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PubMed1996

Perceptions of the risks and benefits of orthodontic treatment.

Recent National Health Service changes have brought about a greater involvement of the consumers of medical and dental care in decision making regarding their treatment. The aim of this study was to investigate the level of awareness of the risks and benefits of orthodontic treatment among potential consumers and their referring dentists. Parents of patients referred for orthodontic treatment were issued with a questionnaire about the risks and benefits of treatment and the reason the child had been referred. Study models were also made of the child's teeth. The patients' dentists were issued with a similar questionnaire. The results revealed that most of the parents were aware of the benefits of treatment in general and the reason that their own child required it. This awareness was greater where the orthodontic need on aesthetic grounds was greater. There was less awareness of the risks of treatment though again this was greater among those with a greater need for treatment. When the perceptions of the dentists were evaluated, they were more aware of the risks but were not communicating this to the parents. Since for some patients the risks of treatment may outweigh the benefits, it would be helpful if dentists could provide this information for patients before referral.

Adolescent↗
PubMed1995

Adult orthodontic treatment.

The scope of Orthodontic treatment then in adults is considerable. At examination it is prudent to assess carefully the patients wishes and expectations in relation to treatment. Many adults can be treated by orthodontics alone but for the remainder the multifaceted nature of the work involved calls for a high degree of co-operation and understanding between the different dental disciplines involved. Special attention has to be given to the retention phase. The patients satisfaction and fulfilment with well executed treatment is generally remarkable and suggests that the increase in demand for adult orthodontics will continue.

Adult↗
PubMed1995

Occlusal contact changes before and after orthodontic treatment of a group of child & adolescent patients with TMJ disturbance.

Occlusal contacts were examined before and after orthodontic treatment in 32 eight- to seventeen-years-old patients with temporomandibular joint disturbance. Add-Picture, a computer image system, was applied to a silicone occlusal record obtained in the intercuspal position (ICP) to assess the qualitative and quantitative changes of occlusal contacts. Comparing the two images before and after treatment, significant difference was noted in the number, size, location and type of contacts. After orthodontic treatment: the mean number of contacts on anterior teeth reduced, the mean area per contact decreased, the number of contacts on centric stops increased and type IV contacts (on the inclined plane) decreased. The present study indicates that orthodontic treatment has a positive effect, both qualitatively and quantitively, on the distribution of occlusal contacts in ICP and seems to contribute to the establishment of occlusal stability in ICP.

Adolescent↗
PubMed1997

Orthodontic residents' indications for use of the lateral TMJ tomogram and the posteroanterior cephalogram.

The purpose of this study was to determine the selection criteria used by orthodontic residents for ordering a corrected lateral tomogram (LT) of the temporomandibular joint (TMJ) and a posteroanterior cephalogram (PAC) for the diagnosis of patients needing orthodontic care. The impact of the radiographs on their treatment plans was also assessed. We conducted a study of the 144 new patients assigned to eight orthodontic residents during a two-year period. The residents responded through questionnaires describing their rationale for ordering the radiographs. A LT was ordered for twenty-eight (19 percent) of the patients. The most common reasons cited for requesting the LTs were TMJ clicking (67 percent) and pain (33 percent). The residents also perceived a need to order the LT for medico-legal protection in 85 percent of these cases. The LT tended not to have an impact on treatment planning. A PAC was ordered thirty-eight times (26 percent). The most common reasons cited by residents for ordering a PAC included clinical findings of facial asymmetry (41 percent) and maxillary airway anatomy (24 percent). Medico-legal protection was a perceived need in only 12 percent of the cases. While the PAC had no impact on treatment planning for 56 percent of the cases, they did define the transverse problems as dental or skeletal for 38 percent of the cases. Six patient traits were statistically associated with PAC requests: difficulty chewing, abnormal TMJ, TMJ clicking, facial asymmetry. crossbite, and midline discrepancy. The teaching of appropriate selection criteria for ordering these radiographs needs to be emphasized early in a resident's training.

Adult↗
PubMed1997

The provision of orthodontic treatment: some ethical considerations.

