Samer Mheissen
@moh.gov.sy
DDS, Syrian Board in Orthodontics, Former instructor in Orthodontic Department
Syrian Ministry of Health Private Practice, Damascus, Syrian Arab Republic
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Samer Mheissen, Loukia M. Spineli, Baraa Daraqel, and Ahmad Saleem Alsafadi
Public Library of Science (PLoS)
Background Orthodontic systematic reviews (SRs) include studies published mostly in English than non-English languages. Including only English studies in SRs may result in a language bias. This meta-epidemiological study aimed to evaluate the language bias impact on orthodontic SRs. Data source SRs published in high-impact orthodontic journals between 2017 and 2021 were retrieved through an electronic search of PubMed in June 2022. Additionally, Cochrane oral health group was searched for orthodontic systematic reviews published in the same period. Data collection and analysis Study selection and data extraction were performed by two authors. Multivariable logistic regression was implemented to explore the association of including non-English studies with the SRs characteristics. For the meta-epidemiological analysis, one meta-analysis from each SRs with at least three trials, including one non-English trial was extracted. The average difference in SMD was obtained using a random-effects meta-analysis. Results 174 SRs were included in this study. Almost one-quarter (n = 45/174, 26%) of these SRs included at least one non-English study. The association between SRs characteristics and including non-English studies was not statistically significant except for the restriction on language: the odds of including non-English studies reduced by 89% in SRs with a language restriction (OR: 0.11, 95%CI: 0.01 0.55, P< 0.01). Out of the sample, only fourteen meta-analyses were included in the meta-epidemiological analysis. The meta-epidemiological analysis revealed that non-English studies tended to overestimate the summary SMD by approximately 0.30, but this was not statistically significant when random-effects model was employed due to substantial statistical heterogeneity (ΔSMD = -0.29, 95%CI: -0.63 to 0.05, P = 0.37). As such, the overestimation of meta-analysis results by including non-English studies was statistically non-significant. Conclusion Language bias has non-negligible impact on the results of orthodontic SRs. Orthodontic systematic reviews should abstain from language restrictions and use sensitivity analysis to assess the impact of language on the conclusions, as non-English studies may have a lower quality.
Mohammed Almuzian, Samer Mheissen, Haris Khan, Fahad Alharbi, Emad Eddin Alzoubi, and Mark Brian Wertheimer
Galenos Yayinevi
Objective: To investigate the most common retention practices, factors influencing the retention protocol, and the differences among orthodontists regarding retention practices. Methods: An online validated questionnaire was anonymously sent to 3,000 orthodontic residents and clinicians. The survey consisted of 19 questions regarding the participants’ demographics, prescribed retention appliances, factors affecting retention appliance choices, and adjunctive retention procedures. Descriptive statistics, Chi2 and Kendall’s Tau-b tests were applied. Results: Five hundred fifty-five orthodontic residents and clinicians, 53.3% males and 46.7% females, completed the survey, indicating a response rate of 18.5%. Although participants’ demographics, type of treatment and pre-treatment malocclusion influence the choice of retention protocols, thermoplastic retainers (TR) were the most popular retention regime for the maxillary arch for both adults (47.4%) and adolescents (42.3%). Bonded retainers (BR) were the favored option for the mandibular arch (44.9% of adults and 40.7% of adolescents). The degree of arch expansion (64.1%) and the degree of interdigitation (50.1%) after treatment were the most influential factors for the choice of the preferred type of retainers by the respondents. 68.6% of the participants thought professional retention guidelines would be useful. Conclusion: Thermoplastic retainers were the most common retention appliances for adults and adolescents in the maxilla. At the same time, BR was the most favored retainer in the mandibular arch, with clinical experience, practice setting, and malocclusion- and treatment-related factors influencing the type of the chosen appliance. The demographic differences and the uneven participation in the survey need to be considered while interpreting the findings of this 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.
