevant available evidence.

Materials And Methods: Search without restrictions in eight databases and hand searching until March 2020 took place. We searched for prospective human studies measuring the levels of markers of bone formation and resorption in PMCF under the effect of orthodontic forces. Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed following the Cochrane Collaboration guidelines.

Results: Four studies, two randomized and two non-randomized, were finally identified, following miniscrews for a period up to 90 days. Loading of miniscrews led to a transient increase in C-telopeptide of type I collagen amounts. Temporary increases were also observed for the enzymes: alkaline phosphatase and aspartate aminotransferase. Under the effect of orthodontic loading the total amount of Receptor Activator of Nuclear Factor-κB Ligand (RANKL) in the PMCF consistently increased compared to the unloaded group, at all sampling points. These changes led to a stable decrease in the osteoprotegerin (OPG)/RANKL ratio under force application throughout the study period, as OPG in this group, together with OPG and RANKL in the unloaded group, remained mostly unchanged. No differences were detected for the total OPG quantity between the two loading groups. The levels of bone specific alkaline phosphatase and chondroitin sulfate did not change significantly during observation. All studies presented some issues of concern regarding the risk of bias.

Conclusion: Biomarkers of bone turnover in PMCF showed variable responses following orthodontic loading. Overall, the findings were suggestive of adaptive bone alterations to physiologic force stimuli.
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http://dx.doi.org/10.1016/j.ortho.2020.03.005DOI Listing
September 2020

Do probiotics promote oral health during orthodontic treatment with fixed appliances? A systematic review.

BMC Oral Health 2020 04 25;20(1):126. Epub 2020 Apr 25.

Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences, Building 34, Dubai Healthcare City, Dubai, United Arab Emirates.

Background: Treatment with fixed orthodontic appliances has been associated with significant biofilm accumulation, thus putting patients at a higher risk of oral health deterioration. The use of probiotics has been proposed to be useful in the prevention or treatment of oral pathologies such as caries and diseases of periodontal tissues. Our aim was to investigate the effects of probiotic use on inflammation of the gingival tissues and the decalcification of the enamel in patients being treated with fixed orthodontic appliances.

Methods: We searched without restrictions 8 databases and performed hand searching until September 2019. We searched for randomized controlled trials (RCTs) evaluating whether individuals with fixed orthodontic appliances benefit from probiotic treatment in terms of the inflammation of the gingivae and decalcification of the enamel. Following the selection of studies and the extraction of pertinent data, we appraised the risk of bias and the confidence in the observed effects based on established methodologies.

Results: From the final qualifying studies, three did not show any statistically significant effect on gingival inflammation after probiotic administration of up to 1 month. Similarly, non-significant differences were noted in another study regarding white spot lesions development (mean administration for 17 months). No adverse effects were reported and the level of evidence was considered moderate.

Conclusions: Supplementation of orthodontic patients with probiotics did not affect the development of inflammation in the gingivae and decalcification in the enamel. Additional RCTs, with longer intervention and follow-up periods, and involving different combinations of probiotic strains are required.

Trial Registration: PROSPERO (CRD42018118008).
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http://dx.doi.org/10.1186/s12903-020-01109-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183645PMC
April 2020

Tooth Wear in a Sample of Community-Dwelling Elderly Greeks.

Oral Health Prev Dent 2020;18(1):133-138

Purpose: Increased wear of teeth may constitute a major problem in the future for the elderly. The aim of the present study was to investigate tooth wear in a sample of elderly Greeks and explore the presence and extent of severe occlusal/incisal wear in relation to the parameters of age, gender and remaining teeth.

Materials And Methods: A convenience sample of 70 dentate elderly (60-92 years old) was examined. Tooth wear was assessed using a modification of the tooth wear index. The presence of severe occlusal/incisal wear was explored using the multiple correspondence analysis (MCA) and x2 tests and the extent (% of surfaces) with analysis of variance (ANOVA).

Results: Increased prevalence of severe wear was observed in the occlusal/incisal and, to a lesser extent, in the cervical surfaces of the examined teeth. Seventy per cent (70%) of the participants had at least one severely worn tooth surface. Advanced age seemed to be associated with severe occlusal/incisal wear (>70 years: 79.4%; 60-70 years: 52.8%; x2 test, p = 0.024). The mean (± SD) percentage of severely worn teeth and surfaces was 34.2 ± 32.6% and 9.6 ± 9.6%, respectively. ANOVA showed that males and those with less than 20 remaining teeth exhibited more severely worn occlusal/incisal surfaces (p = 0.031 and p = 0.000, respectively).

Conclusions: The presence and the extent of severe wear in the sample of the examined elderly is high compared to elderly populations in other countries. Severe wear was more prevalent with advanced age and more extensive in the occlusal/incisal surfaces in males and those having less than 20 remaining teeth.
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http://dx.doi.org/10.3290/j.ohpd.a43348DOI Listing
April 2020

Molecular Characterization of Isolates Associated with Nasal Colonization and Environmental Contamination in Academic Dental Clinics.

