Orthodontic Office Research Articles

Factors influencing young patient arrival date at the orthodontic office: a study of 456 cases

The arrival date young patient's first orthodontic consultation is unrestricted but may influence the choice of treatment plan as well as its modalities. The objective of this study was to determine the factors that influence the date of the first consultation at the orthodontic office: advice from a third party or a health professional, the patient's gender, the socioeconomic level, the actual need for orthodontic treatment, and the vertical and anteroposterior skeletal dysmorphia. Young patient's file younger than 16 years were systematically included. A Wilcoxon and Kruskal-Wallis test was performed in univariate and multivariate analysis. The threshold was 5%. 456 young patients were included. Anteroposterior skeletal discrepancy, referral by an acquaintance, and socioeconomic level appeared to be factors influencing patient arrival date. Gender, actual need for orthodontic treatment, referral from a health professional, and vertical skeletal discrepancy did not influence the arrival date at the office. The date of consultation is not related to the actual orthodontic treatment need. Word-of-mouth seems to play an important role. Patients seem to relate an anteroposterior discrepancy to the need to consult an orthodontist, but do not relate it to vertical discrepancy, although ventilation may be related to severe dysmorphia. This study encourages more communication about orthodontic treatment indications with patients and caregivers.

Orthodontic Aligners: Current Perspectives for the Modern Orthodontic Office.

Orthodontic aligners are changing the practice of orthodontics. This system of orthodontic appliances is becoming the mainstay appliance of choice for orthodontic offices in many countries. Patient preferences and lifestyle needs have made this appliance the primary choice when seeking care. In the early days, appliances lacked the efficiency and effectiveness of traditional bracket-wire systems, but modern systems are now able to handle a more comprehensive orthodontic caseload. Current systems provide newer biomechanical strategies and artificial intelligence-driven tooth movements for better outcomes. These improvements now mean that an orthodontist can be better prepared to manage a larger number of orthodontic malocclusions. This paper aims to discuss some of the evolution of orthodontic aligners and to describe to orthodontists the fundamentals of aligner therapy. In addition, it will provide an evidence-based outcome to the existing treatment outcomes in the current literature.

Orthodontic Patients’ Perception of Orthodontic Office Changes during COVID-19 Pandemic in Brazil: A National Cross-Sectional Survey

There is still limited information regarding patients’ perception of the dental approach changes in the pandemic circumstance. Therefore, the aims of this study were, firstly, to evaluate patient perception regarding the COVID-19 infection risk in the orthodontic office in Brazil, and to assess the influence of age in infection risk perception. Orthodontic patients from five states answered an online questionnaire, anonymously, about quarantine behavior, perception of the infection risk in the orthodontic office, as well as the apparent need for the new biosafety approach. Descriptive analyses were performed for each question. Correlations between age and concern of getting infected were calculated with Spearman correlation tests. There were 406 responses. Most patients respected the quarantine, and 93.10% of those who were scheduled for appointments realized that their appointment would be safe enough. From the total, 83.99%, 84.98%, 89.90%, and 95.81% of patients judged, respectively, health status checks by phone, temperature checking, disposable coat, and face shield, as necessary. Only 6.40% reported an increase in the concern of returning to appointments. The younger the patient, the greater the concern of getting infected in future appointments (p = 0.042). Most patients were confident in the professional care before the appointment. The new biosafety approach was well accepted by the majority, with less agreement with temperature checking and the use of disposable coats. The younger the patient, the greater the concern of getting infected in future appointments. The rate of patients with risk factors for COVID-19 was 14.77%.

