Browsing by Author "Athanasiou, Athanasios E"

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Amelogenesis imperfecta and anterior open bite: Etiological, classification, clinical and management interrelationships
(2014-03) Athanasiou, Athanasios E
Abstract: Although amelogenesis imperfecta is not a common dental pathological condition, its etiological, classification, clinical and management aspects have been addressed extensively in the scientific literature. Of special clinical consideration is the frequent co-existence of amelogenesis imperfecta with the anterior open bite. This paper provides an updated review on amelogenesis imperfecta as well as anterior open bite, in general, and documents the association of these two separate entities, in particular. Diagnosis and treatment of amelogenesis imperfecta patients presenting also with anterior open bite require a lengthy, comprehensive and multidisciplinary approach, which should aim to successfully address all dental, occlusal, developmental, skeletal and soft tissue problems associated with these two serious clinical conditions.
Anterior teeth root inclination prediction derived from digital models: A comparative study of plaster study casts and CBCT images
(2018) Dastoori, Mahmoud; Athanasiou, Athanasios E
Background: To assess the accuracy of digital models generated using commercially available software to predict anterior teeth root inclination characteristics and compare the results to relevant data obtained from CBCT images. Material and Methods: Following sample size calculation and after application of inclusion and exclusion criteria, pre-treatment maxillary and mandibular plaster models and the corresponding CBCT scans of 31 patients attending a private orthodontic clinic were selected. The subjects were 10 males and 21 females with age range 12 to 40 years. Plaster models were scanned using the high resolution mode of an Ortho Insight 3D scanner and CBCT scans were taken using a Kodak 9500 Cone Beam 3D System machine. The teeth on the digital scans were segmented and virtual roots were predicted and constructed by the Ortho Insight 3D software. The long axes of the predicted roots and the actual roots, as segmented from the CBCT images, were computed using best-fit lines. The inter-axis angle was used to assess error in root inclination prediction by the software. Mann-Whitney and Kruskal-Wallis tests were used. Intra-examiner error was evaluated using the Bland-Altman method. Results: The maximum disparity in angle between images derived from digital models and CBCT data was almost 40 degrees (upper left canine). The upper and lower canines produced the worst results, followed by the lower lateral incisors. The upper central incisors showed the best results, although the maximum angle of difference exceeded 20 degrees (with the median around 8 degrees). Conclusions: Root morphology imaging prediction is not a primary function of this software and this study confirmed its limitation as a sole tool in routine clinical applications. At present these predictions cannot be considered accurate or reliable unless correlated clinically with a radiographic image.
Apical root resorption of deciduous teeth: a review
(2016) Athanasiou, Athanasios E
Abstract: The resorption of deciduous teeth is considered a necessary process leading to their exfoliation. In most cases it begins in the apical root region and proceeds coronally, yet some local or systemic factors can influence this normal procedure. The aim of this article is to review current concepts regarding apical root resorption of deciduous teeth, to update awareness on factors possibly affecting the physiologic process, and to discuss proposed treatment options. A novel classification is adopted by the review authors, which comprehensively discriminates among the various types of root resorption based on physiologic timing or the various etiologic factors of pathologic appearance. The article reviews the (a) normal physiologic resorption, (b) delayed physiologic resorption, (c) pathologic resorption caused by systemic or general factors, and (d) pathologic resorption caused by local factors. The above-mentioned mechanisms are explained with regard to the management of the problem by the clinician where possible.
Are asthma and allergy associated with increased root resorption following orthodontic treatment? A meta-analysis
(2023) Al-Saqi, Reem Kais; Athanasiou, Athanasios E; Kaklamanos, Eleftherios G
Objective: The aim of this study is to systematically investigate the available evidence from human studies regarding the association of asthma and/or allergy with EARR. Materials and methods: Unrestricted searches in 6 databases and manual searching were performed up to May 2022. We looked for data on EARR after orthodontic treatment in patients with/without asthma or allergy. Relevant data were extracted, and the risk of bias was assessed. An exploratory synthesis was carried out using the random effects model, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation. Results: From the initially retrieved records, nine studies met the inclusion criteria (three cohort and six case-control). Overall, increased EARR was observed in the individuals with allergies in their medical history (Standardised Mean Difference [SMD]: 0.42, 95% Confidence Interval [CI]: 0.19 to 0.64). No difference in EARR development was observed among individuals with or without a medical history of asthma (SMD: 0.20, 95% CI: -0.06 to 0.46). The quality of available evidence, excluding studies at high risk, was rated as moderate for the exposure to allergy, and low for the exposure to asthma. Conclusion: Increased EARR was noted in individuals with allergies compared to the control group, while no difference was observed for individuals with asthma. Until more data become available, good practice would suggest that it is important to identify patients with asthma or allergy and consider the possible implications.
