Orthodontic Profession Research Articles

Effect of NSAIDs in the Tooth Movement in Orthodontic Treatment

Background: Patients undergoing tooth movement in orthodontics often utilize non-steroidal anti-inflammatory medications (NSAIDs) to alleviate inflammation and discomfort. On the other hand, the orthodontic profession is still debating whether or not NSAIDs slow down or hinder tooth mobility. Materials and Methods: About 60 mouths that needed their teeth moved participated in a randomized controlled experiment. There were two groups of patients: Group A received NSAIDs (ibuprofen, 400 mg), while group B received a placebo. Tooth movement was measured using digital calipers at baseline and then at intervals of 4 weeks over a period of 12 weeks. Results: The mean rate of tooth movement in group A was 1.5 ± 0.3 mm per month, whereas in group B it was 1.8 ± 0.4 mm per month. Analysis of variance (ANOVA) showed a statistically significant difference (p < 0.05) in the rate of tooth movement between the two groups, with group B demonstrating faster tooth movement compared to group A. Conclusion: The administration of NSAIDs during orthodontic treatment appears to have a modest but statistically significant inhibitory effect on the rate of tooth movement. Clinicians should consider the potential impact of NSAIDs on treatment outcomes when managing pain and inflammation in orthodontic patients.

Evaluation of orthodontic retention and retainer content on the Reddit social media website.

Social media can provide insight into patient experiences with health care. The aim of this study was to evaluate the content regarding orthodontic retention and retainers on the social media website, Reddit. A systematic search for relevant content submitted over a 12-month period on the Reddit forum, r/braces, was conducted. Qualitative analysis of the initial posts for themes and subthemes was conducted by two investigators. Responding comments to the initial posts were assessed for supportiveness for each initial poster and alignment with the evidence-base. Quantitative assessment was via descriptive statistics. A total of 271 initial posts and 984 comments satisfied the inclusion/exclusion criteria. All initial posts were by patients. Just 1.12% (n=11) of the comments appeared to be provided by oral health professionals. Most initial posts were negative (50.18%; n=136), and most comments were positive (70.42%; n=693). Alignment with the evidence-base was high among the comments (67.89%; n=668). Eight main themes were identified with concerns regarding the negative impact of retention and retainers on quality of life, compliance with retention protocols and relapse commonly expressed. Concern regarding fear of relapse when waiting for the initial or renewal of retainers was a novel finding. More negative sentiments about orthodontists were expressed than positive. Reddit is a supportive and reliable environment for patients regarding orthodontic retention and retainers. The content evaluation suggested deficiencies in communication processes between clinicians and patients. Greater engagement of the orthodontic profession in the provision of supportive and evidence-based information on an individual patient basis and through appropriate information channels is required.

3D printed removable functional appliances for early orthodontic treatment – Possibilities and limitations

The early treatment of certain malocclusions, such as class II division 1, is recommended to decrease the likelihood of upper incisor trauma. However, the lack of skilled technicians and economic constraints prevent the availability of well-known removable functional appliances. The orthodontic profession is undergoing changes, and automation may offer a solution to these challenges. This article discusses the potential for automating the production of two commonly used removable orthodontic appliances. While CAD-CAM systems have streamlined dental manufacturing, 3D printing is a popular option for certain manufacturing processes. However, the adoption of 3D printing for orthodontic devices faces hurdles, such as redesigning devices for this new manufacturing process, material considerations, and necessary certifications. To showcase the potential design and manufacturing process of 3D printed devices that fall under the category of appliances similar in type and style to FR II and Sander II, the article centers on these two widely recognized appliances. As it is currently not possible to replicate all analog features in 3D, it may be appropriate to use a more general name for the FR II and Sander II appliances. In summary, the article examines the potential and limitations of automation in orthodontic appliance manufacturing.

Remote consultations in orthodontics: factors to consider for success

Remote consultations in orthodontics were quickly thrust to the forefront of the orthodontic profession during the COVID-19 pandemic of 2020. With the UK public now accepting telephone consultations and various video applications as a convenient and secure method of communication, it seems likely that, even after the ramifications of the COVID-19 pandemic have dissipated, increased use of remote consultations will continue to be seen as desirable. It is therefore important that orthodontists, and any other orthodontic staff who have been delegated the task of being involved in teleorthodontics ensure they are aware of the limitations as well as the benefits of teleorthodontics. They should also be able to demonstrate competence in how to effectively and appropriately carry out teleorthodontic appointments remotely with patients. CPD/Clinical Relevance: It is likely that patient expectations surrounding traditional face-to-face consultations will change as a result of the COVID-19 pandemic and the opportunity to investigate and explore new ways of working should be embraced. Working through the considerations that must be taken at each stage of the remote consultation as well as the use of appropriate checklists will ensure that the risk of human error is reduced, while undertaking remote consultations in orthodontics.

