Orthodontic Treatment Outcome Research Articles

Quality of Life of Patients with Jaw Deformities

Recently, the importance of subjective measures such as patient satisfaction and quality of life has been recognized in clinical practice. Surgical orthodontic treatment for patients with jaw deformities not only improves maxillofacial morphology and occlusion, but also has a positive impact on oral and maxillofacial function, psychological and social aspects, and improves the quality of life of the patients. The Orthognathic Quality of Life Questionnaire, which was developed as a jaw deformity disease-specific quality-of-life scale, is also a useful method for assessing the quality of life in patients with jaw deformities. On the other hand, patient satisfaction is an important quality-of-life measure, but not all patients are satisfied with the results of surgical orthodontic treatment. Therefore, in order to increase patient satisfaction, it is essential to carefully analyze the patient’s complaints during the preoperative medical interview based on a correct diagnosis of jaw deformities, to fully discuss the surgical technique and the direction and amount of jaw movement with the patient, and to obtain sufficient informed consent for any possible complications.

Soft tissue profile changes during treatment of patients with class II malocclusion

Introduction/Objective. The class II malocclusion results in disbalanced facial harmony, primarily noticeable in the profile and the lower facial third. Aside from skeletal evaluation, orthodontic diagnosis and treatment planning should include facial soft tissue analysis. The aim of the study was to identify the soft tissue profile outcomes of orthodontic treatment of class II, division 1 malocclusion patients and to determine if these changes are related to different treatment protocols. Methods. The first group was the non-extraction group (25 patients) initially treated with the Herbst appliance, and the second group was four premolars extraction group (25 patients) treated with a multibracket appliance. The patients? cephalograms and pre- and post-treatment profile photographs were used. Results. The improvement in the non-extraction group was evident in the decrease of the nasomental angle, the angle representing the projection of the upper lip to the chin, as well as the upper lip angle. In the extraction group, the nasolabial angle showed a significant increase. Soft tissue variables showed significant differences between the groups: the total facial angle or facial convexity including the nose and the angle presenting the projection of the upper lip to the chin. Conclusion. The patients treated without extractions showed a significant improvement of the convex profile and favorable soft tissue changes in the lower third of the face.

Ability of piezocision to retain orthodontically moved teeth in a goat model: A split-mouth study.

OBJECTIVES:to evaluate the effectiveness of piezocision in enhancing retention when performed after orthodontic tooth movement.METHODS:Four mature goats had their second incisors removed bilaterally. For each goat, the two sides of the mandible were either treated with piezocision or served as a positive control. Using fixed orthodontic appliance, the first and third incisors on each side were approximated and then retained in place for two weeks. Relapse was measured by the amount of space developed between the approximated incisors after six weeks from the end of the retention period. The periodontal ligament of all incisors was assessed histologically with micro computed tomography and regular hematoxylin and eosin staining.RESULTS:A significantly less relapse was observed in the piezocision group than in the control group (p ≤ 0.05). Bone formation occurs in the vicinity and periphery of the periodontal ligament and thus results in the narrowing of the periodontal ligament.CONCLUSION:A protocol of post-orthodontic retention involving piezocision can be promising to enhance stability of orthodontic treatment outcome.

Patient’s expectation of orthodontic treatment attending tertiary care dental hospital in Kathmandu

Introduction: Understanding of patient’s expectation and attitude towards orthodontic treatment plays an importantrole towards a successful treatment outcome and behavioral management. Materials and Method: All the patients (270) attending department of Orthodontics in Nepal Medical College for the first time were included in the study. The descriptive study is done. A structured questionnaire was used to obtain the socio-demographic information and responses to questions on their expectation of orthodontic treatment. Results: Majority of the respondents had higher expectations on aesthetic outcome of orthodontic treatment than the functional outcomes. They expected to have better smile, teeth straightened and have confidence socially. The lowest mean scores were obtained in the domains of improvement in career and making speech easier. Females had significant higher scores than male participants in all domains explored with the mean highest score in the domain of better smiles; while the highest male mean score was in the domain of straightened teeth. Conclusion: To achieve successful orthodontic treatment result, patient cooperation is necessary. Agreeing with the patient on realistic expected treatment outcomes by the orthodontist before the treatment is required so that they are not disappointed with the final appearance.

