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PubMed2005

Quality management in orthodontics.

The introduction of modern quality thinking to orthodontic care should be a continuing effort on the part of the orthodontic profession. The strategy for the development of a European quality management system in orthodontic care was developed from 1993 to 2000 during the EURO-QUAL project. During the project's first stage, the basic prerequisites were identified for a general model of quality management in orthodontic care. A supra-national agreement was reached on policy statements for orthodontic care in Europe. The essential components of an orthodontic quality management system are: linking orthodontic care to population need, patient partnership, clinical accountability, and containing costs.Value-based health care and "TQM", the philosophy of total quality management, are basic principles applied in accordance with the recommendations of the European Health Committee of September 1997 and the "Health-for-All" policy framework of the World Health Organization.

European Union↗
PubMed1983

Adjunctive orthodontic therapy in the treatment of juvenile periodontitis: report of a case and review of the literature.

Historically, the patient with juvenile periodontitis (periodontosis) presented as somewhat of an unknown entity to the orthodontist. With uncertainties concerning etiology still present, the orthodontist may be hesitant to undertake orthodontic treatment for the juvenile periodontitis patient. The literature pertaining to proposed etiologic factors and treatment modalities for juvenile periodontitis is briefly reviewed. Current evidence indicates that juvenile periodontitis patients have a compromised host response which allows an exaggerated susceptibility to certain gram-negative organisms. The disease is characterized by rapidly progressing bone loss, which is not associated with marked local irritation or gingival inflammation. Early diagnosis and conservative periodontal treatment have demonstrated good results. However, cases of advanced lesions or those cases that also involve malocclusion and potential occlusal traumatism may benefit from adjunctive orthodontic therapy. Successful management of a case involving multiple tooth loss along with a moderate degree of malocclusion is presented, with emphasis on the coordination of periodontic, orthodontic, and prosthodontic care. Orthodontic movement of teeth into previously affected areas was quite successful after a short healing period following extractions. A suggested protocol for the combined orthodontic, periodontic, and fixed prosthodontic management of the juvenile periodontitis patient is presented. Once the disease process has been arrested, the prognosis of each tooth is evaluated and possible rehabilitations, including orthodontic treatment and fixed prostheses, are planned. Periodontal evaluations are scheduled concurrently with orthodontic appointments to monitor the condition as tooth movement occurs.

Child↗
PubMed1983

Histochemistry of enzymes associated with tissue degradation incident to orthodontic tooth movement.

Orthodontic tooth movement in rats was examined by histochemical techniques for some enzymes associated with bone resorption and tissue damage. The maxillary first molar was moved buccally by means of a fixed appliance with predetermined forces for periods of from 10 hours to 6 days. The activities of acid phosphatase and lactate dehydrogenase were higher in cells in the connective tissue of the periodontal membrane (PDM) than in the oral mucosa. A low orthodontic force resulted in an initial redistribution of acid phosphatase-containing cells in the PDM followed by an increased activity of acid phosphatase. The activity of lactate dehydrogenase in the PDM was not affected by low orthodontic forces. The changes in distribution and activity of acid phosphatase and lactate dehydrogenase incident to a high orthodontic force were similar to those seen incident to a low force. However, there was one definite difference. A zone which lacked acid phosphatase activity and lactate dehydrogenase activity developed in the most compressed areas of the PDM. Prostaglandin synthetase activity was found exclusively in the bone marrow and seemed not to be affected by the orthodontic forces. However, some prostaglandin synthetase activity was found in the oral mucosa corresponding to the site of the orthodontic appliance. The adjacent bone surface was covered with cells showing an intense acid phosphatase activity. In the present study the magnitude of the orthodontic force seemed to be a determining factor for the vitality of the PDM but not for the tissue-degradation activity.

Acid Phosphatase↗
PubMed1983

Quantitative analysis of the orthodontic and orthopedic effects of maxillary traction.

