Displaying all 11 publications

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  1. Sivarajan S, Ringgingon LP, Fayed MMS, Wey MC
    Am J Orthod Dentofacial Orthop, 2020 Mar;157(3):290-304.
    PMID: 32115107 DOI: 10.1016/j.ajodo.2019.10.009
    INTRODUCTION: Minimally invasive micro-osteoperforations (MOPs) look promising for a routine acceleration of orthodontic tooth movement (OTM). The objective of this research was to systematically evaluate evidence regarding the effects of MOPs on the OTM rate, treatment duration, and associated complications.

    METHODS: Electronic database and hand search of English literature in PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, and clinical trial.gov, with author clarification were performed. The selection criteria were randomized controlled trial (RCT) comparing MOPs with conventional treatment involving both extraction and nonextraction. Cochrane's risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation approach were used for quality assessment. Studies were analyzed with chi-square-based Q statistic methods, I2 index, fixed-effects, and random-effects model. Quantitative analysis was done on homogenous studies using Review Manager.

    RESULTS: Eight RCTs were included for the qualitative analysis. Meta-analysis of 2 homogenous studies indicated insignificant effect with MOPs (0.01 mm less OTM; 95% CI, 0.13-0.11; P = 0.83). No difference (P >0.05) was found in anchorage loss, root resorption, gingival recession, and pain.

    CONCLUSIONS: Meta-analysis of 2 low-risk of bias studies showed no effect with single application MOPs over a short observation period; however, the overall evidence was low. The quality of evidence for MOP side effects ranged from high to low. Future studies are suggested to investigate repeated MOPs effect over the entire treatment duration for different models of OTM and its related biological changes.

    TRIAL REGISTRATION NUMBER: PROSPERO CDR42019118642.

  2. Wey MC, Salah Fayed MM, Ringgingon LP, Sivarajan S
    Am J Orthod Dentofacial Orthop, 2020 08;158(2):159-160.
    PMID: 32576428 DOI: 10.1016/j.ajodo.2020.04.010
  3. Asif MK, Ibrahim N, Sivarajan S, Heng Khiang Teh N, Chek Wey M
    Am J Orthod Dentofacial Orthop, 2020 Oct;158(4):579-586.e1.
    PMID: 32826123 DOI: 10.1016/j.ajodo.2019.09.022
    INTRODUCTION: The study aimed to investigate the effects of micro-osteoperforations (MOPs) on the mandibular bone volume/tissue volume (BV/TV) ratio changes and the rate of orthodontic tooth movement using cone-beam computed tomography images. Another objective was to evaluate the effects of MOP frequency intervals (4 weeks, 8 weeks, and 12 weeks) on the BV/TV ratio and rate of tooth movement.

    METHODS: In 24 participants, 140-200 g of force was applied for mandibular canine retraction. Three MOPs were made according to the scheduled intervals of the 3 different groups: group 1 (MOP 4 weeks), group 2 (MOP 8 weeks), and group 3 (MOP 12 weeks) directly at the mandibular buccal cortical bone of extracted first premolars sites. Cone-beam computed tomography scans were obtained at the 12th week after MOP application. Computed tomography Analyzer software (version 1.11.0.0; Skyscan, Kontich, Belgium) was used to compute the trabecular alveolar BV/TV ratio.

    RESULTS: A significant difference was observed in the rate of canine movement between control and MOP. Paired t test analysis showed a significant difference (P = 0.001) in the mean BV/TV ratio between control and MOP sides in all the frequency intervals groups. However, the difference was significant only in group 1 (P = 0.014). A strong negative correlation (r = -0.86) was observed between the rate of canine tooth movement and the BV/TV ratio at the MOP side for group 1 and all frequency intervals together (r = -0.42).

    CONCLUSIONS: The rate of orthodontic tooth movement can be accelerated by the MOP technique with frequently repeated MOPs throughout the treatment.

  4. Sivarajan S, Mani SA, John J, Fayed MMS, Kook YA, Wey MC
    Korean J Orthod, 2021 Jan 25;51(1):55-74.
    PMID: 33446621 DOI: 10.4041/kjod.2021.51.1.55
    Objective: To systematically review studies on canine agenesis prevalence in different populations and continents, based on the jaw, sex, location, and associated dental anomalies.

    Methods: Electronic and hand searches of English literature in PubMed, Web of Science, Scopus, OpenGrey, and Science Direct were conducted, and the authors were contacted when necessary. Observational studies (population-based, hospital/clinic-based, and cross-sectional) were included. For study appraisal and synthesis, duplicate selection was performed independently by two reviewers. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology checklist, with main outcome of prevalence of canine agenesis.

