Orthodontic Specialists Research Articles

Orthodontic treatment standards in Norway

The outcome of orthodontic treatment is reported for a sample of 220 patients treated by Norwegian specialist orthodontists. The outcome was assessed using objective measures. The indices can be used to identify differences not only between individual practitioners, but also health care systems. It can be confirmed that the Norwegian orthodontists are producing a high standard of orthodontic treatment, the malocclusion is on average reduced by 78 per cent.

Contemporary trends in orthodontic practice: A national survey

This study involved the development of a questionnaire to elicit information about current trends in orthodontic practice compared with trends of 5 years ago. The subjects addressed included the use of fixed appliances, functional appliances, extraction therapy, orthodontics and the temporomandibular joint, current diagnostic aids, and medicolegal implications of orthodontic treatment. The questionnaire was mailed to 1400 orthodontic specialists who were randomly selected from across the United States. There were 814 questionnaires returned, representing a 58.14% response rate. The major results of this survey are as follows: (1) The reported extraction rate has declined from a mean of 37.74% 5 years ago to 29.28% today. (2) TMJ concerns (or medicolegal implications thereof) have had a considerable impact in this decline, with 26.4% of orthodontists being influenced, to some extent, to extract fewer teeth because of this factor. (3) The use of functional appliances has remained somewhat static over the last 5 years, after a period of rapid growth in the 5 years previous to that. (4) The preadjusted edgewise appliance is by far the most popular fixed appliance in use today, being chosen by 72.6% of respondents. Analysis of the overall results lead to the following conclusions: (1) Fixed appliance therapy is the therapy of choice of the overwhelming majority of orthodontists. The use, benefits, and role in orthodontics of functional appliance therapy is considerably less defined. (2) Treatment modalities, notably on the use of extraction and its relationship to the health of the temporomandibular joint, should be determined by research, not by legal fears or unsubstantiated allegation.

Orthodontic practice in The Netherlands.

Free movement of dental practitioners between the United Kingdom and The Netherlands presents no registration problems. Difficulties still exist for the registration of orthodontic specialists, but these should be solved with the introduction of the specialist register in Britain. Information is presented here which describes the mechanism for registration.

Glove use by orthodontists: results of a survey in England and Wales.

Attitudes to glove wearing during treatment of patients were tested by distribution of a questionnaire to 2000 dentists known to be practising under the National Health Service regulations in England and Wales. Of the dentists who replied, 41 specialist orthodontists, representing approximately one-sixth of all orthodontists working in the general dental services in England and Wales, were identified. Results indicate that 39 per cent of these orthodontic respondents wore gloves routinely for all patients and procedures, while 49 per cent wore gloves for some patients or procedures, with 12 per cent never wearing gloves. Reasons given by the occasional glove wearers for not wearing gloves routinely included loss of tactile sensation, perceived small risk, lack of comfort, and restriction of movement. Six per cent of those who replied had experienced skin irritation considered to be associated with glove wearing, while latex gloves were preferred by 78 per cent of respondents who wore gloves.

Orthognathic diagnosis and treatment planning: a cephalometric approach

Cephalometric analyses have long been important diagnostic tools for the orthodontic specialist. Such analyses, as they pertain to adult skeletal problems and their consequent therapy, should also be a valuable adjunct for various dental specialties, e.g. the oral surgical clinician. However, because of the complexity of most analyses, it is difficult to glean the important values needed for most orthognathic cases. In this article an analysis is presented to aid the clinician in surgical diagnosis and treatment planning.

Conservative approach to unerupted teeth within cystic lesions in Gorlin's syndrome

The unerupted maxillary canine is the tooth that most commonly requires surgical exposure and guided eruption. The orthodontic specialist must be aware that delayed eruption is caused, sometimes, by serious pathologic conditions such as cystic or neoplastic malformation. A case of a 12-year-old girl who suffered from Gorlin's syndrome (nevoid basal cell carcinoma syndrome) is presented. Her symptoms were multiple jaw keratocysts, skeletal anomalies, and cleft lip and palate. Some authors advocate an aggressive surgical approach to jaw keratocysts because of their tendency to recur, thus sacrificing those teeth associated with them. Our view is that in young patients with Gorlin's syndrome, an attempt should be made to preserve permanent teeth, especially those vital for a normal growth pattern of the jaws. Therefore we recommend a conservative surgical approach, enabling guided eruption of unerupted teeth associated with cystic lesions in patients with Gorlin's syndrome.

