Orthodontic Treatment Decisions Research Articles

Association between Gingival Phenotype and Periodontal Disease Severity-A Comparative Longitudinal Study among Patients Undergoing Fixed Orthodontic Therapy and Invisalign Treatment.

This longitudinal study aimed to compare the association between gingival phenotype (thin vs. thick) and periodontal disease severity in patients undergoing fixed orthodontic therapy (FOT) and Invisalign treatment over a six-month follow-up period. Clinical periodontal parameters, including full mouth plaque score (FMPS), full mouth bleeding score (FMBS), gingival index (GI), probing pocket depth (PPD), clinical attachment loss (CAL), gingival recession (GR), keratinized tissue width (KTW), transgingival probing, and gingival biotype assessment, were recorded at baseline and 6 months into treatment for both orthodontic groups and a control group. Statistical analysis evaluated differences in parameters between groups and across time points. In the thick phenotype, both Invisalign and FOT groups showed a significant mean reduction in FMPS (baseline to 6 months) by -24.8707 and -12.3489, respectively (p < 0.05). The gingival index decreased significantly for both groups, with Invisalign and FOT showing reductions of -0.83355 and -1.10409, respectively (p < 0.05). FMBS (baseline to 6 months) decreased significantly for Invisalign and FOT, with mean differences of -9.10298 and -12.6579 (p < 0.05). Probing pocket depth (baseline to 6 months) was also significantly reduced for both Invisalign and FOT groups while CAL showed non-significant differences in both groups (p > 0.05). Similar changes were seen in the thin phenotype too. This study highlights the positive influence of both Invisalign and fixed orthodontic therapy on periodontal health, particularly in patients with thin and thick gingival biotypes. These findings, with significant reductions in key periodontal parameters, offer valuable insights to guide orthodontic treatment decisions and enhance patient outcomes.

Current Trends in Skeletal Borderline Patients: Surgical versus Orthodontic Treatment Decisions—What Is the Evidence?

Background: The aim is to assess the current evidence-based knowledge about treatment decisions for skeletal malocclusion in adult borderline patients. Methods: A literature search was conducted through three databases. Inclusion criteria were restricted to systematic reviews, prospective, retrospective, and control studies. Only articles comparing orthodontic camouflage and orthognathic surgical treatment for Class II and Class III malocclusions in adult patients were selected to be reviewed. Results: Seven articles concerning Class II and nine concerning Class III met the inclusion criteria. Scientific evidence was poor due to low methodological quality. Conclusions: Surgical treatment was found to better improve skeletal and soft-tissue cephalometric values, whereas camouflage treatment mainly involved dentoalveolar movements. Aesthetic changes, as perceived by the patient, were not significantly different in the two groups. Recently improved surgical techniques, differing from those described in the analyzed articles, may provide similar or more stable outcomes compared with orthodontic-only treatment. Although some cephalometric variables can be helpful, the most important parameters for treatment selection are the patient’s presenting complaint and their self-image perception. Further studies with larger sample sizes and similar pretreatment conditions, and considering patient self-evaluation of esthetics and function, should be undertaken.

Factors influencing the desire for orthodontic treatment among patients and parents in Saudi Arabia: A cross-sectional study.

OBJECTIVES:The decision to pursue orthodontic treatment is influenced by a variety of cosmetic, functional, and social reasons. This study compared the factors that influence adults’ decisions before orthodontic treatment versus parents’ decisions prior to their children's orthodontic treatment in Jeddah city, Saudi Arabia.MATERIALS AND METHODS:A cross-sectional survey was distributed to the patients of orthodontic clinics of King Abdulaziz University in addition to a private orthodontic clinic in Jeddah city, Saudi Arabia. The survey consisted of two versions of a questionnaire: one for adults and one for children's parents. The survey inquired about the participants’ demographics, factors that led to the necessity of treatment, and considerations before opting for orthodontic treatment. The factors influencing the decision-making process of adults were compared to that of parents using the Chi-square test.RESULTS:A total of 417 subjects participated, 331 adults and 86 parents. The majority of the respondents in both groups were females. When compared to children, adults were more aware of the necessity for orthodontic treatment (78.5% of adults vs. 41.9% of children). The primary motivation for adults and parents to begin orthodontic treatment was to improve their esthetic appearance (58.6% and 87.2%), whereas functional concerns were less frequently reported (12.1% and 15.1%). Adults relied on less trustworthy sources of information about orthodontic treatment options, whereas parents relied on more dependable sources.CONCLUSIONS:The main reason for opting for orthodontic treatment in Jeddah city, Saudi Arabia was esthetic for both adults and children.

