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Duration of tooth alignment with fixed appliances: A systematic review and meta-analysis

  • Fidaa Wazwaz
    Affiliations
    Department of Orthodontics, Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Craniofacial Development and Regeneration, King's College London, London, United Kingdom
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  • Jadbinder Seehra
    Affiliations
    Department of Orthodontics, Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Craniofacial Development and Regeneration, King's College London, London, United Kingdom
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  • Guy H. Carpenter
    Affiliations
    Department of Mucosal Biology, Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Host Disease, King's College London, London, United Kingdom
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  • Anthony J. Ireland
    Affiliations
    Department of Orthodontics, University of Bristol Dental School, London, United Kingdom
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  • Spyridon N. Papageorgiou
    Affiliations
    Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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  • Martyn T. Cobourne
    Correspondence
    Address correspondence to: Martyn T. Cobourne, Centre for Craniofacial Development and Regeneration, Faculty of Dentistry, Oral and Craniofacial Science, King's College London, Floor 27, Guy's Hospital, London SE1 9RT, United Kingdom.
    Affiliations
    Department of Orthodontics, Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Craniofacial Development and Regeneration, King's College London, London, United Kingdom
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Published:November 16, 2021DOI:https://doi.org/10.1016/j.ajodo.2021.06.016

      Highlights

      • Alignment of the dentition is a common outcome in orthodontic trials.
      • We have undertaken a systematic review and meta-analysis of alignment randomized clinical trials.
      • Alignment of the mandibular dentition takes 263.0 days.
      • Patient- and treatment-related characteristics affect tooth alignment duration.

      Introduction

      A key goal of orthodontic treatment with fixed appliances is alignment of the dentition, and this remains a commonly selected outcome in clinical studies investigating orthodontic tooth movement. This systematic review has evaluated treatment duration to achieve alignment of the mandibular dentition using fixed appliances.

      Methods

      Systematic literature searches without restrictions were undertaken in 9 databases for randomized clinical trials (RCTs) assessing duration and rate of tooth alignment using fixed appliances with or without treatment adjuncts published up to January 2021. After duplicate study selection, data extraction, and risk of bias assessment according to Cochrane, random-effects meta-analyses of aggregate data, and individual patient data were conducted.

      Results

      Thirty-five trials were included with 2258 participants (39% male; mean age 17.8 years), giving a pooled duration to achieve whole-arch alignment of the mandibular dentition of 263.0 days (4 trials; 95% confidence interval [CI], 186.7-339.4 days) and incisor alignment in the mandibular arch of 100.7 days (9 trials; 95% CI, 84.1-117.4 days). Surgical-assisted orthodontics was associated with reduced duration of incisor alignment: mean difference of 44.3 days less (4 trials; 95% CI, 20.0-68.9 days; P <0.001; high quality of evidence), whereas subgroup and meta-regression analyses indicated significant effects of baseline crowding and premolar extractions. Individual patient data analysis from 3 RCTs indicated that for each additional participant age year, whole-arch alignment of the mandibular dentition took 13.7 days longer (3 trials; 95% CI, 7.7-17.7 days; P <0.001) and for each additional mm of irregularity, 17.5 days more were needed (2 trials; 95% CI, 9.8-25.2 days; P <0.001).

      Conclusions

      Patient and treatment-related characteristics can significantly affect the duration of tooth alignment and should be taken into account both clinically and when designing trial outcomes. Future research studies investigating rates of orthodontic tooth alignment would benefit from adequate sample sizes and a more consistent methodology in outcome assessment. Data in this systematic review provides a basis for appropriate trial design for future RCTs investigating the rate of orthodontic tooth alignment with fixed appliances.
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