Are orthodontic landmarks and variables in digital cephalometric radiography taken in fixed and natural head positions reliable?
(2020) Athanasiou, Athanasios E
Objective: The purpose of the study was to evaluate the reliability of the most common landmarks and variables in digital lateral cephalometric radiographies in fixed and natural head positions. Materials and methods: Twenty-one patients with anterior or distal displacement of the mandible treated in the Postgraduate Orthodontic Clinic of the Aristotle University of Thessaloniki had a digital lateral cephalometric radiography in fixed and in natural head position. The images where digitized. The main investigator and 6 examiners, digitized 61 landmarks and analysed 34 var- iables. We examined the intra-observer and inter-observer variability. Results: There was a significant difference in X-axis in the distribution (hence the mean results) according to the reliability of the landmarks and in only 2 variables in digital lateral cephalograms between fixed and natural head position. Conclusions: Cephalometric landmarks and variables showed reliability in digital lateral cephalo- metric radiography in fixed and natural head position. In lateral cephalograms taken in fixed head position an anterior inclination of the head was noticed compared to those in natural head position.
Assessing small study effects and publication bias in orthodontic meta-analyses: a meta-epidemiological study
(2014-05) Athanasiou, Athanasios E
Objective: The aim of this study was to examine the presence and extent of small study effects and publication bias in meta-analyses (MAs) based on orthodontic studies. Materials and methods: Following an extensive literature search, 25 MAs including 313 studies were identified and were possible to be re-analyzed. For the assessment of publication bias, contour-enhanced funnel plots were examined and their symmetry was tested using the Begg and Mazumdar rank correlation and Egger's linear regression tests. Robustness of MAs' results to publication bias was examined by Rosenthal's failsafe N, and adjusted effect sizes were calculated after consideration of publication bias using Duval and Tweedie's "trim and fill" procedure. Results: Only few of the originally published MAs assessed the existence and effect of publication bias and some only partially. Inspection of the funnel plots indicated possible asymmetry, which was confirmed by Begg and Mazumdar's test in 12 % and by Egger's test in 28 % of the MAs. According to Rosenthal's criterion, 62 % of the MAs were robust, while adjusted effect estimates with unpublished studies differed from little to great from the unadjusted ones. Pooling of Egger's intercepts of included MAs indicated that evidence of asymmetry was found in the orthodontic literature, which was accentuated in medical journals and in diagnostic MAs. Conclusions: Small study effects and publication bias can often distort results of MAs. Since indications of publication bias in orthodontics were found, the influence of small trials on estimated treatment effects should be routinely and more carefully assessed by authors conducting MAs.
