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PubMed2004

Performance measures to improve the quality of orthodontic services and control expenditures.

One of the most critical and contentious issues for specialist and nonspecialist professionals in the coming decades will be to evaluate the outcomes of health care services. Performance measures are imperative for elective orthodontics, because of the relatively weak evidence that they lead to significant improvements in dental and oral health, occlusal function, and psychological well-being of patients. Such measures are particularly crucial for orthodontic treatment eligible for benefit payments, because they will assure third-party dental insurers that the annual premiums levied from governments (taxes), employers (in lieu of salary increments), and individuals (in lieu of other discretionary expenditures) are well spent (ie, not wasted). Performance measures will also improve the "standards of orthodontic practice," so the continued integrity of the profession is contingent on their development.

Cost Control↗
PubMed1991

Surgical orthodontic treatment of anterior skeletal open bite using small plate internal fixation. One to five year follow-up.

Thirty-eight patients with skeletal open bite were studied retrospectively to assess stability of surgical-orthodontic treatment when small plate internal fixation was used. 86% of the sample population showed stable clinical results. Follow-up was from 1-5 years. Only 1 patient experienced skeletal relapse (3%) and 5 patients (13%) dento-alveolar relapse. Fifty percent of relapses were due to transverse relapse of orthodontically expanded maxillary arches. No relapse was seen with surgically assisted orthodontic expansion or surgical expansion at the time of osteotomy. Stable results can be achieved in treating skeletal open bite when small plate internal fixation is used and proper consideration given to the cause of skeletal open bite when planning treatment.

Adolescent↗
PubMed1994

Localized alveolar ridge augmentation before orthodontic treatment. A case report.

Extraction spaces are usually characterized by narrow, atrophic alveolar ridges, which make it difficult to move teeth orthodontically within these areas. Guided tissue regeneration is often used for alveolar ridge augmentation in implantology. In the case presented, localized alveolar ridge augmentation was performed as a preliminary procedure before orthodontic closure of an edentulous space. Guided tissue regeneration enhances the possibilities of orthodontic treatment in adult patients.

Adult↗
PubMed1995

Decision analysis to optimize the outcomes for Class II Division 1 orthodontic treatment.

Selection of the treatment method of choice in orthodontics is usually a question of the clinician's personal preference and is generally based on subjective criteria. Orthodontic treatment of malocclusions is unlike treatment of a disease and hence terms such as success and failure are relative and undefined. Ideally, both patients and providers should be able to arrive at treatment decisions that have the greatest potential for optimum outcomes at minimal cost and risks. This article applies the method of decision analysis to demonstrate how policy choices between "one-stage" or "two-stage" treatment of Class II Division 1 malocclusions for children between 11 and 14 years old can be based on objective criteria. A decision tree was designed to yield the value of payoffs, or outcomes, at each of the possible terminal nodes, and the probability of each payoff. Both positive (ie, improvement in malocclusion) and negative (ie, extraction of teeth and long treatment duration) attributes of outcomes were considered, and numerical values, or "utilities," were assigned to each outcome. For this model, one-stage nonextraction treatment yields the highest probability of maximum benefit. Further applications of decision analysis to resolve clinical uncertainties in orthodontics are discussed.

Adolescent↗
PubMed1995

Implications of temporomandibular disorders for facial growth and orthodontic treatment.

The purpose of this article is to review the literature concerning the possible associations between temporomandibular disorders (TMD), orthodontic therapy, mandibular growth, and facial form. Consideration of the association between TMD and orthodontic treatment leads to one conclusion: there is no evidence that orthodontic treatment generally increases or decreases the chances of developing TMD later in life. Still, our understanding of TMD is not final, and the expanding diagnostic knowledge continues to call for new longitudinal studies focusing on the developmental basis of temporomandibular disorders. Little is known about the potential effect of TMD on facial development. However, information relating to the normal development, growth, and adaptation of the temporomandibular joint all tend to emphasize the significant ontogenetic plasticity of the growth-related secondary cartilage associated with the TMJ, within the bounds of normal function and histophysiology. With the exception of such diseases as juvenile rheumatoid arthritis and osteoarthritis, little is known about the influence of TM pathology or myofascial disorders on facial growth. Also, little is known about the possible influence of disc interferences on facial growth. However, the condyle is known to play a prominent role in normal mandibular growth and, consequently, facial development. Thus, categories of TMD that involve dysplasia of the condylar cartilage could be associated with aberrant facial growth and form.