Transverse Malocclusions: Etiology, Development, Diagnosis and Treatment

Malocclusions that involve the transverse dimension are very common in the orthodontic office. They can be as simple as a crossbite of the posterior teeth or as severe as a Class III malocclusion with a mandibular asymmetry. Transverse malocclusions can vary from being a simple dento-alveolar problem to a more complex challenge as represented by a skeletal asymmetry that has developed after puberty and causing temporomandibular disorder (TMD) problems. In this review we shall address the most common types of transverse malocclusions and review their etiology and development. The most typical etiology of transverse anomalies will be discussed, and we will suggest diagnostic criteria to differentiate the individual malocclusions. We shall also introduce a frontal cephalometric analysis that relates to the anterior part of the face helping to differentiate between dento-alveolar and skeletal transverse malocclusions as well as determine the presence of dento-alveolar compensations. Furthermore, we shall suggest possible treatment approaches and the best timing of treatment for the most common types of transverse malocclusion. Finally, we shall present several cases with more unusual etiology including a case with mandibular asymmetry due to an anterior disc displacement of temporomandibular joint. A case with Class III malocclusion with mandibular overjet caused by maxillary stenosis will also be presented. Furthermore, we will show an example of a late developing mandibular asymmetry which is not an uncommon problem and document a case of excess mandibular growth with mandibular asymmetry and Class III malocclusion combined with posterior crossbite. This review will also address considerations that may affect the post treatment stability.

Directly Printed Aligner: Aligning with the Future

Orthodontics stands on a junction where traditional analog appliance manufacturing slowly but steadily changes to a digital one with the use of 3D technology. The main cause of this shift was the invention and use of computers. The use of computers, computer-aided design (CAD) software, computerized machines, and newly invented materials allowed this change to occur in a relatively short time in dentistry and orthodontics. The trigger for this transformation is the ability to digitally scan the oral cavity. CAD software and 3D printers already existed. It took a few years to include this technology in orthodontics and continuously apply it in the orthodontic office. Orthodontic treatment is mainly based on the use of fixed appliances, while in the last years, thermoformed aligners have been introduced as an alternative whenever a more invisible treatment modality is preferred. Clear aligner treatment is performed using thermoformed aligner. A new aligner resin has been recently invented to allow direct aligner printing. Directly printed aligner possess many advantages compared to thermoformed one. Research has been initiated to investigate all the aspects of the workflow and aligner printing outcome. More studies must be performed to look into the various aspects of directly printed aligners.

Association between arch width changes and long-term stability 20 years after orthodontic treatment with and without extractions.

To investigate long-term stability 20 years after orthodontic treatment and the association with arch width changes during treatment. This retrospective study investigated 103 patients with Class I and II malocclusions treated with fixed appliances with and without extractions. The sample was treated by one experienced orthodontist and collected from a private orthodontic office. Dental casts were obtained pretreatment (T1), posttreatment (T2), and long-term postretention (T3); they were scanned and converted to STL files. Measurements were evaluated in for the upper and lower arch: intercanine width (IC), intermolar (IM) width, Little's irregularity index (LII). There were 73 female and 30 male patients. Class I was present in 74 patients and Class II in 29. Average postretention time was 17.2 (±6.5) years after an average active retention time of 3.4 (±1.17) years. Extraction was performed in 55 patients while 48 received nonextraction treatment. Bonferroni Post Hoc test showed that LII in the upper and lower arches at T1 was significantly higher in the extraction group (P < .001). Upper and lower arch LII at T3 was slightly higher in extraction cases but remained under 2.05 mm. LII at T3 in the upper and lower arches showed negative correlation with IM T3 in the upper arch (Pearson, N = 103, P = .047), while IC in the upper and lower arches at T3 correlated with IM T3 in the upper and lower (N = 103, P < .001). Clinically relevant long-term stability in both arches was found in extraction and nonextraction cases. Intermolar width and its change during orthodontic treatment was an influential factor on long-term stability in extraction cases.

Seamless Workflows for In-House Aligner Fabrication

In-house aligner systems (IHAs), alternatively known as in-office aligners (IOA), in the strictest sense, refer to clear aligner systems wherein every aspect of the aligner fabrication from digital treatment planning (DTP) to the delivery of the orthodontic care is managed in the orthodontic office itself. Although still in its nascent stages, increased accessibility to chairside intra-oral scanners and office-based 3D printers, rapid advances in DTP software and aligner fabrication materials, have all helped the cost-effective concept of fabricating aligners in orthodontic offices, take a definite shape. The aim of this paper is to elaborate on the essential components of an IHA system and elucidate a systematic workflow for seamless in-house clear aligner fabrication with an emphasis on clinical reproducibility, along with a clinical illustration of a patient treated with IHAs. The authors believe that the development of a standard operating protocol for in-house clear aligner systems may help reduce the heterogeneity associated with IHA fabrication and subsequently allow meaningful comparisons with established commercial clear aligner systems of the day.

