David Normando

RESEARCH INTERESTS

Orthodontics; malocclusion; biostatistics; indigenous health

Scopus Publications

Tooth wear and tertiary crowding: a 13-year cohort study in Amazon Indigenous populations
Renata Travassos da Rosa Moreira Bastos, Eduardo Oliveira da Costa, and David Normando
Springer Science and Business Media LLC
Abstract Background Tooth wear is an important mechanism for reducing dental dimensions and, consequently, dental crowding. The objective of this cohort study was to examine the relation of tooth wear, adjusted for covariates (age, tooth loss, arch perimeter and intercanine width), on tertiary crowding in Amazon Indigenous populations. Methods A sample of 40 Indigenous people in permanent dentition at T0 (baseline) and after 13 years (T1) were evaluated. The sample included 16 males and 24 females belonging to two villages, Arara (n = 22, mean ages 16.6 and 29.9 years) and Assurini do Xingu (n = 18, mean ages 16.0 and 29.6 years). Clinical, intraoral photograph and dental cast evaluations were performed at both times. The anterior crowding was measured using Little’s Irregularity Index (LI) and modeled through a multilevel linear regression with the predictor variables: village, tooth wear (T1-T0), age (T0), tooth loss (T1-T0), changes in intercanine width (T1-T0) and changes in arch perimeter (T1-T0). Results A slight increase was observed (< 1 mm) in anterior dental crowding and a decrease in arch perimeter < 1.5 mm, while tooth wear increased between 0.65 and 0.99 units. The contextual variable (village) had no significant association with LI. In the upper arch, tooth loss was the only variable that showed an inverse association with LI (β=-0.41, p < 0.05). In the lower arch, the increase in dental crowding was inversely associated with tooth wear (β=-1.30, p < 0.05) and changes in arch perimeter (β=-0.31, p < 0.05). The other variables did not show significant associations. Conclusion After 13 years, dental crowding and tooth wear increased, while the arch dimensions tended to decrease. The changes in long-term dental crowding seem to have distinct etiological components for each dental arch. In the mandible, the changes in incisor alignment were associated with increased tooth wear and decreased dental arch dimensions. Whereas in the maxilla, only tooth loss caused alterations in tooth alignment. It is suggested that the effect of increased tooth wear on the etiology of tertiary crowding is of small magnitude and restricted to the lower dental arch.


Incidence of Tooth Loss in Remote Indigenous Populations of the Amazon Region: A 13-Year Cohort Study Before and After Belo Monte Dam
Renata Travassos da Rosa Moreira Bastos, Eduardo Oliveira da Costa, Lucca Sicilia, and David Normando
MDPI AG
Tooth loss among indigenous people in the Amazon emphasizes the need for culturally appropriate oral health interventions. The objective of this study was to analyze the incidence of tooth loss in two remote Amazon indigenous populations. This prospective cohort evaluated a total of 47 indigenous in the permanent dentition at T0 and thirteen years later (T1) from two villages, Arara-Laranjal (n = 28, mean age 16.1 and 29.9 years) and Assurini do Xingu (n = 19, mean age 15.9 and 29.5 years), of different ethnic groups. A multilevel Poisson regression model assessed the influence of village, sex, and age on tooth loss. At T0, the indigenous people had all their permanent teeth. Forty-two lost at least one tooth (89%), and a total of 172 teeth were lost at T1 at an incidence of 97% among females and 76% in males. There was no influence of ethnicity on tooth loss (p = 1.000). A lower risk of tooth loss was associated with male subjects (β = −0.50, p < 0.05) but not with age. In females (22/46.8%) and males (11/23.4%), the highest incidence of tooth loss was the lower second molars. The risk was higher among females, and there was no influence on age, village, or ethnicity. The second and first molars were the most affected teeth. These findings suggest an increase in tooth loss caused by close contact between indigenous and urban populations.


