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PubMed2002

Orthodontic adhesives: a systematic review.

OBJECTIVES: To evaluate which orthodontic adhesives (a). bond orthodontic brackets to teeth more reliably and (b). are more effective at preventing decalcification. DATA SOURCES: The search strategy for the literature review was carried out according to the standard Cochrane systematic review methodology. The Cochrane Clinical Trials Register and the Cochrane Oral Health Group Specialized Register were searched for randomized clinical trials and controlled clinical trials. All volumes that had not already been assessed by the Oral Health Group in the European Journal of Orthodontics, American Journal of Orthodontics, Journals of Orthodontics, and Angle Orthodontist were hand-searched. Inclusion and exclusion criteria were applied when considering the studies to be included in this review. DATA SELECTION: The primary outcome measure was the failure of the orthodontic adhesive. A secondary outcome of decalcification occurring around the orthodontic bracket was also recorded, if data were available. DATA EXTRACTION: Two randomized clinical trials and one controlled clinical trial were identified that fulfilled all the inclusion and exclusion criteria. The trials compared: (a). light- and chemically-cured composite; (b). chemically-cured composite and conventional glass ionomer cement; and (c). chemically-cured composite and light-cured compomer. DATA SYNTHESIS: Each paper was quality assessed by two people independently. A qualitative analysis of the trials in the review is presented. The data presentation, for the majority of the trials, precluded the use of suggested Cochrane Health Group statistical analysis. CONCLUSIONS: It is difficult to draw any conclusions from this review; however, suggestions are made for methods of improving future research involving orthodontic adhesives.

Compomers↗
PubMed1982

Orthodontic treatment and socioeconomic status in Danish children aged 11-15 years.

The orthodontic situation in 2042 children in 4th to 8th schoolgrades was described by placing each child in one of five orthodontic categories (percentage refers to observed frequencies): I. No anomaly (25%), II. Malocclusion-under observation only (40%). III. Undergoing orthodontic treatment (20%). IV. Orthodontic treatment completed (12%) and V. Orthodontic treatment discontinued (3%). The socioeconomic status of the child's family, determined by the occupation of the father or mother, was described by one of the following five terms: A. Low, B lower middle, C. Middle, D. Upper middle and E. Upper socioeconomic group. The distribution of the orthodontic categories within the socioeconomic groups were found to be almost equal, but three trends could be noted: a slightly higher frequency of malocclusion in the low socioeconomic group; children from the middle socioeconomic group represented a relatively large part of the orthodontic treatment group and children in the two lowest socioeconomic groups showed a greater frequency of discontinued orthodontic treatment than the rest of the children.

Adolescent↗
PubMed2006

Moderately roughened- and roughened-surface implants used as rigid orthodontic anchorage: a case series.

BACKGROUND: Osseointegrated implants, especially Brånemark turned-surface implants, have been shown to function as stable and efficient orthodontic anchors. While it is generally accepted that prostheses can be attached to implants that have been used as anchors, it has not been clarified if the same applies to moderately roughened- and roughened-surface implants. PURPOSE: The purpose of the present study was to assess the differences between moderately roughened- and roughened-surface implants that are used as orthodontic anchors and then bonded with prostheses and those that are bonded with prostheses without serving as orthodontic anchors. MATERIALS AND METHODS: A total of 43 moderately roughened- and roughened-surface implants (ITI titanium plasma spray TPS] Straumann AG, Waldenburg, Switzerland], ITI sandblasted large-grit acid-etched SLA] Straumann AG], Nobel TiUnite Nobel Biocare AB, Göteborg, Sweden]) were placed in 11 partially edentulous patients, aged 35-61 years (two men and nine women). After an appropriate healing period, orthodontic therapy was performed in 11 patients using 27 implants as orthodontic anchors. After completion of the orthodontic therapy, the prostheses were attached at the same time to both types of implants: the 27 implants that were used as anchors, and 16 implants that were not used as anchors. All 11 patients were followed up regularly. RESULTS: Regardless of use as orthodontic anchorage, all implants maintained osseointegration and continued to function properly. CONCLUSION: No differences existed in therapeutic results after prosthesis bonding whether or not moderately roughened- and roughened-surface implants were used as orthodontic anchors.