Cephalometric Analysis: History and Clinical Application

When roentgen cephalometry was first introduced to the orthodontic profession in 1931 by Broadbent in the USA and Hofrath in Germany it was a major milestone in terms of new diagnostic tools available to orthodontists. Until that time only clinical observation and study casts of the patients had been available to the clinician but now a more in depth understanding of the facial makeup became possible. This meant that each patient’s malocclusion could now be related to their facial skeletal and dental morphology. The dentoalveolar components could now be studied in detail and better treatment plans could be developed that addressed the individual patient’s needs. This new technology, the cephalometric analysis, was initially only used to developed what is called a morphological analysis. This type of analysis primarily describes the facial makeup of an individual, so to speak, and is somewhat limited in its clinical value as a predictor of future facial development. Today there are many morphological analyses available to the clinician and most are based on individual preferences and frequently lack sufficient data base to support their use on larger groups of individuals. Unfortunately, many of the cephalometric analysis that now a days are computerized analysis offer large amounts of data which is not very helpful to the orthodontist. We shall present a simplified cephalometric analysis, that fits the practical needs for most clinicians. This so-called “Björk Morphological Analysis,” can be applied to most clinical cases. The introduction of the CBCT now several decades ago greatly improved the diagnostic possibilities for the orthodontic profession. Lateral headfilms can now be formatted from the so-called DICOM files that provide greater details and resolution of the patient’s dental and skeletal problems. We shall discuss the CBCT’s use in clinical diagnosis and the pros and cons of using this technique. Finally, we shall look at the changes of some of the most used cephalometric measurements over time as these variables change with the patient’s growth and maturity.

Analysis of the information contained within TikTok videos regarding orthodontic retention

To analyze the content, reliability, and quality of relevant TikTok videos regarding orthodontic retention. Six relevant terms were searched on the TikTok social media Web site. Uploaded videos satisfying inclusion/exclusion criteria were assessed for the presence of nine predetermined content domains and categorized as "high-content" (≥5) or "low-content" (<5). Reliability was determined using the DISCERN instrument and quality by the Global Quality Score (GQS). Layperson videos were evaluated for themes using discourse analysis. Intraclass coefficients for content, DISCERN scores, and GQS were calculated for intrarater reliability. Statistical analysis was via IBM SPSS Statistics (version 27.0.0.0; SPSS Inc. Chicago, IL). Orthodontists uploaded 37.8% and laypersons 34% of the 209 assessed videos. Just 22.1% of videos were considered to be 'high-content.' Quality of life issues related to retainer wear was the domain that was present least often in the videos provided by orthodontists (13.9%) and most often in those uploaded by laypersons (53.5%). High-content videos recorded greater mean GQS and DISCERN scores compared with low-content videos (P < 0.001). Strong positive associations existed between the number of domains present and DISCERN scores (rho=0.808; P < 0.01) and between GQS and DISCERN scores (rho=0.67; P < 0.01). Intraclass coefficient scores ranged between 0.92 and 0.98. Dissatisfaction with the need for long-term retainer wear was a prevalent negative theme in layperson videos. The content, reliability, and quality of TikTok videos regarding orthodontic retention were poor. The orthodontic profession must use TikTok effectively to ensure it delivers high-quality information relevant to laypersons' concerns.

Orthodontic clear aligners and TikTok videos: A content, reliability and quality analysis

The social media platform, TikTok, has the potential to disseminate orthodontic information to an enormous global audience. The aim of this investigation was to assess the content, reliability and quality of videos regarding orthodontic clear aligners (OCAs) on the TikTok platform. Three search terms were used to identify relevant videos. Characteristics such as video source and the number of views were documented. An 8-point information domain score was applied to categorise the videos as "not useful", "slightly useful", "moderately useful" and "very useful". The DISCERN tool and the Global Quality Score (GQS) were used to evaluate video reliability and quality. Intraclass coefficients (ICC) were computed for intrarater reliability. Statistical analyses were via IBM® SPSS®, version 27.0.0.0 (SPSS Inc. Chicago, IL, USA). Of the 117 videos that satisfied inclusion/exclusion criteria, most were uploaded by laypersons (44.4%) and orthodontists (35.9%). The assessed videos had over 300 million views. The overall mean (SD) number of information domains present in the videos was 1.85/8 (1.73). Most videos were deemed "slightly useful" (54.7%) or "not useful" (26.5%). The overall mean (SD) DISCERN score was 1.8/5 (1.28). The overall mean (SD) GQS was 2.48/5 (0.86). Higher DISCERN scores correlated with higher GQS (r=0.73; P<0.01). ICC scores (0.92-0.94) indicated excellent intrarater reliability. The content, reliability and quality of videos found on TikTok related to OCAs was poor. The orthodontic profession must direct patients to reliable and high-quality resources as well as uploading content onto TikTok to counteract the deficiencies highlighted in this study.

