Evidence regarding lingual fixed orthodontic appliances' therapeutic and adverse effects is insufficient

Abstract

Data sourcesMedline, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Virtual Health Library and Web of Science were systematically searched up to July 2015 without limitations. Scopus, Google Scholar, ClinicalTrials.gov, the ISRCTN registry as well as reference lists of the trials included and relevant reviews were manually searched.Study selectionRandomised (RCTs) and prospective non-randomised clinical trials (non-RCTs) on human patients that compared therapeutic and adverse effects of lingual and labial appliances were considered. One reviewer initially screened titles and subsequently two reviewers independently screened the selected abstracts and full texts.Data extraction and synthesisThe data were extracted independently by the reviewers. Missing or unclear information, ongoing trials and raw data from split-mouth trials were requested from the authors of the trials. The quality of the included trials and potential bias across studies were assessed using Cochrane's risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. For parallel trials, mean difference (MD) and the relative risk (RR) were used for continuous (objective speech performance, subjective speech performance, intercanine width, intermolar width and sagittal anchorage loss) and binary outcomes (eating difficulty), respectively. The standardised mean difference (SMD) was chosen to pool, after conversion, the outcome (oral discomfort) that assessed both binary and continuous. Random-effects meta-analyses were conducted, followed by subgroup and sensitivity analyses.ResultsThirteen papers pertaining to 11 clinical trials (three parallel RCTs, one split-mouth RCT and seven parallel prospective non-RCTs) were included with a total of 407 (34% male/66% female) patients. All trials had at least one bias domain at high risk of bias. Compared with labial appliances, lingual appliances were associated with increased overall oral discomfort, increased speech impediment (measured using auditory analysis), worse speech performance assessed by laypersons, increased eating difficulty and decreased intermolar width. On the other hand, lingual appliances were associated with increased intercanine width and significantly decreased anchorage loss of the maxillary first molar during space closure. However, the quality of all analyses included was judged as very low because of the high risk of bias of the included trials, inconsistency and imprecision.ConclusionsBased on existing trials there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances regarding their therapeutic or adverse effects, as the quality of evidence was low.

Impact of orthodontic treatment on speech and phonetics: a review

“…[15][16][17] In addition, keeping up to date with the most recent evidence is increasingly challenging for clinicians. 18 When compared to labial appliances, lingual appliances cause greater levels of speech and phonetic problems, according to several systematic evaluations. 4,7,18,19 Runte et al reported that a 30° palatally pointed maxillary incisor might impact the fricative sound.…”

“…18 When compared to labial appliances, lingual appliances cause greater levels of speech and phonetic problems, according to several systematic evaluations. 4,7,18,19 Runte et al reported that a 30° palatally pointed maxillary incisor might impact the fricative sound. 20 The morphologies of the lingual tooth surface and the second articulation zone were changed when the brackets were positioned on the lingual surface of the anterior teeth, which caused problems with speech and phonetics.…”

From dental science to clinical practice: Knowledge translation and evidence-based dentistry principles

“…The credibility of systematic reviews depends on whether or not the authors addressed a sensible clinical question, included an exhaustive literature research section, demonstrated reproducibility of the selection and assessment of the studies, and presented the results in an useful manner (Bayne and Fitzgerald, 2014, Murad et al, 2014). Varying intensities of appraisals to assess the entire evidence base exist such as Cochrane Collaboration, ADA-EBD Library, UTHSCSA CATs and Evidence-Based Dentistry by nature (Afrashtehfar, 2016a, Afrashtehfar, 2016b). Unfortunately, only a fraction of the available evidence is often presented in a usable form, and few clinicians are aware that such usable shared decision aids exist (Greenhalgh et al, 2014, Murad et al, 2014, Afrashtehfar et al, 2016b).…”

Efficacy and safety of piezocision in accelerating maxillary anterior teeth en-masse retraction: study protocol for a randomized controlled trial

“…To improve facial appearance and oral function, numerous people have an increasing demand for orthodontic treatment [ 1 , 2 ]. One of the main challenges adult patients and orthodontists face is the prolonged orthodontic treatment time.…”