Acid Etching, Dental↗
PubMed1996

An analysis of papers published in the British and European Journals of Orthodontics.

UNLABELLED: The aims of this study were to assess the type, subject, setting and methods of papers published in British Journal of Orthodontics (BJO) and European Journal of Orthodontics (EJO) between 1989 and 1993 to allow all published randomized controlled trials (RCTs) to be identified and a comparison of the papers published in the journals to be made. A hand search of all papers published in BJO and EJO between 1989 and 1993 was performed, and the type, subject, setting, and methods of each paper were classified and recorded. Of the studies, 59.3 per cent related to clinical orthodontics, but only three RCTs were identified in each journal. This comprised 2.8 per cent of the clinical research papers which were analysed. The remaining studies used non-randomized controls or were uncontrolled. Significant differences were found between the type (P < 0.001), subject (P < 0.001), setting (P < 0.01) and methods (P < 0.05) of papers published in the two journals. Relatively more papers in BJO were case reports, clinical opinions and update articles, reported on orthodontic materials or assessed methods of measuring the outcome of treatment. Ninety per cent of papers in EJO reported the results of research projects and relatively more papers, than in BJO, were related to animal studies, and were laboratory based or epidemiological. OBJECTIVES: To identify all randomized controlled trials (RCTs) and compare papers published in two orthodontic journals. DESIGN: A retrospective, observational study. SETTING: The British Journal of Orthodontics (BJO) and European Journals of Orthodontics) (EJO). DATA SOURCE: Papers published between 1989 and 1993. METHOD: A hand search of all papers was performed. The type, subject, setting and methods of each paper were classified and recorded. RESULTS: 200 papers were identified in BJO and 275 in EJO. Six RCTs were identified which represents 2.8 per cent of clinical research papers. Significant differences were found between the type (P < 0.001), subject (P < 0.001), setting (P < 0.01), and methods (P < 0.05) of papers published in the two journals. More papers in BJO were case reports, clinical opinions, and update articles, and reported on orthodontic materials or assessed methods of measuring the outcome of treatment. Ninety per cent of papers in EJU reported the results of research projects. More papers were related to animal studies; were laboratory based on epidemiological. CONCLUSION: Despite the RCT being regarded as the 'Gold Standard' for the evaluation of therapeutic interventions and materials only six (5.1 per cent) of such studies used this method. Significant differences in the type, setting and subject of papers published in BJO and EJO between 1989 and 1993 were found.

Animals↗
PubMed2005

[Malocclusion prevalence and orthodontic treatment need in 10-14-year-old schoolchildren in Belo Horizonte, Minas Gerais State, Brazil: a psychosocial focus].

The objectives of this cross-sectional study were to assess the prevalence of malocclusion and to verify the association between normative orthodontic treatment need and certain psychosocial aspects. The sample (n = 333) was representative of the population of adolescents (10-14 years) in Belo Horizonte, Minas Gerais, Brazil. The dependent variable "normative orthodontic treatment need" was evaluated through the Dental Aesthetic Index (DAI) and the independent variables (gender, age, mother's schooling, economic status, parent's perception of the child's oral aesthetics, parent's perception of the child's orthodontic treatment need, and the adolescent's desire for orthodontic treatment) were evaluated through questionnaires. Descriptive, bivariate, and logistic regression (stepwise forward procedure, p <or= 0.05) analyses were performed. Malocclusion prevalence was 62.0% and normative orthodontic treatment need was 52.2%. The variables adolescent's orthodontic treatment desire and parents' perception of the child's oral aesthetics were significantly associated with normative orthodontic treatment need. These results suggest that psychosocial factors should be considered in making the decision to undergo orthodontic treatment.

