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PubMed2005

Comparison of university and private-practice orthodontic treatment outcomes with the American Board of Orthodontics objective grading system.

INTRODUCTION: Treatment outcomes and duration of treatment for patients treated in university graduate orthodontic programs and private orthodontic practices were assessed and compared with the ABO objective grading system. METHODS: The treatment records of 139 randomly selected adolescents who had received comprehensive orthodontic treatment were examined. Seventy-seven subjects had been treated in 3 postgraduate orthodontic clinics, and 62 had been treated in 3 private orthodontic practices. Pretreatment, all subjects had Class II Division 1 malocclusions and ANB angles equal to or greater than 4 degrees . All patients were treated with premolar extractions. Posttreatment dental casts were measured and scored with the ABO objective grading system. RESULTS: No significant differences were found between the groups in the alignment, buccolingual inclination, and overjet components. Patients treated in private practice had significantly lower scores for marginal ridge height and occlusal relationship. Patients treated in the university programs had significantly lower scores for occlusal contact and interproximal contact components. CONCLUSIONS: There was no significant difference in the overall score, thus no significant difference in the overall quality of orthodontic treatment outcome between patients treated in university programs and private practices. However, the university group had a significantly larger sample variance for the overall score. There was no significant difference in the duration of the treatment between patients treated in a university setting and in a private practice.

Adolescent↗
PubMed1995

[The development of a resorbable implant system for orthodontic anchorage. The BIOS implant system. Bioresorbable implant anchor for orthodontic systems].

The use of endosseous implants as temporary orthodontic anchoring elements has proven itself to be efficacious in many clinical applications. If, however, an implant is inserted into the jaw solely to correct a malocclusion without being used subsequently for prosthetic purposes, secondary surgery is required to remove the anchoring implant. The development of an orthodontic implant anchor system consisting of an implant made of biodegradable polylactide with a metal abutment may offer a solution to this problem. On the basis of its good mechanical properties, the BIOS implant system (bioresorbable implant anchor for orthodontics system) presented here is designed to assume orthodontic anchoring functions as long as necessary and then be resorbed by hydrolysis without foreign body reactions. Shear strength and maximum vertical strength were measured in biomechanical in vitro tests in which BIOS fixtures can be loaded with horizontal shear forces of 50 N with a mean deflection of 0.26 mm and mean vertical pull-off forces of 155 N. In a clinical case report the application of the BIOS implant system during orthodontic tooth movement is here illustrated. In vitro and in vivo results obtained to date suggest that the BIOS implant system can be used as an orthodontic anchoring system up to the time of degradation.

Absorption↗
PubMed2004

Allergies induced by orthodontic alloys: incidence and impact on treatment. Results of a survey in private orthodontic offices in the Federal State of Hesse, Germany.

BACKGROUND: The incidence of allergies in general is on the increase. An allergic reaction can also occur during any dental and orthodontic treatment. However, the allergic potential of orthodontic appliances is frequently overestimated. MATERIAL AND METHOD: The incidence of suspected allergic reactions during fixed appliance therapy in 68 orthodontic offices in the German State of Hesse was determined by questionnaire at approximately 0.3% of the 60,000 patients covered. RESULTS: More extraoral (45%) than intraoral (17%) skin changes were registered, with both intraoral and extraoral changes being observed in 38%. In 53% of the affected cases the therapy was adapted to nickel-free materials, whereas it was continued as planned after a brief recovery period in 33%. The treatment was discontinued in 14% of the affected patients, corresponding to one in every 3150. The individual tolerance can often be tested by inserting one bracket or one band. In addition, early orthodontic treatment seems to promote a certain immune tolerance, especially towards extraoral nickel contacts. However, if a patient is known to have a nickel allergy, materials containing nickel should be renounced on principle in the orthodontic appliances. CONCLUSION: Skin changes occurring in the course of orthodontic treatment should be examined and verified if necessary by a dermatologist. Gold plating and other coatings (titanium nitride) of the metal elements even encourage corrosion after a brief protection period. Soldering should be avoided.

Adolescent↗
PubMed2003

Clinical trials in orthodontics I: demographic details of clinical trials published in three orthodontic journals between 1989 and 1998.