Tingkat Kebutuhan dan Perubahan Hasil Perawatan Ortodonti Berdasarkan Indeks ICON (Kajian pada Pasien Klinik Ortodonti RSGM-P FKG USAKTI)

Background: Malocclusion is a common oral health problem. Orthodontic treatment is needed to treat malocclusion so that the teeth can achieve a good occlusion. The need for orthodontic treatment and the outcome can be measured using an orthodontic index. One of the orthodontic indexes that can measure the need for orthodontic treatment and the outcome is ICON index. Purpose: To find out the level of need and changes in the outcome of orthodontic treatment in the RSGM-P FKG USAKTI’s orthodontic clinic based on the ICON index. Method: This research is a descriptive observational study with a cross-sectional design. Examination and measurement of the study model of patients aged 8 – 12 years old who came to the orthodontic clinic of RSGM-P FKG USAKTI in January 2018 – December 2019 was carried out based on the ICON component. a score was given based on the condition of the teeth in the study model. Result: the assessment of 48 patients showed that 36 patients (75%) were categorized as needing orthodontic treatment and 12 patients (25%) were categorized as not needing orthodontic treatment. Treatment result were assessed with improvement level. It was found that no subject was categorized as greatly improved, 5 patients (10,42%) were categorized as substantially improved, 15 patients (31,25%) were categorized as moderately improved, 15 patients (31,25%) were categorized as minimally improved, and 13 patients (27,08%) were categorized as not improved/worst. Conclusion: The research results illustrate that most of the patients treated at the orthodontic clinic RSGM-P FKG USAKTI require orthodontic treatment and the improvement level are mostly categorized as moderately improved and minimally improved.

A method of fabricating computer aided design-computer aided manufacturing implant-supported provisional restorations with clear aligner attachments: A technical report.

To provide a method of fabricating implant-supported provisional restorations with orthodontic attachments by digital technique. Polymethylmethacrylate (PMMA) provisional restorations are usually necessary when dental implants are serving as anchors for orthodontic treatments. For clear aligner treatment, it is possible to setup the teeth virtually and determine the final position of the implants, indicating that the provisional restorations can be also predetermined. However, attachments on PMMA restorations have a higher risk of debonding due to low bond strength. To fabricate provisional restorations with predetermined shape and position and no risk of attachment debonding immediately after implant placement, a digital workflow is introduced in this article. By combining "pick-up" technique and prefabricated monolithic PMMA provisional restorations, this technique is recommended for making implant-supported provisional restorations with integrated orthodontic attachments based on the digitally designed positions of the teeth. The present protocol describes a digital workflow of designing and manufacturing implant-supported PMMA provisional restorations with orthodontic attachments in the predetermined position of implants, which should lead to more reliable and predictable orthodontic treatment outcomes.

Knowledge of Students as Orthodontic Users in Maintaining Dental and Oral Hygiene

Interest and awareness to take care of dental and oral hygiene is upstanding. Orthodontics besides filling and extraction in the practice of dental and oral health is in use. Maintaining oral hygiene during orthodontic treatment will greatly result in good gingival health, which can be seen in the final results of orthodontic treatment.This paper outlines the knowledge of maintaining oral and dental hygiene by orthodontic users among students in Poltekkes Kemenkes Banjarmasin. This study is descriptive research. The research was conducted with a cross-sectional approach. The research took place at Poltekkes Kemenkes Banjarmasin. Sixty students became the population. The research sample was selected by Total Sampling, namely all orthodontic users, totaling 50 students.Remarkably, the knowledge of maintaining oral and dental hygiene of orthodontic users are good, that is 5 students with a percentage of 10%, fair category as many as 32 students with a percentage of 64%, and a bad category as many as 13 students or 26%.In conclusion, the knowledge of most students of Poltekkes Kemenkes Banjarmasin as the users of orthodontics is fair in maintaining dental and oral hygiene. It is expected that students will pay more attention and expand their knowledge about how to keep their teeth and mouth clean while using orthodontics in order to obtain maximum orthodontic treatment results.

Effects of self-ligating brackets and other factors influencing orthodontic treatment outcomes: A prospective cohort study.