Adolescent↗
PubMed2004

Orthodontic treatment need of Nigerian outpatients assessed with the Dental Aesthetic Index.

BACKGROUND: When limited resources are available for orthodontic treatment, it is important that those with the greatest need receive treatment. AIMS: The aims of this study were to determine the orthodontic treatment needs of Nigerian children and young adults attending a University Hospital as outpatients, and to determine if a relationship exists between social class and orthodontic treatment need. METHODS: Of 148 consecutive patients attending a hospital department for orthodontic treatment, 136 were children and young adults (67 males, 69 females) between 6 and 18 years of age. These subjects were assessed with the Dental Aesthetic Index (DAI), and classified into two social classes with the Standard Occupational Classification. RESULTS: Almost 30 per cent of the children and young adults presenting for treatment had "no/little" need of orthodontic treatment, 20 per cent had DAI scores between 26 and 30 indicating that treatment was "elective", 15 per cent had a "desirable" need for treatment, and 35 per cent had a "mandatory" need for treatment. There was a significant association (p < 0.05) between treatment need and social class: more subjects from the lower social classes (semi-skilled and unskilled occupations) needed orthodontic treatment than subjects from the higher social classes (professional, managerial, and skilled occupations). CONCLUSION: The study has shown that not all outpatients presenting/referred for orthodontic treatment "need" treatment. Patients from the semi-skilled and unskilled occupations were more likely to need orthodontic treatment than patients from the professional, managerial and skilled occupations.

Adolescent↗
PubMed2006

Clinical applications of mini-implants as orthodontic anchorage and the peri-implant tissue reaction upon loading.

Orthodontic tooth treatment depends on anchorage for improved results. There are many different sources of orthodontic anchorage. Segments of teeth or the entire arch have been the most common type of orthodontic anchorage. But in challenging situations, orthodontists frequently need extra-dental supplements of anchorage such as headgear, face mask, and intermaxillary elastics. Most of them require the patient's compliance. Recently, temporary mini-implants placed within the bone tissue have been used as orthodontic anchorage. It has been proven in many studies and case reports that the mini-implant is a very reliable anchorage source clinically and histologically. The purpose of this article is to introduce the basic clinical application of mini-implants as orthodontic anchorage and to discuss basic concepts about the tissue reaction of peri-implant bone upon placement and loading either from orthodontic mechanics and/or function in the orthodontic treatment of the patients. It is possible for mini-implants to supply absolute anchorage even though they may move slightly within the bone tissue without losing clinical stability. The primary application of mini-implants as orthodontic anchorage will be cases that need absolute anchorage for desired tooth movement.

Adult↗
PubMed1990

[The present states and considerations of orthognathic surgery in Japan. Questionnaire in department of orthodontics of university dental hospital, and department of oral surgery of university medical hospital].

To investigate the present state of orthognathic surgery, questionnaires were sent to 30 departments of orthodontics of university dental hospital and 60 departments of oral surgery of university medical hospital. 1. Orthognathic surgery was carried out in 100% of the departments of orthodontics and 91.8% of the departments of oral surgery examined. 2. There was a difference in the number of patients between individual hospitals. 3. Analyses of cephalogram were used in 96% of the departments of orthodontics and 93% of the departments of oral surgery. 4. Pre- and post-surgical orthodontic treatments were carried out in all of the departments of orthodontics. 5. Orthodontic appliances (83.9%) were used in the departments of orthodontics for intermaxillary fixation, while orthodontic appliances (47.8%) and wire splints (49.2%) were used in the departments of oral surgery. 6. It is pointed out that the criterion of orthognathic surgery, treatment objectives on soft and hard tissue, selection of surgical method, adaptability of soft tissue after surgery, relapse, treatment planning of two jaw surgery, and postoperative stability remain to be solved in future.

Humans↗
PubMed1993

Retreating orthodontic failures: Part II.

