Effect of clear aligner attachment design on extrusion of maxillary lateral incisors: A multicenter, single-blind randomized clinical trial.

INTRODUCTION: Extrusion of maxillary lateral incisors during aligner treatment is a difficult movement to achieve accurately. Despite recommendations regarding attachment design, few studies and no prospective trials compare predictability among attachments. This study aimed to compare the efficacy between optimized and horizontal attachment designs for achieving maxillary lateral incisor extrusion during clear aligner treatment. METHODS: The study included maxillary lateral incisors in 3 orthodontic practices requiring at least 0.3 mm of extrusion during the first series of 20-25 aligners in patients aged ≥16 years who were scheduled to begin clear aligner treatment (Invisalign; Align Technology, San Jose, Calif). Teeth were randomly assigned to receive optimized (O), rectangular horizontal nonbeveled (H), rectangular horizontal incisally-beveled (HIB), or rectangular horizontal gingivally-beveled (HGB) attachments. After the first series, a blinded evaluator measured extrusion using superimpositions with initial and predicted models. Linear models determined the difference in the predicted extrusion percentage achieved on the basis of attachment design. Other covariates were patient age, sex, number of trays, and self-reported compliance. RESULTS: Forty patients (74 teeth) were enrolled, and 38 patients (71 teeth) completed the study. Intraexaminer and interexaminer reliability for extrusion measurements was high (intraclass correlation coefficient, 0.985 and 0.991, respectively). The achieved extrusion was significantly less than predicted (mean, 73%; P <0.0001). The average achieved extrusion was 62%, 79%, 78%, and 78% for O, H, HIB, and HGB attachments, respectively, with H significantly more effective than O (P = 0.0403). Horizontal attachments (H, HIB, and HGB combined) were significantly more effective than O attachments (P = 0.0060), with an average difference in achieved extrusion of 14% of the predicted amount (95% confidence interval, 4-23; estimated 76% vs 62%). Horizontal attachments were an estimated 22% more effective than O attachments for extruding maxillary lateral incisors. CONCLUSIONS: Horizontal attachments are more effective than O attachments for predicted maxillary lateral incisor extrusion between 0.3 and 2.5 mm. The 3 horizontal attachment designs evaluated performed similarly for achieving predicted extrusion. TRIAL REGISTRATION: This randomized clinical trial was registered and reported at clinicaltrials.gov (NCT04968353). PROTOCOL: The protocol was not published before trial commencement. FUNDING: This study was funded in part by the Alexander Fellowship of the Virginia Commonwealth University School of Dentistry, the Southern Association of Orthodontists, and the Virginia Orthodontic Education and Research Foundation. No funding source influenced the study design, the collection, analysis or interpretation of data, writing of the report, or the decision to submit the article for publication.

Research and orthodontics: About scientific progress in biomechanics.

This article describes the importance of biomechanics in orthodontics through the development of the segmented arch technique and the research performed in this field. Clinicians are encouraged to develop specific goals of treatment based on a precise diagnosis and to design appliances that will deliver the desired force system. In this article we emphasize the importance of a thorough analysis of the force system needed to achieve the desired orthodontic tooth movement and avoid any of the undesired side effects of treatment mechanics. We show that a well-thought out and planned treatment will lead to better clinical outcomes that will benefit our patients.

Clear aligner therapy in the mixed dentition: Indications and practitioner perspectives.

INTRODUCTION: This study evaluated current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors. METHODS: An original, 22-item survey was mailed to a randomized, nationally representative sample of practicing orthodontists (n = 800) and a specific, randomized subsample of high-aligner-prescribing orthodontists (n = 200). Questions assessed respondents' demographic information, experience with clear aligner therapy, and perceived advantages and disadvantages of CAMD compared with fixed appliances (FAs). Responses were compared using McNemar's chi-square and paired t tests to assess CAMD vs FAs. RESULTS: One thousand orthodontists were surveyed, and 181 (18.1%) responded over 12 weeks. CAMD use was less common than mixed dentition FAs, but most respondents predicted an increase in their future CAMD use (57.9%). Among respondents using CAMD, the number of patients with mixed dentition treated with clear aligners was significantly lower than the number of total patients with clear aligners (23.7% vs 43.8%; P <0.0001). Fewer respondents considered skeletal expansion, growth modification, sagittal correction, and habit cessation feasible indications for CAMD compared with FAs (P <0.0001). Perceived compliance was similar for CAMD and FAs (P = 0.5841), but perceived oral hygiene was significantly better with CAMD (P <0.0001). CONCLUSIONS: CAMD is an increasingly common treatment modality for children. Most surveyed orthodontists reported limited indications for CAMD compared with FAs but perceived noticeable benefits for oral hygiene with CAMD.

