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PubMed2005

Measuring the cost, effectiveness, and cost-effectiveness of orthodontic care.

AIM: To determine the relative effectiveness and cost-effectiveness of orthodontic treatment per case in one "fee for item" and two different types of salaried orthodontic clinics. SUBJECTS AND METHODS: This prospective study recruited a random sample of six self-employed orthodontists (fee-for-item) and six orthodontists from both hospital and community clinics (salaried services). One hundred patients were followed to completion of orthodontic care. Questionnaires were employed to determine cost of treatment from the clinicians' and patients' points of views. Four cost-effectiveness models were developed. RESULTS: Complete records of outcome were available for 1,087 patients, but only 789 had complete data on costing. Three of the four cost-effectiveness models indicated similar rankings for the 18 clinicians. The most cost-effective service was provided by clinicians working in community clinics, followed by clinicians working in hospitals, then self-employed clinicians. The preferred cost-effective model takes into consideration the initial need and successful outcome of orthodontic treatment. CONCLUSION: Cost-effectiveness models have been developed to quantify the performance of individual clinicians working in self-employed and salaried clinics. Costs and effectiveness of the clinicians in each clinical setting show considerable variation.

Cost-Benefit Analysis↗
PubMed2005

[Research methods in dentistry 10. Assessment of orthodontic treatment need].

Approximately one third of the Dutch population has an objective need for orthodontic treatment. Yet, patients mostly seek treatment because of aesthetic reasons. Recent social developments and the increased attention for aesthetics ask for ways to objectively measure treatment need. This is not only important because of the risks of orthodontic treatment, but also because of financial reasons. In this article indices to verify treatment need, i.e. the Index for Orthodontic Treatment Need (IOTN), de Dental Aesthetic Index (DAI) en de Index of Complexity, Outcome and Need (ICON), are discussed. All three indices seem to lead to a reduction of treatment need, especially in borderline cases. They can serve as 'neutral' instruments to discuss treatment need with patients and as instruments to allocate financial resources for orthodontic care.

Dental Health Surveys↗
PubMed2005

Colony forming unit levels of salivary Lactobacilli and Streptococcus mutans in orthodontic patients.

The purpose of this study was to compare the levels of Lactobacilli (LB) and Streptococcus mutans (SM) colony forming units (CFU) in the saliva of subjects before and after orthodontic appliance placement. This was a controlled, prospective two-group, two-measurement, clinical trial performed on 64 study patients, 12-15 years old. Subjects in the experimental group were sampled for LB and SM in stimulated saliva collected on the same day but prior to band and bracket placement. The subjects in the control group were sampled on their first screening appointment two months prior to band and bracket placement. The second samples of LB and SM were taken from the experimental and control groups after two months. Saliva was transferred to a selective agar carrier and incubated for 48 hours at 37 degrees C / 99 degrees F. LB and SM colonies forming units were compared with standard densities. The experimental group wearing orthodontic appliances had significantly higher mean LB CFU counts than the control group at the 2 month follow-up (3.25 vs. 2.57, p = 0.0036). The two groups, however, did not show any difference in mean SM CFU counts at the 2 month follow-up (3.0 vs. 3.1, p = 0.66). The results of this study showed that a higher number of CFUs of LB were associated with the group wearing orthodontic appliances after two months and may play a role in the increased levels of plaque seen in many orthodontic patients.

Adolescent↗
PubMed2005

[Correction of dento-maxillofacial deformities following cleft lip and palate repair with orthognathic surgery and orthodontics].

OBJECTIVE: To restore good occlusion and face profile, the orthognathic operation and orthodontics were used to correct the dento-maxillofacial deformities following the repair of cleft lip and palate. METHODS: 21 patients (7 males and 14 females, mean age of 20.6 years) were included in this study. Their dento-maxillofacial deformities following the repair of cleft lip and palate have been corrected in our hospital since 1996. Of them, 17 patients received pre- and postoperative orthodontic treatments. 21 cases underwent the following surgical procedures: Le Fort I osteotomy in 7 cases, multisegmental Le Fort I osteotomy in 5 cases, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) in 4 cases, Le Fort I osteotomy and mandibular body osteotomy in 2 cases, BSSRO and genioplasty in 2 cases, BSSRO in 1 case. Rigid internal fixation was used in all patients. After multisegmental Le Fort I osteotomy, the rigid fixed palatine splint was used for 6 approximately 8 weeks. RESULTS: Osteotomy segments healed well in all cases without severe complications. 14 patients were followed-up for an average of 25.6 months. There was no evident relapse. 12 patients who received pre- and postoperative orthodontic treatments had satisfactory occlusion and face profile. CONCLUSIONS: Orthognathic operation combined with orthodontics can be used satisfactorily to correct the dento-maxillofacial deformities following cleft lip and palate repair.