This article analyzes differences in displacement of ANS and of the upper first molar when different vectors of force are delivered to the maxilla in non-full-banded Phase I mixed-dentition treatment of Class II malocclusion. The sample is identical to that for which we have previously reported differences in change in several key measures of mandibular and facial shape. It includes a cervical-traction group, a high-pull-to-upper-molar group, a modified-activator group, and an untreated Class II control group. Using newly developed computer-conducted procedures, which are described, we have been able to partition the orthodontic and orthopedic components of upper molar displacement and also to isolate treatment effects from those attributable to spontaneous growth and development. In the region of ANS, small but statistically significant and clinically meaningful differences were noted between treatments. When the intercurrent effects of growth and development had been factored out (Table III), orthopedic distal displacement of ANS was significantly greater in the high-pull and cervical groups than in the activator group. Orthopedic downward displacement of ANS was seen to be significantly greater in the cervical group than in the high-pull and activator groups. In the region of the first molar cusp, mean distal displacement of the tooth as an orthopedic effect was found to be almost identical in the cervical and high-pull groups (although variability was greater in the cervical group), but the mean orthodontic effect was significantly greater in the high-pull group than in the cervical group. In the cervical group, where relatively light forces were used for relatively long treatment periods on average, more of the total distal displacement of the upper molar was of an orthopedic character than of an orthodontic character. Conversely, in the high-pull group, in which relatively heavier forces tended to be used for briefer treatment periods, most of the distal displacement at the upper molar was of an orthodontic character. These observations are contrary to expectations from conventional orthodontic theory. In the activator-treated group, roughly equal components of the treatment-associated distal displacement of the upper molar were of the orthodontic and orthopedic types. As concerns changes in the vertical direction in the region of the molar cusp, significant intrusion of both the orthopedic and orthodontic types was seen in the high-pull sample as compared to each of the other groups examined.(ABSTRACT TRUNCATED AT 400 WORDS)

Activator Appliances↗
PubMed1989

Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment.

In the present study the prevalence of white spot lesions (initial enamel lesions) on the vestibular surfaces was recorded in 19-year-olds subjected to and not subjected to orthodontic treatment. Fifty-one orthodontic patients and 47 untreated subjects were examined. On the average, 5.7 years had elapsed since orthodontic appliances were removed. The median white spot score was significantly higher in the orthodontic group than in the untreated group. The orthodontically treated subjects also had more teeth with white spot lesions than the untreated subjects. The highest prevalence was noted on the first molars in both groups. In the orthodontic group the mandibular canines and premolars and the maxillary lateral incisors were also affected. The present study showed that white spot lesions after orthodontic treatment with fixed appliances may present an esthetic problem, even more than 5 years after treatment.

Adult↗
PubMed2005

The effectiveness of computer-aided learning in teaching orthodontics: a review of the literature.

INTRODUCTION: The purposes of this review were to evaluate the effectiveness of computer-aided learning (CAL) in orthodontic education, to make evidence-based recommendations for the use of CAL in orthodontics, and to develop guidelines for conducting comparative trials to evaluate CAL as a mode of learning in orthodontic education. METHODS: Medline, the Cochrane Library Database, ERIC, CINAHL, LISA, Psycinfo, and IPA were searched for randomized controlled trials evaluating the effectiveness of CAL in orthodontics. Outcome measures included objectively measured posttest scores on multiple choice, written, or oral tests; performance on a clinical procedure or clinical interview; time spent on CAL programs to learn the material presented; and responses to questionnaires conveying participants' attitudes toward various modes of learning. RESULTS: Four randomized controlled trials comparing CAL with conventional teaching fulfilled the inclusion criteria and met the cutoff quality assessment checklist (QAC) score of > or = 8. Each study was assessed for quality by 2 independent reviewers. The validity and strength of the selected studies were assessed by using a QAC for an educational intervention. CONCLUSIONS: The controlled trials of CAL in orthodontics that met our QAC cutoff score of 8 were split, with 2 showing that CAL enjoyed a significant advantage over conventional teaching, 1 showing no difference, and 1 showing that the conventional tutorial method was better. More high-quality trials evaluating the effectiveness of CAL in orthodontics are needed. CAL programs in orthodontics elicit mostly positive responses and attitudes from students toward learning.