Adaptations in orthodontics for current and future coronavirus disease 2019 best practices.

INTRODUCTION: This study aimed to determine adaptations orthodontists made during the coronavirus disease 2019 pandemic to maintain safety and determine which adaptations will remain after the pandemic. METHODS: An original 34-question survey was sent by mail to a randomized selection of practicing orthodontic specialists (n = 1000). Questions included the changes made during the pandemic in 4 categories (infection control, social distancing, appliance type, and teleorthodontics) and whether those changes will remain postpandemic. RESULTS: The use of personal protective equipment increased during the pandemic, with a significant decrease anticipated after the pandemic. The most common aerosol modification during the pandemic and predicted after the pandemic was using an assistant with high-volume suction (61% and 49%, respectively; P = 0.0013). Ninety-six percent of orthodontists changed their waiting room protocol during the pandemic, but only 23% plan to continue that practice (P <0.0001). Forty-two percent of orthodontists increased clear aligners during the pandemic in response to patient demand (91%). The use of teleorthodontics increased from 8% to 68% during the pandemic and is expected to decrease significantly postpandemic. Virtual appointments are anticipated to be used for screening and consultations of new patients and monitoring active patients in clear aligners but not fixed appliances. CONCLUSIONS: The specialty recommended patient safety modifications during the coronavirus disease 2019 pandemic. Postpandemic, enhanced personal protective equipment is expected to decrease, and high-volume suction will likely be continued for aerosol-producing procedures. Teleorthodontics will likely remain in limited use.

Total arch maxillary distalization using infrazygomatic crest miniscrews in the treatment of Class II malocclusion: a prospective study.

OBJECTIVES: To evaluate treatment effects in Class II patients using infrazygomatic crest (IZC) miniscrews (MS). MATERIALS AND METHODS: A prospective sample of 25 adolescents (14 females and 11 males; mean age: 13.6 ± 1.5 years) who underwent maxillary dentition distalization treatment with IZC MSs were recruited. Lateral cephalograms and digital models at the beginning of treatment (T1) and after Class II molar correction (T2) were obtained. To compare cephalometric and digital model changes, paired t-test and Wilcoxon test were used. A significance level of 5% was used. RESULTS: All patients achieved Class II molar correction over a mean period of 7.7 ± 2.5 months. The IZC MS therapy provided 4 mm of distalization; there was 1.2 mm of intrusion of the first molar with 11.2° distal tipping. The maxillary incisors were retracted 4.7 mm and tipped lingually 13.4°. Overjet and overbite showed a reduction of 3.6 mm and 2.4 mm, respectively. The occlusal plane rotated clockwise 2.8°. The upper lip was retracted by 1 mm and the nasolabial angle increased 5.1°. There was an increase in the interpremolar and intermolar distances. CONCLUSIONS: Total arch distalization of the maxillary dentition using IZC MS was effective in the treatment of Class II malocclusions.

Patient perspectives on teledentistry and face-to-face doctor interaction during orthodontic treatment.

