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PubMed1998

Orthodontic competency in predoctoral education in American dental schools.

Predoctoral orthodontic education is evolving in the United States to reflect the move towards competency-based education. This trend focuses on teaching to competency in an area or procedure. In orthodontics, this creates a dilemma for the educator in determining what orthodontic competency actually is and how to achieve it. A survey of United States orthodontic departments was conducted to aid in examining the change toward competency-based education in predoctoral clinical orthodontics. The results demonstrated a large amount of diversity regarding both the definition and the use of competencies. The most recent US accreditation standards and guidelines are moving away from specific treatment techniques and more towards management and recognition of malocclusions for the recently-graduated general dentist.

Clinical Competence↗
PubMed2004

Disparity in orthodontic utilization and treatment need among high school students.

OBJECTIVES: The aim of this cross-sectional study was to assess the disparity in utilization of orthodontic services among high school students and to measure and characterize the extent of unmet treatment needs among untreated students at the time of examination. METHODS: The sample consisted of 2,808 tenth grade students enrolled in different public and private high schools. All subjects completed a dental survey that included questions on demographic, dental health, and orthodontic services, and assessment of smile using the visual analog scale. A subsample of dental study casts that were available for 561 untreated subjects were scored using the Dental Aesthetic Index (DAI) to estimate unmet treatment need. RESULTS: The orthodontic utilization rate was 37 percent. The odds of being orthodontically treated were 8.7 times greater among those with dental visits within the past year than among those without, and three times greater among Caucasians than among other ethnic groups. The DAI indicated that the unmet treatment need was 29 percent, with ethnic minority groups having 2.6 greater odds of needing treatment than Caucasians. CONCLUSION: Minority groups and infrequent dental attenders may experience disparities in unmet orthodontic treatment need.

Adolescent↗
PubMedDate not supplied

Dentists' attitudes and practices toward provision of orthodontic treatment for children with visual and hearing impairments.

The objective of this study was to determine differences in behavior and attitudes of dentists in Riyadh, Saudi Arabia, in providing orthodontic care for children who are sensory impaired. A self-administered questionnaire was sent to all dentists working in Riyadh to assess the following domains: personal characteristics of the dentists and their practices, provision of dental care for children who are visually-impaired (Vl) and/or hearing-impaired (HI), and their attitude toward providing orthodontic care for these children. Attitudes were measured on two scales and the overall score of these two scales represented each respondent's attitude. Thirty percent of the dentists provided dental care for children with VI and 45.3 percent did for children with HI. The provision of orthodontic care was significantly affected by the country in which the dentists had received their dental training, both for children with VI and HI (p < 0.01), and by number of years they had been in practice for children with VI (p < 0.05). Regression analysis showed that only the country of dental training significantly affected the dentist's attitude score. There were also significant variations in attitudes toward the provision of orthodontic treatment for children with sensory impairment (SI), influenced by dental training and experience. In practical terms, this means that improvement in attitudes needs to be initiated at the dental undergraduate level. Establishing global guidelines for the provision of orthodontic treatment for patients with sensory impairment is likely to assist both professionals and patients.

Adult↗
PubMed2006

Accessing government subsidized specialist orthodontic services in Western Australia.

BACKGROUND: In Australia there is growing demand for dental services. This leads to more pressure on the oral health service providers, and in particular government subsidized dental care. Against this backdrop it is important that government dental services (rationed to health care cardholders) are provided equitably on a basis of need, not access. The primary hypothesis investigated in this study was that there would be an even distribution of patients referred for government subsidized orthodontic care across Western Australia when regionally adjusted for socio-economic status. METHODS: Data were obtained as a de-identified waiting list for orthodontic treatment at The University of Western Australia. The data included all patients on the orthodontic waiting list as at December 2003. RESULTS: Significant differences between ARIA categories were detected when all waiting list entries were distributed. However, the trend was towards more entries (adjusted for population) in highly accessible areas. It was found that people from relatively wealthy areas tended to be more likely to be on the waiting list than those from more disadvantaged regions. CONCLUSION: In summary, the results of this study indicate that there is an uneven distribution of demand for orthodontics waiting list positions across Western Australian postcode areas by remoteness (ARIA) and by socio-economic disadvantage (IRSD). The results suggest that demand for subsidized orthodontic care may be influenced by the general demand for treatment of that region and not on what would be expected to be an even need for treatment across all health care cardholders.