Adolescent↗
PubMed2006

[Attitudes towards orthodontic treatment. A comparison of treated and untreated adolescents].

Dutch adolescents' attitudes towards orthodontic treatment and the determinants of these attitudes are unknown. The aim of the present study was to evaluate treated and untreated adolescents' attitudes towards orthodontic treatment, and to examine possible determinants of these attitudes. Previously treated adolescents were found to have a more positive attitude towards orthodontic treatment than untreated adolescents. Age, but not gender, was found to be a significant predictor for their general attitude towards orthodontic treatment. Consequently, it was concluded that attitudes were not determined by one specific aspect, but by a combination of several determinants.

Adolescent↗
PubMed2006

Root resorption in relation to orthodontic tooth movement.

Root resorption is an undesirable sequela of orthodontic tooth movement. The odontoclasts are responsible for root resorption and the process of hyalinization is known to preceed the orthodontic root resorption. It is found that there are several predisposing factors, therefore an evaluation of these factors should be done by careful examination of personal medical history, severity of malocclusion and dental treatment (if any due to previous history of trauma), anterior crossbite etc. The evaluation becomes an essential factor as it helps the orthodontists in detecting the occurance and severity of the root resorption and thereby plan out the treatment more effectively. Orthodontic tooth movements especially intrusion and other movements like tipping, torque are all known to influence the root resorption, therefore the detection using radiographs and repair of root resorption is of utmost significance as root resorption is a more serious problem from a medicolegal stand point of view. However some studies have shown that the repair process is known to occur after the cessation of orthodontic treatment by the deposition of cementum of cellular type. In the light of orthodontist's liability of what is basically an unpredictable phenomenon, it is necessary that the speciality define this uncertainity and protect its members against unnecessary and unjustified litigation.

Humans↗
PubMedDate not supplied

The students of Edward Hartley Angle, the first specialist in orthodontics: a definitive compilation.

Edward Hartley Angle, MD, DDS, (1855-1930) was ardent in making orthodontics a distinct specialty. In 1900, he founded the first school in the world devoted to specialty training in orthodontics, the Angle School of Orthodontia in St. Louis, Missouri. Over the next 30 years, the Angle School moved from St. Louis to New York City to New London, Connecticut, and finally to Pasadena, California. There was always some uncertainty regarding the accuracy of lists of graduates of the Angle School, since the associated prestige was often a lure for false representation by some practitioners. The purpose of this article is to delineate an authoritative list of Angle's students. Recent additions to primary source material help in reconstructing Edward Angle's seminal educational contributions. From 1900 to 1930, Angle taught orthodontics to 198 students of which 185 received certificates of course completion. The remaining 13 received some training from Angle, but did not complete his formal course for a variety of reasons. He was highly selective in choosing the best dentist-students. Among his students were 8 women, 6 Canadians and 27 from 15 countries outside North America. Angle's graduates invariably became worldwide leaders and contributors in orthodontics in the first half of the 20th century.

Education, Dental↗
PubMed2006

External root resorptions and orthodontic forces: correlations and clinical consequences.

Orthodontically induced root resorption is the most frequent unwanted side effect of orthodontic tooth movement that is unavoidable. This is due to the fact that both bone remodelling and root resorption are based upon a sterile inflammatory process, initiated by force application. In addition to individual factors that have a bearing on the amount of resorption, the type and magnitude of orthodontic forces play a major role. In animal and human experiments it could be shown that continuous forces, as produced by materials with pseudo- elastic characteristics, seem to produce more resorptions than discontinuous forces. Recent research shows that the magnitude of the orthodontic force up to 200cN is probably not decisive for root resorption.

Animals↗
PubMed1991

Education, research, and personnel needs in orthodontics.

Because of changing patterns of dental care delivery, the nature of orthodontic education, research, and personnel needs has changed markedly in recent times. Changes have occurred in the university environment, dental education, and undergraduate and graduate orthodontic education. Orthodontic research is shifting to more clinically oriented topics. Orthodontic personnel needs are being addressed by changing levels of specialist and general practitioner involvement.

Education, Dental, Graduate↗
PubMed1991

[Loss of permanent upper incisors--orthodontic treatment].