INTRODUCTION: Teledentistry in orthodontics is growing, yet patient preferences for its use is unknown. This study aimed to determine the perceived value of doctor-to-patient face-to-face interaction, convenience, and attitudes toward specific uses of teledentistry among orthodontic patients. METHODS: Private practice orthodontists emailed an electronic survey to active patients. Patients aged ≥18 years completed the survey regarding their treatment. Parents of patients aged <18 years completed a separate survey regarding their child's treatment. Responses were compared on the basis of patient characteristics (adult vs child, braces vs clear aligners, etc). RESULTS: Three hundred and seventy-seven respondents from 8 orthodontic practices participated in the survey. Eighty-five percent of parents considered face-to-face interaction important, and 85% said that their child's treatment fit conveniently into their schedule. Adult responses were 86% and 89%, respectively. Adult preference for face-to-face was significantly higher than parents of adolescent patients (83% vs 78%; P = 0.038). Adults treated with clear aligners were less likely to strongly agree that their treatment fitted conveniently in their schedule (51% vs 76% in braces; P = 0.0490) and were more likely to be interested in using teledentistry (27% vs 18% in braces; P = 0.0429). CONCLUSIONS: Most orthodontic patients prefer to be seen face-to-face. This is due to the high value placed on face-to-face interaction with the orthodontist. Most patients do not consider their treatment inconvenient. Patients prefer that teledentistry be used to enhance communication as opposed to replacing face-to-face interaction. Implementing teledentistry in orthodontics should be applied on a patient-to-patient basis with continued emphasis on the doctor-patient relationship.

Perceived efficacy of extrusion of maxillary lateral incisors with aligners.

INTRODUCTION: This study aimed to assess the perceived efficacy of aligners (Invisalign; Align Technology, Santa Clara, Calif) at performing extrusive movements of maxillary lateral incisors and to evaluate and compare differences in treatment planning protocols and other interventions used when required between orthodontists and general dentists with various degrees of experience. METHODS: An original 18-question survey was sent by mail to a randomized and geographically proportionate selection of orthodontic specialists (N = 400) and general dentists (N = 400) listed as providers on the Invisalign Web site. The data were analyzed using analysis of variance and chi-square tests. RESULTS: One hundred twenty-six providers responded to the survey (15.8% response rate), including 36 general dentists and 90 orthodontists. Overall, the average perceived efficacy was 4.71 out of 10 (95% confidence interval, 4.28-5.14). The threshold for identification of tracking issues was significantly associated with provider type (P = 0.0305). General dentists were significantly more likely to prefer an optimized attachment (P = 0.0001), whereas orthodontists were significantly more likely to prefer a gingivally-beveled horizontal rectangular attachment (P <0.0001). A refinement scan was the most common intervention method, followed by the bootstrap technique. CONCLUSIONS: The average perceived efficacy for extruding maxillary lateral incisors with aligners was 4.71 out of 10. Orthodontists had a lower tolerance than general dentists for tracking issues. A refinement scan was the most common method of intervention. General dentists and orthodontists differed in their treatment planning preferences and timing of intervention.

A comparison of patient testimonials on YouTube of the most common orthodontic treatment modalities: Braces, in-office aligners, and direct-to-consumer aligners.

INTRODUCTION: The aims of this study were to (1) investigate and compare the educational value of the most popular YouTube (www.youtube.com; Google, San Bruno, Calif) orthodontic patient testimonials between braces, in-office aligners (IOA), and direct-to-consumer aligners (DTCA), and (2) classify the emotional response of the viewers through sentiment analysis of the video comments. METHODS: Three different phrases relevant to braces, IOA, and DTCA were searched on YouTube. The 20 most popular patient testimonial videos meeting the criteria for each group were selected for a total of 60 videos. Using the YouTube application program interface for each video, 13 video metrics were extracted. An information completeness score was assigned, and the video comments were analyzed using sentiment analysis software. RESULTS: The 60 videos included were viewed 34.4 million times by internet users. Braces videos had significantly more likes, comments, and a higher viewer interaction score than the IOA and DTCA videos. IOA videos had a higher median information completeness score than braces and DTCA videos. Of the 5149 video comments with polarity, 53.6% were positive, and 46.4% were negative (P <0.0001). There was no significant association between the treatment modality and positive or negative comments (P = 0.5679). CONCLUSIONS: There is high user engagement on YouTube with orthodontic patient testimonials. YouTube users interact with braces patient testimonials the most. YouTube viewers' comments on orthodontic patient testimonials express more positive sentiment than negative sentiment. There was no significant difference in positive and negative sentiment between the video comments for the 3 different treatment modalities.

Orthodontists' and parents' perception of finished occlusion and willingness to extend treatment time.