Part II. What drives Korean adults to seek orthodontic treatment: Factors contributing to orthodontic treatment decisions.

ObjectiveThis study aimed to identify the perceptions of orthodontic treatment among Korean adults and determine the factors that drive them to seek orthodontic treatment.MethodsA total of 2,321 adults aged 19–64 years were surveyed using an internet research system from a specialized research company. The participants were divided into the following groups based on their experience of and willingness to undergo orthodontic treatment experience, acceptance, and non-acceptance groups. The characteristics of the participants were compared using analysis of variance with post-hoc analysis. Multinomial logistic regression analysis was performed in all three models with the non-acceptance group as a reference.ResultsIn terms of demographic characteristics, age, gender, marital status, and education had significant influences on orthodontic treatment decisions in adults in the experience and acceptance groups (p < 0.001). When all the factors were analyzed, age, marital status, past dental treatment experience, regular oral examinations, demand for orthodontic treatment, optimal treatment period, health insurance coverage, information on orthodontic treatments, perceptions regarding orthodontic treatment, and psychosocial impact of dental esthetics significantly influenced orthodontic treatment decisions in adults in the experience and acceptance groups (p < 0.001).ConclusionsThese findings suggest that various factors influence orthodontic treatment decisions in adults. Individuals who seek orthodontic treatment were found to undergo more regular dental treatment and oral examination than those who did not. They also had a better perception of orthodontic treatment and more negative values for the psychosocial impact of dental esthetics.

Patients' and parents' concerns and decisions about orthodontic treatment.

ObjectivePatients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level.MethodsOne hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents.ResultsConcerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients.ConclusionsThe results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment.

Does a true knowledge of dental crowding affect orthodontic treatment decisions?

To assess whether a true knowledge of crowding alters treatment decisions compared with estimates of crowding. Thirty-six orthodontists were asked to estimate crowding using visualization on eight mandibular arch study models and to indicate possible extraction choices. For each model, the intermolar widths, intercanine widths, and clinical scenarios were identical, but the true crowding varied from 0.2 to 8.4mm as to a lesser extent did the curve of Spee. Eleven orthodontists repeated the visualization exercise after 2 weeks to assess reliability. All 36 of the orthodontists were asked to repeat the treatment planning exercise on the same models, but this time was provided with the true amount of crowding in each case. When the 36 orthodontists used direct visualization of the models to assess crowding, the range of their estimates of crowding increased as the crowding increased. As might be expected, they also tended to move towards extraction treatments as the crowding increased (P = 0.013, odds ratio = 3). Although the reliability of the repeat estimates of crowding were moderate, the mean estimates were greater than the true crowding for each model. When orthodontists were presented with the true amount of crowding, rather than their estimate of crowding, it had a significant effect on the decision to extract, with fewer orthodontists recommending extractions. The principal limitation of this study is that it was a laboratory-based study and utilized just the mandibular arch model for estimation and treatment planning. Direct visualization may overestimate the amount of crowding present. When the true amount of crowding is known, it can lead to more consistent treatment planning, with the decision to extract fewer teeth in the borderline cases. A formal space analysis is likely to assist with treatment planning.

