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Abstract
Background
Recently, increasing attention has been paid to the periodontal health of orthodontic
patients in the maintenance stage in clinical practice. The focus of this meta-analysis
was to compare the effects of vacuum-formed retainers (VFR) and Hawley retainers (HR)
on periodontal health, in order to provide a reference for clinical selection.
Methods
From the establishment of the database until November 2020, a large number of databases
were searched to find relevant randomized control trials, including the Cochrane Library
databases, Embase, PubMed, Medline via Ovi, Web of Science, Scopus, Grey Literature
in Europe, Google Scholar and CNKI. Related literature was manually searched and included
in the analysis. Two researchers screened the literature according to relevant criteria.
The size of the effect was determined using RevMan5.3 software, and the mean difference
and 95% confidence intervals (CI) were used to estimate the results using a random
effects model.
Results
This meta-analysis included six randomized controlled trials involving 304 patients.
The results of the meta-analysis showed that there was no statistical difference in
sulcus probing depth status between the VFR group and the HR group, including at 1,
3, and 6 months. Compared with the VFR group, the HR group showed a lower gingival
index at 1 month (mean difference = 0.12, 95%CI: 0.06 to 0.19) and 3 months (mean
difference = 0.11, 95%CI: 0.06 to 0.17), while there was no statistically significant
difference at 6 months (mean difference = 0.10, 95%CI: -0.07 to 0.27). The plaque
index of the HR group also showed a good state at 1 month (mean difference = 0.06,
95%CI: 0.01 to 0.12), 3 months (mean difference = 0.12, 95%CI: 0.08 to 0.16), and
6 months (mean difference = 0.19, 95%CI: 0.09 to 0.29). Subgroup analysis of PLI showed
that when all teeth were measured, PLI status was lower in the HR group at 6 months
(mean difference = 0.32, 95%CI: 0.18 to 0.46). PLI status was also low for the other
teeth group (mean difference = 0.15, 95%CI: 0.08 to 0.22).
Conclusion
Our meta-analysis showed that patients using the Hawley retainer had better periodontal
health compared with those using vacuum-formed retainers. However, more research is
needed to look at the periodontal health of patients using these two retainers.
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field,1,2 and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research,3 and some health care journals are moving in this direction.4 As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in 4 leading medical journals in 1985 and 1986 and found that none met all 8 explicit scientific criteria, such as a quality assessment of included studies.5 In 1987, Sacks and colleagues6 evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in 6 domains. Reporting was generally poor; between 1 and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement.7 In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials.8 In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Terminology The terminology used to describe a systematic review and meta-analysis has evolved over time. One reason for changing the name from QUOROM to PRISMA was the desire to encompass both systematic reviews and meta-analyses. We have adopted the definitions used by the Cochrane Collaboration.9 A systematic review is a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies. Meta-analysis refers to the use of statistical techniques in a systematic review to integrate the results of included studies. Developing the PRISMA Statement A 3-day meeting was held in Ottawa, Canada, in June 2005 with 29 participants, including review authors, methodologists, clinicians, medical editors, and a consumer. The objective of the Ottawa meeting was to revise and expand the QUOROM checklist and flow diagram, as needed. The executive committee completed the following tasks, prior to the meeting: a systematic review of studies examining the quality of reporting of systematic reviews, and a comprehensive literature search to identify methodological and other articles that might inform the meeting, especially in relation to modifying checklist items. An international survey of review authors, consumers, and groups commissioning or using systematic reviews and meta-analyses was completed, including the International Network of Agencies for Health Technology Assessment (INAHTA) and the Guidelines International Network (GIN). The survey aimed to ascertain views of QUOROM, including the merits of the existing checklist items. The results of these activities were presented during the meeting and are summarized on the PRISMA Website. Only items deemed essential were retained or added to the checklist. Some additional items are nevertheless desirable, and review authors should include these, if relevant.10 For example, it is useful to indicate whether the systematic review is an update11 of a previous review, and to describe any changes in procedures from those described in the original protocol. Shortly after the meeting a draft of the PRISMA checklist was circulated to the group, including those invited to the meeting but unable to attend. A disposition file was created containing comments and revisions from each respondent, and the checklist was subsequently revised 11 times. The group approved the checklist, flow diagram, and this summary paper. Although no direct evidence was found to support retaining or adding some items, evidence from other domains was believed to be relevant. For example, Item 5 asks authors to provide registration information about the systematic review, including a registration number, if available. Although systematic review registration is not yet widely available,12,13 the participating journals of the International Committee of Medical Journal Editors (ICMJE)14 now require all clinical trials to be registered in an effort to increase transparency and accountability.15 Those aspects are also likely to benefit systematic reviewers, possibly reducing the risk of an excessive number of reviews addressing the same question16,17 and providing greater transparency when updating systematic reviews. The PRISMA Statement The PRISMA Statement consists of a 27-item checklist (Table 1; see also Text S1 for a downloadable template for researchers to re-use) and a 4-phase flow diagram (Figure 1; see also Figure S1 for a downloadable template for researchers to re-use). The aim of the PRISMA Statement is to help authors improve the reporting of systematic reviews and meta-analyses. We have focused on randomized trials, but PRISMA can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions. PRISMA may also be useful for critical appraisal of published systematic reviews. However, the PRISMA checklist is not a quality assessment instrument to gauge the quality of a systematic review. Box 1 Conceptual issues in the evolution from QUOROM to PRISMA Figure 1 Flow of information through the different phases of