Assessing Treatment Outcomes of a Graduate Orthodontic Program
(2018) Athanasiou, Athanasios E
Objectives: To assess treatment outcomes of a graduate orthodontic program during two different periods. Materials and Methods: Consecutive orthodontic patients’ files were selected from the archives of the Graduate Orthodontic Program, Aristotle University of Thessaloniki, Greece. Following the application of certain inclusion criteria, the final sample consisted of 109 patients. The sample was allocated into two groups depending on the time of treatment [Group A: 1998-2003, (n=60); Group B: 2004-2009 (n=49)]. The first period started a few years after the inception of the program and the second 10 years later. All pre- and post-treatment dental casts were blindly assessed by one investigator using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON). Statistical analysis included Student’s t-test, Mann-Whitney U test, Pearson Chi-Square test and Spearman correlation coefficient. The level of significance was set at p < 0.05. Results: In Group A, the mean PAR index changed from 28.6 before treatment to 5.5 after treatment and the mean ICON index changed from 71.9 to 23.5. In Group B, the mean PAR index changed from 23.6 before treatment to 4 after treatment and the mean ICON index changed from 62.8 to 19.8. The mean PAR score reduction was 78.4% for the 1st group and 81.4% for the 2nd group, respectively. Ninety percent of the cases of Group A and 89.8% of the cases of Group B had a post-treatment ICON score < 31. The severity of the initial malocclusion was found to be positively correlated with the treatment occlusal outcome. Out of the 109 cases, 68 were considered as substantially or greatly improved, 29 moderately improved, 8 showed minimal improvement and 4 cases were considered as not improved or worse. The mean PAR percentage improvement and the ICON score at the end of treatment were not correlated to the presence or absence of tooth extractions in the treatment plan. There was no correlation between the treatment outcome and the number of graduate residents involved in the therapy. The treatment outcomes were not correlated to the gender or age of patients. Conclusion: Patients treated by graduate orthodontic residents during 1998-2009 demonstrated significant improvement of their occlusion and the quality of the treatment remained constant throughout the years. The outcome of orthodontic treatment was not correlated to the gender and the age of patients, the number of postgraduate students performing the treatment, and the presence of tooth extractions in the treatment plan.
Authorship characteristics of orthodontic randomized controlled trials, systematic reviews, and meta-analyses in non orthodontic journals with impact factor
(2018) Alqaydi, Ahlam R; Naser-ud-Din, Shazia; Athanasiou, Athanasios E
Background/Objective: This study was conducted to explore authorship characteristics and publication trends of all orthodontic randomized controlled trials (RCTs), systematic reviews (SRs), and meta-analyses (MAs) published in non-orthodontic journals with impact factor (IF). Materials and methods: Appropriate research strategies were developed to search for all articles published until December 2015, without restrictions regarding language or publication status. The initial search generated 4524 results, but after application of the inclusion criteria, the final number of articles was reduced to 274 (SRs: 152; MAs: 36; and RCTs: 86). Various authorship characteristics were recorded for each article. Frequency distributions for all parameters were explored with Pearson chi-square for independence at the 0.05 level of significance. Results: More than half of the included publications were SRs (55.5 per cent), followed by RCTs (31.4 per cent) and MAs (13.1 per cent); one hundred seventy-eight (65 per cent) appeared in dental journals and 96 (35 per cent) were published in non-dental journals. The last decade was significantly more productive than the period before 2006, with 236 (86.1 per cent) articles published between 2006 and 2015. European countries produced 51.5 per cent of the total number of publications, followed by Asia (18.6 per cent) and North America (USA and Canada; 16.8 per cent). Limitations: Studies published in journals without IF were not included. Conclusions/Implications: Level-1 evidence orthodontic literature published in non-orthodontic journals has significantly increased during 2006–15. This indicates a larger interest of other specialty journals in orthodontic related studies and a trend for orthodontic authors to publish their work in journals with impact in broader fields of dentistry and medicine.
Color changes of maxillary and mandibular incisors following surgical orthodontic treatment: A prospective controlled clinical pilot study
(2021) Athanasiou, Athanasios E
Objective: To assess possible color changes of natural teeth after surgical orthodontic treatment. Methods: This prospective controlled clinical pilot trial included 6 consecutively treated surgical orthodontic patients with class III malocclusion and neutral vertical relation (ST: surgical treatment), 3 of which received double jaw osteotomies (SGI: surgical subgroup I) and 3 received single mandibular sagittal split ramus osteotomies (SGII: surgical subgroup II). Eleven untreated individuals (UC: untreated control) and 9 individuals who received conventional comprehensive orthodontic treatment only (OC: orthodontic control) served as controls. Tooth color measurements were performed using a reflectance spectrophotometer on the upper and lower incisors before the initiation of the surgical orthodontic treatment (T1) and after its completion (T2). Primary endpoint was E* (T1–T2) of summarized CIE-L*a*b* color differences. The null hypothesis of this study was that there is no statistically significant change in total tooth color difference E* CIE-(L*a*b*) in vivo at baseline and following surgical orthodontic treatment. Results: There was a statistically significant increase in E* (T1–T2) in the ST group compared to the UC and OC groups. Single mandibular surgery had a stronger effect on the lower teeth in comparison to double jaw surgery, while Le Fort I osteotomy, as part SGI, had a stronger effect on the upper teeth. Despite statistical significance, the majority of mean values of these color changes were lower than the threshold value of color alterations considered to be perceivable by the naked eye in a clinical setting (3.7 E units), with the exception of the mandibular incisors in SGII, where this threshold value was slightly exceeded. Conclusions: Orthognathic surgery showed a measurable effect on tooth color. However, esthetic disturbance or patient discomfort based on these color and lightness alterations are unlikely, due to their small impact and low perceptibility in a clinical setting.
