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 20 th November. Selection criteria Randomized controlled trials (RCT) and controlled clinical trials (CCT) reporting piezocisionassisted 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 (tau 2 , and I 2). 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

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.

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.

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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.

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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.

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.