To compare the level of oral health-related quality of life (OHRQoL) between patients receiving clear aligners or fixed appliances within one year of follow-up using Oral Health Impact Profile 14 (OHIP-14), a validated self-administered questionnaire. A single-centered, two-arm parallel-group randomized controlled clinical trial was conducted on 36 adult patients (19 females, 17 males; age range: 18 to 25 years) who had severe crowding and require orthodontic treatment with first premolars extraction. The patients were equally and randomly divided into two groups: The clear aligners (CA) group and the fixed appliances (FA) group. OHRQoL was assessed using the OHIP-14 tool at various times during comprehensive orthodontic therapy: baseline (T0), one week (T1), two weeks (T2), one month (T3), 6 months (T4), and 12 months (T5) after starting the active orthodontic treatment. Mann-Whitney U test or Friedman test were used to detect significant differences. The level of significance was set at 5%. All of the selected patients entered the statistical analysis stage. There were no significant differences between the CA and FA groups for the psychological discomfort, psychological disability, social disability, and handicap (P˃0.05) at almost all assessment times. For the functional limitation, physical pain, physical disability, and the overall score, there were significant differences between the studied groups (P˂0.05), with the FA group having higher mean scores than the CA group in all of the assessment times. Patients' treatment with clear aligners has less impact on OHRQoL than those treated using conventional fixed appliances during the first year of treatment.

To assess the impact of clear aligner treatment on oral health-related quality of life (OHRQoL) compared to fixed appliance treatment. Two-arm parallel group single-centre randomized controlled trial. Forty-four adult patients (8 males, 36 females) were randomly and equally assigned to either the fixed appliances group (FA) or the clear aligners group (CA). Randomization with an allocation ratio of 1:1 was performed by a researcher who is not involved in the study using a random sample table. Non-extraction cases were included in this study. Outcome measures were the OHRQoL of patients and the duration of orthodontic treatment. The OHRQoL of patients was assessed by the short-form Oral Health Impact Profile (OHIP-14) at the following assessment times: before the start of treatment (T0), 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after the start of orthodontic treatment and post-treatment (T5). The assessor was blinded during outcomes assessment and statistical analysis. Two hundred and eighteen patients were evaluated for eligibility, 44 of them fulfilled the inclusion criteria and were randomly allocated to treatment groups. None of the patients was lost to follow-up. Accordingly, the results of 44 patients were statically analysed. The total OHIP-14 score was not statistically different between the FA and the CA groups at T0 (P = 0.91) and T5 (P = 0.16), whereas it was significantly lower in the CA group as compared to the FA group at T1 (mean difference [MD] = 11.04, 95% CI 8.7 to 13.42, P < 0.001), T2 (MD = 6.00, 95% CI: 4.3 to 7.7, P < 0.001), T3 (MD = 3.37, 95% CI: 1.5 to 5, P < 0.01), and T4 (MD = 3.32, 95% CI: 1.7 to 4.9, P < 0.001). Treatment duration in the CA group was significantly shorter than in the FA group (MD = 4.18, 95% CI: 2.8 to 5.5, P < 0.001). No harms were observed. The results were limited to the non-extraction treatment of mild to moderate crowding cases. Patients treated with clear aligners reported higher OHRQoL and shorter treatment duration as compared to those treated with fixed appliances. Retrospectively registered (DRKS-ID: DRKS00023977).

The current review aimed to critically and systematically evaluate the available evidence regarding the effectiveness of periodontally accelerated osteogenic orthodontics (PAOO) in accelerating orthodontic tooth movement and supporting the alveolar bone. Additionally, this review aimed to analyze the untoward effects of this procedure and the patient-reported outcome measures. A comprehensive electronic search was performed on 10 databases in addition to a manual search to retrieve all relevant studies. Randomized controlled trials (RCTs) were only included in this review. The interventional group was the PAOO procedure, whereas the control group was either a non-accelerated traditional fixed orthodontic treatment or an accelerated treatment using any other intervention. The Cochrane risk of bias tool for randomized controlled trials (RoB 2) was employed to estimate the risk of bias in the included studies. The current review included eight RCTs evaluating 175 participants (63 males and 112 females) with a mean age ranging from 18.8 to 29.6 years. Five of them assessed the effectiveness of PAOO versus traditional orthodontic treatment, i.e. without any adjuvant surgical intervention. At the same time, the remaining three studies evaluated the effectiveness of PAOO versus corticotomy-only as an adjunctive procedure. The PAOO accelerated the leveling and alignment stage from 39% to 47% and accelerated the retraction of the upper anterior teeth from 41% to 61% compared to conventional orthodontic treatment. One study only indicated that PAOO reduced treatment time by 30.3% versus a corticotomy-only as an adjunctive procedure. No significant side effects have been reported with the PAOO procedure. The PAOO procedure was effective in accelerating orthodontic movement and tended to increase the thickness of the alveolar bone. But most periodontal outcome measures regarding PAOO application were not comprehensively covered in the included trials.

