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PubMed2003

Dental abnormalities, bone graft quality, and periodontal conditions in patients with unilateral cleft lip and palate at different phases of orthodontic treatment.

OBJECTIVES: To evaluate the dental and periodontal condition of patients with unilateral cleft lip and palate (UCLP) before orthodontic treatment and evaluate whether the dental and periodontal condition of these patients during and after orthodontic treatment was jeopardized by the duration of the orthodontic and surgical treatment. DESIGN: Seventy-five individuals with UCLP (52 males, 23 females), between ages 8 and 20 years, participated in a retrospective study during their final follow-up visit with regard to dental abnormalities, such as hypodontia, external root resorption, crown and root malformation, and supernumerary teeth. Alveolar bone height and periodontal attachment loss on the cleft side were also screened before or after bone grafting and at different stages of orthodontic treatment. RESULTS: Hypodontia of the lateral incisor was found in more than 50% of the patients on the cleft side. Second premolars and/or lateral incisors outside the cleft area were missing in 27.2% of the patients. In 32%, malformations of the teeth near the cleft were noticed. In general, the teeth around and in the cleft of the patients showed normal septal bone heights and a healthy periodontium. Sixty of the 75 patients received a bone graft to restore the interrupted alveolar process. In 93.3% of these patients, the cleft was grafted before the eruption of the canine. CONCLUSION: The periodontium of the teeth in and around the cleft in patients with UCLP observed during and after orthodontic treatment can cope relatively well with the long orthodontic treatment and combined surgical interventions. The children, who had not yet started treatment, also showed enough bone support and no periodontal problems of the teeth besides the cleft. Early secondary bone grafting seems to give optimal periodontal results.

Adolescent↗
PubMed2004

Periodontal parameters around implants anchoring orthodontic appliances: a series of case reports.

BACKGROUND: Implants replacing missing teeth provide advantages over clinical orthodontic treatment as compensation for reaction forces is no longer necessary and the lack of teeth is immediately resolved. METHODS: A total of 38 two-stage implants were inserted (16 in maxilla, 22 in mandible) in 10 partially edentulous patients with orthodontic problems. Osseointegration and marginal bone levels were assessed via intra-oral radiographs taken at the abutment stage and at the completion of the orthodontic treatment and also via probing depth, measurement of recession toward the implant/abutment (I/A) interface, and sulcus bleeding index, recorded after completion of orthodontic treatment. RESULTS: In the maxilla, the cumulative survival rate was 87.1% after 2 years; for the mandible, it remained 100%. Mean amount of bone loss was 1.6 mm for maxilla and 0.8 mm for mandible. No correlation could be found between directions of orthodontic forces and marginal bone loss. Mean percentage of bleeding sites was 38.5% and 25%, respectively, for implants in the maxilla and mandible. Attachment level was 1.2 mm (SD: 1.2) below I/A interface after completion of the orthodonic treatment. CONCLUSION: No significant marginal bone loss was present. Using implants during orthodontics can result in an easier and more predictable treatment.

Adolescent↗
PubMed1992

Orthodontic adjunctive treatment in fixed prosthodontics.

The purpose of this article has been to increase the restorative dentist's appreciation for the rationale justifying preprosthodontic orthodontic treatment. It has not been intended to identify all the specific indications for the use of orthodontic treatment to enhance prosthodontic treatment nor has it been intended as a reference to assist the restorative dentist in placing and using orthodontic appliances. Figure 12 illustrates a typical case in which the combination of orthodontic and prosthodontic treatment resulted in a more favorable outcome than prosthodontic treatment alone. When planning prosthodontic treatment, the dentist should embrace a dynamic view of tooth position and determine whether restorative treatment can be enhanced by tooth movement. Improved tooth position can eliminate potentially pathologic occlusion and create a healthier periodontal environment that is easier to maintain. In addition, it permits the dentist to place restorations that often require less natural tooth reduction during preparation, and that are more esthetic, functional, stable, and durable. Orthodontic treatment that accomplishes these benefits may be limited to a partial fixed appliance localized to one segment of an arch or require a more extensive fixed appliance. Much of this treatment can be accomplished by the interested restorative dentist. Addressing more comprehensive orthodontic problems in patients requiring prosthodontic care is best managed through a restorative dentist and orthodontist team approach to treatment.