Microb Drug Resist 2020 Jun 7;26(6):661-669. Epub 2020 Jan 7.

InfectoGnostics Research Campus Jena, Jena, Germany.

To determine the genetic makeup of methicillin-sensitive/methicillin-resistant (MSSA/MRSA) from nasal colonization and environmental contamination in dental clinics. Nasal swabs from students and health care workers and environmental swabs were obtained at two academic dental clinics in the United Arab Emirates. The StaphyType DNA microarray-based assay was used for molecular characterization. Forty-eight isolates were identified phenotypically (nasal:  = 43; environmental:  = 5), but 6 of these were assigned to by genotyping. These were CC2596, CC2250-MSSA, CC2250-MSSA-(Panton Valentine leukocidin [PVL]+) ( = 2), and CC2198-MSSA ( = 2). MRSA nasal colonization rate was 5.4% (n/ = 8/146) with the following strain affiliations: CC5-MRSA-[IV++], "Maltese Clone"; CC6-MRSA-IV, "WA MRSA-51"; CC22-MRSA-IV (PVL+/); CC22-MRSA-[IV+]; and two each of CC5-MRSA-[VI+] and CC97-MRSA-[V/VT+]. The SCC-borne fusidic acid resistance () gene was detected in MRSA ( = 5) and MSSA ( = 1). Some MSSA strains, CC1-MSSA-[+] and ST1278-MSSA-[], harbored recombinase genes. A CC30-MSSA harbored ACME locus/-genes, while ST1278-MSSA-[] had an ACME-III element. Enterotoxin genes were commonly carried, but gene was found in only CC22, CC30, and CC34 strains, while genes were identified in CC2250 and CC22-MRSA-IV. Of the 51 noncoagulase staphylococci (CoNS) identified, 18 were positive. The findings demonstrate the first report of rare strains (ST1278 MSSA, CC2198, CC2596, and PVL+CC2250) in our region. Detection of MSSA with recombinase genes and ACME loci alongside -positive CoNS is of clinical significance as this could provide a milieu for acquisition and transfer of SCC-elements, either with different ACME types, with or the gene resulting in conversion of MSSA into MRSA.
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http://dx.doi.org/10.1089/mdr.2019.0318DOI Listing
June 2020

Do analgesics used for the pain experienced after orthodontic procedures affect tooth movement rate? A systematic review based on animal studies.

Orthod Craniofac Res 2020 May 9;23(2):143-150. Epub 2019 Nov 9.

Department of Dentistry, School of Medicine, European University Cyprus, Nicosia, Cyprus.

Background: Using analgesics for a short period to relieve the pain following specific orthodontic procedures is common. Such medications may influence orthodontic tooth movement biochemical pathways; however, the information originating from human studies is limited.

Objectives: To systematically investigate current evidence from animal experiments on the effect of administering analgesics for a few days, which is consistent with usual clinical practice, on the speed of orthodontic tooth movement.

Search Methods: Eight databases were searched without restrictions, and hand searching was conducted until June 2019.

Selection Criteria: Animal controlled studies assessing the short-term impact of analgesics that can be consumed for orthodontic pain on the speed of orthodontic tooth movement.

Data Collection And Analysis: Subsequent to retrieving relevant studies and information extraction, the SYRCLE's Risk of Bias Tool was used for risk of bias assessment.

Results: Finally, seven studies were selected, and most of them were assessed at unclear risk of bias. Short-term administration of acetaminophen did not affect significantly the speed of tooth movement, while ibuprofen and indomethacin were reported to decrease it. After administering acetylsalicylic acid and celecoxib, the noted effects were inconsistent. The quality of the available evidence for the animal setting was considered as moderate at most.

Conclusions: Consuming specific analgesics for a few days may influence the speed of orthodontic tooth movement in animals. Clinicians should be aware of the relevant implications and be capable to identify those substances that may not interfere with treatment processes.
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http://dx.doi.org/10.1111/ocr.12357DOI Listing
May 2020

Do orthodontic patients develop more gingival recession in anterior teeth compared to untreated individuals? A systematic review of controlled studies.

Int Orthod 2020 Mar 2;18(1):1-9. Epub 2019 Nov 2.

European University Cyprus, Department of Dentistry, School of Medicine, Nicosia, Cyprus.

Objective: To investigate, in an evidence-based manner, the contemporary available information regarding the development of gingival recession in the anterior teeth of orthodontically treated and age-matched untreated individuals.

Material And Methods: Eight databases were searched without restrictions from the date of coverage initiation to June 30th, 2019 (registration in PROSPERO: CRD42018080948). Studies evaluating gingival recession development following comprehensive orthodontic treatment were reviewed. Following study selection, data extraction and risk of bias assessment, the random effects model was employed for exploratory data synthesis. The confidence in the retrieved estimates was appraised using current guidelines.

Results: Finally, three studies, with a follow-up of 6 years maximum, were identified. Overall, the amount of gingival recession did not increase significantly immediately after treatment with normal occlusion. However, for some of the comparisons considered, the risk for orthodontic patients to present with labial gingival recession seemed to increase, especially during retention [mandibular incisors 6 years post-treatment: Odds Ratio: 8.81, 95% Confidence Interval: 1.93-40.07, p=0.005].