3D Printing of in Office Custom-Made Brackets: Concept, Design, Production and Evidence

During the last few years, digital technology has been the main cause of many changes in dentistry and orthodontics. The ability to digitization of the oral cavity, the invention of CAD software, 3D printers, and printing materials helped the formation of the in-office designing and printing appliances concept. Fixed appliance customization on the other hand is a concept that could only be applied in special manufacturing companies. The installation of a digital laboratory in the orthodontic office allowed the production of customized fixed appliances. The workflow configuration of in-office printing of custom-made brackets consists of a novel CAD software called Ubrackets, a 3D printer for the printing of the customized brackets and a resin or slurry to be used for the manufacturing of the brackets. Brackets printing can be performed by the use of hybrid ceramic permanent crown resin or zirconia slurry in a slightly different workflow configuration. Research has been conducted to study the various stages of printing as long as the material properties of the various resins and slurries to be used for customized bracket printing. More studies need to be performed in order to optimize the printing outcome.

Patient and Caregiver Perceptions of Animal Assisted Activity in Orthodontics.

Simple SummaryDental anxiety impacts a significant fraction of children and adults, leading to lifelong avoidance of the dentist and increased emergency dental care. Animal-assisted activity (AAA) is widely used in medicine to reduce anxiety and pain, with promise in dentistry. However, dentistry has been slow to adopt AAA, with a state dental board banning therapy animals in dental clinics due to patient concerns over dog safety, allergies, and cleanliness. Our goal was to determine how orthodontic patients and their caregivers viewed canine therapists in dental clinics to see whether AAA would be welcomed by most families. (No dog therapy occurred as part of this study, so the efficacy of AAA for dental anxiety management was not evaluated). Orthodontic patients and parents/caregivers were asked to fill out a survey about their dental anxiety and their desire for and concerns regarding therapy animals in dental clinics. More than a third of patients had moderate or greater anxiety related to dental care. A vast majority of participants believed that therapy dogs would make dental experiences more enjoyable and reduce fear, with a small minority raising concerns about cleanliness, allergies, and safety. Among patients and caregivers, there is broad acceptance and desire for AAA in dental and orthodontic settings. Future research should be aimed at determining how AAA can improve the experiences of dental patients.Dental anxiety affects up to 21% of children and 80% of adults and is associated with lifelong dental avoidance. Animal assisted activity (AAA) is widely used to reduce anxiety and pain in medical settings and has promise in dentistry. The primary objective of this study was to evaluate caregiver and patient perceptions of canine AAA in orthodontics. A cross-sectional survey consisting of pre-tested and validated questions was conducted (n = 800) including orthodontic patients (n = 352 minors, n = 204 adults) and parents/caregivers (n = 244) attending university orthodontic clinics. In this study, AAA and dog therapy were not used or tested for dental anxiety management. More than a third of orthodontic patients (37%) had moderate or greater anxiety related to care. Participants believed that therapy animals would make dental experiences more enjoyable (75%) and reduce anxiety (82%). There was little to no concern expressed regarding cleanliness (83%), allergies (81%), and safety (89%) with a therapy animal in dental settings. Almost half of the participants would preferentially select an orthodontic office offering AAA. In light of the COVID-19 pandemic, we assessed whether perceptions of AAA changed before and after the shutdown of dental offices, with no significant differences. Across patients and caregivers, the responses support the use of AAA in orthodontic settings with minimal concerns.

In-house customization of lingual orthodontic brackets using Ubrackets computer-aided design orthodontic software

During the past years, digital technology has been introduced in the orthodontic specialty. Many of the conventional procedures have been changed to digital procedures. Three-dimensional surface scanning, volume scanning, computer-aided design (CAD), and 3-dimensional printing are technologies that are changing orthodontic practices. One of the major changes is the ability to design and print customized fixed orthodontic appliances. In contrast, digital technology allowed the implementation of many laboratory procedures in the virtual environment of a computer in the orthodontic office. Customization of labial or lingual trade orthodontic brackets using dedicated orthodontic CAD software has never been attempted in an orthodontic office until now. In our case report, we used novel orthodontic CAD software named Ubrackets to transform trade lingual orthodontic brackets into customized by adding composite to their bases. The complete lingual bracket customization designing, indirect bonding tray design, printing, and bonding workflow are presented. • Converting trade lingual, or labial brackets can be done using the software UBrackets • Trade brackets customization can be done in the orthodontic office without the need of an external company. • Trade brackets customization is performed by adding composite to their bases. Composite amount and volume is determined in the Ubrackets software. • Indirect bonding can be done using the traditional way using transparent silcone impression or 3D printed IDB trays. • 3D printed resins need to be optimized for more accurate indirect bonding.