Part I of this series (June 1993 JGO) clearly documented the inadequacies of some orthodontic methods to obtain satisfactory stable results for patients. Forty-four patients were selected for this study, as their prior orthodontic treatments--all from orthodontic specialists or orthodontic postgraduate institutions--had failed for a variety of functional reasons. The treatment for the 44 patients would not have been necessary if the initial orthodontic treatment had been successful. Therefore, somewhere in the treatment, problems existed which were not corrected by the treatment methods, or problems arose because of the treatment methods. Part I of this series clearly and precisely showed that some orthodontic methods initiate TMJ problems. In a review of the literature presented in Part I, the following conclusions were reached: 1. The optimum functional relationship of the human temporomandibular joint exists when the force vectors within the joint are directed anteriorly and superiorly. 2. Some orthodontic treatments disrupt this optimum functional relationship by placing posterior or posterior/superior forces on the structures of the temporomandibular joint. 3. There is an increased incidence of joint signs and symptoms for some of the patients treated with those conventional methods which place pathologic forces on the temporomandibular joints. Present treatment methods are inadequate if they damage the patient's structures. The guidelines of treatment are wrong if problems exist because of the treatment methods and these guidelines then need to be corrected. What is offered in this article is a method of treatment that was and is successful in retreating those patients who were initially treated by orthodontic specialists, yet who developed TMJD problems during or after their treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Occlusion, Centric↗
PubMed1996

Long-term stability following surgical orthodontic treatment of mandibular prognathisms: investigation by means of lateral X-ray cephalogram.

The purpose of this study was to investigate the long-term stability of jaw relations and occlusion following surgical orthodontic treatment of mandibular prognathisms and skeletal openbites. Subjects consisted of fifteen adult patients. Ten patients underwent the sagittal split ramus osteotomy (SSRO) of the mandible and five patients underwent two jaw surgery (Le Fort I osteotomy of the maxilla and SSRO of the mandible). They were observed over five years after the end of active treatment, and lateral X-ray cephalograms were taken at each stage. In the SSRO group, pogonion was retrograded an average of 8.7mm due to the operation and it was further replaced 0.4mm backward after the end of active treatment. Although the vertical distance between nasion and menton decreased 2.9mm between the operative period, it increased 1.8mm after the end of active treatment. On the other hand, in the two jaw surgery group, point A was advanced 4.0mm forward and < SNA increased 3.1 degrees between the operative period. Pogonion was retrograded 11.4mm between the same period, but moved 0.7mm forward after the end of active treatment. A comparison of the osteosynthesis methods revealed that pogonion in the wiring group was retrograded 8.3mm backward between the operative period, but moved 2.1mm forward during the postsurgical orthodontic treatment. Pogonion in the rigid group was retrograded 12.6mm backward between the operative period, but moved 1.6mm forward during the postsurgical orthodontic treatment. However, both groups were stabilized completely after the end of active treatment. A comparison of the differences in the orthodontic treatment method revealed that < Ul-SN in the extraction group inclined 8.3 degrees lingually during presurgical orthodontic treatment, but it tipped 7.0 degrees labially during the postsurgical orthodontic treatment and inclined 3.4 degrees lingually after the end of active treatment. < Ul-SN in the non-extraction group inclined 5.5 degrees lingually during the presurgical orthodontic treatment, but it tipped 2.0 degrees labially during the postsurgical orthodontic treatment and inclined 1.9 degrees lingually after the end of active treatment.

Adult↗
PubMed2006

Factors affecting patient satisfaction after orthodontic treatment.