Attitude of Health Personnel↗
PubMed2005

Graduate orthodontic education: the residents' perspective.

INTRODUCTION: The purpose of this study was to identify current demographic trends of orthodontic residents, their goals for the future, and their perspectives on orthodontic training. METHODS: A 26-item survey was conducted at the Graduate Orthodontic Residency Program (GORP) at Harvard University in August 2003. Questionnaires were distributed to residents representing 51 orthodontic programs (of 58 in the United States). Surveys were sent to 5 of the 7 programs whose residents did not attend GORP. RESULTS: Of the 380 questionnaires distributed, 295 were completed and returned at the meeting for a 77% response rate. Additionally, 35 of the 50 mailed questionnaires were completed and returned, for a total response rate of 77% (330 completed/430 distributed). Most residents stated that clinical education was the most important factor when choosing a residency. Most residents planned to publish their research, complete American Board of Orthodontics certification requirements, and work 4 days a week after program completion. CONCLUSIONS: Several trends were identified since orthodontic residents were last surveyed in 1992. The most significant change reported was an increase in the number of those who plan to complete American Board of Orthodontics certification requirements.

Adult↗
PubMed2006

Comparative study of 3 types of toothbrushes in patients with fixed orthodontic appliances.

INTRODUCTION: Plaque and trapped debris that accumulate gingivally to orthodontic wire are difficult to remove. The triple-headed toothbrush (TH-TB) was designed to reach the gingival tooth margin. In this study, we examined its effectiveness in improving the oral health of orthodontic patients as compared with conventional and orthodontic toothbrushes. METHODS: Orthodontic patients (n = 94; mean age, 15.6 +/- 3.9 years) receiving edgewise treatment in both arches were randomly assigned to 1 of 3 groups (TH-TB, orthodontic toothbrush, and conventional toothbrush). After toothbrushing instruction, each participant received professional tooth cleaning. Tooth plaque index, bracket plaque index, gingival index, and bleeding index were recorded at baseline and after 4 weeks of usage. Satisfaction level was obtained after 4 weeks. RESULTS: The TH-TB was significantly more effective than conventional and orthodontic toothbrushes in tooth-plaque removal by 2-fold and 1.5-fold, respectively (P < .001); in bracket-plaque removal by 3-fold and 2-fold, respectively (P < .001); and in improving gingival health by 6-fold and 1.5-fold, respectively (P = .011). Patients who used the TH-TB were significantly more satisfied than those who used the other toothbrushes (P < .001). CONCLUSIONS: The TH-TB is a practical alternative to other manual toothbrushes to improve tooth and gingival health in orthodontic patients wearing fixed appliances.

Adolescent↗
PubMed2006

Orthodontic bracket bonding: enamel bond strength vs time.

INTRODUCTION: Tests of bond strength between orthodontic brackets and enamel are generally conducted after at least 24 hours storage in water. However, debonding might occur soon after bracket placement during orthodontic treatment. We investigated the rate of bond strength development for orthodontic adhesives in bracket bonding. METHODS: Four orthodontic adhesive systems were examined. Bovine incisors were mounted in self-curing acrylic resin, and the facial surfaces were wet-ground to expose flat enamel. Orthodontic brackets were bonded according to the manufacturers' instructions. Shear bond strengths were measured after storage in water for 5, 10, and 60 minutes, and 24 hours. Differences between bond strengths at 24 hours and the other test periods were statistically analyzed. RESULTS: All materials tested had the highest bond strengths at 24 hours, and bond strength increased with storage time. The earliest time point at which there was no significant difference in bond strength compared with that at 24 hours was defined as the initial stable time. Differences in this value might have clinical implications for the assessment of orthodontic adhesives, which can incur high stresses immediately after placement. CONCLUSIONS: The rate of development of enamel bond strength must be considered to ensure sufficient maturation of orthodontic adhesives before functional loading.

