Discussion
dentofacial deformities, dentofacial malocclusion, Dentofacial deformities, pain, tooth, orthodontic
PLAQUE
- Limitations and generalizabilityThis study’s major limitation is the relatively small sample size, potentially reducing the statistical power. However, statistically significant differences were proven for the main outcome. Since candidates where not excluded regarding their age, or their type or severity of dentofacial malocclusion, this study closely simulates the real daily clinical practice. This is a strength of this study and allows for applicability of our treatment protocol to other settings and populations.- InterpretationOrthognathic surgery is the mainstay of treatment for dentofacial deformities. The aim of our study was to determine whether OS in combination with clear aligners affords advantages in terms of periodontal health and patient satisfaction. Our study found advantages of a clear aligner-based orthodontic treatment compared with fixed appliances in terms of QoL, pain intensity and periodontal health among patients with dentofacial deformities treated with a surgery-first protocol.Oral health:The beneficial effects of clear aligners lie in their intrinsic characteristic of being removable, and therefore in the easiness of tooth cleaning. Fixed orthodontic appliances make tooth cleaning slower and more difficult, usually leading to greater plaque accumulation. Different studies have compared fixed appliances versus clear aligners in isolated orthodontic treatment (Patient satisfaction:Different authors have concluded that, apart from objectively improving facial appearance and dental occlusion, orthognathic surgery can improve patient QoL. The changes in QoL during and after orthognathic surgery have been widely studied in the last few decades (In our study, the duration of treatment was very similar in both groups, and the difference was not statistically different. All patients in both groups finished their treatment uneventfully and with very satisfactory esthetic and functional outcomes. These results remained sTable at four-year follow-up.Dentofacial deformities have an important psychosocial impact upon patients. The orthodontic phase of the ortho-surgical treatment may be regarded by patients as an important reason for avoiding correction of their problem. Although the present study is limited by the relatively small number of patients, our surgery-first and clear aligners protocol obtained significantly better outcomes in the periodontal assessment and in the quality of life questionnaires. Further RCT with a larger sample size are required to confirm these findings, but we believe that the possibility of offering clear aligner treatment to our orthognathic surgery patients, may play a major role in consolidating patient acceptance and cooperation during treatment, especially in adults.Authors contributions Patricia de Leyva: conception and design of study, data acquisition, analysis and interpretation of data collected, drafting of article.
Jose Miguel Eslava: conception and design of study, data acquisition, final revision of manuscript.
Julio Acero: final revision of manuscript.
Federico Hernández-Alfaro: conception and design of study, final revision of manuscript.Ethics This study followed the Declaration of Helsinki and was approved by the Institutional Review Board of Ramón y Cajal University Hospital (IRB number 095/17). Patient consent was obtained from each patient.
This trial was registered with study ID ISRCTN11587056.Conflicts of interest There are no conflicts of interest to disclose.Funding The study was awarded with the 2017 Align Research Award Program International.