Baraa Daraqel, Khaled Wafaie, Hisham Mohammed, Li Cao, Samer Mheissen, Yang Liu, and Leilei Zheng
Elsevier BV
Baraa Daraqel, Samer Mheissen, Jiahua Li, Haris Khan, Shawkat Allan, and Leilei Zheng
Oxford University Press (OUP)
Summary Background Orthodontic space closure of extraction sites can be initiated early, within 1-week post-extraction, or it can be delayed for a month or more. Objective This systematic review aimed to evaluate the effect of early versus delayed initiation of space closure after tooth extraction on the rate of orthodontic tooth movement. Search methods Unrestricted search of 10 electronic databases was conducted until September 2022. Selection criteria Randomized controlled trials (RCTs) investigating the initiation time of space closure of extraction sites in patients undergoing orthodontic treatment were included. Data collection and analysis Data items were extracted using a pre-piloted extraction form. The Cochrane’s risk of bias tool (ROB 2.0) and the Grading of Recommendations, Assessment, Development, and Evaluation approach were used for quality assessment. Meta-analysis was undertaken if there are at least two trials reporting the same outcome. Results Eleven RCTs met the inclusion criteria. Meta-analysis revealed that early canine retraction resulted in a statistically significant higher rate of maxillary canine retraction when compared to delayed canine retraction [mean difference (MD); 0.17 mm/month, 95% CI: 0.06 to 0.28, P = 0.003, 4 RCTs, moderate quality]. Duration of space closure was shorter in the early space closure group, but not statistically significant (MD; 1.11 months, 95% CI: −0.27 to 2.49, P = 0.11, 2 RCTs, low quality). The incidence of gingival invaginations was not statistically different between early and delayed space closure groups (Odds ratio; 0.79, 95% CI: 0.27 to 2.29, 2 RCTs, P = 0.66, very low quality). Qualitative synthesis found no statistically significant differences between the two groups regarding anchorage loss, root resorption, tooth tipping, and alveolar bone height. Conclusions Based on the available evidence, early traction within the first week after tooth extraction has a minimal clinically significant effect on the rate of tooth movement compared to delayed traction. Further high-quality RCTs with standardized time points and measurement methods are still needed. Registration PROSPERO (CRD42022346026).
Samer Mheissen, Mays Aldandan, and Haris Khan
Oxford University Press (OUP)
Abstract Background Meta-analysis (MA) is a common mathematical method used in systematic reviews (SRs) to gather data from different studies. MA may result in overestimation or underestimation of the effect due to systematic and random errors. Trial sequential analysis (TSA) has been used to overcome the limitations of conventional MA. The objective of this study was to re-evaluate the findings of orthodontic MAs using TSA to investigate the conclusiveness of the effect and to estimate the required information size (IS). Methods Orthodontic SRs with MA published between 1 January 2013 and 31 December 2022 in the leading orthodontic journals were sourced. Data from arm-level MAs were extracted and re-entered in TSA software. Results A total of 180 papers were assessed against the inclusion criteria. Finally, 50 SRs with MAs were included. TSA found that almost half of the MAs with significant results demonstrated firm evidence of effect. While 38% of the significant MAs confirmed potentially spurious evidence of effect. In contrast, only one MA with insignificant findings showed a lack of effect. Furthermore, a larger number of patients were needed when the evidence of the effect was absent. Conclusions TSA revealed that many orthodontic MAs have potentially false-positive results and have insufficient IS.