3D printing in orthodontics: A practical guide to the printer technology and selection

The utilization of 3D printing technologies in orthodontics is expanding on a daily basis. While much has been written about the technology, the costs and involvement to setup and implementation in the office has not had as much exposure. This article is intended to compare the costs of various printer setups and the associated degree of difficulty of assembly, setup, calibration, and maintenance of the machine in an orthodontic office.

Survival analysis of three types of maxillary and mandibular bonded orthodontic retainers: a retrospective cohort.

BackgroundRetention is an important aspect of orthodontic treatment. This study aimed to analyze the survival of three types of maxillary and mandibular bonded orthodontic retainers.MethodsThis retrospective cohort study evaluated the records of 118 orthodontic patients (90 females, 28 males, mean age of 22.34 ± 6.44 years) retrieved from a private orthodontic office. Data regarding the retainer failure, dental caries, unwanted tooth movements, maximum pocket depth (PD), and bleeding on probing (BOP) recorded at the follow-up sessions were extracted from patient records. Three types of retainer wires namely Bond-A-Braid, Orthoflex, and Retainium were compared regarding the abovementioned parameters. Data were analyzed by ANOVA, Chi-square, Monte-Carlo Chi-square, and Kruskal Wallis tests, the log rank test, and the Cox regression model.ResultsThe frequency of retainer failure was not significantly different between males and females, different age groups, or different treatment durations (P > 0.05). Wire fracture was the most common failure type in both the maxilla and mandible. Also, the frequency of failure was not significantly different between the maxillary and mandibular retainers (P > 0.05). The frequency of failure, and survival of the three types of retainer wires were not significantly different during a 5-year period (P > 0.05).ConclusionsThe three types of orthodontic retainers had comparable survival rates. Their failure rate was not correlated with the age or gender of patients or the treatment duration.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-022-02202-5.

In-house computer-aided design and 3-dimensional printing of customized orthodontic brackets using hybrid ceramic resin: Is it the time for the orthodontist to take over?

Customized brackets can be designed and printed in the Orthodontic office using a permanent crown resin. The whole workflow is fast, easy to handle and predictable. 2. Designing of customized brackets and customized archwire can be done using a novel Orthodontic CAD software called UBrackets. 3. For every customized brackets design case a customized archwire 3D file is also created that can be manufactured using an in-house archwire bending robot or can be manualy bended. 4. Customized posititioning keys can be printed together with the customized brackets in order to accurately bond the brackets.Ei.e., Digital technology advancements have been introduced into the orthodontic specialty in the last few years. Three-dimensional (3D) surface scanning, 3D volume scanning, computer-aided design (CAD) software, and 3D manufacturing have irreversibly altered and refined processes that were previously performed more conventionally. As a result, customized fixed orthodontic appliance production has been made possible by a few manufacturing companies. An attempt at implementing the in-house designing and manufacturing of customized fixed orthodontic appliances using dedicated orthodontic CAD software has never been undertaken until now. Our case report used a novel orthodontic CAD software named UBrackets to design in-house customized orthodontic brackets. Three-dimensional printing was performed in the orthodontic office using a permanent crown ceramic resin. The complete customized fixed appliance's design, printing, postprinting, and bonding workflow are also presented.