Malocclusion and methodology: The problem and relevance of recording dental malalignment in archaeology

AbstractThe study of incorrectly positioned teeth has a long history, especially in relation to human groups and domestic dogs. Dental and orthodontic specialists have been particularly concerned to establish ways of recording and comparing such anomalies. However, Colyer and others have established that anomalous dental positioning occurs in a wide variety of species, and might at times even have had adaptive advantage. In the case of dogs, some modern varieties clearly have severe malocclusion problems, while others are little affected. Because it has been suggested that early domesticated dogs already display some degree of dental crowding or malpositioning, it seems important to consider the methodology for recording such anomalies. It is suggested that a quick and easy method of recording and comparing tooth positioning is by angular measurements (preferably taken on standard photographs of occlusal views). In the British archaeological dog samples selected, it was found that tooth malpositioning (and thus malocclusion of upper and lower dentitions) was only slight, compared to the overall occurrence of such anomalies in modern dogs. It is suggested that this kind of simple procedure may be of value in the investigation of secular trends in the frequency of malpositioning and malocclusion of dogs, if not other species, through time.

Profiling providers of orthodontic services in general dental practice

This study was designed to ascertain whether general practitioners who provide some orthodontic treatment to a relatively large proportion of their patients tend to limit themselves to the treatment of simple cases while they continue to refer more difficult cases or whether a high volume of orthodontic treatment is linked to an expanded scope of treatment and fewer referrals. Data pertaining to volume, scope, and other correlates of orthodontic services in general practice were obtained through a survey of dentists currently in general practice in Iowa. Of 1159 questionnaires mailed out, 728 (62.8%) were returned. To determine how the values of recorded variables differ among the providers of high and low volumes of orthodontic services and to determine whether these differences are significant, chi 2 tests of independence were calculated. The results obtained were used to generate descriptive measures of the profiles of providers of a high volume of orthodontic services in general practice. These profiles indicated that providers of a high volume of orthodontic treatment (1) performed the same amount of limited orthodontic treatment as providers of a low volume of orthodontic treatment; (2) performed significantly more major orthodontic treatment; (3) used significantly more fixed appliances, functional appliances, and headgears, but not removable appliances; (4) took significantly more hours of continuing education in orthodontics; and (5) referred significantly fewer patients to orthodontic specialists. In view of the projected increase in the amount of orthodontics performed in general practice, these findings suggest that, in the future, relatively more major orthodontic treatment is likely to be provided by general practitioners.

An orthodontic expert system

A Fuzzy Relational Inference Language, FRIL has been used to generate an expert system to help non-specialist dentists with orthodontic problems. The use of fuzzy relations, descriptors and numbers has been found useful in modelling the thought processes of orthodontic specialists.

Thoughts on the future of orthodontic education and practice

Only by hnvolvement and constructive planning for our specialty can we as a group influence dental education—specifically, orthodontic training—and the conditions for practice we will face in the future: The development of undergraduate orthodontic teaching has been slow. It is argued that it is a necessity, and in our best interest, that we formulate an innovative curricular standard for orthodontic instruction to be included in the strategic planning for the future dental educational program. Regarding advanced training, orthodontics as a specialty branch of dentistry would be at a disadvantage if the number of places in orthodontic specialty programs is significantly reduced. Rather, assuming the accuracy of predictions of future increased demands for orthodontic care under decent economic conditions, it is suggested that if we allow for a slow but steady increase in the number of orthodontic specialists, we are going to create reasonably sound circumstances for future orthodontic specialty practice.

Future manpower requirements for orthodontics undertaken in the General Dental Service.

The fall in the number of births in England and Wales which took place between 1964 and 1977 is beginning to have an effect on the present-day demand for orthodontic treatment. Using the best available data a mathematical model has been used to predict the likely demand for orthodontic treatment in the General Dental Services of England and Wales from now until 2008. This suggests that there is likely to be a sharp decline in the number of new orthodontic patients presenting for treatment at practices limited to orthodontics during the next 5 years. The recent expansion in the number of places available for postgraduate study of orthodontics makes it extremely unlikely that the position will improve significantly thereafter. There can be little doubt that we are now producing too many orthodontic specialists even allowing for the increase in manpower which might be required to satisfy a future demand for higher standards of treatment.

Radiographs taken for orthodontic purposes in general practice.