Animals↗
PubMed1998

A practice-based randomised controlled trial of the efficacy of an electric and a manual toothbrush on gingival health in patients with fixed orthodontic appliances.

OBJECTIVES: The aim of the present study was to evaluate the efficacy of an electric toothbrush with a specially designed orthodontic brush head compared with a manual toothbrush in controlling plaque and gingivitis in patients with fixed orthodontic appliances over an 8-week period in a dental practice setting. METHODS: This was a randomised controlled, single blind, stratified, parallel group trial conducted in two specialist orthodontic dental practices by a specialist orthodontist. Group 1 comprised 41 subjects who used the electric toothbrush and Group 2 consisted of 43 subjects who brushed with a manual toothbrush around the orthodontic appliance for a timed 2 minutes twice daily for 8 weeks. Plaque around the fixed appliance attachments was measured using an orthodontic modification to the Silness and Loe plaque index, while gingival condition was scored using the gingival index and Eastman interdental bleeding index. RESULTS: There was baseline balance for all clinical variables (p > 0.05). Both groups had significantly less plaque after 8 weeks than at baseline (p < 0.001) but the group using the electric brush also had significantly less interdental gingival bleeding, as determined by the Eastman interdental bleeding index both at week 4 (p < 0.001) and week 8 (p = 0.004). The majority of subjects (n = 54, 64.3%) preferred the electric toothbrush. CONCLUSIONS: In conclusion, the results from this study would suggest that use of an electric toothbrush with an orthodontic brush head may be of benefit in promoting gingival health in fixed orthodontic appliance patients; however, the long-term effects (over at least 6 months) need to be evaluated.

Adolescent↗
PubMed1990

Orthodontics and temporomandibular disorders: a review of the literature (1966-1988)

The orthodontist has been both accused of causing and complimented for curing temporomandibular dysfunction. To better understand the origins of these conflicting opinions, a review of the orthodontic and temporomandibular joint journals was performed for articles published since 1966. A total of 91 publications that discussed the relationship between orthodontics and temporomandibular disorders was found, and these articles were divided in three categories: viewpoint publications, case reports, and sample studies. Among the areas scrutinized in each category was the method that has led to the diversity of viewpoints. From this analysis, the following conclusions were drawn: (1) viewpoint publications and case reports were excessively represented in comparison with the number of sample studies; (2) viewpoint publications and case reports described a wide variety of conflicting opinions on the relationship between orthodontics and temporomandibular disorders; (3) unlike sample studies, viewpoint publications and case reports have little or no value in assessment of the relationship between orthodontics and temporomandibular disorders; (4) sample studies indicate that orthodontic treatment is not responsible for creating temporomandibular disorders, regardless of the orthodontic technique; and (5) sample studies indicate that orthodontic treatment is not specific or necessary to cure signs and symptoms of temporomandibular dysfunction.

Humans↗
PubMed1993

Biodegradation of orthodontic appliances. Part II. Changes in the blood level of nickel.