Evaluation of Cephalometric Standards for Zanjanian Population According to Downs' Analysis

Background: Following the morphological features of different races and ethnic groups, knowledge of standard dentofacial patterns of each ethnic group is essential. Therefore, this study aimed to explain cephalometric standards for the Zanjanian population according to Downs' analysis and compare them to Caucasian individuals. Methods: Seventy lateral cephalometries of Zanjanian adults (17 - 29 years old) who had been referred to a private orthodontic office in Zanjan, Iran with class I molar and canine relationship and normal overjet and overbite as well as minimum crowding/spacing/rotations were scanned and traced with the Novatech scanner and Dolphin software version 10. Next, statistical analyses were performed in order to compare the Zanjanian population to Caucasians. Results: We found a significant difference between males and females in terms of interincisal angle, incisor-occlusal angle, incisor-mandibular plane angle, upper incisor proclination, facial angle, and angle of convexity. Discussion: The analysis of six statistically significant parameters indicates that the upper and lower incisors in women of Zanjan were proclined and protruded compared with those of Caucasian subjects. Due to the statistical analysis on facial angle and angle of convexity, women also show more maxillary prognathism and skeletal class II pattern. Generally, a comparison of Zanjanian population cephalometrics based on Downs' analysis showed an increase in maxillary prognathism, maxillary and mandibular incisal protrusion and posterior rotation of the mandible. Conclusions: In conclusion, the Zanjanian population tends to have more dental and skeletal class II patterns than the Caucasians. In addition, gender comparison indicates lower and upper-incisors protrusion in women of Zanjan.

Patient-reported experiences and preferences with intraoral scanners: a systematic review.

Intraoral scanners have become an increasingly popular alternative to conventional impression methods. Although their accuracy and validity have been examined thoroughly, patient-reported information including experiences, preferences, and satisfaction has not yet been investigated in a systematic way. The objective of this systematic review is to investigate the available data and appraise the evidence on patient-reported experiences and preferences following impression taking with intraoral scanners. Unrestricted search of seven databases (Pubmed, CENTRAL, Cochrane reviews, Scopus, Web of Science, Clinical Trials, and ProQuest) and grey literature were conducted until October 2020. Detailed search strategies were developed for each database. Studies involving individuals of any gender or age, subjected to full arch impression taking with conventional and intraoral scanning methods were eligible for inclusion. Following the retrieval and selection of the studies, data extraction was performed. Risk of bias assessment was performed using the RoB 2 and ROBINS-I tools. From the initially identified records, nine studies [eight crossover (two of them randomized) and one parallel group] were eventually included in the present systematic review. Randomized studies were shown, overall, to have some concerns regarding bias, whereas the non-randomized studies were found to be at serious risk, mainly because of bias due to confounding. All studies demonstrated some benefit in favour of intraoral scanning compared with conventional techniques. More positive feelings were generally observed with the intraoral scanners regarding smell, taste, sound, vibration, nausea, and queasiness. Overall, comfort assessment mostly favoured digital methods. No differences were found concerning the level of anxiety between the two methods. Among the included studies, time perception was a parameter leading to contradictory results. These emerge due to the nature and characteristics of the information retrieved from the included studies. The validation of the instruments to capture patient-reported outcomes needs to be further elaborated. Intraoral scanners seem to be a promising new asset in the orthodontic office from the perspective of individuals' experiences and preferences. Nevertheless, to investigate patient-reported outcomes correctly, further high-quality studies are required in the future. Open Science Framework (https://osf.io/ayug2/).

Estimation of x-ray radiation related cancers in US dental offices: Is it worth the risk?

The objective of this study was to estimate the possible number of cancer cases produced during 2019 in US dental offices from radiography, estimate the possible reduction in those rates resulting from use of intraoral rectangular collimation and selection criteria, and determine the frequency and quality of website radiation risk information and informed consent forms. An analysis of dental radiation examinations in 2014 to 2015 US national survey data, Nationwide Evaluation of X-ray Trends, and National Council on Radiation Protection and Measurements surveys was performed, in addition to an analysis of 2008 to 2020 Journal of Clinical Orthodontics national orthodontic surveys for radiographic examination frequencies. Lifetime attributable cancer risk estimates from US and European studies were used to generate the total dental and orthodontic office cancer totals. In total, 150 offices were examined online for the quality and frequency of risk information in websites and consent forms. The 2019 estimate for all office cancers is 967. Collimation and selection criteria could reduce this to 237 cancer cases. Most cancers arise from intraoral and cone beam computed tomography examinations, with 135 orthodontic cancers over 21 months (average treatment time). Collimation and selection criteria could reduce this to 68. Only 1% of offices use collimators or informed consent for radiography. The website and consent information were of poor quality. Dentists are not following selection criteria or using collimators according to guidelines. Up to 75% of cancer cases could be avoided.