INTRODUCTION: Patients and parents want shorter treatment times, but it is unclear whether they would compromise outcome quality to shorten treatment. The purpose of this study was to compare orthodontists' and parents' perceptions of finished occlusion and their willingness to extend treatment time to achieve improved outcomes. The effects of elapsed treatment time and patient compliance were also investigated. METHODS: Parallel surveys for orthodontists (n = 1000) and parents (n = 750) displayed simulated treatment outcomes of well-aligned teeth with occlusions in 1 mm increments from 3 mm Class III to 3 mm Class II. Participants rated their preferences on a visual analogue scale (VAS; 0-100) and specified whether they would extend treatment, and for how long, to improve the occlusion. RESULTS: Two hundred thirty-three orthodontists (23%) and 243 parents (32%) responded. Despite differences between the scores given (P < 0.0001), both groups rated Class I occlusion most acceptable (mean VAS = 93.9 and 80.7, respectively) and 3 mm Class III malocclusion least acceptable (mean VAS = 25.9 and 40.9, respectively). Parents were willing to extend treatment more often and for a greater time than orthodontists to improve results (P < 0.0001). In addition, parents were less willing to terminate treatment early (P < 0.05). Both groups perceived existing outcomes as more acceptable if the patient was noncompliant (P < 0.05), but elapsed time in treatment had no significant effect on ratings. CONCLUSIONS: For outcomes with well-aligned teeth, orthodontists and parents agreed on what the most and least acceptable occlusal relationships were. To achieve better outcomes, parents were willing to extend treatment duration more often and for a greater time than were orthodontists. In addition, parents were less willing than orthodontists to terminate treatment early.

The effect of orthognathic surgery on facial recognition algorithm analysis.

INTRODUCTION: The purpose of this study was to evaluate the ability of a publicly available facial recognition application program interface to calculate similarity scores for presurgical and postsurgical photographs of patients who underwent orthognathic surgeries. Our primary objective was to identify which surgical procedure(s) had the greatest effect(s) on the similarity score. METHODS: Existing photographs for 25 orthodontic-orthognathic patients were analyzed using the application program interface to calculate similarity scores between the presurgical and postsurgical photographs. Photographs from 2 presurgical timepoints were compared as controls. Both relaxed and smiling photographs were included to assess the added impact of a facial pose. Patient characteristics and surgery types were recorded for statistical analysis. Nonparametric Kruskal-Wallis rank-sum tests were performed to analyze the relationship between patient characteristics and similarity scores. Multiple comparisons Wilcoxon rank-sum tests were performed on the statistically significant characteristics. RESULTS: Recognition scores were significantly lower after orthognathic surgery at rest (P = 0.009) and smiling (P <0.001). Patients receiving both LeFort I and bilateral sagittal split osteotomy (BSSO) surgeries had a lower median similarity score compared with those that received only BSSO (P = 0.009) when comparing relaxed photographs before and after surgery. Similarly, for the score comparing presurgical relaxed photographs to postsurgical smiling photographs, patients that received both surgeries were found to have lower similarity scores compared with those receiving only BSSO (P = 0.036). CONCLUSIONS: Two-jaw surgeries were associated with a statistically significant decrease in similarity score when compared with 1-jaw procedure. Pose was also found to be a factor influencing similarity scores, especially when comparing presurgical relaxed photographs to postsurgical smiling photographs.

Comparison of patient factors influencing the selection of an orthodontist, general dentist, or direct-to-consumer aligners.

INTRODUCTION: This study aimed to evaluate the factors that influence potential orthodontic patients choosing an orthodontist, general dentist, or direct-to-consumer (DTC) aligners for their treatment, and to determine the level of interest in each provider type. METHODS: An electronic survey was administered to 249 adults among the general population in the United States to determine and evaluate the level of interest in pursuing orthodontic treatment with each provider type. RESULTS: When asked their preference for provider type, 44% of respondents selected orthodontist, 34% selected DTC aligners, and 22% selected general dentist. Among respondents with the highest level of interest in pursuing orthodontic treatment, 50% selected orthodontist, and 27% selected DTC aligners (P = 0.002). For respondents with a moderate interest in pursuing treatment, only 21% selected orthodontist, and 48% selected DTC aligners (P = 0.002). The biggest perceived advantage of treatment with orthodontists was the quality of treatment, and for DTC aligners, it was convenience, followed by cost. Among adults with children, 34% selected DTC aligners for themselves, and only 16% selected DTC aligners when selecting for their children (P = 0.0001). CONCLUSIONS: There is a high level of interest among adults in pursuing treatment with both orthodontists and DTC aligners. Patients with the highest level of interest in pursuing orthodontic care tend to prefer orthodontists, whereas those with a moderate interest in pursuing treatment prefer DTC aligners. Patients tend to select orthodontists primarily because of treatment quality, whereas they select DTC aligners for convenience and then cost. Parents tend to select an orthodontist for their child's treatment, even when selecting DTC aligners for themselves.