The objective of this study was to identify factors that may affect patients' satisfaction with their dentition after orthodontic treatment. Fifty patients (20 males and 30 females; mean age 20.7 +/- 4.2 years) who successfully had finished fixed orthodontic treatment were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances for an average duration of 19 +/- 4 months and were in retention stage (6-12 months) with upper Hawley and lower fixed bonded retainers. Dental Impact on Daily Living questionnaire was used to assess the effect of orthodontic treatment on daily living and satisfaction with the dentition in the study sample. The NEO Five Factor inventory was used to assess personality profiles in the study sample. Comparisons between groups were made using chi-square test. Personality traits were found to be correlated with patients' satisfaction with their dentition after orthodontic treatment. Higher neuroticism scores had a significant negative relationship with total satisfaction with the dentition (P < .05). Age, sex, and pretreatment orthodontic treatment need had no relationship with the patient's satisfaction. Patients treated nonextraction showed more dissatisfaction with their dentition (P < .05). In orthodontically treated patients, higher neuroticism scores were associated with lower levels of satisfaction with the dentition.

Activities of Daily Living↗
PubMed2002

Orthodontic finishing after TMJ disk manipulation and recapture.

Orthodontic treatment has as its goal in most patients to achieve a cosmetic and functional result. There are functional goals for all orthodontic treatment and in some few cases the functional outweigh the cosmetic; an example would be a cleft-palate case. Orthodontic finishing to a specific condylar position is not routinely a goal of orthodontic care. The reason for this is that only patients who have pain, dysfunction and a negative change in quality of life from their temporomandibular apparatus need this tangential type of treatment. Research has shown that most patients suffering from a temporomandibular disorder (TMD) have displacement of the temporomandibular disk(s). Research has shown that when the mandibular condyle is repositioned to the Gelb 4/7 position that the temporomandibular joint disk is recaptured to a normal position between 85% and 96% of the time. The Gelb 4/7 position has been equated to the physiologic position of the mandibular condyle in the glenoid fossa. TMJ condyle repositioning to the physiologic position has been correlated to disk recapture proven by magnetic resonance imaging (MRI). A case is shown in which a displacement without reduction is manipulated into reduction and maintained with orthodontic correction. TMJ disk displacement without reduction is usually preceded by TMJ disk displacement with reduction. Pumping of the upper joint compartment can assist in reducing the TMJ disk displacement without reduction. Magnetic resonance imaging before and after the manipulation and after orthodontic treatment are shown. A detailed method of orthodontic finishing that maintains a specific condylar position and TMJ disk recapture is shown.

Adolescent↗
PubMed1984

Treatment of Class II deep bite by orthodontic and surgical means.

Conventional orthodontic correction of the Class II deep-bite deformity with a decreased lower anterior facial height tendency can be mechanically difficult, inefficient and, in many instances, impossible. Orthodontic treatment alone of either adults or adolescents with such deformities frequently can neither increase lower anterior facial height sufficiently to achieve ideal facial proportions nor achieve long-term occlusal stability. Despite the need for surgical intervention to achieve satisfactory occlusal and esthetic results, many patients with such deformities are still being treated in clinical practice by traditional orthodontic procedures, with less than ideal esthetic and/or occlusal results. The challenge to achieve efficient and stable treatment of this deformity has been met by the use of various surgical techniques in combination with orthodontic treatment. This combined surgical-orthodontic approach can provide increased treatment efficiency, long-term stability, and optimal esthetic results. The proper sequencing and correct selection of orthodontic mechanotherapy are essential to ensure the desired results. This article purposes to detail basic problems involved in diagnosis and treatment planning for the combined surgical-orthodontic approach to patients exhibiting Class II deep bite and decreased lower facial height. Orthodontic and surgical treatment objectives are explained, and representative case reports are presented and discussed to illustrate this method of treatment. Extraction patterns, control of the transverse dimension, arch wire selection, auxiliary wires, elastics, and extraoral appliance use are described. Surgically, the dentofacial disharmony associated with this deformity may defy treatment by surgical advancement of the mandible only. Genioplasty, Le Fort I osteotomy, symphyseal osteotomy, anterior or total mandibular subapical osteotomy, body osteotomy, submental lipectomy, and rhinoplasty are adjunctive procedures that are described and may be used in concert with mandibular advancement surgery.

