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PubMed1997

A study to determine if changes to an undergraduate orthodontic course improved course quality and student satisfaction.

A study was carried out to determine if changes to the undergraduate orthodontic course at Leeds Dental Institute resulted in increased student satisfaction. The study was based on a questionnaire distributed to dental students comprising statements related to the undergraduate orthodontic course. Questionnaires were distributed in 1993 and 1995 to 2 groups of 4th year undergraduate dental students at the same stage of their course on both occasions. Questions were in the form of 16 statements with which students expressed a level of agreement, ranging from strongly agree to strongly disagree. The numbers of responses at each level of agreement were compared between the 2 groups. Statistical differences were determined using a Mann Whitney-U test. 8 of the 16 statements had more favourable responses in 1995 than in 1993. No statement received a less favourable response in 1995 than in 1993. It is concluded that changes in the undergraduate orthodontic course at Leeds Dental Institute aimed at increased problem-based learning and clinician-led tutorials, have resulted in improved student satisfaction with the teaching.

Consumer Behavior↗
PubMed2006

Undergraduate clinical orthodontic experience: a discussion paper.

Undergraduate clinical orthodontic experience may be expressed in a variety of ways. The most common way (used, inter alia, in the DentEd school visits) is by number of curriculum hours. Other ways include the number of patients seen, or number of procedures carried out. Whilst any of these methods may allow comparison between cohorts of students within a school or between schools, none of them are suitable to determine how much experience is 'satisfactory', nor do they indicate what the student should know, understand, or be able to do, to be considered 'satisfactory', and hence fit to graduate. This situation may be addressed by the use of competences and/or learning outcomes, and in 2004 the Association for Dental Education in Europe (ADEE) adopted a document that contained one major competence and five supporting competences in orthodontics. This paper considers the shortcomings of conventional methods of recording orthodontic experience in relation to the acquisition of these competences, and some ways in which staff and students may assess competence.

Clinical Competence↗
PubMed1984

Scanning electron microscopic study of orthodontically induced injuries to the periodontal membrane.

Scanning electron microscopy was used to study vascular and cellular changes in the periodontal membrane (PDM) in rats after orthodontic treatment ranging from 3 h to 9 days. The orthodontic forces ranged between 200 mN and 400 mN. Within the first hours of treatment extravasated erythrocytes, eichinocytes and platelets in various stages of degeneration were found in the pressure zones. The connective tissue of the pressure zones developed an amorphous appearance lacking discernible fibers and blood vessels following treatment for 24 h. These areas are known as hyaline zones, an area of local aseptic necorsis. Three days after the application of an orthodontic force macrophage-like cells were abundant close to the hyaline zone. They adhered to the hyaline zone with filopods radiating from pseudopods. Large osteoclast-like cells with several projections towards the bone surface were found around the hyaline zone and in the marrow spaces close to the pressure zones. The results indicated that the tissue reactions leading to remodeling of the PDM in the pressure zones are closely related to vascular injuries and subsequent formation of coagulated blood. Furthermore, macrophages seem to be the cells which play the most important role during degradation of the hyaline zone.

Animals↗
PubMed1993

Cytotoxic and antibacterial effects of orthodontic appliances.

The cytotoxic and antibacterial effects of orthodontic appliances were assessed. Metallic devices used in orthodontics, such as molar bands, brackets, and archwires were tested by the agar overlay cytotoxicity test with mouse fibroblast cells. The same devices were tested for antibacterial effect with Streptococcus mutans and S. sanguis. The multicomponent devices, which are bonded with silver- and copper-based brazing alloys, were more cytotoxic than the single-component devices, probably because copper is more cytotoxic than nickel. The devices had a definite, but low, antibacterial effect, as compared with the 0.05% chlorhexidine positive control. A cytotoxic effect of the devices per se might contribute to a localized gingivitis. It is uncertain whether orthodontic devices have any significant inhibitory effect on dental plaque viability.

Animals↗
PubMed1993

Dentin formation in miniature pigs with special reference to indomethacin and orthodontic treatment.

The rate of dentin mineralization and the influence of indomethacin on the dentin mineralization rate during orthodontic treatment was determined in miniature pigs by intravital labeling with tetracycline. The results demonstrated that the dentin mineralization rate in the control animals was 3.8 microns/day, a rate corresponding to that of human teeth. Both indomethacin and orthodontics had an effect on the dentin mineralization rate, indomethacin reducing and orthodontic forces increasing it. In combination, the two factors neutralized each other.