Conclusion: Although the amount of recession does not differ, some increase in the risk for gingival recession development in the anterior teeth may be encountered in orthodontically-treated individuals compared to untreated subjects with normal occlusion. However, these findings should be viewed cautiously until more studies of high quality become available. Good practice would suggest that it is important to identify patients at potential risk and consider the possible implications for orthodontic treatment.
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http://dx.doi.org/10.1016/j.ortho.2019.08.025DOI Listing
March 2020

A single-centre investigator-blinded randomised parallel group clinical trial to investigate the effect of probiotic strains M18 and on gingival health of paediatric patients undergoing treatment with fixed orthodontic appliances: study protocol.

BMJ Open 2019 09 8;9(9):e030638. Epub 2019 Sep 8.

College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates

Background: There is limited data on the beneficial effects of probiotics on the gingival health of patients undergoing treatment with fixed orthodontic appliances. This study aims to compare the effect of probiotic tablets combined with regular oral hygiene versus regular oral hygiene alone on gingival status in these patients. The effect of probiotic intake on plaque formation and salivary microbiome composition will be also assessed.

Methods And Analysis: This is a 3 month single-centre, single blind (clinical and laboratory examiners), parallel group randomised controlled two arm superiority trial. Fifty paediatric patients attending the Postgraduate Orthodontic Clinic at the Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates, who meet the eligibility criteria will be recruited. Block randomisation with 1:1 allocation and concealment of allocation will be carried out. The treatment group will receive probiotic tablets containing M18 and together with regular oral hygiene versus the control group on regular oral hygiene alone. Clinical examination and collection of saliva for microbiome assay will be carried out at baseline and end of study. Self-reporting by patients will be used to document acceptability and adverse effects. Statistically significant decrease in gingival bleeding on probing in the treatment group will be classified as primary outcome of treatment success. Statistically significant reduction in Plaque Index, Gingival Index and shift in the composition of the oral microbiome in favour of beneficial bacteria are secondary outcomes indicative of efficacy of probiotic intake.

Ethics And Dissemination: Ethical approval for the study has been granted by the HBMCDM, MBRU, Institutional Review Board (Reference #: MBRU-IRB-2018-015). Study findings will be disseminated via publication in peer-reviewed journal.

Trial Registration Number: ISRCTN95085398.
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http://dx.doi.org/10.1136/bmjopen-2019-030638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738688PMC
September 2019

Does medication administration affect the rate of orthodontic tooth movement and root resorption development in humans? A systematic review.

Eur J Orthod 2020 09;42(4):407-414

Department of Dentistry, European University Cyprus, Nicosia, Cyprus.

Background: Recently, the potential impact of different medications on the rate of orthodontic tooth movement and the associated root resorption has been systematically reviewed in animal studies and various effects have been shown. However, animal data cannot be extrapolated to human clinical situations directly.

Objectives: To systematically investigate the most up to date available evidence from controlled human studies regarding the effect of medication administration on the rate of orthodontic tooth movement and associated root resorption development.

Search Methods: We searched eight databases (covering also grey literature) without restrictions and we performed hand searching up until October 2018.

Selection Criteria: Controlled studies in humans assessing the effect of various medications on the rate of orthodontic tooth movement and root resorption development.

Data Collection And Analysis: Study selection was followed by data extraction and risk of bias assessment using the ROBINS-I tool for non-randomized and the Cochrane Risk of Bias Tool for randomized studies.

Results: Eight studies, at various risk of bias, were finally identified. With regard to the rate of orthodontic tooth movement, local injections of prostaglandin E1 were found to exert an increasing effect, whereas systemic intake of nabumetone decreased it. Following tenoxicam administration, drinking water with fluoride or local injections of calcitriol (vitamin D metabolite), no significant effects were demonstrated. Concerning root resorption development, nabumetone administration was shown to reduce it, whereas fluoride, overall, was not observed to exert any effect. Only in individuals subjected to heavy orthodontic forces, did fluoride show a protective effect for the period of force application, but not in the longer term during retention.

Conclusions: The aforementioned substances may show varying effects on the rate of orthodontic tooth movement and root resorption development in human subjects. Despite the observed limitations, the orthodontist should be able to identify patients taking pharmaceuticals and consider any implications related to orthodontic treatment.

Registration: PROSPERO (CRD42017078208).
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http://dx.doi.org/10.1093/ejo/cjz063DOI Listing
September 2020

Do facial morphology, posture and function change following glossectomy? A systematic review.

J Orthod Sci 2019 23;8. Epub 2019 May 23.

Department of Dentistry, School of Medicine, European University Cyprus, Nicosia, Cyprus.

Objectives: To systematically investigate and critically appraise the quality of the currently available literature regarding the morphological, postural, and functional changes observed in individuals following glossectomy.