This paper deals with the orthodontic aspects of a wider survey undertaken to determine the use of radiographs in general dental practice in the county of Avon. During the sample week 218 patients had radiography for orthodontic purposes of whom 184 were below the age of 15 years. There were marked differences in the radiographs used by general practitioners and specialist orthodontists and the possible reasons for these differences are discussed.

Some aspects of orthodontic specialist practice in the United Kingdom.

A questionnaire sent to orthodontic specialist practitioners provided information about the nature of specialist practice, the training of specialist practitioners and the patterns of treatment within orthodontic practices. Specialists are now undergoing more extensive postgraduate training and the use of fixed appliances is increasing. General dental practitioners are referring larger numbers of patients to orthodontic specialist practitioners. Several factors will soon be operating to encourage a raising of treatment standards in British orthodontics, namely a falling birth rate, an increased interest in dentistry by the general public and the availability of an increased number of well-trained orthodontic specialist practitioners. Some form of official recognition for the specialist practitioner role is now desirable whilst the historical model for delivery of orthodontic care defined at the inception of the National Health Service in in urgent need of revision.

A comparison of the frequency of general practitioner orthodontic treatments in Scotland 1966 and 1975. Should the present system be reviewed?

In both 1966 and 1975, a relatively high proportion of general dental practitioners in Scotland failed to provide orthodontic treatment in the General Dental Service (35 and 38 per cent respectively), and the majority of those practitioners providing an orthodontic service commenced treatment for no more than ten patients in each of these years, i.e. 56 per cent (1966) and 61 per cent (1975). These findings indicate that an urgent review of the present system is required if the quantity and quality of orthodontic treatment provided by the British National Health Service is to be improved. The present system has remained virtually unchanged since 1947, and it can now be seen to be both inefficient and uneconomic. The anomaly of specialist orthodontists acting as ‘general dental practitioners’ in practices ‘limited to orthodontics’ in the General Dental Service is also discussed. It is suggested that those dental specialties requiring prolonged postgraduate training should receive formal specialist recognition and status in the United Kingdom, and that the most satisfactory method of providing a more comprehensive service is by the recognition of orthodontics as a true specialty and by the simultaneous expansion of the hospital service to play a more positive role in the provision of treatment.

Minor Tooth Movement について

Although the definition of the term "minor tooth movement" has not been clearly established, the description by Drs. A. Geiger and L. Hirschfeld in their Minor Tooth Movement in General Practice that "to move a few teeth slightly to bring them to the proper positions" seems to be most valid. Among the reports made to date on minor tooth movement, some are rather remote from the securing of an ideal occlusion, from the viewpoint of orthodontists. With a view to establishing an overall occlusion with one mouth one unit, through the period from the deciduous to permanent dentitions, in terms of the management of oral health, a method using minor tooth movement to achieve a better occlusion has been described in the present paper. In comparison with the major orthodontic therapy, minor tooth movement generally involves a slight degree of movement of a limited number of teeth. There is therefore a tendency to consider it as a relatively simple operation. Minor tooth movement however has its rightful place in the category of orthodontics. The fundamental principles involved in therapy are the same as for the major orthodontic therapy. An extensive knowledge of diagnosis, tissue reactions of organism, and biomechanics of orthodontic appliances is therefore essential in performing minor tooth movement. Proficiency in techniques is also naturally required. Consequently, advice of orthodontic specialists should be sought and attention must always be given to the new developments in orthodontics. In addition to satisfying the requirements for the operators, patients' understanding and cooperation must be obtained in order to make the therapy a success. For the maintenance of functional occlusion, teeth must be in the physiologically proper positions and the periodontal tissues supporting them must be healthy. For the purpose of achieving such an occlusion, minor tooth movement will be an increasingly necessary therapy in general clinical work in the future. Furthermore, the day will come when it will be one of the clinically required treatments.

Continuing education for the orthodontist.

The need for continuing education is not confined to the general practitioner of dentistry. The specialist orthodontist generally welcomes new ideas but his isolation is even greater than that of the general practitioner. Facilities for refresher courses exist within the National Health Service and it is suggested that these should be of three types. Short symposia give an opportunity for the interchange of ideas between a large number of specialists. Courses of about one week's duration would involve limited numbers and might be either of a non-technical nature, concentrating on advances in orthodontic thought, or of a technical nature, teaching a new appliance.

Two years' basic specialty training in orthodontics: the British prospect in 1975.