Adolescent↗
PubMed1997

Orthodontic wire: a continuing evolution.

Wires have substantial structural presence in active and retentive orthodontic therapy. Wires, and auxiliaries fabricated from wire, may deliver force to produce dental displacements, they may attempt to prevent unwanted displacements, or they may simply carry force from one location to another within the dentofacial complex. Wires may have relatively simple or rather convoluted geometries. The most prominent wire in clinical orthodontic treatment is the "arch wire." Marketed in just two, symmetrical, cross-sectional shapes, its sizes are numerous, and arch wires are manufactured of a variety of metallic alloys and compositions. The primary objective of this article is to trace the history of arch wires over the past century, considering the evolution from the stiff arch bow to the wire exhibiting Hookean material behavior, from the precious metal to the stainless steel to the titanium alloys, and into the era of the "superelastic" wire and a thermomechanical behavior decidedly more complex than its predecessors. Timely, relevant questions that are addressed herein pertain to the current "state-of-the-art" of orthodontic wires, the extent to which the mechanics of the "old" and new wires are understood, and the anticipated arch wire advancements in the near future as a new millennium approaches.

Dental Alloys↗
PubMed1997

Corrosion of orthodontic devices.

A brief overview of the theory of corrosion and the formation of galvanic couples is presented, followed by a discussion of the metals and alloys used in the fabrication of orthodontic appliances and devices. Attention is paid to the factors that contribute to establishment of corrosion cells in the mouth. Although oral corrosion generally does not cause significant destruction of metal, it can elicit in patients adverse physiological responses such as local irritation and metal hypersensitivity. There are indications that orthodontic treatment may lower the incidence of nickel hypersensitivity. Destructive attack on orthodontic appliances does occur, however, when certain types of denture cleanser are used to clean appliances that contain soldered joints.

Corrosion↗
PubMed1999

Treatment planning and biomechanics of distraction osteogenesis from an orthodontic perspective.

As in traditional combined surgical and orthodontic procedures, the orthodontist has a role in the planning and orthodontic support of patients undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function in addition to planning both the predistraction and postdistraction orthodontic care. Based on careful clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and evaluation of three-dimensional computed tomographic scans, the orthodontist, in collaboration with the surgeon, plans distraction device placement and the predicted vectors of distraction. Both surgeon and orthodontist closely monitor the patient during the active distraction phase, using intermaxillary elastic traction, sometimes combined with guide planes, bite plates, and stabilization arches, to mold the newly formed bone (regenerate) while optimizing the developing occlusion. Postdistraction change caused by relapse is minimal. Growth after mandibular distraction is variable and appears to be dependent on the genetic program of the native bone and the surrounding soft tissue matrix. A significant advantage of distraction osteogenesis is the gradual lengthening of the soft tissues and surrounding functional spaces. Distraction osteogenesis can be applied at an earlier age than traditional orthognathic surgery because the technique is relatively simple and bone grafts are not required for augmentation of the hypoplastic craniofacial skeleton. In this new technique, the surgeon and the orthodontist have become collaborators in a process that gradually alters the magnitude and direction of craniofacial growth.

Biomechanical Phenomena↗
PubMed1997

Orthodontic anchorage capacity of short titanium screw implants in the maxilla. An experimental study in the dog.

The aim of this study was to investigate experimentally the effect of long term orthodontic loading on the stability as well as on the peri-implant bone findings of short titanium screw implants (Bonefit, submersion depth 6 mm, phi 4 mm) inserted in regions with reduced vertical bone height. For this purpose, 6 maxillary premolars (1P1, 2P2, 3P3) were extracted from each of 2 foxhounds and reduction of alveolar bone height was performed by osteotomy. After a 16-week healing period, 8 implants (4 per dog) were inserted in the edentulous areas. Simultaneously, 2 implants (1 per dog) were positioned in the palatal suture (one-stage surgery). After an 8-week implant healing period, the fixtures in the P1/P2 areas (n = 4) and the palate (n = 2) were loaded (test implants) by means of transpalatal bars running anteriorly, fixed on the implants in the P1/P2 areas, and Sentalloy traction springs (approximately 2 N continuous force) inserted midsagittally between palatal implants and bars (force application period: 26 weeks). The fixtures in the P2/P3 areas served as controls (n = 4). Clinical measurements and histological evaluation revealed no implant dislocation of the loaded fixtures. These results suggest that short titanium screw implants inserted in the alveolar bone and palatal suture region retain their stability during long-term orthodontic loading, even following a relatively short unloaded implant healing period. Furthermore, it seems that long-term orthodontic loading may induce marginal bone apposition adjacent to the implants.