Materials And Methods: A search without restrictions in eight databases (including grey literature) and hand searching from inception until March 2018 was performed. Data on morphological, postural, and functional changes after glossectomy were reviewed. Methodological quality was evaluated using the risk of bias in nonrandomized studies of intervention tool.

Results: Out of 835 initially identified unique records, only three articles following patients for 1 year after glossectomy fulfilled the selection criteria. Overall, no significant morphological, postural, and functional changes were observed. Only the distance between the dorsum and the nasal line increased and the freeway space decreased significantly.

Conclusions: Overall, no significant differences were noted in the medium term, in terms of dentofacial structures adaptation and tongue function following glossectomy. Further research is warranted in order to elucidate the consequences of the altered oral environment.
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http://dx.doi.org/10.4103/jos.JOS_97_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540768PMC
May 2019

Medication and orthodontic tooth movement.

J Orthod 2019 06 28;46(1_suppl):39-44. Epub 2019 Mar 28.

3 Department of Dentistry, European University Cyprus, Nicosia, Cyprus.

As any pharmaceutical substance may influence the events associated with orthodontic tooth movement, it is of importance for the clinician to be able to recognize any prospective patient's history and patterns of medicinal consumption. This review presents the effects of various commonly prescribed medications on the rate of orthodontic tooth movement. The article concludes that it remains, to a degree, unclear which types of medication may have a clinically significant effect in everyday clinical scenarios. However, since both prescription and over-the-counter medication use have recently increased significantly among all age groups, good practice suggests that it is important to identify patients consuming medications and consider the possible implications in orthodontic therapy.
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http://dx.doi.org/10.1177/1465312519840037DOI Listing
June 2019

Effects of systematic bisphosphonate use in patients under orthodontic treatment: a systematic review.

Eur J Orthod 2020 Jan;42(1):60-71

Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece.

Background: Bisphosphonates are a class of drugs prescribed for several osseous related disorders owing to their ability to regulate bone turnover, which could in turn affect orthodontic treatment outcomes.

Objective: To examine the effect of bisphosphonate (BP) use on orthodontic patients through clinical and radiographic measurements.

Search Methods: Systematic and unrestricted search of 17 databases complemented with additional hand-searches were performed up to March 2019.

Selection Criteria: Articles reporting on human patients with a history of BPs administration that received orthodontic treatment were eligible for inclusion.

Data Collection And Analysis: Data regarding the medical profile of the patients, the specific type of malocclusion and the performed treatment plan, as well as the clinical and radiographic outcomes were extracted. Quality assessment was performed by the ROBINS-I tool for the cohort studies and by a slightly modified checklist from the original one proposed by Agbabiaka et al. for the case reports.

Results: 7 articles (1 retrospective cohort study and 6 case reports) were eventually included in the present review including 122 subjects (29 patients and 93 controls) reporting on the clinical and radiographic changes following orthodontic treatment of patients during or after BPs use. BPs seem to have a controversial effect on the clinical and patient-reported variables, even though the majority of the included patients presented with compromised treatment results and a rather slow rate of tooth movement. Most radiographic findings revealed mild root resorption, widened periodontal ligament spaces and sclerotic changes on the surrounding alveolar bone. However, these results should be interpreted with caution, due to the limited number of the eligible articles and their limitations.

Limitations: The included studies were of rather low quality due to study design and incomplete reporting.

Conclusions And Implications: BP administration seems to be associated with compromised clinical outcomes, prolonged treatment time, and moderate changes on the roots and surrounding tissues of orthodontic patients.

Registration: Non-registered.

Funding: None.
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http://dx.doi.org/10.1093/ejo/cjz021DOI Listing
January 2020

Does long-term use of pain relievers have an impact on the rate of orthodontic tooth movement? A systematic review of animal studies.

Eur J Orthod 2019 Sep;41(5):468-477

Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: Pain relief drugs are used and misused widely and may theoretically affect the events leading to orthodontic tooth movement.

Objective: To systematically investigate and appraise the quality of the available evidence regarding the effect of pain relief medications on the rate of orthodontic tooth movement.

Search Methods: Search without restrictions in eight databases (including grey literature) and hand searching until October 2018.

Selection Criteria: Animal controlled studies investigating the effect of pain relievers on the rate of orthodontic tooth movement.

Data Collection And Analysis: Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed using the SYRCLE's risk of bias tool.

Results: Fourteen studies were finally identified, most of which at unclear risk of bias. Ibuprofen and loxoprofen did not show any significant effects on the rate of orthodontic tooth movement, whereas indomethacin, ketorolac, morphine, and high doses of etoricoxib were found to decrease it. Inconsistent or conflicting effects were noted after the administration of acetaminophen, acetylsalicylic acid, celecoxib, meloxicam, and tramadol. The quality of the available evidence was considered at best as low.

Conclusions: Long-term consumption of pain relievers may affect the rate of orthodontic tooth movement. The orthodontist should be capable of identifying patients taking pain relievers independently of orthodontic treatment and consider the possible implications.