Dental Stress Analysis↗
PubMed2003

Preventive and interceptive orthodontic demand for malocclusion.

Orthodontic unit, University College Hospital, Ibadan is young and in need of baseline data for effective planning. The main aim of this study was to determine the nature of orthodontic demands in the unit that could benefit from preventive and interceptive treatment so as to enhance treatment planning, teaching and further research. Consecutive patients who presented for treatment in the Unit between May 1997 and November 1999 were included in the study. The patients aged 5-19 years with mean age of 8.8 +/- 0.82 years. One hundred and twenty-one (60.5%) of the orthodontic cases that presented for treatment needed one form of preventive and interceptive treatment or the other such as extraction of retained primary teeth, use of upper removable orthodontic appliances to correct teeth in cross bite, extraction of erupted supernumerary teeth and fabrication of oral habit breaking appliances such as goal post appliance. Ninety-three (76.9%) of these children had retained primary anterior teeth while 9.1% had proclination of maxillary anterior teeth with moderate spacing. Based on dental history and clinical examination, nine (7.4%) children were involved with oral habits, seven (5.8%) and one (0.8%) had anterior crossbite and supernumerary teeth, respectively. The remaining 39.5% needed full-blown orthodontic treatments. No sex predilection was found in relation to the various needs (P > 0.05). We suggest a need for more emphasis on preventive and interceptive orthodontic treatment in our environment due to the relatively high prevalence ofthese presenting needs.

Adolescent↗
PubMed1993

Contemporary trends in orthodontic practice: a national survey.

This study involved the development of a questionnaire to elicit information about current trends in orthodontic practice compared with trends of 5 years ago. The subjects addressed included the use of fixed appliances, functional appliances, extraction therapy, orthodontics and the temporomandibular joint, current diagnostic aids, and medicolegal implications of orthodontic treatment. The questionnaire was mailed to 1400 orthodontic specialists who were randomly selected from across the United States. There were 814 questionnaires returned, representing a 58.14% response rate. The major results of this survey are as follows: (1) The reported extraction rate has declined from a mean of 37.74% 5 years ago to 29.28% today. (2) TMJ concerns (or medicolegal implications thereof) have had a considerable impact in this decline, with 26.4% of orthodontists being influenced, to some extent, to extract fewer teeth because of this factor. (3) The use of functional appliances has remained somewhat static over the last 5 years, after a period of rapid growth in the 5 years previous to that. (4) The preadjusted edgewise appliance is by far the most popular fixed appliance in use today, being chosen by 72.6% of respondents. Analysis of the overall results lead to the following conclusions: (1) Fixed appliance therapy is the therapy of choice of the overwhelming majority of orthodontists. The use, benefits, and role in orthodontics of functional appliance therapy is considerably less defined. (2) Treatment modalities, notably on the use of extraction and its relationship to the health of the temporomandibular joint, should be determined by research, not by legal fears or unsubstantiated allegation.

Activator Appliances↗
PubMed1998

Clinical assistant training in orthodontics--how effective is it?

OBJECTIVE: To investigate the quantity and the quality of orthodontic treatment carried out by dentists who have completed a 2-year orthodontic clinical assistant training programme. DESIGN: Retrospective analysis. SUBJECTS AND METHODS: During a 12-month period the volume of orthodontic treatments completed by 18 dentists who had participated in a clinical assistant training scheme was analysed. Using study models the initial need for treatment and the outcome of treatment of a consecutive sample of each dentist's completed cases were assessed. MAIN OUTCOME MEASURES: IOTN and PAR indices used by expert examiners. RESULTS: The median number of cases treated by the dentists was 37 with a range of 2 to 488. No significant predictive variables were associated with the higher volume operators. Of the 166 orthodontic cases evaluated 72.9% had a definite dental health need for orthodontic treatment. Following treatment the mean post-treatment PAR score for the whole sample was 9.2 (median = 8.0). Thirteen (72%) of the dentists had an average post-treatment PAR score of 10 or less. CONCLUSIONS: The outcomes achieved by the Northern Irish clinical assistants were similar to those reported for other clinical assistant schemes. A significant proportion of the dentists treated a relatively low volume of patients and two of the dentists treated a very high volume of cases.