AIM: To test the hypothesis that there is insufficient evidence available, from clinical trials, to allow evidence-based decisions to be made on the effectiveness of orthodontic treatment. OBJECTIVES: To identify reports of orthodontic clinical trials and assess their demographic characteristics. DESIGN: A retrospective, observational study. SETTING: The American Journal of Orthodontics and Dentofacial Orthopedics, British Journal of Orthodontics, and European Journal Orthodontics. DATA SOURCE: Clinical trials published between 1989 and 1998. METHOD: A hand-search was performed to identify all clinical trials. The journal and year of publication, research method, interventions, and sample size of the trials reported were recorded. RESULTS: One-hundred-and-fifty-five trial reports were identified of which 56 (36.1%) were published from 1989 to 1993 and 99 (69%) from 1994 to 1998. Ninety-nine (69%) reports were published in the AJO-DO, 18 (11.6%) in the BJO and 38 (24.5%) in the EJO. Eighty-five (54.8%) were reports of randomized controlled trials and 70 (45.2%) of controlled clinical trials. The interventions most frequently assessed were bonding materials (21.9%), growth modification treatments (21.3%), and oral hygiene procedures (9.0%). The median sample size was 32 (IQR 19.5, 50). CONCLUSION: There is sufficient evidence available from clinical trials to warrant doing systematic reviews of orthodontic clinical trials to aid decision-making.

Controlled Clinical Trials as Topic↗
PubMed2003

Clinical trials in orthodontics II: assessment of the quality of reporting of clinical trials published in three orthodontic journals between 1989 and 1998.

AIMS: To test the hypothesis that the quality of reporting of orthodontic clinical trials is insufficient to allow readers to assess the validity of the trial. DESIGN: A retrospective observational study. SETTING: The American Journal of Orthodontics and Dentofacial Orthopedics (AJODO), the British Journal of Orthodontics (BJO) and European Journal of Orthodontics (EJO). DATA SOURCE: Clinical trials published between 1989 and 1998. METHOD: A hand search was performed to identify all clinical trials. The concealment of allocation, whether the trial was randomized, double blind, and whether there was a description of withdrawals and dropouts was recorded. RESULTS: One hundred and fifty-five trial reports were identified of which 4 (2.6%) were adequately concealed, 85 (54.8%) were described as being randomized, 10 (6.5%) as double-blind, and 44 (28.4%) gave a description of withdrawals and drop-outs from the trial. The type of randomization was considered appropriate in 78 (50.3%) reports and in 57 (36.8%) reports the level of blinding was considered appropriate. When assessed for the risk of bias in the reported trials,(1) one trial (0.6%) had a low risk of bias, 17 (11%) a moderate risk, and 137 (88.4%) a high risk. CONCLUSIONS: In general the quality of reporting orthodontic clinical trials was insufficient to allow readers to assess the validity of the trials. Reporting of clinical trials could be improved by orthodontic journals adopting the CONSORT statement(2,)(3) to ensure that all relevant information is provided.

Chi-Square Distribution↗
PubMed1992

A new Norwegian index of orthodontic treatment need related to orthodontic concern among 11-year-olds and their parents.

A new index of orthodontic treatment need was introduced in Norway in 1990. On a morphologic and functional basis the four groups very great (A), great (B), obvious (C) and little/no (D) need were defined for social insurance refunding. The purpose of the present study was to investigate to what extent the new index corresponded with orthodontic concern among potential orthodontic patients and their parents. Of 104 randomly selected fourth grade children, 99 (48 girls, 51 boys, mean age 10.7 yr) presented themselves for clinical examination and interview. One parent was asked to accompany the child, and 93 parents attended. On the basis of clinical examination, morphologic measurements on study casts, and X-rays, the children were allocated to one of the four groups defined by the index. In separate questionnaires the children and the parents were asked to assess satisfaction with own/child's dental arrangement and desire for orthodontic treatment. The interview data were transformed into a composite measure representing orthodontic concern. The results indicated that orthodontic concern was significantly related to index group. For the individuals who expressed concern the new index seemed to be meaningful for allocation of public subsidies, as most individuals (85%) who expressed concern exhibited malocclusions fulfilling the criteria for receiving public subsidies of treatment costs. However, more than 50% of the individuals allocated to group B (great need) did not experience a need for treatment.

Adolescent↗
PubMed2004

Comparing a quality of life measure and the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN) in assessing orthodontic treatment need and concern.