a systematic review Table 1 Checklist of items to include when reporting a systematic review or meta-analysis From QUOROM to PRISMA The new PRISMA checklist differs in several respects from the QUOROM checklist, and the substantive specific changes are highlighted in Table 2. Generally, the PRISMA checklist “decouples” several items present in the QUOROM checklist and, where applicable, several checklist items are linked to improve consistency across the systematic review report. Table 2 Substantive specific changes between the QUOROM checklist and the PRISMA checklist (a tick indicates the presence of the topic in QUOROM or PRISMA) The flow diagram has also been modified. Before including studies and providing reasons for excluding others, the review team must first search the literature. This search results in records. Once these records have been screened and eligibility criteria applied, a smaller number of articles will remain. The number of included articles might be smaller (or larger) than the number of studies, because articles may report on multiple studies and results from a particular study may be published in several articles. To capture this information, the PRISMA flow diagram now requests information on these phases of the review process. Endorsement The PRISMA Statement should replace the QUOROM Statement for those journals that have endorsed QUOROM. We hope that other journals will support PRISMA; they can do so by registering on the PRISMA Website. To underscore to authors, and others, the importance of transparent reporting of systematic reviews, we encourage supporting journals to reference the PRISMA Statement and include the PRISMA web address in their Instructions to Authors. We also invite editorial organizations to consider endorsing PRISMA and encourage authors to adhere to its principles. The PRISMA Explanation and Elaboration Paper In addition to the PRISMA Statement, a supporting Explanation and Elaboration document has been produced18 following the style used for other reporting guidelines.19-21 The process of completing this document included developing a large database of exemplars to highlight how best to report each checklist item, and identifying a comprehensive evidence base to support the inclusion of each checklist item. The Explanation and Elaboration document was completed after several face-to-face meetings and numerous iterations among several meeting participants, after which it was shared with the whole group for additional revisions and final approval. Finally, the group formed a dissemination subcommittee to help disseminate and implement PRISMA. Discussion The quality of reporting of systematic reviews is still not optimal.22-27 In a recent review of 300 systematic reviews, few authors reported assessing possible publication bias,22 even though there is overwhelming evidence both for its existence28 and its impact on the results of systematic reviews.29 Even when the possibility of publication bias is assessed, there is no guarantee that systematic reviewers have assessed or interpreted it appropriately.30 Although the absence of reporting such an assessment does not necessarily indicate that it was not done, reporting an assessment of possible publication bias is likely to be a marker of the thoroughness of the conduct of the systematic review. Several approaches have been developed to conduct systematic reviews on a broader array of questions. For example, systematic reviews are now conducted to investigate cost-effectiveness,31 diagnostic32 or prognostic questions,33 genetic associations,34 and policy-making.35 The general concepts and topics covered by PRISMA are all relevant to any systematic review, not just those whose objective is to summarize the benefits and harms of a health care intervention. However, some modifications of the checklist items or flow diagram will be necessary in particular circumstances. For example, assessing the risk of bias is a key concept, but the items used to assess this in a diagnostic review are likely to focus on issues such as the spectrum of patients and the verification of disease status, which differ from reviews of interventions. The flow diagram will also need adjustments when reporting individual patient data meta-analysis.36 We have developed an explanatory document18 to increase the usefulness of PRISMA. For each checklist item, this document contains an example of good reporting, a rationale for its inclusion, and supporting evidence, including references, whenever possible. We believe this document will also serve as a useful resource for those teaching systematic review methodology. We encourage journals to include reference to the explanatory document in their Instructions to Authors. Like any evidence-based endeavour, PRISMA is a living document. To this end we invite readers to comment on the revised version, particularly the new checklist and flow diagram, through the PRISMA website. We will use such information to inform PRISMA's continued development. Note: To encourage dissemination of the PRISMA Statement, this article is freely accessible on the Open Medicine website and the PLoS Medicine website and is also published in the Annals of Internal Medicine, BMJ, and Journal of Clinical Epidemiology. The authors jointly hold the copyright of this article. For details on further use, see the PRISMA website. The PRISMA Explanation and Elaboration Paper is available at the PLoS Medicine website. Supporting Information Figure S1 Flow of information through the different phases of a systematic review (downloadable template document for researchers to re-use) Text S1 Checklist of items to include when reporting a systematic review or meta-analysis (downloadable template document for researchers to re-use)
To determine the effects of fixed orthodontic appliances on periodontal health and microbiological composition of subgingival dental plaque. This prospective longitudinal self-controlled study was conducted on 32 adolescents (13 males, 19 females), who were scheduled for fixed orthodontic treatment between 2002 and 2005. Dental plaque accumulation, gingival inflammation and pocket probing depth were measured at the mesio-vestibular angle of the examined group of teeth followed by collection of subgingival dental plaque samples in the same points. These periodontal indices and microbiological parameters were determined prior to the placement of fixed appliances and 1, 3 and 6 months after the beginning of orthodontic treatment. All values of both clinical and microbiological parameters started to increase after the placement of fixed appliances. Maximum values were reached 3 months after fixed appliance placement followed by their decrease in the last registration period of 6 months after the placement of fixed appliances. Treatment with fixed appliances in adolescents may transitionally increase the values of all periodontal indices and stimulate the growth of periodontopathogenic bacteria, but without destructive effects on deep periodontal tissues.