Effectiveness of dental arch expansion in the orthodontic treatment with clear aligners: a scoping review
Monica Lídia Santos de Castro Aragon, Suelly Maria Mendes Ribeiro, Nathalia Carolina Fernandes Fagundes, and David Normando
Oxford University Press (OUP)
Abstract Background The clinical protocol and effectiveness of dental expansion with Clear Aligner Therapy (CAT), especially among adults is still unclear. There is a need to map and explore knowledge gaps of dental expansion with CAT among children and adults. Objective This scoping review explores the extent and depth of the available literature regarding the effectiveness and predictability of CAT in performing orthodontic expansion in both children and adults. Methods The following databases were consulted as sources of information: PubMed, MEDLINE, Embase, Web of Science, Scopus, LILACS, COCHRANE Library, and ProQuest Dissertations & Thesis, in which the search was limited to studies on children or adults requiring transverse arch expansion and using clear orthodontic aligners. Two independent reviewers assessed the citations and extracted data, which was then synthesized in a narrative format. Results Over all, 698 citations were retrieved, and 33 were included. Among these, 3 were systematic reviews, 4 were cohort studies, 2 were case-control studies, and 24 were case series. Eighty-five percent of the included studies were published in the last 5 years. Despite different protocols and measurement methods, aligners were effective for arch expansion in adults and children, and the expansion predictability was greater for the lower arch than for the upper arch. The evidence suggests that arch width increment is more predictable in the premolar region and less predictable in the canine and second molar areas, with high variability across studies. Conclusions Orthodontic aligners have demonstrated effectiveness in expanding arches in both adults and children. However, the literature suggests a decrease in arch width toward the posterior region, and there is no evidence of skeletal gains. To provide more conclusive evidence, randomized controlled clinical studies are warranted. Registration This review was registered in the Open Science Framework database (DOI: https://doi.org/10.17605/OSF.IO/6EG8F)


Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross-over randomized controlled trial
Maria Cecilia Magalhães, David Normando, Carlos José Soares, Eustaquio Araujo, Ricardo Maurício O Novaes, Vinicius Vasconcelos Teodoro, Carlos Flores‐Mir, Ki Beom Kim, and Guilherme A. Almeida
Wiley
AbstractObjectiveTo determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea‐hypopnea index (AHI) and minimum oxygen saturation (MinSaO2) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship.Study Design/MethodsThirty‐two nonobese children with balanced maxillomandibular relationship and a mean age of 8.8 years, with a graded III/IV tonsillar hypertrophy and maxillary constriction, participated in a cross‐over randomized controlled trial. As the first intervention, one group underwent AT while the other underwent RPE. After 6 months, interventions were switched in those groups, but only to participants with an AHI > 1 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T0), 6 months after the first (T1) and the second (T2) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO2 severity, and intervention sequence were evaluated using linear regression analysis. Intra‐ and intergroup comparisons for AHI and MinSaO2 were performed using ANOVA and Tukey's test.ResultsThe initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO2 severity accounted for 83.1% of MinSaO2 improvement changes. Most AHI reductions and MinSaO2 improvements were due to AT.ConclusionsInitial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO2 severity alone accounted for the most changes in MinSaO2 increase. In most cases, RPE had a marginal effect on AHI and MinSaO2 when adjusted for confounders.


Self-correction of the ectopic eruption of the maxillary first permanent molar and its predictive factors: A systematic review
Renata Travassos da Rosa Moreira Bastos, Cibelle Cristina Oliveira dos Santos, Silvio Augusto Bellini‐Pereira, and David Normando
Wiley
AbstractBackgroundEctopic eruption of the maxillary first permanent molar is a local disturbance that affects the development of the occlusion.AimTo evaluate the occurrence of self‐correction of maxillary first permanent molar's ectopic eruption and its predictive factors.DesignFive electronic databases and part of the gray literature were investigated. The risk of bias was assessed using the Newcastle–Ottawa scale and the certainty of evidence using the GRADE tool.ResultsFour studies were selected: Three had a low risk of bias, and one, moderate. Evidence with a moderate level of certainty was generated, indicating a possibility of 47%–78% of spontaneous correction up to 7 years of age. Supporting the prognosis, whether reversible or irreversible, there was a positive correlation between the severity of the atypical distal resorption of the second primary molar, a higher magnitude of impaction, a larger eruption angle, and a bilateral occurrence with the irreversibility of the cases.ConclusionSpontaneous correction of the ectopic eruption of the maxillary first permanent molar is feasible and dependent on the severity of predictive factors. Early intervention is mandatory in irreversible cases.