Trial Registration: PROSPERO (CRD42017078208).
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http://dx.doi.org/10.1093/ejo/cjy079DOI Listing
September 2019

Toothbrushing-Should We Advise Mechanical or Power Brushes? Results of an International Delphi Conference.

J Contemp Dent Pract 2018 Oct 1;19(10):1169-1173. Epub 2018 Oct 1.

Procter and Gamble Gulf, Dubai, United Arab Emirates.

Background And Aim: To develop evidence-based answers to a series of questions in relation to toothbrushing using a modified Delphi consensus approach. Oral hygiene and especially toothbrushing have been a fundamental part of the efforts to prevent caries and gingivitis. The questions discussed involved the frequency and duration of brushing, the effectiveness and safety of powered brushes and the recommendations for children and orthodontic patients.

Review Results: The Delphi panel agreed that twice daily brushing for 2 minutes and a systematic pattern is advised. Moreover, it was concluded that evidence suggests that power brushes are safe and more effective in the short and long-term compared to manual brushes in terms of plaque removal and gingivitis reduction. For children and orthodontic patients, the likelihood of enhancing compliance/convenience with use of a power brush was highlighted.

Conclusion: Toothbrushing constitutes a fundamental part of the efforts to prevent caries and gingivitis.

Clinical Significance: Twice daily brushing for 2 minutes and a systematic pattern is advised. Power brushes are safe and could provide benefits, for adults, children and orthodontic patients.
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October 2018

Tooth wear during orthodontic treatment with fixed appliances: a systematic review.

J Orthod 2018 12 19;45(4):260-268. Epub 2018 Sep 19.

a Hamdan Bin Mohammed College of Dental Medicine (HBMCDM) , Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) , Dubai , UAE.

Objectives: Tooth wear, additional to the physiologic alterations of the dentition, may occur during orthodontic treatment. The objective of the present review was to investigate systematically the literature relevant to its progression in patients having undergone comprehensive orthodontic treatment.

Data Sources: Search without restrictions in eight databases since inception and hand searching until October 2017 was performed.

Data Selection: Studies evaluating tooth wear immediately before and after the completion of orthodontic treatment with fixed appliance were evaluated independently and in duplicate.

Data Extraction: Following study retrieval and selection, data on volumetric and surface tooth wear was extracted. Individual study risk of bias assessment was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.

Data Synthesis: All three finally included studies reported wear of teeth during the period of treatment but were at serious risk of bias. Two of them investigated tooth wear by 3D volumetric measurements and one used grading scales. The mean volume reduction was 1.02 mm per tooth for the incisor group [95% Confidence Interval (CI): 0.84-1.20], 1.62 mm for the canines [95% CI: 0.8-2.38; I= 96%; random effects method] and 0.95 mm for premolars and molars [95% CI: 0.84-1.07]. The overall quality of evidence limited the confidence in the observed estimates.

Conclusions: Varying degrees of tooth wear were reported after comprehensive orthodontic treatment. Further studies are needed in order to elucidate how much is associated with orthodontic treatment and/or physiologic alterations of the dentition.
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http://dx.doi.org/10.1080/14653125.2018.1517469DOI Listing
December 2018

Effects of systemic medication on root resorption associated with orthodontic tooth movement: a systematic review of animal studies.

Eur J Orthod 2019 Aug;41(4):346-359

Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: Theoretically, root resorption could be modulated by any medication taken that exhibits possible effects on the implicated molecular pathways.

Objectives: To systematically investigate and appraise the quality of the available evidence from animal studies, regarding the effect of commonly prescribed systemic medication on root resorption associated with orthodontic tooth movement.

Search Methods: Search without restrictions in eight databases (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ClinicalTrials.gov, ProQuest Dissertations and Theses Global) and hand searching until April 2018 took place. One author developed detailed search strategies for each database that were based on the PubMed strategy and adapted accordingly.

Selection Criteria: Controlled studies investigating the effect of systemic medications on root resorption associated with orthodontic tooth movement.

Data Collection And Analysis: Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool.

Results: Twenty-one studies were finally identified, most of which at unclear risk of bias. Root resorption was shown to increase in Vitamin C treated animals in comparison with the control group, whereas a comparative decrease was noted after the administration of the alendronate, ibuprofen, growth hormone, low doses of meloxicam, simvastatin, lithium chloride and strontium ranelate. No difference was noted for acetaminophen, aspirin, fluoxetine, atorvastatin, misoprostol, zoledronic acid and zinc. Finally, inconsistent effects were observed after the administration of celecoxib, prednisolone and L-thyroxine. The quality of the available evidence was considered at best as low.

Conclusions: The pharmaceutical substances investigated were shown to exhibit variable effects on root resorption. Although the overall quality of evidence provides the clinician with a cautious perspective on the strength of the relevant recommendations, good practice would suggest that it is important to identify patients consuming medications and consider the possible implications.

Registration: PROSPERO (CRD42017078208).
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http://dx.doi.org/10.1093/ejo/cjy048DOI Listing
August 2019

Does common prescription medication affect the rate of orthodontic tooth movement? A systematic review.