The majority of orthodontic procedures are elective, aimed at reorganising structures placed by nature in an area of stability. Although these structures are expressions of normal biological diversity, the costs and long-term benefits of treatment are generally accepted by society. In light of this, it is vital to provide orthodontic treatment that is done to the highest possible standard, using techniques based on a sound scientific basis, recognising that the main reason for the treatment is to improve a patient's self-esteem. This is valid reason for treatment, which can benefit a patient enormously. On this basis the patient can make an informed, autonomous decision on whether or not to undergo this treatment, knowing that the treatment benefits will outweigh the risks of having the treatment performed. Only then can the provision of orthodontic treatment be ethically justified.

Cost-Benefit Analysis↗
PubMed1997

[The development of orthodontic biomechanics in relation to treatment of adult patients].

Adults orthodontics shows a great difference from the classic orthodontic therapy performed at school age. The transfer of the basic guidelines and of the clinical experiences in the adult orthodontic management, needs a total reshaping of rules and procedures, and moreover a pluridisciplinary approach. Theoretical and clinical problems related to this topic are discussed, in relation to the possible therapeutic behaviour.

Adult↗
PubMed1997

Effectiveness of the Sonicare sonic toothbrush on reduction of plaque, gingivitis, probing pocket depth and subgingival bacteria in adolescent orthodontic patients.

The Sonicare sonic toothbrush and a traditional manual toothbrush were compared for efficacy in improving periodontal health in young orthodontic patients with existing gingival inflammation. A 4-week, single-blind clinical trial was employed. Twenty-four subjects, ages 11-17 years, who were fully bonded and banded with fixed orthodontic appliances were selected. Subjects were randomly assigned to use either the manual or the Sonicare toothbrush, instructed in its use, and asked to brush each morning and evening for 2 minutes. Plaque index, gingival index, percentage of sites which bled on probing, pocket depth, and total gram-negative bacteria in a subgingival plaque sample were assessed at baseline and 4 weeks around the banded teeth. The results demonstrate that the Sonicare brush was significantly more effective than the manual brush in all clinical parameters. Sonicare was statistically superior to the manual brush in supragingival plaque reduction (57% vs. 10%, respectively; p < 0.001). Gingival Index scores fell by 29 percent in the Sonicare group, but only 3 percent in the manual group. Reduction of bleeding on probing was significantly greater in the Sonicare group than in the manual group (p < 0.001). The Sonicare group decreased from 78% bleeding sites at baseline to 24.5% after 1 month. In the manual group there was only a slight reduction in bleeding on probing (70% of sites at baseline and 64.6% sites after 1 month). Mean pocket depths were significantly reduced compared to baseline values in both the Sonicare and the manual groups (p < 0.001). Pocket depth reduction in the Sonicare group was, however, significantly greater than in the manual group (28% vs. 6%, respectively: p < 0.001). Total gram-negative bacteria in subgingival plaque samples from banded test teeth of a subset of patients were reduced in the Sonicare group (p < or = 0.05), but increased in the manual group. These results clearly demonstrate that the Sonicare sonic toothbrush is superior to a manual toothbrush in improving periodontal health in adolescent orthodontic patients with existing gingivitis.

Adolescent↗
PubMed1994

The new simplified Sim-Gordon orthodontic analysis.

The new Sim-Gordon Computerized Analysis is simple to use, basic in the orthodontic diagnostic values that need to be measured and entered, and serves as an extremely useful guide for the treatment planning of orthodontic patients. It will run on any IBM compatible computer, and uses less than 740 Kb of space on a disk. So far as is known, all insurance companies will accept it. It is a pleasure to announce the availability of this reasonable and cost-effective, simplified, IAO-accepted, professional orthodontic diagnostic system to our fellow practitioners. The authors would like to thank Dr. Duane Keller, Dr. Yosh Jefferson, Dr. Thomas Hughes, Dr. Rudy Postema, Dr. Michel Champagne, Dr. John Byland, Dr. Kenneth Lyle, and Dr. Janet Doerr for their helpful suggestions and aid in the selection of values to be measured.

Adolescent↗
PubMed1997

Inventing innovative orthodontic pliers.