ObjectiveThe purpose of this study was to evaluate the effects of self-ligating brackets (SBs) and other factors that influence orthodontic treatment outcomes.MethodsThis two-armed cohort study included consecutively treated patients in a private practice. The patients were asked to choose between SBs and conventional brackets (CBs); if any patient did not have a preference, he or she was randomly allocated to the CB or SB group. All patients were treated using an identical archwire sequence. Evaluated parameters were as follows treatment duration, number of bracket failures, poor oral hygiene, poor elastic wear, extraction, use of orthodontic mini-implants (OMI), OMI failure, American Board of Orthodontics (ABO) Discrepancy Index (DI), arch length discrepancy, and ABO Cast-Radiograph Evaluation (CRE) score. Stepwise regression analysis was performed to generate the equation for prediction of the CRE.ResultsThe final sample comprised 134 patients with an average age of 22.73 years. The average DI, CRE, and treatment duration were 21.81, 14.25, and 28.63 months, respectively. Analysis of covariance showed a significant difference in CRE between the CB and SB groups after adjusting for the effects of confounding variables. Stepwise regression analysis using four variables, namely extraction, SB use, poor elastic wear, and additional appliance use, could explain only 25.2% of the variance in the CRE.ConclusionsAlthough the CRE was significantly better for CBs than for SBs, the clinical significance of this result seems to be limited. Extraction, SB use, poor elastic wear, and additional appliance use may have significant effects on treatment outcomes.

Longitudinal analysis of the quality of orthodontic treatment outcome and stability of occlusal traits

Objectives To assess the quality and stability of orthodontic treatment outcome relative to the initial malocclusion. Material and methods The study was performed in one public health care clinic in Finland. Study subjects comprised 51 orthodontic patients (age range 12.7–18.7 years). Pre-treatment medical records and lateral skull radiographs were analysed for malocclusion type. The main reasons for orthodontic treatment were mandibular retrognathia, Class II distal bite, deep bite and crowding. At the end of a retention phase (Examination 1), the quality of treatment outcome was assessed using the occlusal morphology and function index (OMFI) and patients were asked about treatment satisfaction. Stability of occlusal traits and patient satisfaction were re-evaluated after a two-year follow-up (Examination 2). Occlusal characteristics descriptive statistics were performed. Results At Examination 1, all six morphological criteria for acceptability were fulfilled by 76% and all functional criteria by 82% of the patients. All OMFI criteria were met by 67% of the patients. At Examination 2, 68% of the patients fulfilled all morphological and 82% all functional criteria of acceptability. At Examination 2, all the OMFI criteria were still met by 64% of the patients and 92% expressed satisfaction with own occlusion. The main reasons for unacceptability were deficiencies in canine relationship and overbite, in addition to functional protrusion interferences. Conclusions In the evaluated health care clinic, patient satisfaction and the quality of treatment outcome were high. However, deep bite showed a tendency for relapse.

Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis.

To answer these PICO questions: #1: In adult patients with malocclusion, what are the effects of orthodontic tooth movement (OTM) on clinical attachment level (CAL) changes in treated periodontitis patients with a healthy but reduced periodontium compared to non-periodontitis patients? #2: In adult patients with treated periodontitis and malocclusion, which is the efficacy of skeletal anchorage devices compared to conventional systems in terms of orthodontic treatment outcomes? Seven databases were searched until June 2020 looking for randomized, non-randomized trials and case series. Mean effects (ME) and 95% confidence intervals (CIs) were calculated. Twenty-six studies with high risk of bias were included. PICO#1: In 26 patients without periodontitis and in 69 treated periodontitis patients, minimal changes in periodontal outcomes were reported after orthodontic therapy (p>0.05). A significant CAL gain (mm) (ME=3.523; 95% CI [2.353; 4.693]; p<0.001) was observed in 214 patients when periodontal outcomes were retrieved before a combined periodontal and orthodontic therapy. PICO#2: Orthodontic variables were scarcely reported, and objective assessment of the results on orthodontic therapy was missing. Based on a small number of low-quality studies, in non-periodontitis and in stable treated periodontitis patients, OTM had no significant impact on periodontal outcomes.

Does quality of orthodontic treatment outcome influence post-treatment stability? A retrospective study investigating short-term stability 2 years after orthodontic treatment with fixed appliances and in the presence of fixed retainers.