Adult↗
PubMed1984

The effect of orthodontic extrusion on traumatically intruded teeth.

The management of traumatically intruded permanent incisors is controversial. Some authors suggest a decreased incidence of ankylosis in cases treated with orthodontic extrusion. The purpose of this study was to examine two common management techniques for traumatic intrusion, orthodontic extrusion, and observation for re-eruption. The four first premolars of three shepherd dogs were traumatically intruded with a mallet while a holding device was used to prevent tooth fracture. Five to 7 days following the injury, orthodontic force was applied unilaterally while the contralateral tooth served as the untreated control. To facilitate serial periapical radiography, x-ray jigs were fabricated for each animal and tantalum implants were placed in the bone distal to the permanent canine and first and second premolars. Observations included radiographic measurement of tooth movement, clinical estimates of tooth mobility, and radiographic and histologic assessment of root resorption, ankylosis, and periapical pathosis. The amount of traumatic intrusion varied from less than 0.5 to 4.1 mm. Following 11 to 13 weeks of force activation, 10 of 12 traumatized teeth showed clinical, radiographic, and histologic evidence of ankylosis irrespective of orthodontic treatment. Whereas the ankylosed teeth did not move with orthodontic forces, the teeth used for force application were orthodontically intruded 1.7 to 6.5 mm. When the injury to the tooth was severe, orthodontic extrusion had little effect on repositioning of the injured tooth but resulted in undesirable movement of the anchorage teeth. When the injury was less severe, orthodontic forces facilitated repositioning of the affected tooth.

Animals↗
PubMed2005

Ethnic variations in orthodontic treatment need in London schoolchildren.

BACKGROUND: The study was carried out to determine the prevalence of orthodontic treatment need in children from minority ethnic groups and compare the need to the white population. The second objective was to explore variations in agreement between subjective and objective treatment need in a multiethnic context using the aesthetic component of Orthodontic Treatment Need Index (IOTN AC). METHODS: A cross-sectional study in North West London, 14 schools were randomly selected from the 27 schools in the two boroughs of Harrow and Hillingdon. Comparison between objective and subjective treatment need was carried out using IOTN AC index. Clinical orthodontic treatment need was also recorded using the dental health component of Orthodontic Treatment Need Index (IOTN DHC). RESULTS: 2,788 children were examined and completed the questionnaire. 16% of the study population were already wearing appliances or had finished orthodontic treatment. Of the remaining children; 15% had definite need for treatment using the dental health component of the IOTN. There was no significant variation in the need for orthodontic treatment between different ethnic backgrounds (P > 0.05) whether using the AC or DHC components of the IOTN index. However, poor agreement was detected between professional and subjective assessment of ethnic minority of orthodontic treatment need using IOTN AC index. CONCLUSION: Orthodontic treatment need in children of ethnic minorities does not differ significantly from the vast majority of white children. However treatment need based on aesthetic index continues to vary in all ethnic groups from the professional aesthetic assessment.

Journal Article↗
PubMed2006

Retention procedures for stabilising tooth position after treatment with orthodontic braces.