Animals↗
PubMed2006

Orthodontically induced inflammatory root resorptions: a case report.

Orthodontically induced inflammatory root resorption is an unfortunate consequence of orthodontic movement. It is an adverse effect of an otherwise predictable force application. The degree of the inflammatory process depends on various factors such as amount of force, bone quality, aggressiveness of the resorbing cells and individual variation. Orthodontists should keep track of tooth movement both clinically and radiographically in order to detect any root resorptions and reevaluate the case. This case report presents the treatment outcome (4-year follow up) of five teeth with different and extensive inflammatory root resorptions following orthodontic treatment.

Adult↗
PubMed2004

Taking stock: passing the torch, who has the light? Reflections about teaching orthodontics at the occasion of the retirement of Prof. Lysle E. Johnston, Jr PhD.

In the Marburg (Germany) 5-year dental curriculum, students enter the orthodontic department in the middle of their third year. Our teaching is student-centered and problem-solving oriented. From day 1 our students are trained to diagnose in three separate levels of development i.e. (i) craniofacial growth, (ii) development of the dentition and (iii) maturation of function. These three levels are kept separate throughout patient examination and up to the strategic treatment planning phase. The examination is performed with the help of three checklists, one for the facial morphology, one for the dentition and one for function. The three resulting problem lists then undergo reduction by selecting one 'key problem' for each level. Next, for every key problem three 'standard solutions' are offered, not in the form of appliances but as vectors that can modify growth. Finally, in a strategic planning phase, one treatment option from each of the three levels is selected and combined in a single, be it hypothetical, treatment plan. Parallel to these, students are exposed to treatment mechanics through the presentation of selected orthodontically treated patients. In our experience the advantage of this diagnostic procedure lies in the structured organization that serves as a GPS system for student and teacher and enables them a clear communication about where they are and what has to be done. By design, treatment options have taken priority over treatment mechanics. We are confident that our students, equipped with real life diagnostic skills, are well prepared for their orthodontic future.

Curriculum↗
PubMed2006

Influence of steroid drugs on orthodontically induced root resorption.

OBJECTIVES: To investigate the effect of acute and chronic corticosteroid treatment on orthodontically induced root resorption. DESIGN: 'Split mouth' design performing orthodontic tooth movement in 64, 6-month-old male rats divided into three groups: acute (n = 22), chronic (n = 23) and control group (n = 19). Acute and chronic group received corticosteroid treatment (8 mg/kg/day) for 3 and 7 weeks, respectively, while no pharmacological treatment was performed in the control group. Performed at the Department of Orthodontics, School of Dentistry, University of Aarhus, Aarhus, Denmark. EXPERIMENTAL VARIABLE: The upper left first molar was moved mesially for 21 days in all three groups with 25 g of force. Undecalcified histological sections were cut at the coronal and apical level. OUTCOME MEASURE: The number of intersections hitting resorption lacunae (ES), defined as a scalloped surface with or without cementoclasts, over the total number of intersections hitting the root surface (RS) were recorded and expressed as percentage. RESULTS: The acute group showed significantly more root resorption at the mesio-coronal level compared with the control and the chronic group. CONCLUSION: This could be ascribed to the lack of balance between blastic activities (inhibited by the drug) and the clastic activities (enhanced or unchanged by drug administration) occurring in the initial phase of drug administration. As a consequence, a careful monitoring of patients undergoing acute corticosteroid treatment is suggested.

Animals↗
PubMed1998

Porcelain veneers: adjunct or alternative to orthodontic therapy.

Elective esthetic dentistry defines "art form" within the field of dentistry. Most frequently, a clinical team of skilled professionals is required to satisfy the discriminating patient who presents with an esthetic-driven agenda. This article describes a patient who has rejected orthodontic therapy but continues to seek esthetic alternatives. Porcelain laminate veneers were an appropriate alternative in this case. The second case demonstrates the synergy of combined therapies that were explained to the patient and strategized from the onset to facilitate a result not obtainable by a singular approach. One should not infer that porcelain laminate veneers are an automatic substitute for orthodontic therapy. There may be instances when this is required; however, in most instances, conservative esthetic therapies, such as porcelain laminate veneers, supplement orthodontic therapy to create a final result not possible with either singular approach.