The present study aimed to evaluate stability 2years after orthodontic treatment and to investigate the influence of various pre-treatment and post-treatment prognostic factors on stability. Consecutive patients treated with full fixed appliance and retained with fixed retainers were retrospectively assessed for eligibility. Digital models were analysed at treatment start (T0), end of treatment (T1) and 2years post-treatment (T2). The Peer Assessment Rating (PAR) index, Little's Irregularity Index (LII), arch width and length, overjet, overbite and presence of unexpected post-treatment changes were assessed. Multiple regression analyses were conducted to model the relationship of all outcomes with several prognostics simultaneously. The sample consisted of 287 subjects (mean treatment time: 25.1months, standard deviation [SD] 7.5; mean post-treatment follow-up: 27.5months, SD 6.1) with a mean weighted PAR score of 29.5 (SD 8.6) at T0, 1.8 (SD 2.9) at T1 and 3.2 (SD 3.6) at T2. At T1, 95% of the subjects had a perfect LII versus 86% at T2. An increased LII at T1 correlated with increased LII and PAR changes from T1 to T2. PAR at T1 as well as overjet at T0 was a significant prognostic factor for PAR at T2. At T2, five cases (1.7%) showed unexpected post-treatment changes related to fixed retainers. Short-term post-treatment stability with fixed retainers was very good. Prognostic factors for stability included LII and PAR at T1, suggesting that high-quality treatment outcome in the presence of fixed retainers may ensure post-treatment stability.

Periodontal support and escort for healthy orthodontic treatment

Health and support of periodontal tissue is the basis for achieving excellent, safe and efficient orthodontic treatment outcome, which also guarantees the esthetics, stability and function of treatment objectives. The support of healthy periodontal tissue contributes to the stability of teeth. Orthodontic treatment also requires adaptive periodontal reconstruction during tooth movement. Well-aligned teeth and balanced occlusion play an important role in maintaining and improving periodontal homeostasis. Healthy orthodontic treatment can improve the health of periodontal structure and functions, which has to rely on the existence and reconstruction of healthy periodontal tissue. Therefore, orthodontics and periodontal health have dialectically close association and mutual maintenance. Favorable "periodontal support and escort" is indispensable for healthy orthodontic treatment.

Influence of functional and esthetic expectations on orthodontic pain.

To investigate the effect of orthodontic treatment outcome (OTO) expectations on the level of pain intensity experienced after orthodontic elastomeric separation (OES). Atotal of 100 orthodontic patients (74female and 26male, age 14years and above) from the Faculty of Dentistry, Mahidol University were enrolled. Before OES, questionnaires were administered to obtain patients' expectations regarding various aspects of OTO as well as OES pain expectations. Real-time self-reported pain intensity from OES at the maxillary and mandibular first permanent molars was obtained before and immediately after separator placement and at 6 h, 24 h, and then every day until day 7after OES. Data were analyzed for the relationship between OTO expectations and OES pain intensity. The level of significance was set at 0.05. The maximum OES pain intensity occurred on day 2after OES and gradually decreased to the pretreatment level on day7. The degree of facial, tooth alignment, masticatory function improvement expectations, and ahigh level of OES pain expectations were significantly associated with the severity of OES pain after separator placement. Esthetic and functional expectations of OTO were significantly associated with OES pain intensity. Thus, knowledge about esthetic and functional expectations may help to predict patient's pain response to orthodontic treatment.

Prioritized Commitment-Based Clinical Assessment: A New Method for Assessment of Orthodontic Treatment Outcomes.

Quality assessment is an essential part of orthodontic treatment. Most of the current indices are essentially based on occlusal assessment. However, an ideal occlusion is only one aspect of an ideal treatment. The aim of this article is to introduce a new prioritized commitment-based clinical assessment (PCCA) method and present its reliability and linear correlation test in comparison with the comprehensive clinical outcome assessment (CCA). One hundred treated cases were scored with the conventional assessment tool--the CCA--and the newly developed assessment tool--the PCCA--with 2 calibrated examiners at 2 different time intervals. These cases were randomly selected including equal numbers of the main malocclusions managed with fixed conventional edgewise appliances within the past 3 years and had complete pre-treatment and post-treatment routine records. The intraclass correlation coefficient (ICC) was used to assess the intra- examiner repeatability of the total scores of both methods. Pearson's correlation coefficients were computed to assess the linear relationships between the CCA and PCCA scores. The intra-examiner reliability assessed for CCA and PCCA showed high repeatability for both examiners (ICC: 0.93 and 0.945, respectively). The inter-examiner reliability values for CCA and PCCA, assessed by ICC, were 0.84 and 0.96, respectively. The linear correlation between the 2 methods, assessed by comparing the mean score of each case by the 2 examiners was significant, at 0.01. The PCCA method can be used for quality assessment in treated orthodontic patients. The preliminary test of the new method presented good inter- and intra-observer agreements and a significant linear correlation with the CCA method.