Clear aligner treatment among patients with compromised periodontal tissue
Cibelle Cristina Oliveira dos Santos, Nathalia Carolina Fernandes Fagundes, Giselle Cabral da Costa, and David Normando
Elsevier BV



Do statistical heterogeneity methods impact the results of meta- analyses? A meta epidemiological study
Samer Mheissen, Haris Khan, David Normando, Nikhillesh Vaiid, and Carlos Flores-Mir
Public Library of Science (PLoS)
Background Orthodontic systematic reviews (SRs) use different methods to pool the individual studies in a meta-analysis when indicated. However, the number of studies included in orthodontic meta-analyses is relatively small. This study aimed to evaluate the direction of estimate changes of orthodontic meta-analyses (MAs) using different between-study variance methods considering the level of heterogeneity when few trials were pooled. Methods Search and study selection: Systematic reviews (SRs) published over the last three years, from the 1st of January 2020 to the 31st of December 2022, in six main orthodontic journals with at least one MA pooling five or lesser primary studies were identified. Data collection and analysis: Data were extracted from each eligible MA, which was replicated in a random effect model using DerSimonian and Laird (DL), Paule–Mandel (PM), Restricted maximum-likelihood (REML), Hartung Knapp and Sidik Jonkman (HKSJ) methods. The results were reported using median and interquartile range (IQR) for continuous data and frequencies for categorical data and analyzed using non-parametric tests. The Boruta algorithm was used to assess the significant predictors for the significant change in the confidence interval between the different methods compared to the DL method, which was only feasible using the HKSJ method. Results 146 MAs were included, most applying the random effect model (n = 111; 76%) and pooling continuous data using mean difference (n = 121; 83%). The median number of studies was three (range 2, 4), and the overall statistical heterogeneity (I2 ranged from 0 to 99% with a median of 68%). Close to 60% of the significant findings became non-significant when HKSJ was applied compared to the DL method and when the heterogeneity was present I2>0%. On the other hand, 30.43% of the non-significant meta-analyses using the DL method became significant when HKSJ was used when the heterogeneity was absent I2 = 0%. Conclusion Orthodontic MAs with few studies can produce different results based on the between-study variance method and the statistical heterogeneity level. Compared to DL, HKSJ method is overconservative when I2 is greater than 0% and may result in false positive findings when the heterogeneity is absent.


Orthodontic Retainers and the Stability of the Maxillary Arch in Unilateral Cleft lip and Palate Patients: A Systematic Review
Cibelle Cristina Oliveira dos Santos, Renata Travassos da Rosa Moreira Bastos, and David Normando
SAGE Publications
Objective The aim of this systematic review was to elucidate the role of orthodontic retainers on the stability of compensatory orthodontic treatment in patients with unilateral cleft lip and palate. Methods Five electronic databases (PubMed, Scopus, Web of Science, LILACS, and LIVIVO) and the grey literature (OpenGrey and Google Scholar) were investigated, according to the population, exposure, comparator, outcomes and Study design eligibility criterion. The risk of bias assessment was determined based on the Risk of Bias In Nonrandomized Studies of Exposure (ROBINS-E) and the level of evidence with the GRADE tool. Results Three studies were included: two presented moderate risk of bias and one high. A moderate level of evidence revealed a mean value of 0.6 mm of intercanine relapse distance, and great variability between the data, regardless of the use or type of retention or rehabilitation. Relapse in the posterior region showed clinical significance, from −1 to −1.7 mm, especially in individuals who did not use retention, except in patients with symmetrical arches with Hawley retainer, where this value varies from −0.2 ± 0.63 mm. Conclusions Orthodontic retainers do not seem essential to prevent relapse at anterior maxillary dimensions after compensatory orthodontic treatment in patients with unilateral cleft lip and palate. Relapse in the posterior region can achieve greater clinical significance, which highlights the need for prolonged use of Hawley retainers and periodic evaluation of the stability of treatment results. Prospective studies with a longer follow-up can improve the certainty of the evidence.


Effect of time between archwire changes on intended dentoalveolar expansion in orthodontic patients treated with fixed appliances: A prospective controlled clinical trial
Murilo Henrique Cruz, David Normando, Marcos Rogério de Mendonça, Eloísa Peixoto Soares Ueno, José Rino Neto, and João Batista de Paiva
Springer Science and Business Media LLC