Analysis of anterior dentoalveolar and perioral aesthetic characteristics and their impact on the decision to undergo a Phase II orthodontic treatment

Researchers have conducted extensive studies regarding dentoalveolar factors that affect anterior dental aesthetics; however, there is no consensus regarding how these factors affect orthodontic treatment decisions. Only a few studies have included multiple factors simultaneously. Therefore, the objective was to investigate if there are identifiable dentofacial and perioral aesthetic factors that bias laypeople towards discontinuing treatment after a phase I treatment with this fixed class II corrector. An analysis of photos and dental casts of 60 children (23 males, 37 females) having received phase I orthodontic treatment with the Xbow appliance was conducted. Variables considered were incisor height and width measurements, incisor proportions, incisor angulations, vertical lip thickness, gingival/incisal display, smile width per cent, diastema, midline deviation, smile arc, gender, and use of a 2×4. A principal component analysis and a logistic regression were used to determine which factors related to a patient's likelihood of receiving further orthodontic treatment. Only the angulation of the right maxillary incisors was significantly related to a patient's likelihood (odds ratio 1.886 (1.004-3.466); P = 0.049) to proceed to phase II orthodontic treatment following phase I orthodontic treatment with the Xbow appliance. The odds of proceeding to phase II treatment were 86.6% greater with a one standard deviation increase in the angulation of the right central and lateral incisors. Other factors demonstrated trends but were not statistically significant. Sample in subgroups was small, excluded smiles that did not expose the upper incisor crowns significantly, smiles in real life are observed three-dimensionally, other factors outside the aesthetic measurements were not considered in the analysis. In this sample, the angulation of the maxillary right incisors was the most significant factor influencing the decision to undergo an orthodontic phase II.

Inter-examiner variability in orthodontic treatment decisions for Danish children with 'borderline' treatment need

This study explored the variation between examiners in the orthodontic treatment need assessments of fifth-grade children with a borderline orthodontic treatment need. Each of three groups of children with borderline treatment need (n = 18, 19, and 19, respectively) were examined by one of three groups of orthodontists (33 in each group), whereby each of 56 children had 33 orthodontic treatment need assessments based on a clinical examination. This treatment need determination exercise was subsequently repeated with treatment need determined based on study casts and extraoral photographs. The proportion of positive treatment decisions based on the clinical examination was 49.3, 49.6, and 52.5 per cent, respectively, and 45.7, 46.3, and 50.5 per cent, based on the model assessments. There was a considerable disagreement between examiners in the treatment need assessments, whether assessments were based on a clinical examination or on a model-based case presentation. The average percentage agreement between two orthodontists for the treatment need based on clinical examination was 69, 66, and 61, respectively, corresponding to mean kappa values of 0.38, 0.32, and 0.22. When the model-based assessments were considered, the average percentage agreement between two orthodontists was 62, 58, and 69, respectively, corresponding to mean kappa values of 0.25, 0.16, and 0.37. Linear regression analysis of the orthodontists' treatment propensity as a function of their gender, place of education, years of orthodontic treatment experience, type of workplace, and place of work showed that only the orthodontic experience was influential for the model-based treatment propensity [β = 0.34 per cent/year (95 per cent confidence interval = 0.01-0.66)].

Is the Royal London Space Analysis reliable and does it influence orthodontic treatment decisions?

The purpose of this study was to investigate the reliability of the Royal London Space Analysis (RLSA) and to evaluate its influence on orthodontic treatment decisions. Thirty-one case records were collected to represent various levels of crowding and different types of malocclusions. Seventeen examiners assessed these records and completed a data sheet that recorded information on their treatment decision. One month later, the examiners attended a course on the RLSA and then used the analysis to rescore the 31 cases. The models were also scored by the expert who led the course and these were then considered the 'gold standard' scores. After a further month, the examiners reapplied the RLSA and formulated a treatment plan for each set of patient records. A paired Student's t-test and intraclass correlation coefficient (ICC) were used to assess the agreement in scoring RLSA, a paired sample t-test was used to compare the scores with the gold standard, and finally the reliability in treatment planning was determined using kappa (kappa) statistics. The scores for lower arch crowding showed the highest inter-examiner agreement with an ICC of 0.93 whereas the lowest level of agreement was for upper arch space requirement with an ICC of 0.77. Intra-examiner agreement was generally high, particularly for the assessment of lower arch crowding (ICC = 0.93) and lower arch space requirement (ICC = 0.88). There was excellent validity for all the examiners against the gold standard scores with a paired samples correlation ranging between 0.96 for lower arch crowding and 0.79 for upper arch space requirement. The intra-examiner reliability in treatment decision was only moderate, with an average kappa value of 0.52 (maximum 0.82, minimum 0.24). Intra- and inter-examiner agreement for scoring the RLSA was acceptable. Nevertheless, the additional information obtained from the application of the RLSA did not have a substantial impact on the treatment decisions.