Adolescent↗
PubMed1994

Effects of topical administration of a bisphosphonate (risedronate) on orthodontic tooth movements in rats.

In orthodontics, undesirable movement of anchor teeth during tooth movement and relapse of moved teeth after treatment are the main causes of unsuccessful results. If these tooth movements could be prevented with pharmacological agents, a less complex orthodontic force system and less extensive retention would be required. The purpose of this study was to examine the effect of topical administration of a bisphosphonate (risedronate), a potent blocker of bone resorption, on orthodontic tooth movements in rats. In the first experiment, both the right and left upper first molars were moved buccally with a standardized expansion spring under administration of risedronate. Risedronate solution was injected into the subperiosteum area adjacent to the left upper first molar. The right first molar served as a control with an injection of 0.9% NaCl solution. The topical administration of risedronate caused a significant and dose-dependent reduction of tooth movement after the orthodontic force was applied. In the second experiment, the right and left upper molars were first moved buccally for three weeks. The spring was then removed, and administration of risedronate was begun. The topical administration of risedronate inhibited relapse of the tooth in a dose-dependent manner. The administration of risedronate did not affect either overall growth of the animals or longitudinal growth of tibiae. These results suggest that topical application of risedronate may be helpful in anchoring and retaining teeth under orthodontic treatment.

Administration, Topical↗
PubMed2004

White lesions after orthodontic treatment: does low fluoride make a difference?

OBJECTIVE: To compare and measure the changes in size of post-orthodontic demineralized white lesion enamel lesions treated with a low fluoride (50 ppm) versus a non-fluoride mouthrinse/toothpaste regime. STUDY DESIGN: An experimental double-blind prospective randomized clinical controlled trial. SETTING: A university dental school orthodontic clinic (Sheffield, UK). PARTICIPANTS: Twenty-six patients identified as having post-orthodontic demineralized white lesions on removal of their fixed appliance. METHOD AND INTERVENTIONS: The participants were randomly and blindly assigned to either a low fluoride mouthrinse/toothpaste treatment regime or an inactive control. Computerized image analysis of calibrated photographic images taken under polarized light were used to measure the lesions. OUTCOME MEASURES: Lesion size and proportion (DWL%t) and percentage reduction (ADPR) at debond, and at 12 and 26 weeks later. RESULTS: Five participants dropped out of the study, 12 had the low fluoride regime and 9 did not. As a percentage of the total labial tooth area (DWL%t) the mean size of the lesions at debond was 8.1% (SD 3.7). After 12 weeks the mean size of lesion had reduced to 4.6% (SD 2.6), which was a significant reduction (p=0.03). After 26 weeks the mean size was 3.5% (SD 2.1), which was a very significant reduction (p<0.003). This confirmed statistically that post-orthodontic demineralized white lesions do reduce in size with time reflecting remineralization or other enamel surface changes. Intervention using a test low fluoride mouthrinse/toothpaste combination at 26 weeks showed an average difference percentage reduction (ADPR) of 54.3% (Upper 95% CI=62.08, Lower 95% CI=46.44%) compared with a non-active control combination, which showed an ADPR of 66.1% (Upper 95% CI=77.74, Lower 95% CI=54.51%). This failed to show any differences or therapeutic affect. CONCLUSIONS: Post-orthodontic demineralized white lesions reduced in size during the 6 months following treatment by approximately half the original size. There was no clinical advantage in using the low fluoride formulation of mouthrinse/toothpaste in this study.

Adolescent↗
PubMed1985

Nailbiting: frequency and association with root resorption during orthodontic treatment.

The purpose of the present investigation was to determine the incidence and intensity of nailbiting and its possible role in root resorption during orthodontic treatment. A sample of 1365 boys and girls, aged 13-15 years old, were investigated about their nailbiting habits. The possible effect of nailbiting on root resorption during orthodontic treatment was evaluated by radiographic examination of two groups, matched with regard to overjet, age, sex, length and type of orthodontic treatment with fixed orthodontic appliances, one group consisting of 21 severe nailbiters and the other a group of 21 patients without the habit. Replies to questionnaires distributed to 340 boys and girls showed that the incidence of nailbiting was 45 per cent. The habit of severe nailbiting among 1025 of the children investigated was registered in 14.3 per cent. There was no significant difference regarding the habit between boys and girls. The apical root resorption index was significantly higher in the severe nailbiters before (p less than 0.01) and after (p less than 0.001) orthodontic treatment.