OBJECTIVE: To compare the use of the Aesthetic Component (AC) of IOTN and the Child Perceptions Questionnaire (CPQ) in assessing orthodontic treatment need and concern. DESIGN: Cross-sectional observational study. SUBJECTS AND METHODS: The subjects were 204 children aged 10-12 years studying in 10 schools in Bristol, UK. They completed a questionnaire comprising the CPQ and questions regarding orthodontic concern. AC scores as rated by the child and by the calibrated examiner were recorded. MAIN OUTCOME MEASURES: CPQ scores were calculated from the responses in the questionnaire. AC scores and responses to questions regarding orthodontic concern were recorded. RESULTS: The children gave themselves lower AC scores compared to the examiner (p<0.001). The only section of the CPQ that correlated significantly with Examiner AC was the emotional impacts section (rho=0.151). CPQ scores had a slightly higher correlation with self-perceived AC than Examiner AC. However, the correlations were still very low. The emotional impacts section of CPQ (rho=0.332) and overall CPQ score (rho=0.282) were better than the examiner AC (rho=0.209) at reflecting how bothered the children were by the alignment of their teeth, and how upset they would be if they couldn't receive orthodontic treatment (rho=0.464, 0.428 and 0.214, respectively). Children with a normative need for orthodontic treatment, based on examiner AC did not have a worse oral health-related quality of life. CONCLUSION(S): The CPQ and IOTN AC measure different attributes. There should be a shift towards using quality of life measures to supplement the IOTN in assessing the perceived need for orthodontic treatment.

Adolescent↗
PubMed1990

[A study of dynamics of orthodontic archwire on the dental arch. 1. Distribution of orthodontic forces during labial movement of bilateral incisors].

The study on labial movement of maxillary unilateral incisor had been reported previously. This study was the case of maxillary bilateral incisors. Orthodontic forces during labial movement of maxillary bilateral incisors which were produced by stainless steel archwire with vertical loops and nickel titanium archwire, were measured and were examined the distribution of orthodontic forces to the dental arch in the experimental apparatus with strain gauges. The following results were found: 1. In nickel titanium archwire, orthodontic forces were distributed to the entire dental arch, and the distribution of orthodontic forces could be classified into three types, which were similar to the previous study. 2. In stainless steel archwire with vertical loops, orthodontic forces were distributed only to bilateral incisors and adjacent tooth to bilateral incisors. 3. When bilateral incisors displaced lingually, it showed that there were additional orthodontic forces distributions as if two unilateral distributions were overlapped. 4. For maxillary bilateral incisors were moved in optimum force, some consideration to adjust the loops of stainless steel archwire was needed.

Dental Stress Analysis↗
PubMed1994

Subjective orthodontic treatment need and perceived dental appearance among young Finnish adults with and without previous orthodontic treatment.

Subjective orthodontic treatment need and perceived oral condition were studied in a sample of 226 young adult Finns with and without previous orthodontic treatment. The subjects, applicants to enter the University of Helsinki, were interviewed immediately after their entrance examination. Altogether 38.5 per cent of the subjects had received some form of orthodontic treatment. A higher percentage of subjects who had been orthodontically treated reported a current subjective need for treatment than did the untreated ones but this only reached statistical significance in men (P < 0.05). Appearance was the reason for the treatment need among 64.7 per cent of treated and among 80.0 per cent of untreated subjects. The differences in proportions were non-significant. Men were more often satisfied with their dentition than women. Most, 56.3 per cent of treated and 66.2 per cent of untreated subjects, considered their anterior teeth regularly positioned. The most prevalent type of malocclusion noted in the anterior segments was crowding (27.0 per cent), followed by malpositioned (18.6 per cent) and protruding (9.3 per cent) teeth. It is likely that those who had received orthodontic treatment, had initially had more, and more severe malocclusions than those who were untreated. Thus, it may be that orthodontic treatment had raised the perceptions of the dentition of the treated individuals to the same level as the untreated individuals.

Adult↗
PubMed1996

Orthodontic care provided by general practitioners and specialists in three Swedish counties with different orthodontic specialist resources.

Three counties in Sweden (A, G, and W) with free orthodontic care and different orthodontic resources and geographic structures were studied in 1987. Samples of totally 942 young adults (mean age 18.8 years, SD 0.44) were examined concerning malocclusions and all orthodontic treatment provided by general practitioners or by orthodontic specialists. The care in a rural area (county G) with abundant specialist resources was based on specialist treatments easy assessable to the patients and supplemented by treatments, mainly without appliances and provided by general practitioners. There was a generous attitude of consultation with specialists and of providing treatment. The sparsity of specialist resources had in an urban area (county A) resulted in a greater restriction on providing treatments. The treatments were performed in a higher age and were, to a greater extent, not completed by the age of 19, and a smaller percentage of individuals were treated than in the other two counties. The care in a large rural area (county W) with long distances to the only specialist clinic was based on treatments provided by general practitioners. In spite of the few specialist resources there was a generous attitude of providing treatments. Interceptive methods were used to a great extent, and later completed with appliance therapy. According to a treatment priority index 44% of the untreated individuals in the three counties had malocclusions and an objective treatment need, and there were no significant differences between the counties. Regardless of differences in specialist resources and structure of the free public orthodontic care, a substantial and equal proportion of the untreated individuals in the counties had malocclusions with treatment need, but they had no treatment desire.

