Progression of Volumetric And Surface Tooth Wear In Patients Having Undergone Orthodontic Treatment: A Systematic Review And Meta-Analysis
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Aim: Tooth surface loss additional to the physiologic alterations of the dentition, may occur during orthodontic treatment due to interferences and functional changes, abrasion by orthodontic appliances and other factors. The aim of this study was to investigate systematically the relevant literature on the progression of volumetric and surface tooth wear in patients having undergone comprehensive orthodontic treatment. Materials and Methods: Search without restrictions for published and unpublished literature and hand searching took place. Data on volumetric and surface tooth wear in patients having undergone comprehensive orthodontic treatment were reviewed and the risk of bias was assessed using the ROBINS-I tool. The random effects method was used to synthesize results, where appropriate, and the Grades of Recommendation, Assessment, Development and Evaluation approach assessed the quality of evidence (confidence in the observed estimates). Results: Three studies met the inclusion criteria from the initial 4,389 identified from the database search. Two studies assessed tooth surface loss using 3D volumetric measurements and one used grading scales. All three studies were deemed to have a serious risk of bias and reported surface loss. Of the two studies that assessed volumetric change, one measured the canines only and the other assessed three groups of teeth; incisors, canines and posterior teeth (premolars and molars). From these two studies the overall mean volume reduction in 342 canines was 1.62 mm3 [95% Confidence Interval (CI): 0.87 – 2.38] in 86 participants [I 2 = 96%]. The volumetric change in 194 incisors was 1.02 mm3 [95% CI: 0.84 – 1.20] and for the 316 posterior teeth it was 0.95 mm3 [95% CI: 0.84 – 1.07] in 30 participants. The overall quality of evidence limited the confidence in the observed estimates. Conclusions: Varying degrees of tooth surface loss occurred after comprehensive orthodontic treatment. Further studies are needed in order to elucidate how much of the reduction is directly associated with orthodontic treatment and how much is due to physiologic tooth wear.