Practices and Perception of Paediatric Obstructive Sleep Apnea Among Orthodontists and Paediatric Dentists in Brazil: A Mixed-Methods Study
Nathalia Carolina Fernandes Fagundes, Renata Travassos da Rosa Moreira Bastos, Arnaldo Perez, Carlos Flores‐Mir, and David Normando
Wiley
ABSTRACTObjectivesTo explore orthodontists' (OTs) and paediatric dentists' (PDs) practices and perceptions regarding the screening and management of paediatric obstructive sleep apnea (OSA).MethodsThis explanatory sequential mixed methods design included OTs and PDs with active clinical practice in Brazil and encompassed a quantitative phase followed by a qualitative phase. In the quantitative phase, a survey assessing OSA screening and management practices was administered to OTs and PDs practicing in Brazil. Information‐rich OTs and PDs were interviewed in the qualitative phase. Descriptive statistics and the chi‐square test were used to analyse the survey data, while inductive content analysis was applied to the interview data. The results from both phases were integrated and reported narratively.ResultsThree hundred eighty‐one OTs and PDs completed the survey, and ten of them were interviewed. Nearly half of OTs and PDs administered sleep questionnaires and demonstrated some knowledge about paediatric OSA signs and symptoms. PDs and OTs primarily offered rapid maxillary expansion and functional mandibular advancement for managing selected children with OSA, with OTs being more frequently involved in this task than PDs. OTs and PDs identified several barriers and expressed the need for support regarding access to reliable screening tools and interprofessional care.ConclusionBrazilian OTs and PDs were aware of the main signs and symptoms of paediatric OSA and were somewhat involved in offering oral appliance management options. To further define the role of these professionals, increasing support for dental professionals in OSA management and updating existing clinical guidelines is warranted.


Impact of fixed orthodontic retainers on oral health-related quality of life: a longitudinal prospective study
Melany Clarissa Gámez MEDINA, Cibelle Cristina Oliveira dos SANTOS, Beatriz Oliveira LIMA, Marina Bosi FERREIRA, and David NORMANDO
FapUNIFESP (SciELO)
ABSTRACT Objective: The aim of the present study was to assess the impact of orthodontic retainers on oral health-related quality of life (OHRQoL) in the short and long terms after orthodontic treatment. Methods: Data from 45 patients up to three years after orthodontic treatment (T0) were analyzed. Patients were reassessed four years (T1) after T0. OHRQoL was measured using the OHIP-14 (Oral Health Impact Profile-14) questionnaire. The presence of a fixed retainer in the upper and/or lower arches, sex, and age were the predictive variables evaluated at T0 and T1. The occurrence of retainer fracture at T0 was clinically evaluated. Due to the COVID-19 pandemic, clinical examination on T1 was not possible, so the OHIP-14 and the self-perception of changes in teeth position and fracture of retainers were examined using an on-line questionnaire. Results: At the initial examination, the presence of upper retainers had a negative impact on quality of life (p=0.018). The OHIP-14 value increased significantly from T0 to T1 (p=0.014), regardless of the presence of retainers. The fracture or debonding of the retainer reported by the patient was the only variable that had a negative impact on OHRQoL (p=0.05). Conclusion: The use of fixed upper retainers suggests a negative impact on the quality of life of the orthodontic patient after the end of orthodontic treatment. This impact, however, is negligible in the long term, except when associated with fracture or debonding. This study emphasizes the need for continuous follow-up of orthodontic patients during the retention period.


A CAD/CAM Maxillary Guiding for Osteotomy, Drilling and Maxillary Positioning in Orthognathic Surgery: Accuracy Analysis
Douglas Voss Oliveira, David Normando, Diogo Souza Ferreira Rubim de Assis, and José Thiers Carneiro Júnior
FapUNIFESP (SciELO)



Patients’ perception of orthodontic retainers: a systematic review
Larissa Barbosa Moda, Renata Travassos da Rosa Moreira Bastos, Carlos Flores-Mir, and David Normando
Oxford University Press (OUP)
Abstract Background Orthodontic retainers are widely used to prevent relapses after orthodontic treatment; however, evidence about patients' perceptions of retainers is lacking. Objective To assess patients’ perception of orthodontic retainers. Search Methods PubMed, Web of Science, Scopus, LILACS, LIVIVO, Cochrane Library, and gray literature (Google Scholar) were searched without date or language restrictions. A manual search of the reference lists of the included articles was also performed. Selection criteria Studies comparing patients’ perceptions of wearing orthodontic retainers were included. Data collection and analysis According to the study design, the risk of bias (RoB) assessment was performed using RoB 2.0 or ROBINS-I. The level of evidence was assessed through the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) tool. Results Seventeen studies met the eligibility criteria. After the RoB assessment, 12 randomized controlled trials presented a high RoB, and 4 non-randomized controlled trials presented a moderate RoB. The certainty of evidence was classified as very low for the four assessed outcomes. The studies generally reported an initial temporary negative impact of orthodontic retainers. Different esthetic, functional, and ease-of-use advantages are reported using removable and fixed retainers. A quantitative analysis was not performed due to the considerable clinical and methodological heterogeneity among the studies. Conclusion The current evidence, although very limited, suggests that orthodontic retainers have an initial negative impact related to discomfort and functional limitations, but they seem to regress over time. There is a preference for thermoplastic over Hawley-type retainers. However, thermoplastic retainers cause different functional difficulties, and bonded retainers present the advantage of affecting speech function less than orthodontic removable retainers, although they can facilitate oral hygiene problems. Registration PROSPERO (CRD42022306665).