Eur J Orthod 2018 11;40(6):649-659

Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: As the taking of any medication may theoretically affect the complex pathways responsible for periodontal tissue homeostasis and the events leading to orthodontic tooth movement, it is considered important for the orthodontist to be able to identify prospective patients' history and patterns of pharmaceutical consumption.

Objective: To systematically investigate and appraise the quality of the available evidence regarding the effect of commonly prescribed medications on the rate of orthodontic tooth movement.

Search Methods: Search without restrictions in eight databases and hand searching until June 2017.

Selection Criteria: Controlled studies investigating the effect of commonly prescribed medications with emphasis on the rate of orthodontic tooth movement.

Data Collection And Analysis: Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool.

Results: Twenty-seven animal studies, involving various pharmacologic and orthodontic interventions, were finally identified. Most studies were assessed to be at unclear or high risk of bias. The rate of orthodontic tooth movement was shown to increase after the administration of diazepam, Vitamin C and pantoprazole, while simvastatin, atorvastatin, calcium compounds, strontium ranelate, propranolol, losartan, famotidine, cetirizine, and metformin decreased the rate of orthodontic tooth movement. No interference with the rate of orthodontic tooth movement was reported for phenytoin, phenobarbital and zinc compounds, whereas, inconsistent or conflicting effects were noted after the administration of L-thyroxine, lithium compounds, fluoxetine and insulin. The quality of the available evidence was considered at best as low.

Conclusions: Commonly prescribed medications may exhibit variable effects on the rate of orthodontic tooth movement. Although the quality of evidence was considered at best as low, raising reservations about the strength of the relevant recommendations, the clinician should be capable of identifying patients taking medications and should take into consideration the possible implications related to the proposed treatment.

Registration: PROSPERO (CRD42015029130).
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http://dx.doi.org/10.1093/ejo/cjy001DOI Listing
November 2018

Short-term and long-term effectiveness of powered toothbrushes in promoting periodontal health during orthodontic treatment: A systematic review and meta-analysis.

Am J Orthod Dentofacial Orthop 2017 Dec;152(6):753-766.e7

Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Introduction: Although powered toothbrushes have been reported to reduce gingivitis more than manual toothbrushes in the general population, the evidence regarding orthodontic patients has been inconclusive. Thus, we aimed to compare their effectiveness in relation to any available parameter regarding oral health in orthodontic patients with fixed appliances.

Methods: Searches without restrictions for published and unpublished literature and hand searching took place up to August 2017. Oral-health relevant data from randomized controlled trials of at least 4-weeks duration comparing powered and manual tooth brushing without supervision were reviewed. Data were classified as short term (assessments at 1-3 months) and long term (assessments at >3 months), and the random-effects method was used to combine treatment effects. Individual study risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of evidence was evaluated according to the Grades of Recommendation, Assessment, Development and Evaluation approach.

Results: The initially identified articles were finally reduced to 9 randomized controlled trials investigating the periodontal health in 434 patients. Eight studies followed patients up to 3 months, and 1 up to 12 months during treatment. One study was at low and the rest at unclear risk of bias. Overall, in the short term, there was low-quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual brushing with regard to the gingival index (weighted mean difference, -0.079; 95% confidence interval, -0.146 to -0.012; P = 0.021) and indexes assessing gingival bleeding (standardized mean difference, -0.637; 95% confidence interval, -1.092 to -0.183; P = 0.006). In the long term, only 1 available study showed a statistically significant benefit of powered over manual toothbrushes with regard to gingival index and bleeding. No differences were observed in probing pocket depth and relative attachment loss. For the rotation-oscillation brushes that involved the greatest body of evidence, statistically significant reductions in gingival index and bleeding were demonstrated only in the long-term study. No included study provided quantified measurements regarding caries activity.

Conclusions: Overall, powered toothbrushes may promote gingival health better than manual toothbrushes in orthodontic patients. However, no type demonstrated clear superiority. Better study standardization and reporting in longer follow-up studies are necessary to elucidate the clinical relevance of these results.
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http://dx.doi.org/10.1016/j.ajodo.2017.09.003DOI Listing
December 2017

Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials.

PLoS One 2017 24;12(7):e0181768. Epub 2017 Jul 24.

Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: Non-syndromic clefts lip and/or palate (CL/P) defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO) was introduced as a means to improve management and treatment outcomes, there still remains a controversy.

Objective: To investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence.

Search Methods: Search without restrictions, together with hand searching, until May 2016.

Selection Criteria: Randomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances.

Data Collection And Analysis: Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.

Results: Finally 20 papers (3 unique trials) were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low.

Conclusions: The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further research, in order to reach more robust relevant recommendations for management decisions in individual cases.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181768PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524403PMC
September 2017

Effectiveness of extraction of primary canines for interceptive management of palatally displaced permanent canines: a systematic review and meta-analysis.

Eur J Orthod 2018 04;40(2):149-156

Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: Although extraction of primary canines in the mixed dentition has been suggested as a measure to prevent impaction of palatally displaced permanent canines (PDCs), the relevant evidence has been inconclusive.