Clinical Competence↗
PubMed2000

The need for treatment and satisfaction with dental appearance among young Finnish adults with and without a history of orthodontic treatment.

The aim of this investigation was to evaluate orthodontic treatment need and patient satisfaction among young adults living in a city where free-of-charge orthodontic treatment was provided. A total of 281 18- to 19-year-old subjects randomly selected from the population register of the city of Vantaa took part in the study. The drop-out rate was 30%. Treatment need was clinically assessed according to the Index of Orthodontic Treatment Need (IOTN), consisting of a Dental Health Component (DHC) and an Aesthetic Component (AC). Information on previous orthodontic treatment was based on the patient records. Satisfaction of the subjects with their dental appearance and with the orthodontic treatment received was obtained using a questionnaire. The rate of orthodontic treatment among the subjects was 46% (54% for the females and 37% for the males, p < 0.05). 4% had discontinued treatment. A definite need for treatment (DHC 4 to 5/AC 8 to 10) was assessed in 15% of the subjects, and borderline/moderate need (DHC 3/AC 5 to 7) in 36%. No difference in IOTN scores between the treated and untreated subjects was found. Females had significantly more often no treatment need (DHC 1 to 2/AC 1 to 4) compared with males (p < 0.05). The majority of subjects (89%) reported that they were very or quite satisfied with their dental appearance. The odds of being satisfied were significantly higher for the treated subjects (OR = 2.71, p < 0.05) and lower for those at the non-attractive end of the AC scale (OR = 0.14, p < 0.01). Neither gender nor DHC grade significantly affected the odds of being satisfied among the subjects. The results indicate that the majority of young adults in this study were satisfied with their dental appearance regardless of objective treatment need of various degrees. The high treatment rate in relation to unnoticed treatment need calls for reevaluation of priorities in patient selection.

Adolescent↗
PubMed1985

Reliability and validity of the Orthodontic Locus of Control Scale.

The Orthodontic Locus of Control (OLOC) Scale was developed to assess the ways in which persons perceive and evaluate the events that determine occlusal status and orthodontic treatment. The children's OLOC Scale is a 34-item self-administered inventory with a 6-point response format. The adult measure is a similar, 28-item version of the scale. A 6-item Occlusal Value Scale, was also developed for administration in conjunction with the OLOC Scale. These instruments were given to 51 children and their mothers who applied for treatment at the School of Dental Medicine's Orthodontic Clinic of the State University of New York at Buffalo. For validity studies, children and their mothers completed the Multidimensional Health Locus of Control (HLOC) Scale and the Orthodontic Opinion Poll (OOP) Subscales. The internal consistency estimates for reliability on both the child and parent versions of the OLOC Scales were in the moderate to high-moderate range. Moderate to high-moderate subscale correlations offer promise for the validity and usefulness of the Orthodontic Locus of Control Scale for future research on psychologic and social responses to malocclusion. The implications of the concept of "orthodontic locus of control" for orthodontists and parent-child treatment-related behaviors are discussed.

Adolescent↗
PubMed1986

Upgrading sterilization in the orthodontic practice.