Using Twitter to promote #orthodontic research and clinical innovations: Practice and challenges

While Twitter has substantial benefits in real-time sharing and dissemination of information and facilitating discussions, currently there is a noticeable absence of its use in the orthodontic profession and peer-reviewed journals. This review aims to introduce the basics of using social media; provide a perspective and prospective vision on effective practices on the use of Twitter in sharing orthodontic discoveries and clinical innovations; and discuss the limitations and caveats of using such approaches in sharing and assimilating information. There has been increasing debate on the potential role of social media, specifically Twitter, in shaping the way scholars and clinicians access, discuss, and disseminate research and clinical innovations. Despite various caveats, such as misinformation, privacy concerns, and unprofessionalism, Twitter can be used to efficiently share discoveries and innovations and facilitate networking. Thus, the use of Twitter during professional orthodontic meetings can enhance their impact by enabling nonattendees to participate in the meeting virtually and in real time. Moreover, utilization of Twitter by peer-reviewed journals can aid in enhancing the dissemination of information. That, with the optimization of algorithms and strategies, can also maximize reach and impact. Future efforts are essential to develop standardized guidelines for the use of Twitter among orthodontic healthcare professionals and scholars to better manage scientific integrity, privacy, and ethical concerns. Professional orthodontic organizations, journals, and researchers should be aware of the potential benefits of Twitter strategies that could be applied to maximize the impact and dissemination of orthodontic discoveries to reach the largest possible audience that will facilitate collaboration and discussion, and advance the delivery of cutting-edge treatments.

Prevention of cross-infection due to the transmission of Covid-19 in orthodontic treatment during the pandemic

Background: In 2020, WHO declared the name of the Coronavirus disease 2019 (Covid-19). In the middle of the pandemic, orthodontists have limited their treatment. The challenges of the orthodontic profession in performing treatment become more difficult due to many factors, such as high saliva concentrations. Objective: To find out how to prevent cross-infection of Covid-19 in performing orthodontic treatment during the pandemic. Methods: By using a literature review, information that is relevant to the topic of the study is collected and then synthesized in an article. Results: It was found that there were similarities in the dis-cussion regarding the difficulty of consulting and taking active and inactive orthodontic treatment actions during the Covid-19 pandemic. Conclusion: In orthodontic treatment during this pandemic, dentists and clinical health staff must triage patients be-fore visiting the clinic and must carry out infection control management at the clinic, both orthodontic treatment procedures and other pressure.

Periodontally Accelerated Osteogenic Orthodontics (PAOO) vs Osteoperforations (A Review on Periodontal Reactions to Orthodontic Tooth Movement)

A high number of adult patients are undertaking orthodontic treatment now because of the newer methods, technology, and innovations available in the market. Orthodontic profession is continually looking for new ways to perform treatment effectively for such patients, as there are many differences in the biology, motivation, and treatment objectives between adults and children. Aligner therapy and mini-implants are some of the ways of managing orthodontic treatment for adult patients. Treatment time is a concern for adult patients and methods to accelerate the orthodontic tooth movement have been a focus in the orthodontic field. Periodontal accelerated osteogenic orthodontics (PAOO) is a surgical procedure that is performed with a combination of alveolar corticotomy, bone grafting, followed by orthodontic treatment. This procedure uses the principle of regional acceleratory phenomenon (RAP). Another procedure commonly used for accelerated orthodontic tooth movement is osteoperforations. This is a minimally invasive procedure, which does not include a flap surgery. The purpose of this article is to describe the differences between adult and children periodontal tissues, the use of different appliances for adult treatment, how orthodontic treatment has been modified for adult patients, and the detailed explanation of procedures for accelerating orthodontic tooth movement such as PAOO and osteoperforations and the potential complications

Aerosol generating procedural risks and concomitant mitigation strategies in orthodontics amid COVID-19 pandemic – An updated evidence-based review