The effect of X-ray irradiation to the formation of polychromatic erythrocyte cell micronucleus in Wistar rats (Rattus norvegicus)

Background: Panoramic and cephalometric radiography is very important for diagnosis, treatment plan, and evaluation of orthodontic treatment results. Panoramic and cephalometric radiography are frequently performed at the same time, causing DNA damage and chromosome aberration. Purpose: This study aims to analyse the effect of X-ray exposure in panoramic and cephalometric radiography on micronuclei cell numbers. Methods: Laboratory-based analytical study with 60 healthy-male Wistar rats weighing 200–300 grams divided into 6 treatment groups (n=10). The control group: without radiographic exposure, the treatment group 2: using panoramic radiographic exposure followed by cephalometric, and the treatment group 3: using panoramic radiographic exposure and 24 hours later performed cephalometric radiographic. The unit of analysis was the polychromatic erythrocytes of mice cell, were examined 24 hours and 48 hours after irradiation had been finished. The polychromatic erythrocytes were examined using May-Gruenwald-Giemsa staining and 100x magnification under a microscope with 2000 cells per view. Data obtained were analysed using the SPSS 20 version software. The mean and standard deviations were calculated for each clinical parameter, and a one‐way ANOVA statistical test of significance was used. Statistical significance was set at p&lt;0.05. Results: The analysis showed a significant increase (p&lt;0.05) in the number of micronucleus in groups that used panoramic radiographic exposure followed by cephalometric. Conclusion: X-ray radiation can increase the number of micronucleus in polychromatic erythrocyte cells in rats.

Diagnosis and Management of Obstructive Sleep Apnoea – A Literature Review

Timely diagnosis of obstructive sleep apnoea and its management is an important factor in terms of orthodontic treatment outcomes. Symptoms of obstructive sleep apnoea being suggestive of the condition need to be given consideration along with predisposing factors that lead to obstructive sleep apnoea. Attention must be given to those patients identified with the predisposing factors who are likely to develop obstructive sleep apnoea. A variety of treatment options are available this day, beginning with lifestyle modifications, appliances, pharmacological management and ultimately surgical management depending on the severity of obstructive sleep apnoea which is identified through grading.

ОЦЕНКА КАЧЕСТВА РЕЗУЛЬТАТОВ ОРТОДОНТИЧЕСКОГО ЛЕЧЕНИЯ В КЛИНИКАХ Г.САНКТ-ПЕТЕРБУРГА

To date, various methods of qualitative and quantitative assessment of dental-facial anomalies have been described in the medical literature. They describe the causes of dental anomalies, determine the localization of disorders, consider the functional state of the dental system, as well as quantify the degree of violations of facial aesthetics, occlusion, morphology and function in various dental-facial anomalies. To assess the effectiveness of orthodontic treatment, it is necessary to conduct a quality assessment in patients with dentofacial anomalies who have completed orthodontic treatment. The essence of the proposed method is that on the basis of tables developed and structured according to several blocks, an assessment of the quality of orthodontic treatment is proposed, including an assessment of the aesthetics of the face and smile, articulation and occlusal ratios, malocclusion anomalies in the sagittal, vertical and transversal directions, the state of periodontal tissues and hard tissues of the teeth, as well as the state of the temporomandibular joint in patients who have completed orthodontic treatment. The assessment of the quality of orthodontic treatment consists of three blocks: assessment of the quality of the results of orthodontic treatment, assessment of the process of orthodontic treatment, assessment of the maintenance of medical records. According to the results of filling in which, a conclusion is made about the quality of the orthodontic treatment. The overall assessment of the quality of orthodontic treatment is obtained by summing up the results of the three assessments received, and the assessment of the quality of clinical work is crucial. The method developed by us allows us to make an expert assessment of the process of orthodontic treatment, the quality of its results and the maintenance of medical records in patients who have completed orthodontic treatment. The article presents the results of the assessment of the quality of orthodontic treatment in the clinics of St. Petersburg.