Objective: To assess the effectiveness of this practice and investigate the quality of the evidence.

Search Methods: Search without restrictions in 15 databases and hand searching until April 2017.

Selection Criteria: Randomized clinical trials comparing extraction of primary canines in the mixed dentition to no treatment.

Data Collection And Analysis: Following study retrieval and selection, data extraction, and individual study risk of bias assessment using the Cochrane Risk of Bias Tool, the random effects method of combining treatment effects was used. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Results: Finally 5 studies were identified involving 214 individuals, followed for up to 48 months post-intervention. Two studies were at low and the rest at high risk of bias. Although at the 12-month evaluation, extraction of the primary canine did not result in a statistically significant difference [risk ratio (RR): 1.537; 95% confidence interval (CI): 0.656-3.601, P = 0.323; 1 study, n = 67 individuals], beyond 12 months a benefit was noted (RR: 1.784; 95% CI: 1.376-2.314, P = 0.000; 5 studies, n = 214 individuals; I2 = 0%). Analysis of the studies at low risk of bias confirmed the above-mentioned result (RR: 1.713; 95% CI: 1.226-2.394, P = 0.002; 2 studies, n = 91 individuals; I2 = 0%; moderate quality evidence). No difference was observed regarding root resorption of adjacent permanent teeth (RR: 0.602; 95% CI: 0.277-1.308, P = 0.200; 1 study; n = 67 individuals; moderate quality evidence).

Conclusions: Extraction of primary canines in the mixed dentition may increase the chance of subsequent successful eruption of PDC in the long term. However, better study standardization is necessary.
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http://dx.doi.org/10.1093/ejo/cjx042DOI Listing
April 2018

Performance of Hawley-type retainers: a systematic review of randomized clinical trials.

Eur J Orthod 2018 04;40(2):115-125

Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: Although post-treatment changes are almost inevitable, and retention has long been recognized as one of the most critical and routine problems faced by orthodontists, there remains a lack of certainty regarding the parameters of any definitive retention protocol following orthodontic treatment.

Objective: To investigate the performance of the Hawley-type retainers.

Search Methods: Search without restrictions in 15 databases and hand searching until December 2016.

Selection Criteria: Randomized clinical trials comparing the performance of Hawley-type retainers to other removable appliances or comparing different Hawley-type retainers' wearing schedules.

Data Collection And Analysis: Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Results: Finally, 10 studies were identified involving 854 individuals, followed for up to 1 year after debonding. Eight studies compared subjects using Hawley and clear thermoplastic retainers; another compared Hawley to positioner and, finally, one trial involved individuals allocated to different Hawley appliance wearing schedules. Three studies were considered as being of low, four of unclear, and three of high risk of bias. In general, few differences were observed between the Hawley and other removable retainers regarding outcomes relevant to maxillary and mandibular dental arch measurements, dental arch relationships and occlusal contacts, speech evaluation, patient reported outcomes, adverse effects, and problems related to the appliances, as well as economic evaluation related outcomes. Moreover, no differences were observed between the compared Hawley wearing schedules. Overall, the quality of the available evidence was considered low.

Conclusions: Given the overall quality of the available evidence and the multitude of parameters, which may have affected the results of the included trials, good practice would suggest further research in the respective field in order to increase both the quantity and quality of information available.

Registration: PROSPERO (CRD42015029279).

Funding: No funding was received for the present systematic review.
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http://dx.doi.org/10.1093/ejo/cjx036DOI Listing
April 2018

Treatment duration and gingival inflammation in Angle's Class I malocclusion patients treated with the conventional straight-wire method and the Damon technique: a single-centre, randomised clinical trial.

J Orthod 2017 06 1;44(2):75-81. Epub 2017 May 1.

a Department of Orthodontics, Faculty of Dentistry , School of Health Sciences, Aristotle University of Thessaloniki , Thessaloniki , Greece.

Objective: To compare the duration of orthodontic treatment and Gingival Index (GI) scores in Class I malocclusion patients treated with a conventional straight-wire method (CG) or the Damon technique (DT).

Design: Two-arm, parallel, randomised clinical trial Setting: A postgraduate orthodontic clinic Participants: Patients with a balanced facial profile, a full permanent dentition and Angle's Class I malocclusion with moderate crowding.

Methods: The primary outcome was the duration of orthodontic treatment in months. GI scores throughout treatment were secondary outcomes and the PAR index was also assessed. Randomisation was accomplished using a table of random numbers and the allocation was concealed in sequentially numbered and opened, opaque, sealed envelopes. Blinding was applicable for PAR assessment only. Comparison of data between groups was performed with appropriate tests for independent samples.

Results: Twenty-two patients were randomly allocated to treatment in a 1:1 ratio to either CG or DT group. Age at the start of treatment, initial PAR index and GI scores were similar between groups. All patients completed the study, but the total duration of orthodontic treatment was almost half of the initial assumption. No statistically significant differences were observed in treatment duration (CG: Mean ([Formula: see text]) = 14.5 months, Standard Deviation (SD) = ±3.03; DT: [Formula: see text] months, SD = ±2.93; 95% Confidence Interval: -0.40 to 4.90; P = 0.093; t-test). The two groups did not differ statistically regarding the GI scores during the observational period. No serious harms were observed other than gingival inflammation associated with oral biofilm accumulation.