Alveolar Process↗
PubMed2001

Ingested foreign bodies associated with orthodontic treatment: report of three cases and review of ingestion/aspiration incident management.

Foreign body ingestion/aspiration episodes are potential complications in all branches of dentistry. The handling of small orthodontic components requires particular care, especially where the patient is supine or semi-recumbent. Three cases of foreign body ingestion are presented, involving patients undergoing orthodontic treatment. Once the foreign bodies had been located, all instances were treated using a combination of serial radiography and 'watchful waiting'. All patients remained asymptomatic during this period, although none of the foreign bodies were retrieved. No active intervention was deemed necessary, and the patients were able to resume their orthodontic treatment. The potential complications of ingestion/aspiration episodes are discussed and a management regime suggested.

Adolescent↗
PubMed1989

Community orthodontic services: a local review.

A review is presented of orthodontic treatment and working conditions in one area of the Community Dental Service over a typical period of one year (1984). Treatment totals, case load, working facilities and schedules are discussed, drawing comparisons with the hospital service and specialist practice and with previously published surveys of orthodontics in the community service. An estimate of the size of school population likely to support a full-time community orthodontist is made together with the number of referring practitioners. Comments are also made on the range of treatment provided, patients' attitudes, cooperation and such problems as missed appointments. A short section is devoted to actual timings of specific procedures in orthodontics, followed by discussion of the hospital attachment for community orthodontists, with some recommendations on working conditions and comments on career structure.

Appointments and Schedules↗
PubMed1989

Report of a survey conducted by the Consultant Orthodontists Group. The nature and distribution of clinical assistant posts in orthodontics in the United Kingdom in 1987.

This paper describes and discusses the results of a survey, conducted by the Consultant Orthodontists Group in the United Kingdom in 1987, which examined the nature and distribution of clinical assistant posts, and consultants' attitudes to the concept of appointing orthodontic auxiliaries. This survey demonstrated a large regional variation in the number of clinical assistant posts and in the number of 'specialist practitioners' and community orthodontists. More than 90% of consultants teach their clinical assistants how to use removable appliances, headgear and simple fixed appliances. More than 70% of consultants also teach their clinical assistants how to use multi-bracketed techniques and functional appliances. Ninety-one per cent of consultants would give their support to developing regional training schemes for clinical assistants in orthodontics. Eighty-eight per cent of consultant orthodontists favoured the appointment of orthodontic auxiliaries to carry out intra-oral work, and 75% believed that they already had a member of staff capable of doing these duties with some further training.

Attitude of Health Personnel↗
PubMed1990

Awareness and knowledge of orthodontics.

Lisa Hirst won the community dentistry section of the 1988 Desmond Greer Walker Award with her study of the level of awareness and knowledge of orthodontics and orthodontic treatment of patients and their parents, and her assessment of the health education material available about orthodontics. We now publish a summary of her paper.

Adolescent↗
PubMed2003

The use of postal reminders to reduce non-attendance at an orthodontic clinic: a randomised controlled trial.

OBJECTIVES: To evaluate the effect of issuing a patient reminder plus a confirmation slip on the attendance of orthodontic new patients. SETTING: Department of Orthodontics, University Dental Hospital of Manchester. DESIGN: A randomised controlled trial. METHODS: New patients were randomly allocated to:receive a reminder letter and return a confirmation slip ornot receive a reminder. OUTCOME MEASURES: Patient attendance at the clinic. RESULTS: A total of 232 patients were entered into the study between June 18, 2001 and August 29, 2001. These were randomly allocated to 115 (49.8%) in the reminder group and 116 (50.2%) in the no reminder group. If the patient received a reminder and returned the confirmation they were less likely to fail the appointment than if they did not receive a reminder (OR 0.4, 95% CI 0.2 to 0.96) There was an effect of social deprivation, if the patients lived in an area of high social deprivation they were 2.7 (95% CI 1.1 to 6.5) times more likely to fail to attend an appointment than people who were more affluent. CONCLUSIONS: The use of postal reminders for orthodontic consultation appointments appears to result in a useful increase of appointments that are kept or cancelled in advance.