Adolescent↗
PubMed1995

Effects of a commercial orthodontic debonding agent upon the surface microhardness of two orthodontic bonding resins.

The bonding techniques employed in orthodontic practice differ from those used in restorative dentistry for, upon the completion of treatment, the appliance is removed. This necessitates breaking the resin/enamel bond. Ideally a smooth, undamaged enamel surface free from all traces of bonding agent should result. Regrettably, however, this ideal is rarely achieved. This investigation assessed the effects of a commercial debonding agent (P-de-A, Oradent Ltd, Eton, Berks, UK), derived from peppermint oil, upon the surface microhardness of two orthodontic resins (Orthodontic Concise and Transbond, both 3M, St Paul, MN, USA). Twenty discs (10 mm diameter x 1.25 mm deep) of each resin were fabricated and, following 1 week's storage in distilled water at 37 degrees C, were allocated to application groups composed of four specimens. The mean initial surface hardness of each group was then determined prior to the application of P-de-A for one of: 30, 60, 90, 120 and 180 s. The hardness was then remeasured. One-way analyses of variance were performed upon the mean initial and final hardness data and revealed only a significant (P < 0.05) reduction in surface hardness following the 180 s application of P-de-A to Orthodontic Concise. We were therefore unable to find little evidence to suggest that the agent facilitates debonding by a softening mechanism and further work is required to elucidate the means whereby orthodontic debonding and 'clean-up' of residual composite, as reported by others, is facilitated.

Acrylic Resins↗
PubMed1994

Combined orthodontic-endodontic therapy: case report of orthodontic movement of a recalcified lateral incisor.

Unlike most cases of combined orthodontic and endodontic therapy that have been reported, in this case endodontic treatment with calcium hydroxide-induced calcification was utilized prior to orthodontic treatment. A 14-yr-old female required orthodontic therapy due to anterior crowding. Preoperative periapical radiographs indicated that the maxillary right lateral incisor demonstrated advanced lateral root resorption of the distal surface. It was decided to use calcium hydroxide therapy to halt any further resorption prior to orthodontic movement. Approximately 1 yr was required to gain calcification, fill the canal with gutta-percha, and place the maxillary closing arch. Subsequent orthodontic treatment did align the teeth in a desirable manner without jeopardy to the recalcified root.

Adolescent↗
PubMed1996

Comparing and contrasting two orthodontic indices, the Index of Orthodontic Treatment need and the Dental Aesthetic Index.

This article compares and contrasts two orthodontic indices, the Index of Orthodontic Treatment Need (IOTN), and the Dental Aesthetic Index (DAI). Both contain esthetic and clinical criteria. Both accept the premise that a significant benefit of orthodontic treatment is improved esthetics and, by inference, social and psychological well-being. Both have as their goal the identification of children most in need of orthodontic treatment subsidized by public funds. The first part of this article describes the IOTN, its development, reliability, and validity. The second section describes the DAI, its development, reliability, and validity. The third part of the article compares and contrasts the indices. There are a number of differences between the IOTN and the DAI. In the IOTN, the esthetic component is a separate instrument from the dental health component. The unique aspect of the DAI is its linking of people's perceptions of esthetics with anatomic trait measurements by regression analysis to produce a single score obviating the need, as in the IOTN, for two separate scores that cannot be combined. Both components of the IOTN have only three grades, "no need," "borderline need," and "definite need." The IOTN cannot rank order cases with greater or lesser need for treatment within grades. In contrast, DAI scores can be rank ordered on a continuous scale and can differentiate cases within severity levels. With the IOTN, about a third of British schoolchildren would be found eligible for treatment in public programs. Providing publicly funded orthodontic care to as many as a third of the schoolchildren would not be feasible in the United States.

Child↗
PubMed2002

A 10-year retrospective audit of consecutively completed orthodontic treatments in a general dental practice and a hospital orthodontic department.