Samer Mheissen, Baraa Daraqel, Khaled Wafaie, and Haris Khan
Oxford University Press (OUP)
Summary Background Assessment of unit of analysis (UoA) in meta-analysis with cluster, split-mouth, repeated measures designs, and multiple intervention groups is a fundamental step in the analysis. The objective of this study was to evaluate the UoAs in orthodontic meta-analysis and determine the error of the analysis. Methods An electronic search was conducted in the Cochrane Library and PubMed to identify orthodontic systematic reviews (SRs) with meta-analyses published in Cochrane and in the highest impact orthodontic journals between 1 January 2013 and 31 December 2022. SRs with meta-analysis assessing at least one of the following UoAs; cluster trials, crossover trials, multiple observations, or multiple intervention groups were included. Screening and data extraction were undertaken by two investigators independently. Descriptive statistics for the study characteristics were provided. The associations between avoiding the unit analysis error (yes, no) and the study characteristics were examined using Fisher’s exact test and chi-square test. Logistic regression was undertaken for the significant predictors. Results Eighty SRs were deemed eligible for inclusion. Only 30 per cent of the included SRs avoided UoA errors. Compared to the split-mouth design, repeated measures designs had higher odds of avoiding UoA error (odds ratio: 9.6, 95% confidence interval: 2.8–32.3, P &lt; 0.001). In contrast, fewer odds of avoiding the UoA error were found in the cluster design (OR: 0.2, 95% CI: 0.4–1.3, P = 0.09). Though multiple intervention groups have higher odds of avoiding UoA error than split-mouth studies, this was not statistically significant (OR: 2.1, 95% CI: 0.5–8, P = 0.28). None of the SRs characteristics have influenced the appropriate handling of the unit analysis except the type of the journal; the odds of avoiding the UoA error were higher in Cochrane reviews than the non-Cochrane reviews (OR: 3.3, 95% CI: 1.2–8.7, P = 0.02), and the number of authors (P &lt; 0.05). Conclusions UoA errors are common in orthodontic meta-analyses and were only partially avoided in split-mouth design, repeated measures design, and multiple intervention groups.
Mohammed Almuzian, Samer Mheissen, Mark B. Wertheimer, and Haris Khan
SAGE Publications
Objectives: To assess technical factors and audience preferences before attending orthodontic online learning activity, the demand for which increased dramatically in the era of the COVID-19 pandemic. Design: Cross-sectional study. Setting: Online survey. Participants: Global orthodontic residents and specialists. Methods: A validated and anonymous survey comprising 17 online questions was sent to 3000 individuals. The data were collected three months later. Descriptive statistics and non-parametric tests were applied. Results: The participants’ response rate was 19.9%, with almost equal gender participation. Most of the responders were based in Asia (51.4%). Almost half of the participants were aged 25–35 years with less than 5 years of clinical experience. Regardless of the age, gender or global distribution, 57.3% of respondents opted to share limited personal information with the host. One-third of the respondents preferred receiving webinar reminders via email, ideally a day and/or one hour before the webinar, especially being exportable to their calendars. Age played a major role in shaping this trend, as young participants favoured the one hour (1-h) pre-webinar reminder more than other age groups ( P=0.02). Receiving information about the speaker, learning outcomes and pre-webinar reading material (WRM) were preferable, particularly among young participants in comparison with the older age groups ( P<0.05). Male participants from Asia and Africa preferred to attend online lectures during the mid-evening on weekends compared with women who were in favour of early evening sessions ( P<0.05). Conclusion: It must be borne in mind during the interpretation of the results that the data were collected during the COVID-19 pandemic. It is important to take into consideration the gender, age, cultural background and level of experience while setting up virtual orthodontic learning sessions. Organisers need to tailor their events to meet the needs of the attendees.
Samer Mheissen, Baraa Daraqel, Emad Eddin Alzoubi, and Haris Khan
Oxford University Press (OUP)
Summary Background Autologous platelet-rich concentrates (PRCs) are recently used as a local biological substance in orthodontics to accelerate the rate of tooth movement. Objectives This systematic review aimed to evaluate the effects of PRCs on the rate of orthodontic tooth movement (OTM). Search methods Unrestricted search of five electronic databases supplemented by the manual and gray literature search were undertaken in March 2022. Selection criteria Randomized controlled trials (RCTs) evaluating the effect of PRCs on the rate of OTM with their side effect were included in this systematic review. Data collection and analysis Data items were extracted by two authors using a pre-piloted extraction form. Similar outcomes within a comparable time frame were synthesized in a meta-analysis. Results Fourteen studies were deemed eligible for inclusion and seven RCTs were pooled in a meta-analysis. Canine retraction rate was higher in the side of PRCs injection than the control side by 0.28 mm/month (95% CI: 0.16–0.40, I2 = 95.6 per cent, P &lt; 0.001, 345 patients) in the first 4 months after PRCs injection. There was no statistically significant difference between the PRCs side and the control side regarding molar anchorage loss (MAL) (MD = 0.03 mm, 95% CI: −0.18 to 0.24, I2 = 46.3 per cent, P = 0.78, 44 patients), canine rotation (MD = −0.19o, 95% CI: −1.95 to 1.57, I2 = 45.4 per cent, P = 0.96, 48 patients), or en-masse retraction. Likewise, there was no difference between both groups in terms of the duration of de-crowding. The mandibular canine retraction was statistically higher on the PRCs side than on the control side by 0.17 mm/month (P &lt; 0.001, one trial). Regarding root resorption, there was no statistically significant difference between the experimental and control sides within the follow-up time. Mild pain scores were reported by the patients in the first 24 hours after injections. Conclusions Low-level evidence indicates that the effect of PRCs on OTM is minor and clinically insignificant. The findings should be interpreted with caution due to the inherent limitations in the included RCTs. Registration PROSPERO (CRD42022300026).