Colour assessment of bleaching effect on orthodontically treated teeth
(2022-03) Athanasiou, Athanasios E
Aim: To assess whether the efficacy of external tooth bleaching differs between untreated and orthodontically treated teeth. Materials and method: Three groups of subjects were formed; group Debonded included 24 consecutive orthodontically treated patients evaluated immediately after removal of fixed appliances. The Retention group included 24 consecutive orthodontically treated patients in the phase of retention. The Untreated group consisted of 24 arbitrarily selected undergraduate dental students without history of fixed-appliances orthodontic therapy. Each of the above three groups was further randomized into two subgroups, Bleaching and Placebo. Each subgroup re¬ceived either a 38% hydrogen peroxide bleaching treatment or a placebo agent, respectively. Tooth colour changes were assessed at seven timepoints: 1 day before intervention; on the day of intervention before and after treatment; and at 7, 14, 21, and 90 days for parameters L*, a*, b*, and ΔΕ in all upper incisors and canines with the use of a reflectance spectrophotometer. Intra-rater agreement was estimated with the Intra-class Correlation Coefficient and method’s error was calculated using the Repeatability Coefficient. Regarding tooth colour changes, an analysis of variance was used to assess differences between groups. Results: Bleaching was associated with an increase of the L* value and decrease of b* and a* values in both orthodontically treated and untreated teeth. Parameters ΔE, L*, and b* exhibited statistically significant differences between the Bleaching-Untreated and Bleaching- Retention subgroups. In the Bleaching subgroups, statistically significant differences were found between different teeth for all parameters. Conclusions: Previous exposure to fixed orthodontic appliance influenced the efficacy of external tooth bleaching. The effect of bleaching was higher after orthodontic treatment and with longer period in retention. Canines changed in colour more than incisors, and the effect was reduced over time.
Demographic characteristics of systematic reviews, meta-analyses, and randomized controlled trials in orthodontic journals with impact factor
(2015-03-18) Athanasiou, Athanasios E
Introduction: The aim of this study was to explore demographic characteristics of systematic reviews (SRs), meta-analyses (MAs), and randomized controlled trials (RCTs) published in orthodontic journals with an impact factor (IF). Materials and methods: An electronic search was developed and implemented to identify all the SRs, MAs, and RCTs published in the seven orthodontic journals with an IF. No restrictions were applied regarding language, publication date, or publication status. The initial search generated 1147 articles, which were reviewed by three authors in order to determine if they met the inclusion criteria. Five hundred and fifty-seven articles were included in the final analysis. Type of article, name of journal, year of publication, number of authors, country of origin, and primary affiliation were recorded. Associations between those parameters were tested with the Pearson chi-square test for independence at the 0.05 level of significance. Results: The majority (72%) of this kind of articles published in the orthodontic literature were RCTs, followed by SRs (20.1%) and MAs (7.9%). Approximately 77.2% of all RCTs, SRs, and MAs were published between 2004 and 2013, and 72.9% came from orthodontic departments. More than 80% of all articles were collaborative efforts between three or more authors. Contributions from Asia, South and Central America significantly increased during last decade, while contributions from North America decreased by almost 30%. Conclusions: Most RCTs, MAs, and SRs have been published between 2004 and 2013, indicating a significant improvement of the orthodontic literature during the last decade. Asia, South and Central America have significantly increased their contributions to the high evidence orthodontic literature since 2004.