Adolescent↗
PubMed1995

Adult orthodontics--a review.

The increased demand for orthodontic treatment by adults suggests a review of the literature might be timely. In this review we explore whether the increased in demand is real and matched by need. We also examine the reasons for treatment being sought and special considerations which are important during orthodontic treatment. Finally, we compare the orthodontic experience of adults and adolescents. We conclude that adults seeking treatment can be excellent patients with high motivation and co-operation. The limitations of orthodontic treatment must be explained at the beginning of treatment since adult expectations of orthodontics can be very high.

Adolescent↗
PubMed1996

A scanning electron microscopic study of early enamel caries formed in vivo beneath orthodontic bands.

A clinical trial was conducted to investigate the development of caries lesions associated with fixed orthodontic appliance therapy. To introduce a cariogenic challenge on sound buccal enamel surfaces in vivo, specially designed orthodontic bands were attached to premolars scheduled for extraction for orthodontic reasons. The bands were modified by having two metal wires (0.8 mm in diameter) welded to the inner surface of the band to produce a space for plaque accumulation similar to that occurring under loose orthodontic bands. The bands were cemented with a zinc phosphate cement (Tenet) and left in situ for 4 weeks. Of 22 premolar teeth banded in eight different patients, eight showed definite white spot lesions, eight showed definite faint enamel opacities, and six showed no discernible lesions. Examination of definite white spot lesions by scanning electron microscopy revealed characteristic patterns of initial tissue destruction. Focal holes and an accentuation of the perikymata were observed affecting the enamel surface zone, an area previously considered to remain relatively intact during the development of a caries lesion. The superficial nature of the caries lesions observed and the rapidity of their formation is significant in the clinical management of decalcified areas forming beneath orthodontic bands.

Bicuspid↗
PubMed2004

Evaluating the cost-effectiveness of orthodontic provision.

The assessment of orthodontic provision is important to determine if treatment was necessary and undertaken appropriately. The ICON objectively quantifies orthodontic treatment need, complexity and outcome and is a valuable occlusal index in the assessment effectiveness of orthodontic care. It is possible to develop cost-effectiveness models by analysing the costs and effectiveness of orthodontic treatment. Several methods are illustrated to compare the orthodontic provision of specialist orthodontists.

Cost of Illness↗
PubMed1996

Biologic responses of autogenous bone and beta-tricalcium phosphate ceramics transplanted into bone defects to orthodontic forces.

This study was conducted to evaluate biologic responses of autogenous bone (particulate marrow and cancellous bone; PMCB) and beta-tricalcium phosphate ceramics (TCPC) to orthodontic stimuli. Nine dogs served as the experimental animals; three dogs underwent orthodontic tooth movement after grafting, three dogs received PMCB grafting without tooth movement, and three dogs received TCPC grafting without tooth movement. Immediately after extraction of the upper second and/or third incisors, the maxillary alveolar bone was resected bilaterally. Autogenous PMCB obtained from the iliac bone and TCPC were transplanted into each bone defect. Experimental tooth movement was initiated 2 to 4 weeks after the grafting and continued for 9 to 15 weeks. Sectional archwires with open-coll springs were used for distal movement of the upper first incisors into the extraction sites. Oxytetracycline and calcein were employed as bone markers. Sections of grafted areas including the teeth were prepared for light and fluorescence microscopy. The results revealed that both autogenous bone and TCPC presented similar adaptive changes to the original alveolar bone without any external stimuli. TCPC exhibited more prominent biodegradative responses to orthodontic force in association with new cementum formation. Root resorption was also less in the TCPC area than in the PMCB region. It is shown that TCPC is biodegradative in nature and adaptive for remodeling during orthodontic tooth movement. This finding indicates that TCPC may be a better biocompatible alternative to autogenous bone transplanted into bone defects subjected to orthodontic tooth movement.

Adaptation, Physiological↗
PubMed2003

Leakage reduction with a surface-penetrating sealant around stainless-steel orthodontic brackets bonded with a light cured composite resin.