Samer Mheissen and Haris Khan
Springer International Publishing
Samer Mheissen and Loukia M. Spineli
Springer Science and Business Media LLC
Mohammed Almuzian, Haris Khan, Samer Mheissen, and Mark B. Wertheimer
Elsevier BV
Samer Mheissen, Haris Khan, Jadbinder Seehra, and Nikolaos Pandis
Elsevier BV
Samer Mheissen, Haris Khan, Mohammed Almuzian, Emad Eddin Alzoubi, and Nikolaos Pandis
Oxford University Press (OUP)
Summary Background In orthodontic trials, longitudinal designs with multiple outcome measurements over time are common. The aim of this epidemiological study was to examine whether optimal statistical analysis approaches have been used in longitudinal orthodontic trials. Methods Pubmed was searched in August 2021 for longitudinal orthodontic trials with at least three time points of outcome assessment published in the 2017–20 period. Study selection and data extraction were done independently and in duplicate. The analysis approaches undertaken were tabulated and associations between study characteristics and the use of optimal analysis or not were assessed using Fisher’s exact test and logistic regression. Results One hundred forty-seven out of 563 unique records were deemed eligible for inclusion. Only 26.50% of these trials used an optimal statistical analysis for longitudinal data where the data structure is accounted for. None of the study characteristics except the statistical significance of the results were associated with the appropriateness of the statistical analysis. The odds of significant results in studies with suboptimal analyses were higher than that in studies with optimal longitudinal analyses (odds ratio: 3.48, 95% confidence interval: 1.62, 7.46, P = 0.001). For the studies with optimal analysis, the most frequent test was repeated-measure analysis of variance (RM-ANOVA). The reporting of the statistical analysis section was suboptimal in the majority of the trials. Conclusion Most longitudinal orthodontic trials are not analysed using optimal statistical approaches. Inferences and interpretation of their results are likely to be compromised.
Samer Mheissen, Jadbinder Seehra, Haris Khan, and Nikolaos Pandis
The Angle Orthodontist (EH Angle Education & Research Foundation)
ABSTRACT Objectives To examine whether optimal calculations of the sample size are being used in longitudinal orthodontic trials. Materials and Methods Longitudinal orthodontic trials with a minimum of three time points of outcome assessment published between January 1, 2017, and December 30, 2020, were sourced from a single electronic database. Study characteristics at the level of each trial were undertaken independently and in duplicate. Descriptive statistics and summary values were calculated. Inferential statistics (Fisher's exact test and logistic regression) were applied to detect associations between reporting of a sample size calculation and the study characteristics. Results A total of 147 trials were analyzed; 75.5% of these trials reported a sample size calculation with none reporting optimal sample size calculation for longitudinal trials. Most of the longitudinal orthodontic trials did not report the correlation and the number of longitudinal measurements in calculating the sample size. An association between reporting of a sample size calculation (yes or no) and the type of journal (orthodontic and non-orthodontic) was detected with higher odds of reporting a sample size calculation in orthodontic journals than in non-orthodontic journals (3.04; 95% confidence interval, 1.4-6.59; P &lt; .01). Conclusions The findings of this study highlighted that the undertaking of optimal sample size calculations in longitudinal orthodontic trials is being underused. Greater awareness of the variables required for undertaking the correct sample size calculation in these trials is required to reduce suboptimal research practices.