Do probiotics promote oral health during orthodontic treatment with fixed appliances? A systematic review
(2020) Hadj Hamou, Riham; Senok, Abiola C; Athanasiou, Athanasios E; Kaklamanos, Eleftherios G
Background: Treatment with fixed orthodontic appliances has been associated with significant biofilm accumulation, thus putting patients at a higher risk of oral health deterioration. The use of probiotics has been proposed to be useful in the prevention or treatment of oral pathologies such as caries and diseases of periodontal tissues. Our aim was to investigate the effects of probiotic use on inflammation of the gingival tissues and the decalcification of the enamel in patients being treated with fixed orthodontic appliances. Methods: We searched without restrictions 8 databases and performed hand searching until September 2019. We searched for randomized controlled trials (RCTs) evaluating whether individuals with fixed orthodontic appliances benefit from probiotic treatment in terms of the inflammation of the gingivae and decalcification of the enamel. Following the selection of studies and the extraction of pertinent data, we appraised the risk of bias and the confidence in the observed effects based on established methodologies. Results: From the final qualifying studies, three did not show any statistically significant effect on gingival inflammation after probiotic administration of up to 1 month. Similarly, non-significant differences were noted in another study regarding white spot lesions development (mean administration for 17 months). No adverse effects were reported and the level of evidence was considered moderate. Conclusions: Supplementation of orthodontic patients with probiotics did not affect the development of inflammation in the gingivae and decalcification in the enamel. Additional RCTs, with longer intervention and follow-up periods, and involving different combinations of probiotic strains are required.
Does interceptive extraction of multiple primary teeth increase the chances of spontaneous eruption of permanent maxillary canines positioned palatally or centrally in the alveolar crest? A Systematic review
(2022-05) Athanasiou, Athanasios E; Kaklamanos, Eleftherios G; AlWadiyah, Mohammed
Introduction: Extraction of primary maxillary canines in the mixed dentition has been suggested to increase the rate of normal eruption of displaced permanent canines (DPCs). In this study we assessed whether extracting multiple primary teeth increases the rate of normal eruption of DPCs positioned palatally or centrally in the alveolar crest. Methods: Unrestricted searches in 8 databases were performed up to March 2021. We looked for data on the prevalence of physiologic eruption of DPCs and the changes in their position from randomized controlled trials. The risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis was carried out using the random effects model. Results: Three studies (at low risk of bias) were identified, involving 128 individuals, followed for up to 48 months. The double extraction did not result in a benefit regarding successful eruption at 24 months follow-up, nor the change in position after 14.8 months. However, after 48 months the double extraction was beneficial (Risk Ratio: 1.17; 95% Confidence Interval: 1.05 to 1.30, P = 0.005). Moreover, after 18 months, the DPCs' position improved more in the double extraction sites. Conclusions: While the extraction of the deciduous canine and first molar does not increase the chance of normal eruption nor improves the position of DPCs in shorter follow-ups, it might confer a benefit after a longer period of observation. Further studies are warranted in order to clarify the magnitude and clinical significance of any potential benefit and provide guidance to clinical decisions.
Estimation of root inclination of anterior teeth from virtual study models: accuracy of a commercial software
(2019) Magkavali-Trikka, Panagiota; Athanasiou, Athanasios E
Background: The aim of the study was to assess the accuracy of commercially available software in estimating anterior tooth root inclination from digital impressions of the crowns of the teeth. Subjects and methods: Following sample size calculation and application of inclusion and exclusion criteria, 55 anterior natural teeth derived from 14 dry human skulls were selected. Impressions were taken and plaster study models were fabricated. Plaster models were scanned using the high-resolution mode of an Ortho Insight 3D laser scanner. The teeth on the digital scans were segmented and virtual roots were predicted and constructed by the Ortho Insight 3D software. The 55 natural teeth were removed from the dry skulls and scanned using the Identica extraoral white-light scanner in order to calculate their actual root angulation. The teeth were scanned twice, once to acquire the crown and the cervical part of the root, and a second time to acquire the remaining part of the root, including the apex. The two scanned segments were joined in software by superimposing them along their common part. The accuracy of the digital models generated by the Ortho Insight 3D scanner in predicting root angulation was assessed by comparing these results to the corresponding measurements of the 55 natural teeth. The long axes of the tooth models obtained from the software prediction and the scanning of the actual teeth were computed and the discrepancy between them was evaluated. The error of the methods was evaluated by repeating the measurements on 14 teeth and showed an acceptable range. Results: The predicted tooth angulation was found to differ significantly from the actual angulation, both statistically and clinically. The angle between the predicted and actual long axes ranged from 2.0 to 37.6°(average 9.7°; median 7.4°). No statistically significant difference was found between tooth categories. Conclusions: Further investigations and improvements of the software are needed before it can be considered clinically effective.
