Systematic review of Present clinical reality Meta analysis on Patient consideration In Lingual Orthodontic Treatment Systematic review of Present clinical reality Introduction Demand for lingual orthodontic appliances has markedly increased among orthodontic patients seeking esthetic improvement. Several seminal studies have shown that lingual appliances can provide treatment outcomes comparable to those achieved with labial appliances. Objective Systematic review of symptomatic considerations of Lingual treatment and its comparative analysis with labial Orthodontics Inclusion Criteria for Study Participants Healthy adults or children who sought orthodontic treatment for dental malocclusion. Both randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were eligible

Materials and Methods Data Recording Study design Participant information Intervention type Follow-up periods Outcomes Cochrane Collaboration Tool for Assessing Risk of Bias Adequate sequence generation; Allocation concealment; Blinding; Management of incomplete outcome data; Absence of selective reporting; and Absence of other sources of bias Meta analysis For dichotomous data, odds ratios (with 95% CI) were used for statistical pooling; For continuous data, standardized mean differences were first converted to ORs through the formula of Chinn I2 statistic greater than 50% was considered a sign of substantial heterogeneity Meta-regression or subgroup analysis to explore the potential heterogeneity Sensitive Analysis to evaluate the robustness of the pooled results from the meta-analysis

Materials and Methods cont..... 1 Search of electronic database & Website i.e Pubmed (604),Embase (314),Web of Science (146),Central (28),clinicalTrail.gov (2) 2 718 articles shortlisted 3 709 articles ruled out due to inclusion criteria 4 9 articles screened with full text for eligibility 5 6 articles included in qualitative analysis 6 4 articles included in quantitative analysis (Meta analysis)

Odd’s Ratio (lingual vs labial) Results Outcomes in lingual and labial orthodontic treatment Odd’s Ratio (lingual vs labial) 95% CI I 2 Sensitivity Analysis Overall pain 1.35 10.20–3.93 65% 0.66 (0.28, 1.55) Tongue 34.64 12.53–69.55 0% Cheek 0.08 0.02–0.35 Lip 0.11 0.03-0.42 64% Eating difficulty 3.59 1.85-6.99 5.21 (0.83, 32.75)* Speech difficulty 7.91 3.75–18.95 23.87 (3.00, 190.16) * Significant change from the original estimates

Conclusion Meta analysis revealed that there is no difference in symptomatic consideration of overall pain of short-term in both techniques However Lingual technique patients are less likely to suffer cheeks problems than tongue difficulties. Other parameters of caries,treatment duration,hygiene and eating were not conclusive indicates more studies preferably with larger sample and controlled trials