Appointments and Schedules↗
PubMed2004

Temporary mental nerve paraesthesia secondary to orthodontic treatment--a case report and review.

Patients complaining of facial paraesthesia may present to the dental practitioner. The differential diagnosis includes malignant neoplastic disease and therefore warrants prompt hospital referral. Mental nerve paraesthesia during orthodontic treatment is a very rare occurrence. A case of mental paraesthesia during fixed upper and lower orthodontic treatment is presented. This report highlights the importance of thorough investigation of patients presenting with a history of facial numbness, and provides a review of the aetiology and management of this problem for the dental practitioner. Guidelines for referral have been suggested where orthodontic treatment is suspected as the cause.

Adolescent↗
PubMed2005

Teamwork in orthodontics: limiting the risks of root resorption.

Orthodontic treatment is not without risk. The risks may be due to patient factors (which may not always be evident before treatment) or may come about because of the treatment itself. While the common types of risk are well documented, less information is available as to how some of the more unusual problems can best be managed when they arise; often the need for teamwork between the patient, orthodontist and general dental practitioner (GDP) are underestimated. This paper presents three patients in whom various root-related problems existed either before orthodontic treatment or which arose during orthodontic treatment; demonstrates how they were managed; and highlights the need for teamwork to ensure a 'least harmful' outcome. All patients were followed up for over a year.

Adolescent↗
PubMed1976

Selection of dentofacial measurements for an orthodontic treatment priority index.

A battery of thirty dentofacial measurements was studied in an attempt to identify those measurements most closely related to a clinical assessment of the need for orthodontic treatment in the Dutch population. This was done by inspecting the mean values of these measurements computed within several treatment priority groups, a stepwise regression analysis relating treatment priority scores to these dentofacial measurements, and a quadratic discriminant function analysis between the group of children requiring orthodontic treatment and the group for which treatment was deemed unnecessary. The variables identified by inspection were 1) overjet, 2) overbite, 3) upper molar arch width, 4) the angle defined by articulare-gonion-menton, 5) lower arch length and 6) the ANB angle; the first four of these proved to be the most important when the contributions of all thirty of the variables to the TPI were assessed by means of the stepwise regression analysis. Overjet was also found to be an important predictor variable by Freer in relating Grainger's orthodontic TPI to dentofacial measurements in a group of patients with distoclusion; the ANB angle was found to be the most effective discriminator between normal and Class II American children. The results of the present study then, to this extent at least, agree with those found in other populations. It would appear that any "universal" TPI would have to involve those aspects of dentofacial morphology measured by overjet and the ANB angle. Within the context of the Dutch population the variables identified proved to be effective discriminators in the decision of "to treat or not to treat," correctly classifying 100% of the children in the sample who were judged by two experienced orthodontists as requiring treatment. While this decision rule did suggest treatment for 17% of the children judged to not require treatment, these cases were in the "doubtful" category (Table I) and might therefore warrant continued monitoring before any final decision is reached.

Child↗
PubMed1977

Further studies in retention of the orthodontic band.

A statistical analysis of 1,976 conventional orthodontic bands cemented to the teeth of 102 patients was carried out to try to establish the relationship of sex of the patient, age of the patient, and the type of malocclusion to the retention of the orthodontic band. The effect of treatment time and the presence or absence of extraoral traction on band recementation were also considered. The results obtained from the study led to the following conclusions: 1) There is no significant difference in the degree of band recementation occurring during orthodontic treatment between girls and boys. 2) There appears to be a tendency for bands to be recemented less frequently in patients 17 years of age and over. A larger sample would be necessary before being more definite. 3) The Class II, Division 2 type of incisor relationship may predispose to a higher rate of band recementation. Once again a greater sample size would be essential to be more categorical. 4) The percentage of bands recemented increased as the duration of treatment increased. 5) The use of early Kloehn cervical facebow therapy leads to a higher rate of band recementation on the maxillary molars.

Adolescent↗