Maxillary Sinus Volume in Cleft Lip and Palate Patients with and without an Oronasal Fistula using CBCT

Introduction Formation of oronasal fistula is a common complication after surgical closure of cleft lip and palate (CLP). This study aimed to compare the maxillary sinus volume in 9-12-year-old CLP patients with and without an oronasal fistula who had undergone surgical closure of the cleft at 1 year of age, using cone-beam computed tomography (CBCT). Methodology This descriptive, cross-sectional, analytical study was conducted on CBCT scans of 50 patients with unilateral CLP who were between 9-12 years and had undergone surgical closure of the cleft at 1 year of age in two groups with and without an oronasal fistula (n=50). The patients were selected among those presenting to a private orthodontic office between 2001-2009 and already had CBCT scans taken for orthodontic treatment. The 3D CBCT scans were reconstructed with Mimics software, and the volume of the maxillary sinuses was measured on the images. Data were compared using t-test. Results The maxillary sinus volume was significantly smaller in patients with oronasal fistula compared with those without it (9510.7±492 mm3 vs. 10278.2±512 mm3, P&lt;0.000). The maxillary sinus of the affected side was smaller than that of the unaffected side in both groups of patients with and without an oronasal fistula (P&lt;0.05). Conclusion IImmature patients with unilateral CLP and oronasal fistula have a smaller maxillary sinus than unilateral CLP patients without an oronasal fistula, and may be at higher risk of respiratory infections.

Your second home- Your orthodontic office!!

Most orthodontists spend the entire day working in their offices. Therefore, it is important that the office be planned to make those hours as efficient and satisfactory as possible. The office should not only be a congenial space for the orthodontist to be in, but also a comfortable place for the staff and patients as well. In this competitive world where time and attention are of utmost importance, appropriate office design will help the orthodontist to stand out and achieve his goals, which in turn will help improve the practice. Keywords: Orthodontic office, Design, Planning.

Shopping for an Orthodontist

Choosing an orthodontist is one of the most important decisions patients need to make for their beautiful smiles. What are the factors that lead a patient to choose an orthodontist for their treatment? To find an answer, a survey was conducted to explore information from patients about the factors influencing them for choosing an orthodontic practice. The questionnaire focused on the role of social media, qualification, patient feedback, general dentist referral, treatment cost, reputation of the dentist, latest technologies used, age and gender of the practitioner, and location of clinic in the selection of an orthodontist by the patient. The research included 400 new orthodontic patients visiting dental college and orthodontic office. The study concluded that advertising tools such as social media, qualification and reputation of the practitioner, feedback from previous patient, age and gender of the practitioner, and dentist referral were important criteria in selecting an orthodontist.

Tooth color alteration after debonding in orthodontic patients with adhesive removal using composite bur or tungsten carbide bur: a single center, randomized controlled clinical trial

Introduction: The objective of this study was to determine whether recently developed fiber reinforced composite burs provided better results by comparing tooth discoloration after debonding of orthodontic brackets.Methods: A split-mouth, randomized controlled trial was carried out in one orthodontic office; including 23 patients with intact, vital and caries-free four upper incisors aged 12 to 30 years who completed their fixed orthodontic treatment. For each patient, upper central and lateral incisors on each side of the mouth were randomly selected to remove the adhesive with either a tungsten carbide bur (TC) (n = 46) or a fiber-reinforced composite bur (FC) (n=46). Color evaluation of each tooth was conducted at two time points: immediately after finishing and polishing procedure and two months afterwards. The primary outcome would be the amount of color change in each group during the post treatment phase. The participants, the person assessing the color change and the statistician were blinded to TC group assignment. Color changes in each group were analyzed with the Paired T-test. The color change corresponding to the resin removal method was also statistically analyzed with the Independent T-test at ?=0.05 as the level of significance.Results: 86 teeth, 43 in each group, were analyzed. The ?E value was 3.713±1.161, for teeth finished TC and 2.114±0.514 for teeth finished with FC (p&lt;0.01).Conclusion: adhesive removal with FC bur results in a more color-resistant tooth surface in comparison with tungsten carbide bur.