The periodontal probe has been and continues to be used as an important diagnostic instrument by the dental profession. The measurements recorded with the probe have generally been considered to represent a reasonably accurate estimate of sulcus or pocket depth. Recent reports on the histopathology of the periodontal lesion and the histological features of a healing lesion, together with histological studies on the relationship of the probe to periodontal tissues, have shed some new light on periodontal probing. It is now apparent that probing depth measured from the gingival margin seldom corresponds to sulcus or pocket depth. The discrepancy is least in the absence of inflammatory changes and increases with increasing degrees of inflammation. In the presence of periodontitis the probe tip passes through the inflamed tissues to stop at the level of the most coronal intact dento-gingival fibers, approximately 0.3-0.5 mm apical to the apical termination of the junctional epithelium. Decreased probing depth measurements following periodontal therapy may be due in part to decreased penetrability of the gingival tissues by the probe. Following treatment aimed at obtaining new attachment in periodontal defects, wider variations may occur between the location of the probe tip and the most coronal dento-gingival fibers than in the case of untreated sites. This is due in part to the formation of a so-called "long" junctional epithelium. In the absence of inflammation this epithelium may not be penetrable during ordinary probing, but could account for a rapid increase in probing depth measurements when inflammatory changes allow the probe to traverse the epithelium and/or the adjacent infiltrated connective tissue. In view of the difficulty inherent in relating periodontal probing measurements to actual sulcus or pocket depth, the interpretation of periodontal probing in the practice of periodontics may need reappraisal.
This is an open access article distributed under the terms of the
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the original author and source are credited.
History
Date
received
: 3
March
2021
Date
accepted
: 16
June
2021
Page count
Figures: 8,
Tables: 3,
Pages: 13
Funding
The author(s) received no specific funding for this work.
Categories
Subject:
Research Article
Subject:
Medicine and Health Sciences
Subject:
Oral Medicine
Subject:
Orthodontics
Subject:
Research and Analysis Methods
Subject:
Mathematical and Statistical Techniques
Subject:
Statistical Methods
Subject:
Metaanalysis
Subject:
Physical Sciences
Subject:
Mathematics
Subject:
Statistics
Subject:
Statistical Methods
Subject:
Metaanalysis
Subject:
Biology and Life Sciences
Subject:
Anatomy
Subject:
Digestive System
Subject:
Teeth
Subject:
Medicine and Health Sciences
Subject:
Anatomy
Subject:
Digestive System
Subject:
Teeth
Subject:
Biology and Life Sciences
Subject:
Anatomy
Subject:
Head
Subject:
Jaw
Subject:
Teeth
Subject:
Medicine and Health Sciences
Subject:
Anatomy
Subject:
Head
Subject:
Jaw
Subject:
Teeth
Subject:
Research and Analysis Methods
Subject:
Database and Informatics Methods
Subject:
Database Searching
Subject:
Medicine and Health Sciences
Subject:
Clinical Medicine
Subject:
Clinical Trials
Subject:
Randomized Controlled Trials
Subject:
Medicine and Health Sciences
Subject:
Pharmacology
Subject:
Drug Research and Development
Subject:
Clinical Trials
Subject:
Randomized Controlled Trials
Subject:
Research and Analysis Methods
Subject:
Clinical Trials
Subject:
Randomized Controlled Trials
Subject:
Medicine and Health Sciences
Subject:
Epidemiology
Subject:
Medical Risk Factors
Subject:
Medicine and Health Sciences
Subject:
Medical Conditions
Subject:
Oral Diseases
Subject:
Periodontal Diseases
Subject:
Periodontitis
Subject:
Medicine and Health Sciences
Subject:
Oral Medicine
Subject:
Oral Diseases
Subject:
Periodontal Diseases
Subject:
Periodontitis
Subject:
Medicine and Health Sciences
Subject:
Clinical Medicine
Subject:
Signs and Symptoms
Subject:
Hemorrhage
Subject:
Medicine and Health Sciences
Subject:
Vascular Medicine
Subject:
Hemorrhage
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