During 1993 and 1994, the author took part in the South West Orthodontic Clinical Assistant Training Programme and worked as a part-time Clinical Assistant in the Orthodontic Department of the Royal United Hospital, Bath. Following the clinical assistantship the author continued to treat patients in the hospital department but under a General Dental Services contract number. This paper is a personal clinical audit of all the orthodontic cases completed within the GDS by the author since 1990, both in general practice in Westbury, Wiltshire and at the Royal United Hospital (RUH), Bath. The aim of the audit was to evaluate the effectiveness of orthodontic treatment carried out by the author, both in general dental practice and in a hospital orthodontic department, and to compare treatment outcomes with other published results.

Dental Audit↗
PubMed2002

Subjective need and orthodontic treatment experience in a Middle East country providing free orthodontic services: a questionnaire survey.

The aims of this study were to explore orthodontic treatment experience, subjective need for treatment, and perceptions of teeth and dental appearance in relation to background factors such as funding system, area of living, age, gender, ethnicity, and socioeconomic status. The subjects were 1076 randomly selected second-year high school students from a rural (Jahra) and an urban (Capital) area of Kuwait, with a mean age of 15.1 years. Kuwaiti citizens constituted 79% of the sample, and the rest were of other Arab origins. The data were collected using a questionnaire. Orthodontic treatment rate was significantly higher for Kuwaitis (10%) than for non-Kuwaitis (2%). Among Kuwaiti subjects, urban area of living and female gender increased the odds of receiving orthodontic treatment. Subjective treatment need was 36%, with no difference between Kuwaiti and non-Kuwaiti subjects, but Kuwaitis in the rural area expressed subjective treatment need less often than those in the urban area. The results suggest that access to free-of-cost orthodontic treatment was likely to affect treatment rate, whereas it did not seem to influence the self-perceived need for treatment. Gender and area of living may be significant for the distribution of free-of-cost orthodontic treatment.

Adolescent↗
PubMed2006

Residual need for early orthodontic treatment and orthodontic treatment experience among 13- to 14-year-old school children in Kuwait.

OBJECTIVE: Our purpose was to determine the residual need for early orthodontic treatment and the parameters associated with orthodontic treatment experience in 13- to 14-year-old school children in Kuwait. SUBJECTS AND METHODS: A total of 788 boys and 795 girls, representing about 6.7% of the target population, were selected according to cluster sampling methods. Information on nationality, family income and orthodontic treatment experience was collected through subject and family interviews. The occlusal morphology was recorded in a well-lit classroom or from initial study models of subjects with orthodontic treatment experience. RESULTS: Only 6.7% of the 225 subjects with early treatment need, defined as overjet >or=6.5 mm, and functional posterior and anterior crossbite on 1 or more teeth, had treatment experience. Residual need for early treatment was present in 13.4% of the subjects. Only 26.8% of the subjects with treatment experience met our criteria for early treatment need. The odds of treatment experience were higher in the subjects attending private schools (p < 0.05), in those from families with an income of KWD >2,000 (USD 6,600; p < 0.01) and in subjects meeting the criteria for early treatment need (p < 0.01). CONCLUSIONS: About 15% of each birth cohort of school children in Kuwait need early orthodontic treatment. Less than 10% of those with a need have treatment experience at 13-14 years of age, and about 75% of those with treatment experience at that age do not need early treatment. The predictors for treatment experience at 13-14 years of age are private-school attendance, a high family income and need for early treatment.

Adolescent↗
PubMedDate not supplied

Perceived, desired, and normatively determined orthodontic treatment needs among orthodontically untreated Nigerian adolescents.

This study assessed perceived, desired, and normative need for orthondontic care in a randomly selected (n=567) Nigerian children aged 12-18 years (mean age, 14.6 +/- 1.5), in Ibadan city. Perceived and desired needs were collected using a pre-tested questionnaire. Normative need was assessed on all participants by one orthodontist using the Dental Aesthetic Index. Results revealed 13.8% of the children having very severe or handicapping malocclusion with treatment considred mandatory; 9.7% with severe malocclusion and treatment highly desirable; 19.0% having definite malocclusions with treatment elective and 57.5% had normal or minor malocclusions with no treatment or slight treatment need. About 48.4% of the children desired orthodontic care and 81.7% perceived the need for orthodontic care. No statistically significant gender differences (P>0.05) were observed in perceived, desired and normatively determined orthodontic treatment needs as well as between socioeconomic backgrounds. Although considerable proportion of the adolescents perceived, desired and objectively needed orthodontic care, a discrepancy was observed as some who had near 'ideal occlusion' felt the need for treatment while some who had handicapping malocclusion felt otherwise. Therefore, in orthodontic counselling of Nigeria adolescents, attention should be paid to how the child perceives his/her dentition.

Adolescent↗