In this study a surface penetrating sealant was used around bonded stainless steel orthodontic brackets. The investigation attempted to identify the effect of surface penetrating sealants on the microleakage associated with orthodontic stainless steel brackets bonded with light cured composite resin. A total of 58 bovine teeth were used for this study, orthodontic brackets were bonded with light cured orthodontic resin. The following groups were assigned: (I) Finished but unsealed, (II) Finished and sealed, and (III) Un-finished but unsealed. The brackets were activated using orthodontic elastics, stained, sectioned, and evaluated under magnification. The following statistical analysis was done Mann-Whitney U test for two independent samples, then confirmed with a Kruskal-Wallis One-Way analysis of variance by ranks. The second and third groups were statistically better in respect of marginal integrity as compared to the first.

Analysis of Variance↗
PubMed2000

Periodontal health of orthodontically extruded impacted teeth. A split-mouth, long-term clinical evaluation.

BACKGROUND: Impaction of front teeth (often upper canines) can result in esthetic, functional, and phonetic problems, in addition to root resorption and chronic or acute infections. Most impacted front teeth can be extruded orthodontically after minor periodontal surgery. The purpose of this retrospective study was to examine the periodontal outcome of surgically exposed and orthodontically extruded impacted teeth compared with the spontaneously erupted contralateral teeth. METHODS: A total of 38 patients, who had been treated by a combined surgical and orthodontic approach (closed eruption technique by same periodontist and 2 associated orthodontists), underwent a periodontal re-examination after 4 to 10 years. Periodontal parameters (plaque and gingivitis indices, probing depth, bleeding on probing, gingival recession and width, bone level, and root resorption) of the orthodontically extruded teeth (test) were scored and compared with those of the contralateral naturally erupted teeth (control) in a masked set-up. RESULTS: No significant differences could be detected between test and control teeth, except for the gingival width, which was 1 mm larger for the spontaneously erupted teeth. CONCLUSIONS: The data indicate that orthodontic extrusion of impacted front teeth does not jeopardize their periodontal health. This procedure appears to be a satisfactory alternative to extraction and/or transplantation.

Adolescent↗
PubMed2001

Orthodontic tooth movement enhances bone healing of surgical bony defects in rats.

BACKGROUND: The question of whether the repair of an alveolar bony defect can be enhanced by orthodontic tooth movement was addressed. METHODS: Alveolar bone defects were created in 52 Wistar male rats anterior to both maxillary first molars. After 1 week of healing, orthodontic protraction was applied for 2 weeks on the right side, resulting in mesial tipping and displacement movement. Subsequently, a retention appliance was inserted for 1 week. The left side served as the untreated (control) group. Vital bone staining (procion brilliant red H-8) was administered before and after orthodontic traction. Histomorphometric analysis was performed on 62 hemimaxillae using UV confocal microscopy and an imaging program. The total area of the bony defect was divided into 4 equal quadrants, and the area of bony apposition in each quadrant was measured. RESULTS: The total area of bony apposition was 6.5-fold larger in the treated (26.41 x 10(4) +/- 28.92 x 10(4) microm2) than in the control group (4.07 x 10(4) +/- 2.82 x 10(4) microm2), approaching statistical significance (P = 0.065). The treated occlusal quadrants demonstrated highly significant (P= 0.010), greater bone apposition compared to the control group (13.8-fold) and to the treated apical quadrants (P= 0.04, 5-fold). CONCLUSIONS: This study confirms that orthodontic tooth movement is a stimulating factor of bone apposition. A conversion in the repair pattern of the bony defect from apicoocclusal in the control group (no tooth movement) to occlusoapical in the treated group (with tooth movement) further supports the linkage between tooth movement and enhanced bone deposition. Clinical implication suggests incorporation of orthodontic tooth movement in regenerative therapy.

Alveolar Process↗
PubMed2003

Use of orthodontic treatment as an aid to third molar extraction: a method for prevention of mandibular nerve injury and improved periodontal status.