After loss of permanent central incisors the treatment of choice could be either orthodontic closure or maintenance of the gap for a replacement-prosthetic, autotransplantation or implant. Cases suitable for orthodontic closure are Angle C1 I space deficiency cases and some C1 II cases, all of these requiring normal size and shape of the lateral. C1 III cases, cases with completely developed ideal occlusion and cases with excess of space are unsuitable for orthodontic closure, as are small pegshaped laterals. Different treatment alternatives are presented, illustrated with treated cases. When one or two central incisors are missing, there will be no treatment alternative giving a 100% satisfactory result. Orthodontic closure, however, proves to be a favourable solution, concerning both long-term prognosis, esthetics and function.

Adult↗
PubMed1990

[Biomechanics of orthodontic movement--initial response of periodontal tissue].

There occurs a biological response of the tissues of dental support, in answer to the external physiological forces and those realized during clinical treatments with orthodontical purposes. These forces differ from the first ones because they are continuous and time dependent. A great dental mobility is related to the degree of tissue organization of the periodontium system and the orthodontical movement must utilize this exceptional capacity of renewal and adaptation of the periodontium structures adequately. Therefore, through histological means a search was made to evaluate the succession of alterations of the periodontium system after the application of an orthodontical force on the molars of young rats and to interpret the standards of horizontal mobility and their consequences on the periodontium structures, biologically. An orthodontic force was applied on young rats utilizing steel wire placed in a ring form on a contact point between the first and second lower molars. The animals were sacrificed after 30 minutes, 1, 2, 6, 12, 24, 48, 72, 96 and 168 hours after the placement of the metal ring. After technical preparation, the microscopic slides were examined and the results were compared. In all the sections there was evidence of an intense metabolic activity. A gradual evolution of modification on the phenomenons had occurred.

Animals↗
PubMed1990

[A study of mechanical properties of orthodontic wires in tension].

Orthodontic forces are applied to the teeth basically by means of different types of orthodontic wires. Knowledge of the mechanical properties of such wires are very helpful to the clinician in design and application of optimal force systems during orthodontic treatment. The basic mechanical properties were studied for 17 types of orthodontic wires (all rectangular and of the same size), in tension. Modulus of elasticity (E), yield strength (YS) and maximum elastic strain (Springback) (YS/E) were calculated for each type of wires. Stainless steel wires have demonstrated higher modulus of elasticity (and yield strength) in comparison with wires of nickel-titanium and beta titanium alloys. B-titanium wires showed higher modulus of elasticity than nickel-titanium ones. In addition stainless steel wires were found to have higher values for springback than cobalt-chromium ones and lower values (for the same variable) than nickel-titanium and B-titanium wires.

Dental Alloys↗
PubMedDate not supplied

[A new experimental approach to the study of mechanical force in orthodontics].

Orthodontics is based upon the cellular response to biomechanical forces. Unfortunately, however, little is known about the manner in which cells respond to such forces. We have, therefore, devised an experimental model to permit morphologic and metabolic characterization of human cells subjected to a range of cyclic or static mechanical stimuli similar to those which may prevail in orthodontic-orthopedic therapy. This system involves attachment of cells to silicon collagen coated membranes which are then subjected to continuous or cyclic stretching by a motor coupled to a movable supporting frame. Because collagenase is an enzyme likely to play an important role in the ultimate effect of orthodontic forces, we evaluated the impact of biomechanical forces on secretion of this protein in a new experimental model in vitro. We found that cyclic stretching of human fibroblasts over a four day period approximately doubles collagenase production as compared to the control. Continuous stretching, on the other hand, is only 50% as effective in enhancing the enzyme release. In contrast, secretion of the inhibitor of metalloproteinases (collagenase inhibitor) is uneffected by either form of mechanical forces. Thus, the mechanical forces applied upon fibroblasts in this system promote gene expression in favor of matrix degradation. This model, we believe, will offer major insights into the cellular basis of orthodontics.

Cells, Cultured↗
PubMedDate not supplied

Water irrigating devices for the orthodontic patient.