Steiner cephalometric analysis: predicted and actual treatment outcome compared

To examine the accuracy and precision of the Steiner prediction cephalometric analysis. The sample consisted of 275 randomly selected patients, treated between 1970 and 1995 at a university department. Lateral cephalograms before (T1) and after orthodontic treatment (T2) were analyzed using the Steiner analysis. A prediction of the final outcome at T2 for the variables ANB degrees, U1 to NA mm, L1 to NB mm, and Pg to NB mm was performed at T1. The difference between the actual outcome at T2 and the Steiner predicted value (SPV), which was done at T1, was calculated. Accuracy (mean difference between T2 and SPV) and precision (standard deviation of the mean prediction discrepancies) of the prediction were studied. Paired t-test was used to detect under- or overestimation of the predicted values. The mean decrease in angle ANB was 1.4 +/- 2.7 degrees and for U1 to NA 2.0 +/- 2.6 mm, while L1 to NB increased 0.8 +/- 2.0 mm and Pg to NB 0.7 +/- 1.1 mm. The predicted values for the changes in ANB angle, the distance of upper incisor U1 to NA as well as the distance Pg to NB were significantly overestimated when compared with the actual outcome, while the change in the distance of lower incisor L1 to NB was underestimated. The prediction of cephalometric treatment outcome as used in the Steiner analysis is not accurate enough to base orthodontic treatment decisions upon.

Consistency of orthodontic treatment decisions relative to diagnostic records

The purpose of this study was to evaluate how incremental information obtained from different types of diagnostic records contributes to the determination of orthodontic treatment decisions. Pretreatment records of 57 orthodontic patients were assessed by five orthodontists who were part-time faculty members and also in private practice. This sample consisted of dental school orthodontic patients who had Class II malocclusions and included patients at three different dental developmental stages. The following diagnostic records were used: study models (S), facial photographs (F), a panoramic radiograph (P), a lateral cephalogram (C), and its tracing (T). Five combinations of diagnostic records were presented to the orthodontists in the following sequence: (1) S; (2) S + F; (3) S + F + P; (4) S + F + P + C; and (5) S + F + P + C + T. The simultaneous interpretation of all diagnostic records (S + F + P + C + T) was used as the "diagnostic standard." There was a diagnostic standard for each of the patients and for each of the orthodontists. The diagnostic standard was achieved: (1) S = 54.9%, (2) S + F = 54.2%, (3) S + F + P = 60.9%, and (4) S + F + P + C = 59.9%. Thus, in a majority of cases (55%), study models alone provided adequate information for treatment planning, and incremental addition of information from other types of diagnostic records made small differences.

A study on the use of diagnostic records in orthodontic treatment decisions: Unae Kim Han Ann Arbor, Michigan: The University of Michigan, 1989

A study on the use of diagnostic records in orthodontic treatment decisions: Unae Kim Han Ann Arbor, Michigan: The University of Michigan, 1989

Autotransplantation of Premolar Teeth to Replace Missing Maxillary Central Incisors

Orthodontic treatment decisions when maxillary central incisors are absent or are of poor prognosis, are discussed. Autotransplantation of mandibular first premolars to the incisor region is suggested as an approach in selected cases. The literature is reviewed, surgical technique described and case selection summarized. Cases are reported where autotransplantation of premolars to the maxillary incisor region has produced good functional and aesthetic results.