ImportanceThe ongoing COVID-19 pandemic has posed unique challenges to orthodontic profession by adversely impacting provision of in-office orthodontic care due to prevailing uncertainty around risks pertaining to splatter and ‘aerosol-generating procedures’ (AGPs). This review aims to provide an insight into the prevailing and emerging evidence informing potential risks related to splatter and AGPs, and risk mitigation strategies employed for reducing the potential risk of SARS-CoV-2 transmission from dental bioaerosols.MethodsPubMed, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, LILACS, WHO COVID-19 databases and preprint databases were searched for eligible English language publications. Citation chasing was undertaken up until the review date of 4 January 2021. Study selection, data extraction and risk of bias assessment was undertaken independently in duplicate, or else by consultation with a third author.ResultsFollowing filter application and duplicates removed, a total of 13 articles assessing procedural mitigation measures were included. Seven included studies revealed overall low-risk of bias. The overall risk varied from unclear to high for rest of the studies, with the most concerning domains being blinding of the participants and the personnel and blinding of the outcome assessors. Accumulated consensual evidence points towards the use of dental suction devices with wide bore aspirating tips as effective procedural mitigation strategies. Variations in the literature can be observed concerning aerosol transmission associated with water spray use during debonding. Emerging direct evidence consistently supports adjunctive use of pre-procedural povidone-iodine mouthrinse to mitigate direct transmission risk in the orthodontic practice.ConclusionsA thorough risk assessment concerning AGPs and implementation of consistent and evidence-based procedural mitigation strategies may play an indispensable role in navigating optimal orthodontic practice through unforeseen similar pandemic threats. High-quality robust research focussing on more biologically relevant models of dental bioaerosols in orthodontic settings is warranted.

The role of AI and machine learning in contemporary orthodontics

In the past 20 years, the orthodontic profession has adopted digital technologies such as computer-assisted tooth movement, automated staged dental aligner production, and 3D simulations. Until recently, the use of artificial intelligence (AI) was limited to narrow intelligence and supervised “learning” such as automated cephalometric point recognition, segmentation of teeth from 3D files, and staging of orthodontic treatment. The next step will be to create neural networks based on general intelligence (the human intelligence is considered general intelligence), where the network using powerful computers and complex algorithms will “learn” orthodontic diagnosis and treatment planning to suggest the most appropriate treatment plan for optimized treatments and more predictable outcomes. The objectives of this paper are to describe the state of the art in AI and orthodontics and explore potential avenues for future developments and applications.

Where do we come from? Where are we going?

The aim of the present paper was to re-analyze the scientific nature of our profession and to attract the focus of the orthodontist to problems and controversies within the development of the orthodontic profession over the past century. The controversy related to the application of the same words used differently within bone biology and orthodontics; the definition of the treatment goal based on perception of beauty; the trend to focus on efficacy and marketing more than on treatment of the individual patients; and the isolation of the effect of the orthodontic appliance from growth and function and the lack of understanding the word “stability” are analyzed from a critical stand point.

Returning to the orthodontic practice amid COVID-19 crisis

Background The coronavirus disease (COVID-19), caused by the novel severe acute respiratory virus syndrome (SARS)-CoV-2, was defined as pandemic on March 11, 2020. All health care providers are at risk of a COVID-19 infection; however, dentists pose the highest risk since SARS-CoV-2 is transmitted through breathing and aerosol, coughing and droplets and direct or indirect contact with infected skin and surfaces. Guidelines for minimizing the risk of transmission in general dental clinics have been published and are regularly updated. Objective The present article aims to specifically address the concerns of the orthodontic profession amid the COVID-19 crisis, and suggest recommendations for orthodontic care settings, infection prevention measures and delivery of clinical procedures. Data Sources An electronic search was conducted via PubMed/MEDLINE, Google and health organization websites from two independent data abstractors. Study Selection All kinds of manuscripts describing guidelines for health care providers to follow during the COVID-19 pandemic were included. No language restrictions were considered. Any disagreements on study inclusion were resolved by discussion between the two reviewers. Data Extraction Information on guidelines and suggestions on the management of clinical orthodontic practice were extracted from studies identified for inclusion in the review. Data Synthesis Orthodontists are at a very high risk for COVID-19 infection and all published guidelines should be followed for the patient and DHCPs safety. The care settings, the infection protocols, and the delivery of AGP clinical procedures must be continuously revised and modified to overcome the threat of the SARS-CoV-2 infection in the orthodontic practice.

