Elisabetta Lalli

Background and Objectives: The impact of orthodontic appliances on oral health-related quality of life (OHRQoL) has gained increasing attention, particularly in relation to patient-centered outcomes. Clear aligners (CAs) are often perceived as more comfortable than fixed appliances (FAs), although evidence remains limited and heterogeneous. This systematic review and meta-analysis aimed to compare the effects of CAs and FAs on OHRQoL in patients with Angle class I malocclusion and to further evaluate the reliability of the findings using trial sequential analysis (TSA). Materials and Methods: This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251051003). A comprehensive search of PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL was conducted. Only randomized controlled trials comparing CAs and FAs and reporting OHRQoL outcomes (OHIP-14) were included. Random-effects meta-analyses were performed on early changes in OHRQoL. TSA was applied to control for type I and II errors and to evaluate the sufficiency of the cumulative evidence. Results: Two randomized controlled trials (n = 74) were included in the quantitative synthesis. Both treatments were associated with a transient deterioration in OHRQoL after appliance placement. Meta-analysis showed statistically significant improvements favoring CAs in psychological discomfort (p = 0.007) and psychological disability (p < 0.001), while no significant differences were observed for other domains or for overall OHRQoL. Exploratory TSA suggested an early signal in favor of psychological outcomes, with the cumulative Z-curve crossing the monitoring boundary; however, given the very small number of included trials, these findings should be regarded as preliminary and hypothesis-generating rather than confirmatory. In contrast, for most other outcomes, the required information size was not reached and results remained inconclusive. For handicap, TSA suggested that a clinically relevant difference is unlikely. Conclusions: Clear aligners may provide a modest short-term advantage over fixed appliances in psychological aspects of OHRQoL, while no consistent differences are observed in physical or overall domains, based on very limited evidence. TSA suggests a preliminary signal in psychological outcomes but highlights insufficient evidence for most other domains. These results should be interpreted with caution, and further high-quality randomized trials are needed.

Transfer accuracy is widely used to evaluate orthodontic indirect bonding workflows, particularly in the context of digital CAD/CAM planning and three-dimensional bracket positioning. However, substantial heterogeneity in its definition, measurement, and reporting may limit comparability and clinical interpretability across systematic reviews. This methodological umbrella review examined how transfer accuracy is operationalized as an outcome construct, with specific focus on conceptual definitions, dimensional frameworks, reference systems, measurement pipelines, and interpretative strategies rather than pooled quantitative deviation estimates. A systematic search of major biomedical databases was conducted to identify systematic reviews evaluating transfer accuracy in orthodontic indirect bonding. Data extraction was performed independently by two reviewers using a predefined methodological mapping framework, and methodological quality was assessed with AMSTAR-2. Four systematic reviews met the inclusion criteria. Across reviews, transfer accuracy was operationalized through heterogeneous linear and angular geometric deviation metrics derived from planned–achieved bracket position comparisons, without use of a standardized composite accuracy indicator. Nevertheless, substantial heterogeneity was found in outcome definitions, dimensional architectures, reference system selection, and analytical workflows, resulting in structurally non-equivalent representations of transfer accuracy and limiting cross-review comparability. Within the included systematic reviews, transfer accuracy functioned primarily as a workflow-dependent geometric measurement construct rather than as an outcome systematically operationalized within clinically validated frameworks. We recommend standardized construct definitions, mandatory reporting of reference systems and registration algorithms, routine uncertainty quantification, and harmonized dimensional frameworks as essential steps toward valid evidence synthesis, reproducible digital orthodontic workflows, and clinically interpretable transfer accuracy measurement.

Background/Objectives: The Agenesis of maxillary lateral incisors occurs with a variable prevalence in different ethnic groups, and there is a need for a temporary replacement until maturity has been reached in patients for whom the replacement solution has been chosen. This study aims to analyze the scientific evidence available to date concerning the use of mini-screw implant (MSI)-supported pontics for the transitional management of permanent maxillary lateral incisors’ agenesis in developmental age subjects. Methods: Electronic research was conducted using four databases: PubMed, Clarivate Analytics/Web of Science Core Collection, Scopus, and the Wiley/Cochrane Library. Six studies were included in the final review. Data were extracted based on the first and second author, year of publication, study design, sample characteristics, mini-screw implant (MSI) characteristics, MSI insertion and loading protocol, characteristics of the prosthetic component, and outcomes during the follow-up time. Results: Clinical outcomes were proven positive in all studies. In only one study did MSIs show mobility and consequent failure after one month. Discoloration of the prosthetic part proved to be the main complication. Conclusions: The comparison with conventional removable prostheses and fixed dental prostheses revealed that MSI-supported pontics are a viable alternative and a promising temporary solution until the end of growth. Further studies to standardize protocols and assess long-term outcomes are needed.