In today's orthodontic practice, disease control must undergo major reevaluation and restructuring. The knowledge of the natural history and treatment of many highly transmissible diseases to which orthodontic personnel are at high risk is changing rapidly. Among these diseases are acquired immune deficiency syndrome (AIDS), hepatitis B virus, and the herpesvirus complex (currently five types). If barrier techniques are not in place, it is possible to cross-infect orthodontic personnel and patients alike. Clinical orthodontics, with its higher volume of patients (on a daily basis) than other dental practices, requires a custom-made sterilization schema tailored to each office. Proper organization of instruments to permit orderly processing, storing, and use is even more important than before. Turnaround time of processing instruments, corrosion control, and minimizing of dulling of cutting edges are critical. Treatment of surfaces and chair/unit facilities with improved disinfection techniques is a necessity. Protection of hands and eyes by appropriate means is discussed with practical guidelines for the use of gloves by chairside personnel. Many fomites (inanimate disease transmitters) lurk in the orthodontic office and must be eliminated. Finally, the most important ingredient to any change--the orthodontic office staff--must be enlightened, trained, and supervised by the orthodontist to effectively and efficiently switch from the old to the new.

Communicable Disease Control↗
PubMed1992

Orthodontic treatment and temporomandibular joint disorders.

The overall objective of this project was to study the relationship between orthodontic treatment and temporomandibular joint (TMJ) disorders. This relationship has been and remains an important and complex issue in orthodontics. The objectives of the study were to determine the incidence of TMJ pain and dysfunction in a group of orthodontic patients who were symptom-free on entering treatment, and to assess and characterize the level of pain and dysfunction in patients with symptoms, and track changes in these parameters during the course of orthodontic treatment. Standardized functional indices and physical measurements were used to describe and assess TMJ pain and dysfunction. The results of this study showed that of 451 patients without symptoms undergoing treatment at our university clinic during the 18-month project, no patient developed signs and symptoms of TMJ disorders during that time. In addition, for the 11 patients who presented with signs and symptoms of TMJ disorders at the time of their entry into the treatment program, no clear or consistent changes in levels of pain and dysfunction occurred longitudinally during the treatment period followed in this study. On the basis of these findings, a relationship between either the onset of TMJ pain and dysfunction and the course of orthodontic treatment or the change in TMJ pain and dysfunction and the course of orthodontic treatment could not be established in this particular patient population.

Adolescent↗
PubMed1993

Nickel hypersensitivity in the orthodontic patient.

Nickel is one of the most common causes of allergic contact dermatitis and produces more allergic reactions than all other metals combined. Currently, several brands of orthodontic wires are made of nickel titanium alloy and potentially have a high enough nickel content to provoke manifestations of allergic reactions in the oral cavity. The objectives of this study were (1) to determine if standard orthodontic therapy can sensitize patients to nickel, and (2) to assess gingival response to nickel-containing orthodontic appliances in patients who are nickel sensitive before treatment. Nickel sensitivity patch tests were conducted to confirm hypersensitivity to nickel. Twenty-nine patients from the Division of Orthodontics, Albert Einstein/Montefiore Medical Center were tested, ranging in age from 12 to 48 years. Of the 29 patients, there were 18 female and 11 males. Five of the patients had a positive nickel patch test, a rate of 18.5%. The five patients that tested positive were all female, meaning that the overall rate for females was 27.7% (5:18). The five female patients sensitive to nickel were followed monthly by intraoral photos and gingival and plaque index scores. The remaining patients began routine orthodontic therapy and were retested 3 months into treatment to see whether sensitization occurred. Two patients converted from an initial negative patch test to a positive test. There may be a risk of sensitizing patients to nickel with long-term exposure to nickel-containing appliances as occurs in routine orthodontic therapy.

Adolescent↗
PubMed1993

A comparison of surgery and orthodontics in "borderline" adults with Class II, division 1 malocclusions.