    Results: The global population prevalence of canine agenesis was 0.30% (0.0-4.7%), highest in Asia (0.54%), followed by Africa (0.33%), and the least in Europe and South America (0.19% in both continents). Canine agenesis was more common in the maxilla (88.57%), followed by both maxilla and mandible (8.57%), and the least common was mandible-only presentation (2.86%). The condition was more common in females (female:male ratio = 1.23), except in Asia (female:male ratio = 0.88) and Africa (female:male ratio = 1). In Asia, unilateral agenesis was almost twice as prevalent as bilateral, but in Europe, the bilateral form was more common.

    Conclusions: The overall prevalence of canine agenesis is 0.30%, with the highest prevalence in Asia, followed by Africa, Europe, and South America. The condition is more common in the maxilla than the mandible, and in females than males (except in Asia and Africa), with unilateral agenesis being more common in Asia and the bilateral form showing a greater prevalence in Europe.

  5. Ibrahim N, Asif MK, Sivarajan S, Teh NHK, Wey MC
    Am J Orthod Dentofacial Orthop, 2021 02;159(2):e83.
    PMID: 33546837 DOI: 10.1016/j.ajodo.2020.11.009
  6. Sivarajan S, Doss JG, Papageorgiou SN, Cobourne MT, Wey MC
    Angle Orthod, 2019 09;89(5):831.
    PMID: 31430196 DOI: 10.2319/0003-3219-89.5.831
  7. Mohan K, Sivarajan S, Lau MN, Othman SA, Fayed MMS
    J Orofac Orthop, 2024 Mar;85(2):146-162.
    PMID: 35829730 DOI: 10.1007/s00056-022-00411-9
    PURPOSE: This review systematically evaluates the evidence related to comparisons between skeletal and conventional anchorage protocols in the treatment of bimaxillary proclination patients who underwent premolars extraction with respect to soft tissue profile changes, treatment duration and three-dimensional (3D) soft tissue changes.

    METHODS: Electronic database search and hand search with no language limitations were conducted in the Cochrane Library, PubMed, Ovid, Web of Science, Scopus and ClinicalTrials.gov. The selection criteria were set to include studies with patients aged 13 years and above requiring extractions of upper and lower first premolars to treat bimaxillary proclination with high anchorage demand. Risk of bias assessment was undertaken with Cochrane's Risk Of Bias tool 2.0 (ROB 2.0) for randomised controlled trials (RCTs) and ROBINS‑I tool for nonrandomised prospective studies. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for quality assessment. Results were summarised qualitatively; no meta-analysis was conducted.

    RESULTS: Two RCTs and two nonrandomised prospective studies were included. According to the GRADE approach, there is low to very low quality of evidence that treatment using mini-implant anchorage may significantly change nasolabial angle, upper and lower lip procumbence, and facial convexity angle compared to treatment with conventional anchorage. Similarly, very low quality evidence exists showing no differences in treatment duration between treatments with skeletal or conventional anchorage.

    CONCLUSIONS: The overall existing evidence regarding the effect of anchorage protocols on soft tissue changes in patients with bimaxillary protrusion and premolar extraction treatment plans is of low quality.

    TRIAL REGISTRATION NUMBER: PROSPERO CRD42020216684.

  8. Lau MN, Kamarudin Y, Zakaria NN, Sivarajan S, Mohd Tahir NNZ, Bahar AD, et al.
    PLoS One, 2021;16(7):e0254478.
    PMID: 34243187 DOI: 10.1371/journal.pone.0254478
    Flipped classroom may overcome weaknesses of live demonstration in teaching orthodontic wire-bending. This study aims to compare the effectiveness between flipped classroom and live demonstration in transferring skills for fabricating Adams clasp. Forty third-year undergraduate dental students were assigned to two groups. The students in group LD (n = 20) attended a live demonstration while students in group FC (n = 20) attended a flipped classroom. Both groups were taught on skills to fabricate Adams clasp in a standardised way. Each student from both groups were asked to submit an Adams clasp for a blinded quality assessment by two trained and calibrated assessors using a 18-item rubric, followed by validated students' satisfaction questionnaires to evaluate their perceived satisfaction on the teaching method received. A crossover study was then conducted three weeks later where LD attended a flipped classroom while FC attended a live demonstration. Students' satisfaction questionnaires were again collected from each student for blinded analysis. Mean scores for the quality of Adams clasp were 9.775 and 9.125 for LD and FC, respectively. No significant difference was detected between the two groups. Statistically significant association was found for one statement on the questionnaire, "I found the classroom arrangements conducive for the wire-bending activity" (p = 0.010). No significant differences were found between the two groups for other statements (p > 0.05). In conclusion, within the limitations of the study, flipped classroom is equally effective as conventional live demonstration in transferring orthodontic wire-bending skills for fabrication of Adams clasp. However, students perceived the classroom arrangements during the flipped classroom significantly more conducive for teaching orthodontic wire-bending.
  9. Sivarajan S, Soh EX, Zakaria NN, Kamarudin Y, Lau MN, Bahar AD, et al.
    BMC Med Educ, 2021 Jun 07;21(1):326.
    PMID: 34098931 DOI: 10.1186/s12909-021-02717-5
    BACKGROUND: Wire-bending skills is commonly taught through live demonstrations (LD) though flipped classroom (FC) method has gained popularity. Continuous formative assessment promotes personalised learning via closely monitored progress, with the identification of students' strengths and weaknesses. This study aims to evaluate the effects of LD and FC teaching methods, supplemented with continuous formative assessment, on dental students' learning of wire-bending skills for six types of removable orthodontic appliance components. A deeper understanding of the relative effectiveness between LD and FC teaching methods can help identify the most appropriate method to achieve student learning objectives, which is especially important given the current Covid-19 pandemic.