Cuspid↗
PubMed1998

Esthetic orthodontic considerations for the adult patient: a general dentist's perspective.

Esthetic orthodontics is a viable treatment option for patients seeking cosmetic enhancement. Today, the use of preadjusted orthodontic brackets and straight wire allow general dentists to create optimum esthetic results in a short period of time. Two cases are presented to demonstrate a clinical technique to enhance a patient's smile through adjunctive orthodontic therapy.

Adult↗
PubMed1998

Aspects of the use of endosseous palatal implants in orthodontic therapy.

Control of anchorage is one of the fundamental aspects in orthodontics and dentofacial orthopedics. Osseointegrated implants provide such an anchorage in a reliable fashion, as has been demonstrated in orthodontic use of dental implants inserted for prosthetic reasons. More recently, special implants have been introduced that serve as temporary anchorage in orthodontics. One example is the Straumann Orthosystem (Institut Straumann AG, Waldenburg, Switzerland), which is inserted in the midsagittal area of the palate. Owing to the reduced bone height available in the palate, only short implants should be considered; surface enlargement by texturing and the achievement of good primary stability are prerequisite for success. The use of a palatal implant provides a continuous stable anchorage for patients with compromised periodontal anchorage potential, as well as in cases in which compliance is not dependable or cases with esthetic considerations in which the use of extraoral anchorage aids or Class II elastics may be problematic. Minimal stress on the patient, combined with maximal anchorage, distinguishes this promising new treatment modality for the orthodontist cooperating with an oral surgeon. The treatment concept is well aligned with the emphasized need for integral treatment in dentistry, especially of the adult patient.

Adolescent↗
PubMed2005

Public assistance orthodontic treatment needs: a report from the state of Indiana.

OBJECTIVE: To determine how many of the orthodontic cases covered by Indiana Medicaid between 1999-2001 would be classified pretreatment as having a malocclusion severe enough to warrant treatment. METHODS: Six examiners were trained and then paired together to examine 249 patient orthodontic case records, consisting either of pre-treatment photographs only, pre-treatment models only, or both pre-treatment models and photos. The examiners applied the Index of Orthodontic Treatment Needs (IOTN) to assign each case a Grade of One to Five, with Grade One representing Ideal Occlusion and Grade Five being Extreme Malocclusion. When two examiners within a pair could not agree, a third examiner reviewed the case record to determine agreement. RESULTS: Of the 249 patient cases examined, 9 were not gradable. In the cases where only pretreatment models were available (n=157), 10% received a Grade of One or Two (Ideal Occlusion or Mild Malocclusion, respectively). Among the cases in which both pretreatment models and photos were available (n=46), 44% of the photos were graded One or Two, while only 2% of the models were graded as One or Two. In the cases where only pretreatment photographs were available (n=37), 27% of cases were Grade One or Two. CONCLUSION: While several of the cases (11%) submitted during the time period of 1999 to 2001 to the Indiana State Medicaid Division for reimbursement were rated as having Ideal Occlusions or Mild Malocclusions, the vast majority (89 %) were scored as having either Moderate, Severe, or Extreme Malocclusion.

Dental Health Surveys↗
PubMed1989

Post-orthodontic occlusal function.

The significance of orthodontic treatment in the aetiology of temporomandibular dysfunction continues to be a matter of controversy. However, the evidence of any association has been generally negative. This investigation involved the examination of a study group of 87 post-orthodontic patients, the average time out of all retention being 52 months. They were compared with an untreated control group. Signs and symptoms of temporomandibular disfunction were assessed for both groups. In only one instance, soft joint click, was there found to be a significant association between the treatment category and the occurrence of the symptom, there being a higher rate of soft clicks in the post-treatment group. While this may be ascribed to orthodontic treatment, there was also a different restorative pattern in the two groups. No other significant associations were found.

Adult↗
PubMed1998

The effects of early orthodontic force application on pulp test responses.