Fixed orthodontic appliances increase the number of retention areas, resulting in increased possibilities for the accumulation of dental plaque. In addition, there is a risk of direct mechanical irritation. In spite of good toothcleaning most orthodontic patients develop generalized moderate gingivitis or an edematous type within one to two months after the placement of the fixed orthodontic appliances. Since the gingival changes represent a reaction to the bacterial plaque products rather than to the orthodontic forces; the only way to control them is by effective oral hygiene. Braces and banded teeth have many tiny recesses that a toothbrush and other cleaning aids have difficulty reaching. For good oral hygiene, these should be kept free of food debris. Water irrigating devices irrigates these hard-to-clean areas to remove food and other debris. Pulsating jets of water very gently lift the free gingiva to rinse out crevices. The water irrigator also pulses into areas between teeth and gums to flush out trapped food and debris. Water irrigating devices cannot by any means be regarded as substitutes for more effective plaque-removing methods, such as tooth-brushing and flossing; rather, they should be considered as an adjunct to the total oral hygiene program.

Dental Devices, Home Care↗
PubMed1990

[An estimation of the future demand in orthodontic needs and of the appropriate number of orthodontists for the period 1989-1999].

The present study is a repetition of two previous orthodontic Gallup polls (Gehrig et al. 1981 and Roh et al. 1986). It was conducted with the goal to reactualize the orthodontic workload in Switzerland in 1989 and to produce prognostic figures for 1994 and 1999. 1092 questionnaires have been sent out and 53.1% were returned duly completed. The number of orthodontic specialists, 79 in 1984, has increased to 104 in 1989. Despite this augmentation and the additional factor of an increase from 152 to 173 new cases per year per specialist, all specialists together treated only 29.5% of the newly started cases. This figure was 22.6% in 1984. The total of Switzerland's orthodontic needs is still not covered and it will therefore be necessary to train 29 new specialists until 1994 and 34 additional specialists in the period 1994 to 1999. This means that 4 to 5 new specialists have to be trained in Switzerland per year over the next ten years.

Forecasting↗
PubMed1990

Controversies in orthodontics.

Three controversial interrelated aspects of orthodontics have been reviewed: retention, the effect of third molars on lower anterior crowding, and extraction and nonextraction orthodontic treatment. Recent studies have shown that unacceptable lower anterior crowding occurs in 90 per cent of well-treated extraction cases. The implication is that nonextraction cases should be 90 per cent or higher. In view of our present general inability to identify the 10 per cent that will remain acceptable, some form of indefinite retention is advised. A literature review of the effect of third molars on lower anterior crowding finds strong opinions on both sides of the issue. Similar studies often show dissimilar conclusions, particularly when observing cases of third molar extraction or agenesis. Certainly the problem is multifactorial; however, the vast bulk of the evidence indicates that the third molars play an insignificant role in lower anterior crowding. Extraction of teeth for orthodontic treatment prior to 1900 was prevalent and indiscriminate. From the turn of the century to the mid-thirties Angle moved the specialty away from extractions to a relatively rigid nonextraction treatment philosophy. Dissatisified with relapsing Class II cases, recurrence and aggravation of crowding, and what he felt were bimaxillary full faces, Tweed and others, circa 1935, redirected the profession back to extractions with a more disciplined approach to treatment by the removal of four first premolars. Fifty years later we have found that extraction treatment and uprighting lower incisors does not prevent long-term postretention crowding and that flattened profiles are not always esthetically desirable. Earlier treatment of maxillomandibular basal discrepancies by old and new treatment philosophies and mechanics have produced more stable nonextraction corrections. Better control of leeway space and a reduction in caries has helped reduce the amount of lower anterior flaring that was seen in the nonextraction cases in the first third of the century. These reasons have moved the specialty of orthodontics to a mixed but more nonextraction-oriented approach to treatment.

Esthetics, Dental↗
PubMed1989

[The vertical changes of orthodontic area with treatment and retention in extraction cases].

The purpose of this study is to determine the vertical changes of orthodontic area during active orthodontic treatment and retention. 10 subjects with Angle class I malocclusion having mean skeletal age of 14 years 3 months were examined. After extraction of first premolars, orthodontic treatments were performed at a mean period of 17.6 months by using "Modified Edgewise Technique"; the Hawley Retainers were used during the retention period for 16.8 months after the active orthodontic treatment. 10 subjects with normal occlusion having mean age 13 years 11 months and 10 subjects with normal occlusion having mean age 15 years 6 months were separated as control groups.

Adolescent↗
PubMed1989

[Orthodontic case report of anterior cross-bite with periodontitis].

In adult orthodontic patients, there is an increasing concern about good looks, esthetic orthodontic appliances, and improved surgical orthodontic treatment. The present report presents a case of a 33-year-old female with cross-bite in 1/12 and marginal periodontitis. Orthodontic tooth movement was performed following a flap operation to eliminate a gingival pocket. The treatment was successful resulting in good occlusion and healthy periodontal tissue.

Adult↗