Three-dimensional dentoalveolar changes in open bite treatment in mixed dentition, spurs/posterior build-ups versus spurs alone: 1-year follow-up randomized clinical trial

Abstract

This randomized clinical trial aimed to compare the three-dimensional dentoalveolar maxillary changes after anterior open bite treatment with bonded spurs and build-ups versus bonded spurs alone. Patients from 7 to 11 years of age with anterior open bite were randomly allocated into two groups. Bonded spurs and posterior build-ups were used in the experimental group and only bonded spurs were used in the comparison group. The randomization sequence was generated at www.randomization.com. Opaque, sealed and sequentially numbered envelopes were part of the allocation concealment. Digital dental models were acquired before (T1) and after 12 months of treatment (T2) and de-identified for analysis purposes. Three-dimensional changes of maxillary permanent incisors and first molars were evaluated by means of T1 and T2 dental model superimposition. Landmark-based registration on the posterior teeth and registration on the palate using regions of interest were performed. T or Mann–Whitney U tests were used for intergroup comparisons (P < 0.05). Mean difference (MD) and 95% confidence interval (CI) were calculated. Twenty-four children (17 girls and 7 boys) were included in the experimental group (mean age 8.22 ± 1.06 years) and 25 children (14 girls and 11 boys) were included in the comparison group (mean age 8.30 ± 0.99 years). After 12 months of treatment, inferior displacements of maxillary incisors were similar in the experimental (1.55–2.92 mm) and comparison (1.40–2.65 mm) groups. Inferior displacement of the maxillary molars was also similar in both groups (MD: − 0.13 mm; 95% CI − 0.38, 0.12). The experimental and comparison groups showed medial and lateral displacements of the permanent first molars, respectively (MD, − 0.31 mm; 95% CI − 0.51, − 0.11). Lingual inclination of the permanent first molars were observed in the experimental group and buccal inclination in the comparison group (MD, − 2.16°; 95% CI − 3.72, − 0.60). Similar three-dimensional displacements of maxillary central and lateral incisors, and inferior displacements of maxillary permanent first molars were observed in both groups. Bonded spurs associated with posterior build-ups demonstrated some medial displacement and lingual inclination of the maxillary permanent first molars while opposite changes were noticed in the comparison group.Trial registration: Clinicaltrials.gov; NCT03702881, date of registration: October 11, 2018.

Management Strategies for Open Bite Relapse: A Systematic Review and Meta-Analysis

“…A specific bias assessment strategy was employed to evaluate the methodological quality and risk of bias in the selected clinical studies. Two different tools were used for this purpose: the RoB-2 (Risk of Bias 2) tool for RCTs [ 9 ] and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool [ 10 ], as shown in Figures 1 - 2 [ 11 - 21 ].…”

“…The results of an RCT [ 11 ] comparing bonded spurs alone and with build-ups showed that both treatment procedures had moderate success rates for anterior OBR correction, with rates of 67% and 72% after a 12-month follow-up. Another retrospective study [ 12 ] focused on mandibular orthognathic surgery and found satisfactory occlusal stability at the one-year postoperative assessment in groups with little to no OBR.…”

“…The pooled OR estimate across the first subdivision of this forest plot was 0.45 (95% CI: 0.27, 0.74), indicating a significant association between fixed orthodontic appliances and a reduced likelihood of noticeable OBR as assessed in four studies [ 11 , 14 - 16 ]. The forest plot also displayed the heterogeneity test results, which showed no significant heterogeneity among the studies (Chi² = 0.43, df = 3, P = 0.93) and a low I² value of 0%, suggesting minimal inconsistency among the included studies.…”

“…A specific bias assessment strategy was employed to evaluate the methodological quality and risk of bias in the selected clinical studies. Two different tools were used for this purpose: the RoB-2 (Risk of Bias 2) tool for RCTs [9] and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool [10], as shown in Figures 1-2 [11][12][13][14][15][16][17][18][19][20][21]. For RCTs, the RoB-2 tool was applied to assess the risk of bias in the following domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcomes, and selection of the reported results.…”

“…Table 1 presents the 11 clinical studies [11][12][13][14][15][16][17][18][19][20][21] focusing on a particular topic, although the specific research objectives and outcomes are not provided.…”