BACKGROUND: Retention is the phase of orthodontic treatment that attempts to keep teeth in the corrected positions after treatment with orthodontic (dental) braces. Without a phase of retention there is a tendency for the teeth to return to their initial position (relapse). To prevent relapse almost every patient who has orthodontic treatment will require some type of retention. OBJECTIVES: To evaluate the effectiveness of different retention strategies used to stabilise tooth position after orthodontic braces. SEARCH STRATEGY: The Cochrane Oral Health Group's (OHG) Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching of orthodontic journals was undertaken in keeping with the Cochrane OHG search programme. No language restrictions were applied. Authors of randomised controlled trials (RCTs) were identified and contacted to identify unpublished trials. Most recent search: May 2005. SELECTION CRITERIA: RCTs on children and adults, who have had retainers fitted or adjunctive procedures undertaken, following orthodontic treatment with braces to prevent relapse. The outcomes were: how well the teeth were stabilised, survival of retainers, adverse effects on oral health and quality of life. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. As no two studies compared the same retention strategies (interventions) it was not possible to combine the results of any studies. MAIN RESULTS: Five trials satisfied the inclusion criteria. These trials all compared different interventions: circumferential supracrestal fiberotomy (CSF) combined with full-time removable retainer versus a full-time removable retainer alone; CSF combined with a nights-only removable retainer versus a nights-only removable retainer alone; removable Hawley retainer versus a clear overlay retainer; multistrand wire retainer versus a ribbon-reinforced resin bonded retainer; and three types of fixed retainers versus a removable retainer. There was weak unreliable evidence, based on data from one trial, that there was a statistically significant increase in stability in both the mandibular (lower) (P < 0.001) and maxillary (upper) anterior segments (P < 0.001) when the CSF was used, compared with when it was not used. There was also weak, unreliable evidence that teeth settle quicker with a Hawley retainer than with a clear overlay retainer after 3 months. The quality of the trial reports was generally poor. AUTHORS' CONCLUSIONS: There are insufficient research data on which to base our clinical practice on retention at present. There is an urgent need for high quality randomised controlled trials in this crucial area of orthodontic practice.

Humans↗
PubMed1993

Juvenile orthodontic treatment claims within a large dental insurer.

Despite many investigations regarding the relationship of health care insurance and the use of dental services, few studies have specifically examined coverage for orthodontic care. This preliminary investigation provides descriptive data concerning orthodontic services from one of the nation's largest health care insurance companies. Of the more than 1.3 million juvenile patients (ages 5 through 15 years) treated between 1986 and 1989, approximately 10.6% received comprehensive orthodontic therapy. Claims were also analyzed for variation across states and National Institute for Dental Research (NIDR) regions (with Alaska and Hawaii comprising region VIII) in terms of use and class of malocclusion. The largest percentage of comprehensive orthodontic cases in relation to the number of persons receiving any dental care exists in region III (Midwest) (11.6%). Analysis by state shows Washington, Delaware, and Pennsylvania as the leading orthodontic providers (14.3%, 13.5%, and 13.0%, respectively). Female patients comprised 56.5% of those with full-mouth treatment. Treatment most frequently commences at ages 12 years (23%) and 13 years (21.8%). In terms of classes of malocclusion, comprehensive treatment for Angle Class II is predominant (55.7%), followed by Class I (40.1%), and Class III (4.2%). Relative to total orthodontic use, Region VIII demonstrates the highest concentration of Class I patients (46%). Region I (New England) displays the greatest number of Class II cases (59.8%), whereas the largest number of Class III patients is found in the southeastern United States (region IV) (5.2%). Overall, the use of comprehensive orthodontic treatment is relatively constant over all regions, (except regions V, VI, and VIII, which fall below 10%), and mirrors that of overall dental services.

Adolescent↗
PubMed2000

The effect of orthodontic referral guidelines: a randomised controlled trial.

OBJECTIVE: To develop and evaluate the effectiveness of referral guidelines for the referral of orthodontic patients to consultant and specialist practitioner orthodontists. DESIGN: Single centre randomised controlled trial with random allocation of referral guidelines for orthodontic treatment to general dental practitioners. SETTING: Hospital orthodontic departments and specialist orthodontic practices in Manchester and Stockport. SUBJECTS: General dental practitioners and the patients they referred for orthodontic treatment. MAIN OUTCOME MEASURE: Appropriateness of referral, defined as whether the patient was accepted for orthodontic treatment. RESULTS: The referral guidelines did not reduce the number of inappropriate referrals. CONCLUSIONS: Referral guidelines for orthodontic referrals did not influence the behaviour of the general dental practitioners. More research into the optimum methods of dissemination and implementation of referral guidelines for use in the general dental service is needed.

Adolescent↗