Determination of Pubertal Growth Plot Using Hand-wrist and Cervical Vertebrae Maturation Indices, Dental Calcification, Peak Height Velocity, and Menarche

Introduction: Pubertal growth stages are important periods in orthodontic treatment with functional appliances and orthognathic surgery. Pubertal growth prediction, which determines the amount of growth that has taken place and estimates the remaining growth, can influence diagnosis, treatment goals, treatment plans, and orthodontic treatment outcomes, especially in cases requiring growth intensity or growth completion. Determination of pubertal growth stages is more accurate when performed using physiological maturation indicators than chronological age. There are several maturation indices that can be used to predict the pubertal growth stage, such as hand-wrist maturation, cervical vertebrae maturation index (CVMS), dental calcification, peak height velocity of body height (PHV), and menarche in females. The aim of this study was to identify the differences and correlation between hand-wrist, CVMS maturation stages, peak height velocity (PHV), canine and M2 calcification stages, and menarche age (of female subjects). The study also aimed to describe the pubertal growth curve plot of female and male subjects. Materials and Methods: This is a retrospective study with a cross-sectional approach, which included 279 females and 144 males aged 8-17 years. Subjects had digital lateral cephalograms, hand-wrist, and panoramic radiographs. The hand-wrist maturation stage was analyzed using the Fishman method, CVMS using Baccetti et al.’s method, and the stages of dental maturation were assessed using Demirjian and Goldstein method. PHV was measured from standing height using a wall-mounted plastic stadiometer, while menarche was analyzed through interviews. Statistical analysis by ANOVA, post hoc analysis, and Spearman’s rank correlation coefficient were determined with Excel Mega Stat. Results: There were significant differences between females and males in CVMS and hand-wrist (P&lt; 0.05) except for radius union (Ru). No significant differences in canine and M2 calcification between females and males were observed. PHV females increased by 7.89 cm at 11-12 years, while males increased by 9.9 cm at 13-14 years. Menarche occurred at the age of 12.2 years on average, with the oldest being 14.7 years and the youngest being 9.6 years. The correlation between females’ and males’ hand-wrist and CVMS was very high. The lowest correlation in females was between menarche and CVMS and in males, it was between PHV and canine. Conclusion: Maturation stages of hand-wrist, CVMS, and PHV females were earlier than males. Pubertal growth curves plot of females tended to skew to the left, demonstrating that the time from the beginning to the peak of pubertal growth is shorter than that from the peak to the end of pubertal growth, while pubertal growth curves plot of males tended to skew to the right, demonstrating that the time from the beginning to the peak of pubertal growth is longer than that from the peak to the end of pubertal growth.

Orthodontic retention and the role of the general dental practitioner.

Introduction Long-term orthodontic retention using removable or fixed retainers is needed to maintain the outcome of orthodontic treatment. The aim of this article is to describe how long-term retention is managed and to report on a survey of general dental practitioners (GDPs) as to how this management currently operates in the UK.Materials and methods GDPs were invited to complete a short online survey on orthodontic retention using an open notice posted in the British Dental Journal and a direct email to the members of a local dental clinical society.Results Fifty-six GDPs completed the online survey. Overall, the findings highlighted poor levels of communication between orthodontists and GDPs with respect to the latter assuming responsibility for the management of long-term retention.Conclusion The management of long-term retention could be improved by more effective communication between the orthodontist and GDP. One solution might be a retention management pro forma. GDPs are in some instances willing to undertake more of the management of retention following further training and possible remuneration.

Fixed retention: pitfalls and complications.

Long-term stability of orthodontic treatment results is problematic. Long-term or even lifelong retention with bonded retainers is being increasingly used among clinicians. Bonded retainers can provide an efficient and attractive method of retention, particularly because they require minimal compliance from patients. However, the use of bonded retainers is associated with relatively frequent complications, such as detachments of the adhesive layer or wire fractures, as well as unexpected complications with potentially severe consequences with associated periodontal and general health risks. It is imperative that the whole dental team are aware of these pitfalls and complications, and appreciate how to minimise and address these.