Objective: To compare the effectiveness and efficiency of the in-house clear aligners with the traditional fixed appliances in treating premolar-extraction-based complex cases. Materials and methods: A single-centered, 2-arm parallel-group randomized controlled clinical trial was conducted on thirty-six (12 males, 24 females; mean age: 21.24 ± 2.33) patients with severe crowding who required orthodontic treatment with four first premolars extraction. The patients were equally and randomly divided into two groups: The in-house clear aligners (CA) group and the fixed appliances (FA) group. All the measurements were made on the pre-and post-treatment dental cast models. The effectiveness was evaluated using Little's irregularity index (LII) and the Peer Assessment Rating index (PAR). The efficiency was evaluated by studying the treatment duration. Two sample t-tests and chi-square tests were used to test for significant differences between the two groups. Bonferroni correction was applied, and the adjusted alpha level was set at 0.006. Results: Before treatment, there were no significant differences between the two groups regarding LII in the upper and lower jaws (p˃0.006). After treatment, the mean LII decreased in both groups, with no significant differences between the two studied groups (p˃0.006). There were no significant differences in all studied PAR domains between the two groups (p˃0.006). The mean score reduction in the CA group was 28.39 (±8.51) points, whereas it was 26.39 (±5.76) points in the FA group, with no significant differences between the two groups. All the patients in this study were improved. However, a great improvement was achieved in 88.9% of the patients in the CA group and 91.7% in the FA group, with no significant differences between them (p=0.674). The average treatment duration in the CA group was 23.27 (±5.28) months, whereas the average was 26.20 (±5.27) in the FA group, with no significant difference between the two groups. Conclusion: In-house clear aligners can be effective as fixed appliances in achieving good occlusion when treating complex orthodontic cases when suitable teeth movement protocol is used.

Objectives: The current parallel group, randomized controlled trial aimed to compare the dentoalveolar and skeletal changes resulting from treatment using two popular functional appliances: the Bite-Jumping Appliance (BJA) and the Twin-Block Appliance (TBA). Study design: This study is designed as a parallel-group, randomized controlled trial. Materials and methods: Patients were screened from the patients who were seeking treatment at the Department of Orthodontics, Al-Baath University. Eligibility criteria included skeletal Class II division 1 malocclusion resulting from the retrusion of the mandible. A computer-generated randomization list was used to randomly divide the patients into two equal groups to be treated with either the BJA or the TBA. Blinding was applicable for outcome assessment only. Forty-four patients (22 male and 22 female) aged 10.2–13.5 years were randomized in a 1:1 ratio to either the BJA or the TBA groups, and four patients were lost to follow-up (two from each group). Lateral cephalometric radiographs were obtained before treatment and after 12 months of active appliance therapy. Inter-group differences were evaluated with two-sample t-tests, and intra-group differences were assessed with paired-sample t-tests at the P <0.05 level. Results: Forty patients (20 in each group) were available for the statistical analysis. Baseline characteristics were similar between groups. Similar changes were observed in the sagittal plane, including a significant increase in the SNB angle. No significant changes were observed in the maxilla. The lower incisors were significantly proclined, and the upper incisors significantly retruded. In the vertical plane, BJA induced mandibular clockwise rotation, and the SN:MP angle increased by 2.14±2.97° (P = 0.002). Conversely, no significant changes took place in this angle in the TBA group 0.75±2.37° (P = 0.096). Similarly, Jarabak ratio decreased significantly in the BJA group by −1.78±0.85% (P = 0.002) and increased significantly in the TBA group by 1.26±0.76% (P = 0.032), with significant differences between the two groups (P ≤ 0.001). No serious harm was observed. Limitations: A limitation of this research is a lack of an untreated control group. However, the resulting differences between the two groups can be attributed to the appliance differences, which fulfil the aim of the current research. Conclusions: Each of the two appliances is recommended for the functional treatment of skeletal Class II malocclusion resulting from the retrusion of the mandible. The BJA is recommended when clockwise rotation is desired, whereas the TBA is recommended to inhibit vertical development. Registration: This trial was registered at the Department of Orthodontics, Al-Baath University, Number 16, on 6/25/2012. Protocol: The protocol was not published before trial commencement. Funding: No funding or conflict of interest to be declared.

Summary: Background: With the widespread of surgically-assisted orthodontic acceleration, the analysis of patient-reported outcome measures (PROMs) has become very important to assure patient acceptance and satisfaction before adopting any acceleration procedure. Objective: This review aimed to critically appraise the available evidence regarding the levels of pain, discomfort, functional impairments, and other patient-reported outcome measures during surgically-assisted acceleration of orthodontic treatment compared with the traditional non-accelerated treatment. Search methods: Eight electronic bibliographic databases were searched from January 1990 till May 2022. A manual search of the selected orthodontic journals was also undertaken. Selection criteria: Randomized controlled trials (RCTs) were included in this systematic review on patients undergoing orthodontic treatment with one group subjected to an acceleration procedure. Data collection and analysis: Cochrane’s risk of bias tool (RoB2 tool) was used to assess the risk of bias of the included RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence. Results: Thirteen RCTs were included in this review (333 patients), and only minimally invasive surgically-assisted acceleration studies were included. Two RCTs were included in the quantitative synthesis of data. After the first day of surgical intervention, the levels of pain and discomfort ranged from mild to moderate in the surgical groups (mean values ranged from 0.8 to 6.8), while it was mild in the control groups. However, on the seventh day after the surgical intervention, the levels of pain, discomfort, swelling, and functional impairments were almost similar between groups. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low. Conclusions: All surgical interventions were minimally invasive. There was very low to low evidence that acceleration caused mild to moderate pain and discomfort on the first day after the surgical intervention and disappeared completely at one week following surgery. Functional impairments were found within acceptable limits immediately and in the short-term follow-up. More high-quality randomized controlled clinical trials are needed to establish good evidence in this field. Registration: The protocol of this systematic review was registered in PROSPERO database (CRD42021274481) during the first stages of this review.