Haris Khan, Samer Mheissen, Ayesha Iqbal, Ali Raza Jafri, and Mohammad Khursheed Alam
Hindawi Limited
Failure of brackets is a common problem in orthodontics. This affects the treatment time, cost, and compliance of the patient. This study was conducted to estimate the bracket failure rate and the related factors for the long term. Methodology. This ambidirectional cohort study included 150 nonsyndromic orthodontic patients undergoing fixed appliance therapy for the last two years. The same patients were followed for 7 months. Different variables related to bracket failure were evaluated. The available data were analyzed descriptively, and the Kaplan-Meier estimate was used to measure the bracket survival rate from the date of bonding to failure. Results. A total of 180 bracket bond failures in the 150 included patients (52.2% males and 47.8% females) with a median age of 17 years (range 10-25 years). 69% of brackets failures were reported within the first 6 months after bonding. About 58.3% of bracket failure was noticed in adolescent patients before the age of 18 years. The majority of the cohort (81.1%) has good oral hygiene. The failure rate in patients with normal overbite was 41.1%, in decreased overbite cases was 15%, while in deep bite cases the failure rate was 43.9% with a statistically significant difference. Adults show less bracket failure (41.7%) than adolescent patients (58.3%). More bracket failure was noted in the lower arch (55%) than the upper arch (45%), and there were more bond failures posteriorly (61%) than on the anterior teeth (39%). Majority (41.1%) of the bracket failed on round NiTi wires. Conclusion. The bracket failure rate was 6.4%, with most bracket failure occurring in the first 6 months after bonding with individual difference. There was more incidence of bond failure in an increased overbite, adolescents, lower arch, posterior teeth, and lighter alignment wires.
Samer Mheissen, Mohammed Almuzian, Mark B. Wertheimer, and Haris Khan
Springer Science and Business Media LLC
Abstract Objectives Understanding the issues concerning the conducting of virtual orthodontic learning sessions (VOLSs) is essential. This study aims to identify attendees- and host-related aspects that could optimise learning and uptake from the VOLSs. Methodology Fourteen pre-validated questions were anonymously and electronically sent to 3000 orthodontic residents and specialists globally. The survey included demographic questions and questions to gauge attendees' engagement, memorising, and motivation-related factors. Reminders were sent at two-week intervals to non-respondents. The survey was closed when the sample size was met. Descriptive and inferential statistics were performed. Results 593 orthodontic residents and specialists (294 males and 299 females), primarily junior orthodontists and residents aged between 25 and 35 years of age, completed the survey. Post-VOLS recording was highly requested by the participants (8.84/10, 95% CI 8.67–9.00) with no significant influence of demographics on this trend (p > 0.05). Most of the participants were in favour of short post-VOLSs feedback (6.79/10 95% CI 6.58–6.99) with significant differences (p = 0.048) between participants from different regions of the world. The average number of screenshots taken was 6.1 per lecture. The learners’ interests in attending on-line lectures were mainly to learn new clinical orthodontic tips (96.8%). Conclusion Implementing a short feedback survey after VOLSs, the provision of recording, and the provision of certificates of attendance need to be considered.
Samer Mheissen, Haris Khan, Ahmad Saleem Alsafadi, and Mohammed Almuzian
SAGE Publications
Objective: To identify and evaluate the body of the evidence regarding the effectiveness of surgical adjunctive procedures (SAPs) in accelerating orthodontic tooth movement (OTM). Data sources: Unrestricted search of three electronic databases and manual search up to 12 June 2020 were undertaken. Data selection: All systematic reviews of randomised and non-randomised controlled trials that investigate the effectiveness of the SAPs in accelerating OTM were included. Data extraction: Study selection and data extraction were undertaken independently and in duplicate by two reviewers. A random-effects model with a 95% confidence interval (CI) was generated for comparable outcomes. Two reviewers assessed the quality of the included studies using AMSTAR2 and GRADE. Results: Fourteen systematic reviews were included; however, four systematic reviews were assessed quantitatively. Meta-analysis showed that mean difference (MD) of canine retraction rate, for the first month after SAPs, was mild (MD = 0.65 mm/month). Compared to control, micro-osteoperforations (MOPs) statistically but temporally accelerate lower canine retraction and en masse retraction by 0.25 mm/month and 0.31 mm/month, respectively. There was no significant effect ( P>0.05) in terms of molar anchorage loss (MAL) between control and MOP groups. Piezocision non-significantly shortens the duration of en masse retraction (4.30 months, P>0.05), but significantly shortens incisors retraction (101.64 days, P<0.001). MAL is mild but significantly less in the piezocision group compared to the control group (MD = 0.53 mm, P=0.03). Low-level evidence showed that SAPs have no significant effect on root resorption or periodontal health; however, piezocision is associated with transient acute inflammation and noticeable scars. Conclusion: Low-level evidence concludes that SAPs accelerate OTMs and reduce treatment duration, but the acceleration is minor and transient. The effect on anchorage loss is variable and technique related. Side effects of SAPs are transient, but some might be aesthetically noticeable. A cost-benefit analysis of SAPs should be considered while making the treatment decision.