From a pool of 108 former patients, discriminant analysis was used to identify a homogeneous borderline prognostic subgroup of 27 adult orthodontic and 26 adult surgical Class II patients who, before treatment, were similar with respect to the characteristics on which the orthodontic/surgical decision appears to have been based. The fact that some had been treated orthodontically, whereas others had been treated surgically, was taken as empirical evidence that the patients in this stratum were equally susceptible to the two treatments and that the actual choice was largely a function of whose office they happened to contact. The former orthodontic patients were recalled an average of 7.1 years after treatment, the former surgical patients, 4.7 years after surgery. Each subject was evaluated with respect to skeletal and dental stability, profile esthetics, and temporomandibular function. Although there were dramatic differences in the nature of the correction (dental versus skeletal), both groups of patients generally thought that their profiles had been improved by treatment. As judged by data generated from visual analogue scales, the mean difference between the orthodontic and surgical patients' evaluations of their treatments was small and nonsignificant. Moreover, the "borderline" Class II orthodontic and surgical patients showed no significant differences in craniomandibular function and incisor stability. There was, however, one profound difference between treatments: 3 of the 26 surgical patients underwent extensive relapse, probably as a result of condylar resorption. From the standpoint of estimated probabilities and utilities for the various outcomes, the present results imply that orthodontics would be the better choice for the borderline adult Class II patient, whereas surgery would be appropriate for the more severely affected patient.

Adult↗
PubMed2004

Aspartate aminotransferase activity in pulp of orthodontically treated teeth.

This study examines the aspartate aminotransferase activity in the pulp of orthodontically treated teeth. Seventeen healthy male and female subjects (ages: 14.5-19.6; mean 16.8 +/- 1.6 years) who needed extraction of the maxillary first premolars for orthodontic reasons were enrolled in the study. One randomly chosen maxillary first premolar, included in a straight-wire fixed orthodontic appliance and supporting orthodontic force, was considered as the test tooth. The contralateral first premolar, included in the orthodontic appliance but not subjected to mechanical stress, was used as the control tooth. After a week of treatment, the dental pulp tissues were extracted from both experimental teeth. Aspartate aminotransferase activity was significantly elevated in the test teeth as compared with the control teeth. These results demonstrate that in the early phases of treatment, orthodontic force application to the teeth can lead to significant metabolic changes in the pulp of these teeth.

Adolescent↗
PubMed2003

The crisis in orthodontic education: goals and perceptions.

A crisis in orthodontic education exists today because of a shortage of qualified people seeking to pursue careers in academic orthodontics; 35% of orthodontic graduate programs in the United States report having at least 1 vacant faculty position. Previous studies have identified several factors that contribute to the current shortage. The purpose of this study was to quantify and compare real and perceived differences in income, workload, and other qualitative characteristics between academic and private practice orthodontists. Orthodontic faculty, private practitioners, and residents were surveyed, and their answers were compared statistically. Faculty annual income was less than one half that of private practitioners matched by experience and geography. Faculty reported working an average of 25% more hours per week, and income per hour for full-time faculty was less than one third that of their private-practice colleagues. In addition, faculty perceived that they experienced more stress, encountered more bureaucracy, received less respect, and had a more difficult time achieving board certification than did private practitioners. Despite these findings, both faculty and private practitioners reported high levels of satisfaction in their respective jobs. Orthodontic residents were better attuned to the differences between academics and private practice than were faculty or private practitioners themselves. Residents perceived that it would take an average of 67% longer to pay off their educational debt in a faculty position than in private practice. It is in the best interest of orthodontics to resolve the crisis in education if it is to maintain its well-respected status among dental and medical specialties.

Adult↗
PubMed2004

Orthodontic care in an insured population in Washington: demographic factors.

Few studies have used insurance claims data to investigate demographic factors related to orthodontic care. This study sought to describe age and sex distributions in a large, insured population in Washington. Additionally, the demand for orthodontic care was evaluated with respect to county population, and the impact of the availability of orthodontists was investigated. All orthodontic claims in 2001 were retrieved from the Washington Dental Service database, along with associated provider and patient information. A total of 102,984 claims were included in this study. A large percentage of subjects (86%) were less than 20 years old, with most patients in their early teens. Overall, about 64% of all orthodontic patients were female. The demand for orthodontic treatment was the highest in the counties with the largest populations. Although there was considerable variation in the data, the number of orthodontic claims submitted by general dentists tended to decline as the availability of orthodontists increased.