The purpose of this study is to determine whether orthodontic patients accumulate measurable concentrations of nickel in their blood during their initial course of orthodontic therapy. Blood samples were collected at three different time periods: before the placement of orthodontic appliances, 2 months after their placement, and 4 to 5 months after their placement. The study involved 31 subjects, 18 females and 13 males, who had malocclusions that required the use of a fully banded and bonded edgewise appliance. The age of the subjects in the study ranged between 12 and 38 years. The blood samples were frozen and shipped to a commercial medical laboratory for analysis by atomic absorption spectrophotometry. The three blood samples for each patient were analyzed in succession on the same day to eliminate equipment variance that could occur if blood samples were analyzed on separate days. A total of 93 blood samples were sent for analysis. From the findings in this study the following can be concluded: (1) Patients with fully banded and bonded orthodontic appliances did not show either a significant or consistent increase in nickel blood levels during the first 4 to 5 months of orthodontic therapy. (2) Orthodontic therapy using appliances made of alloys containing nickel-titanium did not result in a significant or consistent increase in the blood levels of nickel. The results obtained from both parts of this investigation indicate that orthodontic appliances used, in their "as-received" condition, corrode in the oral environment releasing both nickel and chromium, in amounts significantly below the average dietary intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

The evaluation of dual cement resins in orthodontic bonding.

Dual-cement resins are composite resins that are both light activated and chemically cured. They can be cured completely with a visible light source or by the catalyst and base reaction of the material. With the control of setting time, dual cements appear to offer clinicians advantages in orthodontic bonding. The purposes of the present research are to compare various dual cements in regard to orthodontic bonding and to evaluate them in relation to currently used chemically cured and light-cured composite resins for bonding stainless steel mesh-backed orthodontic brackets. Seven currently available orthodontic bonding systems (three light cured and four chemically cured) and three dual cements were evaluated. Each of the 10 groups contained 15 noncarious mandibular incisors. Mandibular incisor brackets were bonded to the teeth in accordance with the manufacturer's recommendation. After bonding, the teeth were stored for 5 days in water at 37 degrees C. An Instron machine (Instron Corp., Canton, Mass.) was used to test samples. All samples were compared with Concise orthodontic bonding composite (3M, St. Paul, Minn.). The results of this investigation show that it is possible to bond solid, mesh-backed metal orthodontic brackets to teeth with a dual cement. The shear bond strengths of the dual cements, as tested in the laboratory, should be adequate to withstand normal orthodontic forces. Increased control of the setting time of the dual cements will allow the clinician more time to correctly position brackets and to remove excess resin before curing. In addition, the clinician can be assured of complete polymerization with the chemical properties of the dual cement resins.

Analysis of Variance↗
PubMed1996

Nickel allergy in adolescents in relation to orthodontic treatment and piercing of ears.

The aim of this study was to investigate the frequency of nickel hypersensitivity in adolescents in relation to sex, onset, duration and type of orthodontic treatment, and the age at which ears were pierced. The subjects were 700 Finnish adolescents, from 14 to 18 years of age, of which 476 (68%) had a history of orthodontic treatment with metallic appliances. The study consisted of patch-testing for a nickel allergy and a patient history obtained by a questionnaire and from patient record. The frequency of nickel sensitization in the whole group was 19%. Nickel allergy was significantly more often found in girls (30%) than in boys (3%) and in subjects with pierced ears (31%) than in those with no piercing of ears (2%). Orthodontic treatment did not seem to affect the prevalence of nickel sensitization. None of the girls who were treated with fixed orthodontic appliances before ear piercing showed hypersensitivity to nickel, whereas 35% of the girls who had experienced ear piercing before the onset of orthodontic treatment were sensitized to nickel. The results suggest that orthodontic treatment does not seem to increase the risk for nickel hypersensitivity. Rather, the data suggests that treatment with nickel-containing metallic orthodontic appliances before sensitization to nickel (ear piercing) may have reduced the frequency of nickel hypersensitivity.

Adolescent↗
PubMed1998

Equity and orthodontic treatment: a study among adolescents in Northern Ireland.