Self-correction of posterior crossbite in childhood: a systematic review of long-term follow-up studies
Bianka Costa do Nascimento, Cibelle Cristina Oliveira dos Santos, Milena Cristina Costa dos Santos, and David Normando
Oxford University Press (OUP)
Summary Background The concept that posterior crossbite is not self-correcting has been controversial in the literature. Objective To evaluate the incidence of self-correction of crossbite in different stages of dentition in childhood. Search methods and selection criteria A bibliographic search using the acronym PECOS was performed in five databases and in partial grey literature. Studies evaluating children with posterior crossbite in the deciduous or mixed dentition at initial examination and followed for at least 3 years were included. Data collection and analysis The data extraction of the studies included presents information on authorship, clinical characteristics, main results, and conclusions. The risk of bias in the studies was evaluated through the Joanna Briggs Institute tool. The certainty of the evidence was assessed using the GRADE tool. Results Among the 3045 references identified, seven cohort studies met the eligibility criteria. The studies evaluated patients in transition from deciduous to mixed, mixed to permanent, and deciduous to mixed dentition. Two studies had a low risk of bias, three had a moderate risk, and two had a high risk of bias. The results showed posterior crossbite self-correction frequencies ranging from 12.2 to 77.1% during the transition from primary to mixed dentition, approximately 16% from mixed to permanent dentition, and a range from 20 to 82.8% from deciduous to permanent dentition. The level of certainty of the evidence generated ranged from very low to moderate. Limitations The observational design of the studies, without adequate control for confounding factors, and non-classification of the samples considering the types or the severity of the posterior crossbite. Conclusion The self-correction of posterior crossbite in childhood is possible. However, the results of this research do not allow to affirm how often the self-correction of posterior crossbite can occur. New studies that assess factors associated with the occurrence of self-correction of this malocclusion, including oral habits, may increase the certainty of the evidence. Registration PROSPERO CRD42022311935


Spontaneous changes in mandibular incisor crowding from mixed to permanent dentition: a systematic review
Cibelle Cristina Oliveira dos Santos, Renata Travassos da Rosa Moreira Bastos, Silvio Augusto Bellini-Pereira, Daniela Garib, and David Normando
Springer Science and Business Media LLC
Abstract Introduction Dental crowding is the most prevalent malocclusion in the mixed and permanent detitions and can have a major impact on dentofacial esthetics. However, adjustments to the development and growth of the dentition can potentiate self-correction of dental crowding during childhood. Objective To evaluate the physiological behavior of mandibular incisor crowding in the transition from mixed to permanent dentition. Methodology Five electronic databases (PubMed, Scopus, Web of Science, LILACS and LIVIVO) and part of the gray literature (Proquest and Google Scholar) were investigated, based on the eligibility criteria associated with the acronym PECO, until June 2022. The risk of bias was assessed using the ROBINS-E tool and the certainty of evidence, the GRADE tool. Results Among the 2.663 studies identified, five were selected for qualitative analysis, of which one have a low risk of bias, and four, a moderate risk. A total of 243 patients were evaluated. Evidence with a high level of certainty was generated indicating a tendency for improvement in mandibular incisor crowding from mixed to permanent dentition, with mandibular incisor crowding decreasing from 0.17 to 4.62 mm on average. The mandibular incisor crowding reduction seems to be associated with the amount of initial crowding and spontaneous dental arch dimensional changes that occur in the mixed dentition and culminate in the increase in arch perimeter, leeway space, incisor protrusion and transverse growth of the maxillary and mandibular arch. Conclusion Based on moderate scientific evidence, spontaneous longitudinal changes in dental arch in the transition from the mixed to the permanent dentition demonstrate a spontaneous improvement in mandibular incisor crowding by up to 4.62 mm. These evidence provide a scientific basis for planning only longitudinal follow-up in patients with mild to borderline moderate mandibular incisor crowding in the mixed dentition avoiding overtreatment.