The present, past and future of orthodontic research

The objective of this paper is to evaluate past and present research efforts, and provide directions for future orthodontic research initiatives. Bibliometric indices show that the highest quality and most impactful research is currently being conducted in the United States, United Kingdom, Germany, Brazil and Italy. While the quality of orthodontic research has improved substantially over time, more and higher quality randomized controlled trials need to be conducted. Research efforts must be devoted toward developing evidence-based standards of care, which are necessary to protect the orthodontic profession from incursions by charlatans and outside entities. Future research in the areas of genetics, technology, artificial intelligence and craniofacial orthopedics offer great opportunities to advance the profession, individualize treatments and make them more effective and efficient.

Will the orthodontic profession disappear?

Will the orthodontic profession disappear?

The Impact of Platelet Rich Fibrin on Periodontally Accelerated Osteogenic Orthodontics (PAOO)-A Perio-Ortho Interdisciplinary Case Report

Background: In the present day scenario as the number of adult patients presenting with severe teeth malocclusions increase, the orthodontic profession constantly debates on ways to accelerate tooth movement and focuses on improving the patient centered outcomes. PAOO, a surgically assisted orthodontic procedure, which combines the use of corticotomy along with bone grafts, has been used to fasten the clinical results. Platelet rich fibrin, (PRF), an autologous platelet concentrate, with its vast release of growth factors plays an important role in enhancing soft tissue outcomes. Aim: This case report aimed to demonstrate the efficacy of PRF on soft tissue outcomes when used as an adjunct to a variation of PAOO technique and also assess the time duration to achieve complete space closure. Case description: A 23 year old female patient had presented herself to the outpatient Department of Orthodontics, Manipal College of Dental Sciences, Mangalore, India, with a chief complaint of protruded upper anterior teeth. The patient had been diagnosed with Class 2 division 1 malocclusion, after which therapeutic extraction of upper 1st premolars and lower 2nd premolars were performed. To facilitate lower molar protraction, the patient was referred to the Dept. of Periodontology for PAOO procedure. PAOO procedure was performed along with PRF and the clinical outcomes were assessed at the end of 6 months. Conclusion: Correction of severe crowding may pose a significant challenge to the orthodontist. A combination of PAOO with PRF has shown beneficial therapeutic outcomes, better patient acceptance and enhanced soft tissue healing. It would be a viable alternative to the invasive orthognathic surgery.

How Orthodontic Therapists have Changed the Provision of Orthodontic Treatment

The last decade has seen the orthodontic workforce transformed by the introduction of orthodontic therapists. This article aims to highlight how they have changed the provision of orthodontic treatment and how the orthodontic profession has caught up with general dentistry where task delegation to dental therapists and hygienists has been commonplace for many years. CPD/Clinical Relevance: This article will enable readers to see just what roles OTs undertake, increase their awareness of who may be undertaking the treatment on the patients they refer on and highlight the guidelines on appropriate supervision that their referring orthodontists should be following.

Informed consent: a changing paradigm?

Abstract: It is both an ethical and legal obligation for clinicians to ensure patients are fully informed and involved in the decision-making process. A recent landmark case, Montgomery vs Lanarkshire, has emphasized the importance of fully informing patients regarding the risks of treatment and is likely to have significant implications for the dental specialty. This paper aims to provide an overview of informed consent in the UK and discuss the implications of this ruling on orthodontists and the wider dental team. CPD/Clinical Relevance: This paper aims to discuss the legal and ethical implications of a recent legal case, Montgomery vs Lankarkshire, on the orthodontic profession and highlight how the case may change the current consent taking process.

Integrating “Experience Economy” into Orthodontic Practice Management: A current perspective on internal marketing

Marketing as a word conjures up different visions for the orthodontic profession. It encompasses so many things and so much variety that it is difficult to discuss it with others in our field. The connotations are so varied that there is so much confusion when you throw in the association of marketing with advertising. Infact, even without knowing about the science of marketing, successful orthodontic practices do incorporate tenets that generate greater patient recall and referrals. The uniqueness, impact, and memorability of patient interaction are critical to generating a consistent referral base. A concept that is, making the industry at large, change its practice is the concept of the Experience Economy. In a survey of orthodontic patients, who were asked to rate the best and worst memories of their orthodontic treatment by the Q sort methodology, the best and the worst memories were experience and not therapy based. This article highlights the Experience Economy Tools for Internal marketing. With changing times, orthodontic practices that are able to implement these Internal marketing strategies in their day-to-day practice protocols will see improved patient satisfaction outcomes and financially successful practice models that will grow in any economy.