Mohammed Almuzian, Josh Rowley, Hisham Mohammed, Mark B. Wertheimer, Aman Ulhaq, and Samer Mheissen
Springer Science and Business Media LLC
Background Class III malocclusions with maxillary retrognathia are commonly treated with single jaw Le Fort I maxillary advancement. The three-dimensional (3D) effects of surgery on the nasolabial region varies among the clinical studies. Quantifying these changes is of great importance for surgical planning and obtaining valid consent. Objectives To investigate the 3D relationship between soft tissue and skeletal changes secondary to Le Fort I maxillary advancement surgery in skeletal class III patients.Search methods Comprehensive search of multiple electronic databases supplemented by a manual and grey literature search were undertaken from inception to 9 June 2020.Selection criteria Studies that evaluated the 3D soft tissue changes of patients before and after maxillary advancement surgery alone.Data collection and analysis Study selection, data extraction and risk of bias assessment were performed independently by two reviewers, with disputes resolved by a third reviewer. A quantitative synthesis of the data was pre-planned for pooling similar outcome measures.Results Four studies were included in the final review and meta-analysis, with a total of 105 patients (mean age 16.7 + 33.9 years). The mean maxillary advancement of the included studies was 5.58 mm (95% CI 5.20-5.96). The sagittal effects of surgery on nose tip projection and prominence were insignificant (P >0.05, two studies); however, subnasal projection (MD 1.7 mm, two studies) and upper lip projection (MD 2.90 mm, four studies) increased significantly in a forward direction after surgery (P <0.05). Le Fort I osteotomy widens the upper philtrum width (MD 0.84 mm, two studies) (P <0.05). Inconsistencies among the included studies were identified; therefore, the results should be interpreted with caution.Conclusions There is weak evidence based on quantitative assessments that Le Fort I maxillary advancement significantly affects the nasolabial soft tissue envelope mainly in a sagittal dimension. These changes are concentrated around the central zone of the nasolabial region. Future prospective studies on maxillary advancement osteotomy with a standardised method of assessment, taking into consideration the confounding factors, are required.
Ayah Jourieh, Haris Khan, Samer Mheissen, Muhammad Assali, and Mohammad Khursheed Alam
Hindawi Limited
Introduction. The determination of skeletal maturity stages is very important in orthodontic treatment planning, especially skeletal discrepancies in growing individuals. A hand-wrist radiograph is considered the most accurate approach for skeletal maturity detection. Dental calcification stages have been suggested as an alternative diagnostic method to decrease radiation exposure. The recent study is aimed at detecting the efficacy of dental calcification stages in assessing skeletal maturity during the prepubertal and pubertal growth periods. Methods. Patients’ records were collected from the Aleppo Orthodontic Center. Dental maturity stages were assessed from a panoramic radiograph using the Demirjian method, while skeletal maturity stages were determined using the Björk method. Four permanent left mandibular teeth were included (canine, 1st premolar, 2nd premolar, and 2nd molar) for the study. Results. From 517 records, 295 records (145 males and 150 females) were included. The Spearman rank-order correlation coefficients between skeletal maturation and dental maturation were strong and statistically significant (ranging from 0.789 to 0.835). The highest correlation was between skeletal stages and the second molar ( r = 0.829 and 0.88 in males and females, respectively). Receiver operating characteristic (ROC ) curve suggested a high validity of the sum of dental stages for the four teeth in identifying MP3= stage (sensitivity was 70%, specificity was 92.77%, and ROC area was 0.81) but not for MP3cap (sensitivity was 50.85%, specificity was 81.36%, and ROC area was 0.66). Conclusions. The correlation between the skeletal maturity stages and the dental calcification stages was high. The orthodontist can use the dental stages as a definite diagnostic tool for prepubertal growth period.