    METHODS: Forty third-year undergraduate dental students were randomly assigned into FC (n = 20) or LD (n = 20) cohort. Each student attended six teaching sessions, each to teach students' competency in fabricating one type of wire component, for a total competency in fabricating six wire components over the course of six teaching sessions. Either LD or FC teaching methods were used. After each session, wire assignments had to be submitted. Wire assignments were then evaluated using a blinded wire-bending assessment protocol. As part of their formative assessment, the assessment results were distributed to students, lecturers, and technicians before the next session. After the first session (T0) and at the end of all six sessions (T1), students completed a self-reported questionnaire.

    RESULTS: The mean wire-bending scores for FC were significantly higher than LD for two of the six assignments, namely the Adams clasp (p 

  10. Lau MN, Sivarajan S, Kamarudin Y, Othman SA, Wan Hassan WN, Soh EX, et al.
    J Dent Educ, 2022 Nov;86(11):1477-1487.
    PMID: 35650663 DOI: 10.1002/jdd.12954
    OBJECTIVE: This study aimed to explore students' perceptions of flipped classroom (FC) compared to live demonstration (LD) in transferring skills of fabricating orthodontic wire components for orthodontic removable appliances.

    METHODS: Forty third-year undergraduate dental students were randomly assigned to two groups: FC (n = 20) and LD (n = 20). Students in group FC attended FC, while students in group LD attended LD. Both groups underwent a series of standardized teaching sessions to acquire skills in fabricating six types of orthodontic wire components. Eight students (four high achievers and four low achievers) from each group were randomly selected to attend separate focus group discussion (FGD) sessions. Students' perceptions on the strengths, weaknesses, and suggestions for improvement on each teaching method were explored. Audio and video recordings of FGD were transcribed and thematically analyzed using NVivo version 12 software.

    RESULTS: Promoting personalized learning, improvement in teaching efficacy, inaccuracy of three-dimensional demonstration from online video, and lack of standardization among instructors and video demonstration were among the themes identified. Similarly, lack of standardization among instructors was one of the themes identified for LD, in addition to other themes such as enabling immediate clarification and vantage point affected by seating arrangement and class size.

    CONCLUSIONS: In conclusion, FC outperformed LD in fostering personalized learning and improving the efficacy of physical class time. LD was more advantageous than FC in allowing immediate question and answer. However, seating arrangement and class size affected LD in contrast to FC.

  11. Othman SA, Kamarudin Y, Sivarajan S, Soh EX, Lau MN, Zakaria NN, et al.
    Eur J Dent Educ, 2023 Aug;27(3):419-427.
    PMID: 35579042 DOI: 10.1111/eje.12823
    OBJECTIVE: To explore students' perception on the implementation of flipped classroom (FC) combined with formative assessment during the undergraduate teaching of orthodontic wire-bending skills.

    METHODS: Third-year undergraduate dental students were taught wire-bending skills via FC teaching method using a series of pre-recorded online video demonstrations. As part of the formative assessment, the students were given the results and assessment rubrics of their prior wire-bending assessment before every subsequent session. Purposive sampling method for focus group discussion was used to recruit eight students comprising four high achievers and four low achievers. Strengths, weaknesses and suggestions for improvement of the FC with formative assessment were explored. Data were transcribed and thematically analysed.

    RESULTS: Students perceived that FC allowed for a more convenient and flexible learning experience with personalised learning and improved in-class teaching efficiency. The pre-recorded online videos were useful to aid in teaching wire-bending skills but lacked three-dimensional representation of the wire-bending process. Students suggested better standardisation of instructions and access to the marking rubric before and after assessment.

    CONCLUSIONS: FC teaching with continuous formative assessment and constructive feedback as a form of personalised learning was viewed favourably by students. The implementation of periodic individual feedback can further enhance their learning experience.

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