Effect of the quality of orthodontic finishing on the stability of anterior tooth alignment
Paulo Mecenas, Paula Coutinho Cardoso, Nair Galvão Maia, Francisco Ajalmar Maia, and David Normando
The Angle Orthodontist (EH Angle Education & Research Foundation)
ABSTRACT Objectives To evaluate whether the quality of orthodontic finishing influences long-term stability of anterior tooth alignment. Materials and Methods This retrospective study evaluated 38 patients. Data were obtained at the beginning of treatment (T0), at the end (T1), and at least 5 years after T1 (T2). At this point, the individuals were no longer wearing retainers. Anterior tooth alignment was measured using Little's index (LI). Effect on alignment stability was tested with multiple linear regression using LI–T0, LI–T1, intercanine width difference T1–T0, overbite (T1), overjet (T1), age, gender, time without retention, and presence of third molars as predictor variables. Well-aligned (LI < 1.5 mm) and misaligned (LI > 1.5 mm) cases were compared at T2. Results At T2, the alignment stability in the upper arch was inversely associated with the alignment quality (R2 = 0.378, P < .001) and directly associated with overbite (R2 = 0.113, P = .008) at T1. Posttreatment changes caused cases finished with poor alignment to become similar to those finished with excellent alignment (P = .917). In the mandible, posttreatment changes were directly associated only with overjet (R2 = 0.152, P = .015) and well-finished cases displayed better alignment than poorly finished cases (P = .011). Other variables showed no significant association. Conclusions In arches without retention, better quality of orthodontic finishing does not guarantee the stability of anterior alignment. In the maxilla, long-term changes were more significant the greater the overbite and the better the quality of alignment at end of treatment. In the mandible, changes were not dependent on the quality of finishing but were associated with greater overbite at T2.


Seeking clarification regarding effects of bonded spurs, fixed and removable palatal crib in the early treatment of anterior open bite
NCF Fagundes and David Normando
Elsevier BV



Orthodontic aligners: between passion and science
Suelly Maria MENDES RIBEIRO, Mônica Lídia Santos de Castro ARAGÓN, Daybelis del Socorro González ESPINOSA, Wendel Minoro Muniz SHIBASAKI, and David NORMANDO
FapUNIFESP (SciELO)
ABSTRACT Introduction: The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. Methods: Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. Conclusions: There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.


Is teledentistry effective to monitor the evolution of orthodontic treatment? A systematic review and meta-analysis
Darlyane Kellen Barros TORRES, Milena Cristina Costa dos SANTOS, and David NORMANDO
FapUNIFESP (SciELO)
ABSTRACT Introduction: With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments. Objective: To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment. Material and Methods: Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed. Results: Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low. Conclusion: With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = −2.75[−3.95, -1.55]; I2=41%; p<0.00001) and the time for starting refinement (mean difference = −1.21[−2.35, -0.08]; I2=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.


Can lingual spurs alter the oral health-related quality of life during anterior open bite interceptive treatment? A systematic review
Larissa Barbosa MODA, Suelly Maria Mendes RIBEIRO, Samuel de Carvalho CHAVES JUNIOR, Flavia ARTESE, and David NORMANDO
FapUNIFESP (SciELO)
ABSTRACT Introduction: The use of lingual spurs has been described as one efficient option, with great stability of results, but with scarce information of toleration for use in the mixed and permanent dentition phases. Objective: The purpose of this study was to assess the impact of lingual spurs on the oral health-related quality of life of children and/or adolescents during anterior open bite treatment. Methods: The review was recorded in the PROSPERO database. Eight electronic databases and partial gray literature were searched, without restrictions until march 2022. A manual search was also performed in the references of the included articles. Studies assessing the impact of lingual spurs on the oral health-related quality of life were included. Risk of bias was assessed using JBI or ROBINS-I tool, according to the study design. The level of evidence was assessed through GRADE. Results: Five studies met the eligibility criteria. Two non-randomized clinical trials had a serious risk of bias. Of the case-series studies, two had a low risk of bias and the other, a moderate risk of bias. The certainty of the evidence was classified as very low for all the evaluated results. In general, the studies reported an initial negative impact with the use of lingual spurs, however this was transitory in nature. A quantitative analysis was not performed due to the great heterogeneity between the studies. Conclusion: Current evidence, although limited, suggests that lingual spurs have an initial transient negative impact during interceptive treatment. Additional well-conducted randomized clinical trials are needed.