Conclusions: The present study did not reveal statistically significant differences between the compared, conventional straight-wire method and Damon technique-treated, Angle's Class I malocclusion groups regarding total treatment duration and GI scores.
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http://dx.doi.org/10.1080/14653125.2017.1316902DOI Listing
June 2017

Dental arch spatial changes after premature loss of first primary molars: a systematic review of controlled studies.

Odontology 2017 Jul 23;105(3):364-374. Epub 2016 Nov 23.

Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, P.O. Box 505055, Dubai, United Arab Emirates.

Studies investigating dental arch spatial changes following first primary molar premature loss are controversial regarding clinical significance. The purpose of this review was to systematically investigate the relevant literature. Controlled studies investigating changes before and after premature loss of first primary molars were searched in various databases. Split-mouth design studies were considered eligible for inclusion. The risk of bias was judged according to ADA Clinical Practice Guidelines. Only two analyzable split-mouth studies on mandibular first primary molar loss were identified. Space loss in the extraction side was greater at 2, 4, 6 and 8-month follow-ups, reaching a -1.5 mm difference in the final examination (95% Confidence Interval: -2.080 to -0.925; p = 0.000; random effects model). Studies were judged to be at unclear risk of bias. The amount of space decrease after premature loss of first primary molars may have management implications under certain circumstances. Comprehensive assessment of the various characteristics of each patient should precede management decisions in individual cases.
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http://dx.doi.org/10.1007/s10266-016-0281-2DOI Listing
July 2017

Erosive Tooth Wear and Related Risk Factors in 8- and 14-Year-Old Greek Children.

Caries Res 2016 10;50(4):349-62. Epub 2016 Jun 10.

Department of Paediatric Dentistry, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki , Greece

The aim of the present study was to investigate the erosive tooth wear of primary and permanent teeth and its association with related risk factors. Two groups of Greek children aged 8 (n = 329) and 14 years (n = 263) were examined in the classroom using the Basic Erosive Wear Examination (BEWE) index. Data concerning risk factors were collected using questionnaires. Dental caries (DMFS/dmfs) was also recorded. The data were analyzed using the t test, one-way ANOVA, multiple regression analysis, Fisher's exact test, and the χ2 test. In the 8-year-olds, the primary teeth showed a predominantly medium level of wear and the permanent teeth no wear. A majority of the 14-year-olds exhibited low risk levels of wear. The most frequently affected dental surface in both age groups was the occlusal surface of the mandibular posterior teeth. In the 8-year-olds, BEWE scores and the prevalence of wear in the primary teeth was influenced by gender (p = 0.020). In their permanent teeth, soft drink consumption (p < 0.0001) and preference for lemon/vinegar (p = 0.041) significantly affected wear prevalence and BEWE scores, while habitually retaining soft drinks in the mouth influenced wear prevalence (p = 0.008), risk (p = 0.004), and BEWE scores (p = 0.022). In the 14-year-olds, wear prevalence was significantly affected by the consumption of lemon-flavored candies (p = 0.016) and soft drinks (p = 0.050). BEWE scores were significantly affected by gender (p = 0.022) and soft drink consumption (p = 0.030). Gender influenced tooth wear risk in both age groups (p = 0.010 and p = 0.021, respectively). The results of this study indicate that erosive tooth wear differed between primary and permanent teeth and was influenced by gender and dietary factors.
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http://dx.doi.org/10.1159/000445980DOI Listing
October 2017

Performance of clear vacuum-formed thermoplastic retainers depending on retention protocol: a systematic review.

Odontology 2017 Apr 6;105(2):237-247. Epub 2016 Jun 6.

Department of Orthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece.

We aimed at comparing the performance of vacuum-formed thermoplastic retainers (VFR) worn either full-time or part-time, in maintaining orthodontic treatment results in terms of tooth alignment, arch form and occlusion. We reviewed randomized and prospective controlled clinical trials comparing VFR wearing protocols and searched databases, without restrictions, for published and unpublished literature. The risk of bias was assessed using the Cochrane Risk of Bias tool and the overall level of certainty in the evidence following ADA methodology. 184 studies were initially identified and reduced to the 3 randomized controlled trials included in the systematic review by means of specific criteria. One study followed patients 1 year into retention, and the other two for 6 months. Little's Irregularity Index, intermolar and intercanine width, arch length, overjet and PAR score did not differ significantly between the patients wearing their retainers part time or full time. We observed a slight increase in the overbite in the part-time group in only one trial. With a moderate level of certainty, we found that during the observation period, full-time VFR wear is not superior to part-time, bearing in mind the potential implications for health burden, retainer longevity and cost-effectiveness, as well as patient satisfaction and compliance.
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http://dx.doi.org/10.1007/s10266-016-0254-5DOI Listing
April 2017