This epidemiological study investigated the reasons why children in Northern Ireland who need orthodontic treatment do not receive treatment even when it is provided free by the state. A total of 1584 15- and 16-year-olds were examined in 23 high schools with the Index of Orthodontic Treatment Need. The characteristics of the adolescents who had received orthodontic treatment were compared with those who had a definite need for treatment and yet did not receive treatment or advice. One in 10 of the adolescents examined had an unmet need for orthodontic treatment. Logistic regression analysis was used to assess the influence of 11 variables including socioeconomic status, religion, and standard of dental health on the uptake of orthodontic care. This analysis revealed that the only significant predictors of whether an adolescent received orthodontic treatment was the dental attendance pattern of the adolescent, the adolescent's dental health, and the dental attendance pattern of the adolescent's mother. Those adolescents who had good dental health, who regularly attended a dentist, and whose mother regularly attended a dentist were more likely to receive orthodontic treatment.

Adolescent↗
PubMed1998

Bone-to-implant contact of orthodontic implants in humans subjected to horizontal loading.

Implant-based anchorage in orthodontics is increasingly obtaining significance. In this study, implants were temporarily inserted into the mid-palatal and the mandibular retromolar areas in humans for orthodontic anchorage. Histological analysis of the implant-bone interface was performed following the retrieval of implants which were subjected to prolonged oblique orthodontic loading. The results of the histomorphometric evaluation indicated that all the implants serving for orthodontic anchorage were well integrated into the bone despite the prolonged application of the orthodontic loading. Hence, it may be concluded that small-size, one-part transmucosal implants with a self-tapping thread and an SLA surface seemed to provide adequate anchorage for orthodontic therapy. Furthermore, the successful integration and the subsequent oblique loading of these orthodontic implants provide evidence that continuous forces in the order of magnitude of 2-6 N are compatible with the maintenance of osseointegration.

Adolescent↗
PubMed2001

Short epithetic implants for orthodontic anchorage in the paramedian region of the palate. A clinical study.

Orthodontic movement of teeth often requires maximum anchorage, so that additional resistance must be added to teeth to avoid reaction to reciprocal forces. Thus, use of endosseous implants may be a valuable alternative for ensuring stable intraoral anchorage. This study was designed to evaluate the efficacy of short epithetic implants for orthodontic anchorage in the paramedian region of the palate. Twenty-one patients (15 female, 6 male; mean age 25.8+/-9.9 yrs, min 12.7, max. 48.1) were included in this study. Following adequate preoperative planning, an implant system with reduced length, which had already been used for anchorage of epitheses, was placed in the paramedian region avoiding the anterior palatine suture. After a mean period of 4 months with unloaded healing, the implants were subjected to direct or indirect orthodontic loading. Despite varying bone quality and varying vertical bone volume in this region, adequate primary stability was achieved for all of the implants. No implant was lost during the healing period. Three out of the 21 implants placed were considered as failures. Two implants loosened shortly after the start of orthodontic loading. One of these was lost at a later stage due to peri-implant inflammation, while the other one was left in place during the 9-month follow-up period because no inflammation developed and this implant is still indirectly included in the orthodontic treatment. Another implant loosening was observed after 8.5 months following direct loading with 8 N. This implant was also lost due to peri-implant inflammation. The time-related survival probability was 84.8% after 22.9 months. As yet, 4 implants have been removed due to completion of orthodontic treatment. The results of this study indicate that short epithetic implants are suitable to achieve maximum anchorage in the paramedian region of the hard palate in orthodontic treatment.

Adolescent↗
PubMed1994

Residual orthodontic treatment need in a sample of 15- and 16-year-olds.

This study investigated the residual unmet orthodontic need, both normative and perceived, in young adults who had passed the age at which orthodontic treatment would have normally commenced. A total of 506 15- and 16-year-olds attending eight secondary schools were screened by a single trained examiner using the 'Index of Orthodontic Treatment Need' (IOTN). There were 154 (30.4%) subjects classified as being in need of orthodontic treatment using IOTN and 82 of these (16% of the sample) were found to be in need of orthodontic treatment but had no recollection of orthodontic treatment ever being discussed with them. Children with malocclusion, who had received no orthodontic advice, came from across the range of socio-economic groups, were more likely to be male, and were less likely to be happy with their appearance than their unaffected peers.

Adolescent↗