The impact of COVID-19 pandemic on total treatment time of fixed appliances
Milena Santos, Guilherme de Araujo Almeida, and David Normando
Springer Science and Business Media LLC
Abstract Background Several aspects of the orthodontic routine seem to have been affected since the emergence of SARS-CoV-2. We aimed to evaluate the impact of the COVID-19 pandemic on the duration of fixed orthodontic treatment. Methods This retrospective study evaluated consecutive cases of patients undergoing fixed orthodontic treatment that completed treatment before (n = 37) or during (n = 26) the COVID-19 pandemic. The impact of the pandemic on treatment time was adjusted for the patient’s initial age, sex, number of debonds/breakages, number of missing teeth, initial PAR (Peer Assessment Rating) index (T0) and operator (n = 2), through multiple linear regression. The impact generated by months of treatment conducted during the pandemic period was also examined. Seven poorly finished cases were previously excluded, including five finished during the pandemic. Results Although the number of absences/missed appointments of patients treated during the pandemic was four months more than those treated in the previous period (p < 0.001), there was no significant effect of the pandemic on total orthodontic treatment time for both operators. There was also an effect of operator (β = 10.42, p < 0.001) and gender, which was lower in females (β = 4.77, p = 0.03), on treatment time (R2 = 0.27). The other variables showed no significant association (p > 0.05). Conclusion The COVID-19 pandemic did not have a significant effect on total orthodontic treatment time, although a greater number of absences/missed appointments were observed.


The impact of the loss of first permanent molars on the duration of treatment in patients treated with orthodontic space closure and without skeletal anchorage
Paula Coutinho Cardoso, Paulo Mecenas, and David Normando
Springer Science and Business Media LLC
Abstract Background This study aims to evaluate the impact of the loss of permanent molars on the duration of orthodontic treatment for space closure and without skeletal anchorage. Methods Records at the beginning (T0) and the end (T1) of orthodontic treatment were selected retrospectively. Patients were divided into two groups: loss of molar (n = 19) and control, without loss (n = 24). The impact of loss on treatment time was assessed using multiple linear regression adjusted for the number of absences, bonding failures, age, sex, PAR index at T0 and T1 at p<0.05. Treatment time was also evaluated by the number of losses and which arches were involved (upper, lower). The systematic and random errors for the PAR index were verified using the intraclass correlation coefficient (ICC) and the Dahlberg formula, respectively. Results A small random error (1.51) and excellent replicability (ICC = 99.6) were observed. Overall average treatment time was 22.5 months (± 7.95) for the group without loss and 44.7 months (± 17.3) with a loss. Treatment time was longer in cases where there was a higher number of missing molars and when both arches were involved. In addition to the loss (β = 4.25, p < 0.001), the number of missed appointments (β = 2.88, p < 0.001) had a significant effect and increased treatment time. Bonding failures, gender, age, and PAR index at T0 and T1 were not significantly associated with treatment time in the multivariate model (p > 0.05). Conclusion Loss of the first permanent molar has a negative impact on orthodontic treatment time in cases of space closure. The treatment time is longer when there are more tooth losses and arches involved. Treatment time also increases with greater numbers of missed clinical appointments.


Effects of oral appliances on serum cytokines in adults with obstructive sleep apnea: a systematic review
Paulo Mecenas, Giza Hellen Nonato Miranda, Nathalia Carolina Fernandes Fagundes, David Normando, and Karina Correa Flexa Ribeiro
Springer Science and Business Media LLC
This review aimed to evaluate the effects of oral appliance (OA) therapy on serum inflammatory cytokines in adults diagnosed with obstructive sleep apnea (OSA). Seven electronic databases and partial gray literature were searched without restrictions through March 2021. Articles evaluating the levels of serum inflammatory cytokines in patients with OSA after OA treatment were included. The risk of bias (RoB) was assessed using the before-and-after tool or RoB 2.0. The level of certainty was assessed using the GRADE tool. Five studies met the eligibility criteria. One was a randomized clinical trial (RCT), while four were non-randomized clinical trials (NRCTs). Among the studies, C-reactive protein (CRP), IL-6, IL-10, IL-1β, and tumor necrosis factor α (TNF-α) were investigated. The RCT reported no significant differences in marker levels after 2 months of OA therapy, while the NRCTs showed improvement on CRP, TNF-α, and IL-1β levels after longer follow-up periods. The RoB was evaluated as showing some concern in the RCT. Three NRCTs presented good RoB, and one showed a fair RoB. The level of certainty was graded as moderate quality for inflammatory marker levels assessed in the RCT The levels of certainty evaluated in NRCTs were classified as very low. Although limited, existing scientific evidence showed that OA therapy may improve serum cytokine levels in adults with OSA. However, short treatment periods are not effective in reducing markers of systemic inflammation which may require extended time and a decrease of in apneic events to improve.