Samer Mheissen, Haris Khan, and Mays Aldandan
Springer Science and Business Media LLC
Design Systematic review for randomised and non-randomised studies. Data sources Eight electronic databases: PubMed, Cochrane, Scopus, Web of Science, Lilacs, Google Scholar, Clinical Trials and OpenGrey were searched without language or date restrictions during the search, in addition to hand-searching. Study selection Randomised and non-randomised controlled trials (RCTs and non-RCTs) and cross-sectional studies that compare pain levels between fixed appliances and clear aligners during orthodontic treatment in adults patients. Data extraction and synthesis The reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study selection was done by two reviewers. The reviewers assessed the risk of bias using three risk of bias tools (ROB.2 tool for RCTs, ROBINS-I tool for non-RCTs and the Newcastle-Ottawa scale for cross-sectional studies). Results Seven studies were included in this review. Five studies were non-RCTs, one was an RCT and one study was a cross-sectional design. The risk of bias was moderate to high in the non-RCTs, low in the RCT and low for the cross-sectional study. All studies used the same type of aligners (Invisalign aligner) and they differed in the fixed appliance type and archwire sequences. However, meta-analysis was not possible. In the first 24 hours of treatment, four studies revealed that the pain is higher in the fixed appliance group. During days three and four, two studies reported a higher level of pain in a fixed appliance group. On days five to seven, only one study reported a higher level of pain in a fixed appliance group. On day 14, two studies evaluated pain levels and reported that there is no difference between the two groups. Conclusions With low certainty, patients treated with clear aligners seems to have less pain perception than patients treated with conventional fixed appliances during the first days of treatment. There were no noticeable differences up to three months between the two groups. Furthermore, the malocclusion was not described in detail in the individual studies, which may play a role in pain level differences.
Samer Mheissen, Haris Khan, and Shadi Samawi
Public Library of Science (PLoS)
Objective This meta-analysis aimed at critically assessing currently available evidence regarding the overall effectiveness of Piezocision in accelerating orthodontic tooth movement, as well as the adverse effects of this intervention in orthodontic patients. Search methods Electronic search of 6 databases and additional manual searches up to April 2019 without restrictions, also update the search was done by 20th November. Selection criteria Randomized controlled trials (RCT) and controlled clinical trials (CCT) reporting piezocision-assisted orthodontics versus conventional orthodontics were included in the review. Data collection and analysis The data are expressed by mean differences (MD), 95% confidence intervals, fixed-effect model or random-effect model in the meta-analysis in regard to statistical heterogeneity analyses (tau2, and I2). Included randomized studies were assessed for risk of bias using the new Cochrane Risk of Bias tool (ROB.2) and the non-randomized studies were assessed using (ROBINS I) tool. The studies were graded according to the GRADE approach. Results Fourteen papers for 13 unique trials were included in this systematic review and eight studies were included in the meta-analysis. The meta-analysis showed that the mean difference of the canine retraction rate in the first and second month after piezocision was 0.66 mm/month and 0.48mm/month, respectively. A total canine retraction rate in the first two months after piezocision was statistically significant (0.57 mm/month, p<0.00001), favoring the piezocision group with a high heterogeneity between studies I2 = 69%. For the total treatment time outcome measure, there was a statistically significant difference in the overall treatment time (MD 101.64 Days, 95% CI, 59.24–144.06) favoring the piezocision group. Conclusions Low quality evidence suggests that piezocision is an effective surgical procedure in accelerating the rate of canine retraction in the first two months and reducing the treatment duration. However, this effect appears to be clinically insignificant. Systematic review registration CRD42019136303.