Not everyone has been offered the rare opportunity to gather a group of "expert consultants" in orthodontics with the stated purpose of re-designing the instruments that orthodontic practitioners live with and practice with every day of their professional lives. This is what I feel we are doing by the designing and manufacturing of these special pliers that incorporate the Simplicity-Innovation-Motion-Saving characteristics that are represented in these remarkable instruments. Few dentists can point to others in the profession and say silently, "Those orthodontic practitioners are using instruments to treat patients that I had a part in bringing into our profession." If the plans for introducing these pliers to fellow professionals come to full fruition over the next few years, it will bring a warm, personal sense of success to all of those who have involved themselves in planning and carrying out this intricate and worthwhile project.

Biomechanical Phenomena↗
PubMed1996

Orthotics and orthodontics.

Many doctors think of orthotics or occlusal splints in connection with temporomandibular joint dysfunction patients and treatments. Few think of occlusal splints or intraoral orthotics in conjunction with orthodontics as diagnostic instruments. This article will demonstrate a close association between intraoral orthotics for diagnostic purposes to establish a functional mandibular-maxillary relationship before or during orthodontic treatment. Orthotics allow the practitioner to establish and maintain a harmony between the joint structures, the muscles and the dentition. Orthotics establish the stable orthopedic relationship prior to orthodontic intervention and thus, the end point of treatment established prior to irreversible corrections and a diagnosis of cause-effect relationships can be determined. Properly relating the mandible to the maxilla allows the opportunity to determine the arch developmental requirements necessary to maintain this functional relationship.

Humans↗
PubMed1998

Stability of transverse maxillary dental arch dimensions following orthodontic-surgical correction of anterior open bites.

A sample of 130 patients with vertical maxillary hyperplasia; mandibular hypoplasia with a high mandibular plane angle; narrow, tapered maxillary dental arch form; and anterior vertical open bite were collected from three different institutions to evaluate the stability of transverse maxillary arch dimensions after correction of the open bite. Surgical treatment consisted of Le Fort I or bimaxillary osteotomies. Intermolar, interpremolar, and anterior arch widths were measured three-dimensionally on dental casts using a Reflex microscope, and transverse stability after orthodontic or surgical maxillary expansion was analyzed. Orthodontic expansion followed by a one-piece Le Fort I intrusion osteotomy was performed in 77 patients, and surgical maxillary expansion by a multisegment Le Fort I intrusion osteotomy was performed in 53 patients. The increase of transverse arch width and the relapse after orthodontic or surgical expansion were not significantly different. The transverse arch width in these two groups did not relapse in 20% of the patients after a mean follow-up of 69 months. An additional bilateral sagittal split osteotomy had no detectable effect on stability. Patients who underwent a multisegment Le Fort I osteotomy stabilized with rigid internal fixation showed better transverse stability than those with intraosseous wire fixation and maxillomandibular fixation. Maxillary intermolar and interpremolar arch width relapses were not correlated with tongue interposition or loss of interdigitation. The relapse of these arch widths showed significant correlations with clockwise rotation of the mandible but not with changes of overbite or overjet.

Adolescent↗
PubMedDate not supplied

The prevalence of TMD in orthodontic patients prior to treatment at NCKUH in southern Taiwan. National Cheng Kung University Hospital.

Orthodontic treatment is considered one of the risk factors for temporomandibular disorders (TMD). However, TMD may occur before orthodontic treatment. The purpose of this study was to investigate the prevalence of TMD in orthodontic patients prior to treatment. The samples consisted of 508 patients (214 males and 294 females) at the National Cheng Kung University Hospital (NCKUH) in southern Taiwan. Ages ranged from 6 to 56 years. TMD signs were recorded by clinical examination prior to treatment. The overall prevalence of TMD was 26.6%. The prevalence was slightly higher in females (27.2%) than males (24.8%). However, the difference was not statistically significant. The prevalence of TMD in children (ages 6-17) and adults (ages 18-56) was 16.5% and 43.6%, respectively. The difference was statistically significant. Distribution of TMD signs was joint sounds (32.3%), muscle or joint pains (32.3%), muscle or joint pains (32.3%), mouth opening less than 35 mm (18%), combination of two signs (16.5%) and combination of three signs (0.8%).

Adolescent↗
PubMedDate not supplied

Advanced lightwire functionals reduce orthodontic relapse factor.