Adolescent↗
PubMed2004

Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children.

The aim of this study was to assess the opinions of Tanzanian children on dental attractiveness and their perceptions of orthodontic treatment need in relation to their own dental attractiveness as measured by the aesthetic component (AC) of the index of orthodontic treatment need (IOTN). In a random sample of 386 school children (48% boys, 52% girls), aged 9 to 18 years, the subjective need was assessed by using a prestructured questionnaire, and attractiveness was scored by using 18 intraoral frontal photographs. Orthodontic treatment need was measured with the IOTN, and 11% of the children definitely needed orthodontic treatment (grades 8-10 of the AC with 4-5 of the dental health component [DHC]). The AC indicated that 11% of the children needed orthodontic treatment, whereas the DHC indicated 22%. Although 38% of the children said they needed treatment, 33% and 31% were unhappy with the arrangement and the appearance of their teeth, respectively. Most children (85%) recognized well-aligned teeth as important for overall facial appearance. Photographs showing severe deviations including crowding were regarded as the most unattractive, with older children tending to dislike them the most (P <.0005). This suggests that, from the children's point of view, grades 8-10 of the AC and 4-5 of the DHC could be given the first priority when considering an orthodontic treatment policy in Tanzania.

Adolescent↗
PubMed2005

Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults.

INTRODUCTION: The aim of this study was to investigate whether young adults with varying dental esthetics and histories of orthodontic treatment also differ in oral-health attitudes, preventive behaviors, and self-perceived oral health. METHODS: The sample comprised 298 young adults, 18 to 30 years old, with at least 13 years of primary and secondary school education. The subjects were asked to complete questionnaires dealing with various measures related to oral-health attitudes, preventive behaviors, and perceptions of oral health. Dental esthetics were assessed by means of the aesthetic component of the index of orthodontic treatment need. Dental plaque accumulation was assessed in a subsample of respondents. RESULTS: Subjects with high dental-esthetics scores reported more favorable oral-health attitudes, such as internal control, dental awareness, value of occlusion, and preventive behavior expectations than subjects with lower scores. Subjects with previous orthodontic treatment showed greater internal control and dental awareness than those who had not previously been treated. Subjects ranking high in dental esthetics and those with previous orthodontic treatment reported stricter oral-hygiene adherence than others. Self-perceived oral health was better in high scorers on dental esthetics. Less plaque accumulation was found in subjects with higher dental esthetic scores and in those with previous orthodontic treatment. CONCLUSIONS: These findings suggest that favorable dental esthetics and previous orthodontic treatment might be important variables in explaining individual differences in oral-health attitudes and behaviors.

Adolescent↗
PubMed2006

Misuses of correlation and regression analyses in orthodontic research: the problem of mathematical coupling.

INTRODUCTION: The aim of this article was to encourage good practice in the statistical analyses of orthodontic research data. Our objective was to highlight the statistical problems caused by mathematical coupling (MC) in correlation and regression analyses. These statistical problems are among the most common pitfalls in orthodontic research when exploring associations among clinical variables. This article will show why these problems arise and how they can be avoided and overcome. METHODS: Four orthodontic journals were electronically and manually searched for articles that used correlation and regression analyses. Studies that seemed to suffer from MC in their statistical analyses were identified and carefully examined. RESULTS: Several examples from our search illustrate that MC in correlation and regression analyses can potentially cause misleading results. More appropriate statistical methods are available and should be used to eliminate confusing results and improve any subsequent interpretations. Because many clinical and radiographic variables used in orthodontic research are correlated due to direct or indirect MC, interpretation of studies in the literature needs to be cautious. CONCLUSIONS: Correlation and regression analyses are useful tools in orthodontic research when their assumptions and limitations are recognized. However, greater care is required in formulating research questions and experimental designs. It is prudent to seek statistical advice when orthodontic research involves complex data analyses.

Analysis of Variance↗