BACKGROUND: Impaction of mandibular third molars predisposes to pathological conditions including periodontal disease. Extraction of these teeth also may lead to damage to the nerve and to periodontal involvement of the second molars. This report describes a series of cases in which the third molars were orthodontically induced to erupt to prevent the sequelae associated with extraction. METHODS: Impacted mandibular third molars in 18 patients were surgically exposed following placement of an orthodontic appliance. Depending on the individual case, 1 of 3 approaches was used: attachment of a bracket, placement of a post in the root canal, or placement of an orthodontic wire through a bucco-lingual canal. After suturing the mucoperiosteal flap, the orthodontic appliance was activated. After the tooth erupted, it was removed and periodontal parameters were measured on the second molar. RESULTS: No damage to the inferior alveolar nerve was found. Probing depths on the second molar were reduced from 7.9 +/- 1.6 mm on the buccal and 7.4 +/- 1.0 mm on the lingual to 1.8 +/- 0.7 mm and 1.9 +/- 0. 7 mm, respectively. There was an average gain of 5.0 mm in attachment. Keratinized tissue increased from 2.9 +/- 0.7 to 3.8 +/- 0.6 mm. CONCLUSIONS: The interdisiplinary use of periodontics and orthodontics results in non-surgical removal of impacted mandibular third molars without damage to the inferior alveolar nerve and iatrogenic periodontal sequelae to the second molars.

Adolescent↗
PubMed1978

Peridontal status following surgical-orthodontic alignment of impacted teeth.

Treatment of impacted teeth is often a combination between oral surgery and orthodontics. This study evaluates the gingival condition of impacted teeth after surgical-orthodontic treatment, where two different surgical methods were used. In one group (n = 11) the teeth were radically exposed and orthodontically moved to their final position. In the other group (n = 11) the teeth were partially exposed by raising a mucoperiosteal flap. Orthodontic traction was then applied; whereafter the flap was sutured back into place. The results showed that one of the teeth in the partial exposure group and seven in the radical exposure group showed loss of attachment. This study indicates that a combination of mucoperiosteal flap technique and applied orthodontic traction is prefered to minimize the loss of attachment in cases of displaced impacted teeth.

Adolescent↗
PubMed2004

Need for orthodontic treatment among Tanzanian children.

OBJECTIVE: To determine the need for orthodontic treatment among Tanzanian Bantu children. DESIGN: Prospective study using dental casts. SETTING: Sixteen randomly selected schools from the Ilala district, Dar-es-Salaam, Tanzania. SUBJECT: Six hundred and forty three Tanzanian children from an urban district. METHOD: Dental casts of 643 Tanzanian subjects in age groups 3-5, 6-8, 9-11 and 15-16 years, were assessed using the Index of Orthodontic Treatment Need (IOTN). MAIN OUTCOME MEASURES: Need for orthodontic treatment. RESULTS: Aesthetic treatment need (AC grades 8-10) and dental health component (DHC grades 4-5) occurred in 5-15% and 16-36% of the studied children, respectively. The need measured by DHC increased significantly between the two oldest age groups. An absolute need measured by combining AC grades 8-10 and DHC grades 4-5 was found in 3-12% of the subjects and it increased significantly with age (p<0.03). The most prevalent severe occlusal feature placing the children in the great need category was cross bite. While about 3-19% of the children had distal occlusion (Angle's Class II), mesial molar occlusion (Angle's Class III) was rare, occurring in 1-3% of the children. CONCLUSIONS: This study provides baseline data on the need for orthodontic treatment among Tanzanian children that may be useful for the public oral health service to determine priority for orthodontic treatment as part of comprehensive child oral health care in Tanzania.

Adolescent↗
PubMed1997

[The experimental study about the relations between Chinese herb-epimedium leptorrhizum stearn (CH-ELS) and endogenous cAMP in alveolar bone of orthodontic tooth in rats].

The aim of this study was, to explore the mechanism of CH-ELS promoting bone remodelling of orthodontic tooth in rats. 11 male sprague-Dawleg rats was divided into 3 groups. Group I (normal control group) Group II (applied force, no injection) Group III (applied force, injection). The experimental period was 3 days. The radioimmunoassay (RIA) method were used to investigate the effects of CH-ELS on the content of endogenous cAMP in alveolar bone of orthodontic tooth in rats. Results indicate that CH-ELS has no significant effects on endogenous cAMP in alveolar bone of orthodontic tooth, perhaps, cAMP were not involved to regulate the mechanism of CH-ELS promoting bone remodelling. To explore the mechanism of bone remodelling of orthodontic tooth is more significant in orthodontic clinic.

Alveolar Process↗