The effects of orthodontic tooth movement on pulpal responses are of interest to the clinician. Alterations to pulpal physiology may result in altered responses to external stimuli. This pilot project tested a small group of orthodontic patients during the early stages of treatment. Heat, cold and electrical stimuli were applied prior to treatment, after the placement of fixed appliances and after one month of force application. A smaller group was tested after two months of force application. One month after force application there was a lack of response to electrical stimulation but there was continued response to thermal stimulation. The lack of response to electrical stimulation continued in the smaller group up to two months. The results suggest that the outcome of electric pulp testing during orthodontic treatment should be interpreted cautiously. Thermal testing will offer more reliable data.

Adolescent↗
PubMed1999

Understanding orthodontic treatment satisfaction from the patients' perspective: a qualitative approach.

OBJECTIVES: To apply qualitative research methods to develop hypotheses about orthodontic treatment process and outcome, as well as treatment satisfaction. DESIGN: Four focused interviews with 4-8 adolescents in retention. SETTING AND SAMPLE POPULATION: UNC orthodontic clinic; 22 patients in retention. RESULTS: Patients expressed dissatisfaction with some aspects of the treatment process, but were generally satisfied with the treatment outcome. Patients were aware of differences between clinic versus private treatment. From these discussions, we infer that there may be important differences between patients' and orthodontists' perceptions of the treatment process. CONCLUSIONS: Qualitative methods are useful tools for exploring orthodontic treatment from the patients' perspective and can be used to suggest important future areas of research.

Adolescent↗
PubMed1999

Patient and parent preferences for orthodontic practices.

This study was designed to identify who chooses an orthodontic office and what factors might induce the attraction. Patients and parents from the lists provided by suburban orthodontic offices were contacted. A mail-out survey instrument was used to gather the data. Results revealed that the reputation of the practitioner was most important along with the level of caring attitude the office projected. It was also important that the office is located near home, interestingly, the mother is the most significant decision-maker in the family in choosing an orthodontic office. Moreover, not the cost of treatment but the payment plan was the critical element in the decision process. The higher income families with three or less children were attracted to office characteristics such as excellence of the orthodontist, attention, and convenience. A marketing strategy based on these elements might provide the best return on the investment.

Choice Behavior↗
PubMedDate not supplied

Caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. A systematic review.

A systematic review was performed of published data on the caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. The purpose was to develop evidence-based recommendations about the most effective means of preventing white spot lesions in orthodontic patients. The 15 studies included were divided into four groups based on comparable preventive measures: fluoride, chlorhexidine, sealants and bonding materials. The caries-inhibiting effect of the preventive measures was expressed by the prevented fraction (PF). The overall PF of the fluoride-releasing bonding materials was 20% (SEM 0.09). This effect was, however, not statistically significant. It was impossible to calculate an overall PF for the other preventive measures, but the tendency of their caries-inhibiting effect has been described. The use of toothpaste and gel with a high fluoride concentration of 1,500-5,000 ppm or of complementary chlorhexidine during orthodontic treatment showed a demineralisation-inhibiting tendency. The use of a polymeric tooth coating on the tooth surface around the brackets showed almost no demineralisation-inhibiting effect. Many publications had to be excluded from this systematic review because of improper research designs. Future clinical trials are needed to give evidence- based advice on the optimal caries-prevention strategy.

Cariostatic Agents↗
PubMedDate not supplied

Typing of mutans streptococci by arbitrarily primed PCR in patients undergoing orthodontic treatment.

The aim of this study was to clarify the genotypic stability of mutans streptococci (MS) longitudinally during orthodontic treatment. Plaque samples were obtained from the supragingival smooth surface of the upper right teeth at four stages: prior to and after 1, 3 and 6 months of orthodontic treatment. Levels of total viable count, total streptococci and MS in dental plaque of 17 patients were recorded. Streptococci isolated from dental plaque samples were identified as MS on the basis of their morphological and biochemical properties. DNA was prepared from 713 strains of MS and the strains were then identified with polymerase chain reaction (PCR) again. Arbitrarily primed PCR (AP-PCR) fingerprinting was applied in determining the genotypes of MS. The results indicated that levels of total viable count, total streptococci and MS increased significantly after the fixed appliances were bonded. A maximum of 3 different genotypes were found in an individual. All the genotypes were found again after the application of the fixed appliances in 17 patients. A new AP-PCR typing pattern was found after the application of fixed appliances for 1 month in patient 1. That strain was not detected either prior to or after 3, or 6 months of treatment. The result indicated that the MS clones were very stable during orthodontic treatment.

Adolescent↗