How orthodontic research can be enriched and advanced by the novel and promising evolutions in biomedicine
(2021) Athanasiou, Athanasios E
Abstract: Recent advances in developmental, molecular and cellular biology as well as biomedical technologies show a promising future for crossing the gap between biomedical basic sciences and clinical orthodontics. Orthodontic research shall utilise the advances and technologies in biomedical fields including genomics, molecular biology, bioinformatics and developmental biology. This review provides an update on the novel and promising evolutions in biomedicine and highlights their current and likely future implementation to orthodontic practice. Biotechnological opportunities in orthodontics and dentofacial orthopaedics are presented with regards to CRISPR technology, multi-omics sequencing, gene therapy, stem cells and regenerative medicine. Future orthodontic advances in terms of translational research are also discussed. Given the breadth of applications and the great number of questions that the presently available novel biomedical tools and techniques raise, their use may provide orthodontic research in the future with a great potential in understanding the aetiology of dentofacial deformities and malocclusions as well as in improving the practice of this clinical specialty.
Novel method to delineate palatal rugae and assess their complexity using fractal analysis
(2022) Athanasiou, Athanasios E
Abstract: Palatal rugae constitute signifcant morphological landmarks, with wide clinical applications in forensics, insertion of mini-screws, and superimposition. Their morphology has been studied mainly with indices relevant to their qualitative characteristics. The present paper aims at presenting a new quantitative method to evaluate their complexity, by means of box-counting fractal dimension analysis, and to investigate its inter- and intra-rater reliability. Twenty maxillary plaster models were scanned for the needs of this study. A sequence of steps, including cropping of the mesh, ball pivoting, distance mapping and fractal dimension analysis, performed with Viewbox 4 software, was followed. Box-counting fractal dimensions were calculated as a measure of rugae’s complexity. Inter- and intrarater reliability were investigated, using Bland–Altman analysis. Fractal dimensions ranged from 1.274 to 1.491 (average: 1.412). Bland–Altman analysis of inter- and intra-examiner reliability demonstrated that the 95% limits of agreement ranged from − 0.012 to 0.011 and from − 0.004 to 0.004, respectively. The method is reliable and can be applied in research and forensics. It ofers comprehensive evaluation of the rugae’s complexity and a complete set of information about their outlines and height profles, with minimum user intervention.
Rejuvenation of the ageing face and the role of orthodontics: Guidelines for management
(2022-03) Athanasiou, Athanasios E
Abstract: The article reviews the ageing changes of the midfacial and maxillary bones, the mandible, the overlaying soft tissues and the smile, and presents clinical guidelines aiming to rejuvenate older faces by means of orthodontic therapy. With regard to the ageing changes, the maxillary skeleton appears to rotate clockwise inferior to the orbit and becomes retrusive, and as a general pattern the midface contracts and deteriorates with age. Resorption below the mental foramen, reduction in alveolar height, loss of bone at the chin region, and relative increase in size and shape are signs of an aged mandible. Epidermal thinning and decrease in collagen in combination with the effect of gravity and various external factors contribute to the ageing of the skin. Atrophy of the superficial and deep fat, changes in ligamentous tissues and changes in muscle structure, position and tone, all contribute to the stigmata of the aged face. In the article, two late adulthood orthodontic cases are discussed as examples, and general guidelines for orthodontic management of the older face aiming at reversing the ‘shrinkage’ of the tissues by restoring the facial shape and tightening the soft tissue mask are described. The possible mechanisms explaining the changes observed on the faces of the clinical cases are also discussed. A properly planned and executed orthodontic intervention reversing changes from the inside-out before embarking on cosmetic surgery might have a synergistic effect multiplying the benefits for adult patients.