In this paper the author acknowledges the importance to the aspirant specialist orthodontist of a 2-year period of basic specialty training, whether the orthodontist is going into an academic post, the hospital consultant service or whether he is going to limit his practice to orthodontics within the general dental services. He discusses the need to complete a period of general training in dentistry before going on to a 2-year course of training in orthodontics. This type of training should be given at a limited number of centres in university departments. During this extended period of basic specialty training the graduate is often under financial pressure. The need to pay the graduates who spend half of their time in a service role is stressed. The author discusses why Britain is moving into a situation in which in orthodontic training it is internationally in a minority of one and considers the dento-political background which has led to this. He is hopeful but pessimistic about the possibility of change.

Gaining Vertical Dimension for the Deep Bite Restorative Patient

The value of utilizing an orthodontic specialist in treating these patients cannot be overemphasized, but it should be borne in mind that the ultimate responsibility for the entire treatment belongs to the referring restorative dentist. Therefore, the restorative dentist must give to the orthodontist a detailed description as to where he wants the teeth to be positioned. At the same time, he should respect and appreciate the limitations of orthodontic treatment. Each case should be discussed in detail before and during treatment so that both orthodontist and restorative dentist know and understand the goals and limitations of the other. Although the authors utilized a modified Crozat technique, they feel that other appliances may produce comparable results. 5 It is suggested that the operator use any appliance which works well in his hands and yields the desired results. Often this requires modifications of basic techniques because of unique problems found in adults. Frequently in discussions of complete prosthetics, mention has been made about the problem of encroachment on freeway space to a point where the patient is uncomfortable and complains of tired muscles, teeth colliding, and so on. However, the authors have not encountered this problem in the treatment of Class II deep bite patients, although the vertical dimension has, in some instances, been increased several millimeters in the anterior region. These patients may not encounter discomfort due to the increased vertical dimension for two possible reasons: first, they are biting on soft acrylic splints or bite planes; secondly, the extended treatment periods necessary for tooth movement allow the patient to accommodate gradually. Once these patients were orthodontically treated and the restoration completed, there was little need for a long retention period, except for some severely rotated anterior teeth. It is felt that the cusp-to-fossa arrangement of the occlusion acts to retain the posterior teeth, while the lips, tongue, and cheeks act to retain the anterior teeth —this may be termed functional retention.

Dental Pathology and Archaeology

This investigation has been carried out to determine if any useful archaeological information can be obtained from the pathological features to be found in ancient human dentitions. Variations in dental decay, attrition, ante-mortem loss of teeth, and malocclusion have been observed in skulls from the Neolithic to Anglo-Saxon periods. Diet has been shown to be a major factor in the aetiology of dental disease and since diet is also related to social conditions it ought to be possible to derive some information from teeth concerning culture.An intractable difficulty in this study is that the skeletal remains of the more ancient civilizations are comparatively rare (n. 1). The material that does exist is often unsatisfactory because of fragmentary condition and sometimes inadequate excavation reporting. Data has to be derived from small samples which may give a misleading picture. Another difficulty lies in the definition of pathological features; for example, the term malocclusion allows broad interpretation which has resulted in wide variations in frequencies observed. In this case specialist orthodontists tend to find a much greater incidence for a particular period than less experienced operators (n. 2). Post-mortem changes may also confuse the picture since in some soils erosion occurs which may simulate caries. Archaeological samples are nearly always drawn from widely differing backgrounds so that the size of the sample and the length of the period it represents may vary greatly. Brinch and Moller-Christensen say it is quite unjustifiable to compare results drawn from such samples (n. 3).

Orthodontic education for the nonorthodontist: Why, where, and how

Malocclusion is found in so many children that orthodontists cannot possibly treat all who need orthodontic care. Treatment is ruled out for many children, not only because of the shortage of qualified orthodontic specialists but also because of their geographic distribution and the relatively high cost of orthodontic treatment. Much malocclusion can be prevented or intercepted by the application of effective and usually simple measures. A list of indications is presented. Prophylactic or interceptive orthodontic techniques can be learned and applied by pedodontists and general practitioners of dentistry. The orthodontist's obligation to serve as teacher and consultant to his nonorthodontist colleagues by being a clinician on local and state dental programs is emphasized. If he assumes this obligation, fewer patients will be the victims of orthodontic treatment that is improperly planned by commercial laboratories and ineptly executed by inexperienced operators.