Mandibular advancement analysis among orthodontists, lay people and patients in class II malocclusion subjects. A three-dimensional imaging study
Daybelis González Espinosa, Gustavo Antonio Martins Brandão, and David Normando
Wiley
OBJECTIVE To evaluate the acceptance of orthodontists, laypeople and the patient when progressive mandibular advancements are performed in Class II subjects with mandibular retrognathism. SETTING AND SAMPLE 3D images were obtained by an optical surface scanning of fifteen individuals (12 males and 3 females, mean age of 23 years and 8 months) with mandibular retrognathism in three mandibular positions: maximum intercuspation (MIC), and progressive mandibular advancement of 2 and 4 mm. METHODS The images (n=45) were evaluated through a scale by two groups of panelist, 20 orthodontists, 20 laypeople and by the patients themselves (n=15). The participants evaluated and rated each video and give scores between 0 and 10, according to their perception of facial harmony. MANOVA for repeated measures was used for intra and intergroup differences and to evaluate the patients' self-perception. RESULTS Laypeople reported better face acceptance than orthodontists in MIC, and progressive mandibular advancement of 2 and 4 mm (p<0.0001). 80% of the patients evaluated their own face as pleasant in MIC. Around half of them did not noted significant difference following mandibular advancement of 2 mm as compared with MIC and even 2/3 attributed lower scores when the mandible was advanced 4 mm. CONCLUSION A high variability was observed among all groups of raters. Patient´s opinion should be taken into account when mandibular advancement of 4 mm or more is planned. This study suggests that a thorough discussion of facial changes resulting from mandibular advancement should be carried out among professionals, parents and patients.


Treatment stability with bonded versus vacuum-formed retainers: a systematic review of randomized clinical trials
Silvio Augusto Bellini-Pereira, Aron Aliaga-Del Castillo, Cibelle Cristina Oliveira dos Santos, José Fernando Castanha Henriques, Guilherme Janson, and David Normando
Oxford University Press (OUP)
Summary Background In orthodontics, the retention phase can be considered challenging and unpredictable. Therefore, evidence obtained from different retention protocols is important to facilitate clinical decision-making. Objectives This systematic review aimed to compare the clinical effectiveness of bonded versus vacuum-formed retainers (VFRs) regarding their capacity to maintain treatment stability, periodontal effects, and failure rates. Search methods and eligibility criteria Ten databases comprising published and unpublished literature were systematically searched up to August 2021. Randomized clinical trials (RCTs) comparing both retainers were included. Data collection and analysis The risk of bias (RoB) evaluation was performed with the Cochrane Collaboration RoB Tool 2.0. All steps of the screening phase and RoB assessment were performed independently by two reviewers. The Grade of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of the evidence. Results Initial database search yielded 923 studies. After duplicates removal and full-text assessment, five RCTs remained. Overall, the studies presented Low RoB, except one study judged with ‘Some concerns’. Based on the included studies, on a short-term (3–6 months) and long-term (4 years) basis, bonded retainers (BRs) were more effective to maintain treatment stability than VFRs in the lower arch. However, from 12 to 24 months both retainers presented the same efficacy. In the upper arch, the retainers were equally effective. BRs were associated with greater plaque and calculus accumulation than VFRs after 12 months. The retainers’ failure rates were similar in the upper arch on the first year of retention; however, after 2 years VFRs showed significantly greater failure rates. Contrarily, BRs presented greater failure rates in the lower arch than VFRs. Limitations The findings of the included studies may be influenced by different factors related to the unpredictability of relapse. Conclusions Most of the evidence generated in this systematic review derived from a moderate level of certainty. In the lower arch, BRs are more effective than VFRs to maintain treatment stability in the initial 6 months of retention and in the long term. In the upper arch, both retention protocols are equally effective. Registration Regist0ration number: PROSPERO CRD42020199392. Funding Coordination for the Improvement of Higher Educational Personnel (CAPES, Process code-001).