Past orthodontic research by Schwarze in "Expansion and Relapse in Long Follow-Up Studies" concluded "... that orthodontically induced transverse sizes of the dental arches are very unstable." The article further stated that, "the majority of patients showed a decrease of the transverse molar and canine distance from the end of treatment to the follow-up examination." Also emphasized was the fact that "prolonged retention periods do not prevent relapses." These findings are based on orthodontic techniques that focus on movement of teeth and maxillary expansion without regard for existing cranial base and cranial bone distortions.

Adolescent↗
PubMed1997

Multidisciplinary approaches: esthetic restorations after orthodontic treatment.

After orthodontic treatment prosthetic restorations are sometimes still necessary to improve the patient esthetics. After routine orthodontic procedures (alignment of teeth and achievement of functional occlusion) conventional crowns and bridges are used. In this case study, the follow-up results of four patients are presented. They had been treated by various disciplines; orthodontics, plastic surgery and prosthodontics. Satisfactory esthetics and function were achieved with all patients.

Adult↗
PubMed1998

Soft laser irradiation induced pain reduction in orthodontic treatment.

It has been emphasized that pain reduction without analgesic drugs is necessary in orthodontic treatment. Especially, needed is reduction after the initial wire application. Soft laser irradiation has been applied in dental clinics, and we reported its effectiveness in pain reduction in orthodontic treatment. In this study, we evaluated the continuous effects of the laser irradiation by questionnaire and pulp sensitization measured by pulp electrodiagnosis. The laser irradiation time required for pain reduction was also examined. We confirmed that soft laser irradiation produced an effective pain reduction in orthodontic treatment.

Adolescent↗
PubMed1999

Lingual orthodontics (part 2): archwire fabrication.

One essential component of a successful lingual treatment concept is the precise calculation and manufacture of individual lingual arch wires. As in several parts of daily life, the use of modern CAD/CAM technology leads in lingual orthodontic treatment to a rationalisation of working processes with maximized precision. The lingual module developed by the author is a new scanner-independent procedure for calculation and manufacture of individual lingual arch wires with the Orthomate/Orthotherm system (OrthoTel, Berlin/Dallas, Tx). Especially the precise individualization of superelastic, shape-memory materials reduces the archwire sequence and simplifies lingual treatment considerably. Individual second and third order overcorrections (incisal torque, reverse curve of Spee) can be programmed into the first archwire, with further three-dimensional corrections being added for each single tooth during finishing. Embedded in a systematic treatment concept, the use of modern CAD/CAM technology for individual lingual archwire production with the Orthomate/Orthotherm system is an important aid to successful integration of lingual orthodontic treatment into routine practice.

Computer-Aided Design↗
PubMed2000

Functional and social discomfort during orthodontic treatment--effects on compliance and prediction of patients' adaptation by personality variables.

During the course of treatment orthodontic patients frequently endure a number of functional complaints and are anxious about their appearance. The aims of this longitudinal study were to follow the progress of patients' adaptation to discomfort, to elucidate the putative relationship between the type of appliance worn and functional and social discomfort experienced, to study potential predictability by their attitude to treatment and to evaluate the effects of discomfort as predictors of patients' compliance. Eighty-four patients undergoing either removable, functional, or fixed appliance treatment monitored their complaints during the first 7 days of treatment and rated them retrospectively 14 days, and 3 and 6 months after appliance insertion. The most frequent complaints were impaired speech, impaired swallowing, feeling of oral constraint and lack of confidence in public. A significant reduction in the number of complaints was observed between 2 and 7 days after insertion of the appliance. No further differences were revealed after longer periods of appliance wear. The type of appliance had an effect on impaired speech and swallowing. Patients' expectations of favourable treatment performance and appreciation of dental aesthetics were predictive of reported feeling of oral constraint and lack of confidence in public. There was a relationship between the complaints and acceptance of the appliance, as well as between lack of confidence in public and compliance with treatment. The results of this study highlight the importance of patients' attitudes to treatment and of functional and social discomfort associated with appliance wear for the theory and practice of the management of orthodontic patients, and the necessity for early intervention by clinicians.

Adaptation, Physiological↗