A needle in a haystack: Report of a retained archwire fragment in the pterygomandibular space.

This clinical report describes a retained archwire fragment, discovered during a new-patient examination of a young woman seeking orthodontic retreatment. The diagnostic process, care coordination, and patient management decisions are discussed, along with a brief exploration of clinical considerations associated with this incident. A suggested emergency prevention and response protocol is also presented.

Clear aligner treatment: different perspectives between orthodontists and general dentists.

PURPOSE: To evaluate differences between orthodontists and general dentists in experience with clear aligners (CA), patients' demand and perception, types of patients, and malocclusion treated with CA and to compare the two groups of clinicians not using CA in their practice. METHODS: A Web-based survey was developed and sent to the 129 members of the European Aligner Society and randomly to 200 doctors of dental surgery by e-mail. They responded on demographics and to one of two different parts for clinicians using CA or not using CA. Statistical analysis was performed with SAS EGv.6.1. RESULTS: The response rate was 74%. Among the total of respondents, the majority reported utilizing CA in their practice with a greater percentage of orthodontists (P = 0.0040). Overall, orthodontists learned more about CA during academic seminars comparing to general dentists, and they treated more class I with crowding (P = 0.0002) and with open bite (P = 0.0462). The majority of patients treated with CA were female and adults with a full-time employment, and the patients' knowledge about CA treatment was mainly provided by information from external media advertising. For respondents not using CA, orthodontists were more likely to report that CA limit treatment outcomes, whereas general practitioners were reported not having enough experience to use them. CONCLUSIONS: There were some significant differences between orthodontists and general dentists mainly in experience and case selection for clinicians using CA as well as in the reasons provided for not using CA in their practice.

Malocclusion as a Cause for Temporomandibular Disorders and Orthodontics as a Treatment.

This article explores the long-standing controversy between orthodontics and temporomandibular disorders (TMDs). It reviews the history of this controversy and presents a discussion of the current literature concerning the potential role of malocclusion in the onset of TMDs. It also explores the potential role of orthodontic treatment as a possible cure for TMDs and concludes, based on the most current evidence-based literature, that there is no relationship.

Management of the Maxillary Diastema by Various Dental Specialties.

PURPOSE: There is considerable controversy in the literature concerning the indications for frenectomy for treating a maxillary diastema and for timing of the procedure. The purpose of this study was to survey pediatric dentists, orthodontists, and oral and maxillofacial surgeons on their opinion of this matter to develop a consensus. MATERIALS AND METHODS: An anonymous 7-item electronic questionnaire was sent to members of the American Academy of Pediatric Dentists, the American Association of Orthodontists, and the American Association of Oral and Maxillofacial Surgeons asking about the etiology of the maxillary diastema, its diagnosis, and treatment. RESULTS: Although there was no agreement among the oral and maxillofacial surgeons for the timing of frenectomy and when the diastema should be closed, the pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space. CONCLUSION: Although there was no complete consensus among the 3 groups, a logical treatment approach for the maxillary diastema is proposed.

Provider Appearance: A Survey of Guardian and Patient Preference.

PURPOSE: The purposes of this study were to: (1) assess children's preferences for their pediatric dentist's attire; (2) assess guardians' preferences for their child's pediatric dentist's attire; and (3) determine which attributes are associated with different types of attire. This was a cross-sectional descriptive study using survey methodology with patients and parents who attended the pediatric dental clinic at Virginia Commonwealth University, Richmond, Va., USA. METHODS: A total sample of 100 guardians and 97 pediatric patients completed the computer-based questionnaire. Four subjects posed for photographs wearing various combinations of attire (professional, casual, white coat, scrubs). RESULTS: Among guardians, 56 percent reported preferring a provider in scrubs, with white coat the second most preferred attire (39 percent) for their children. For pediatric patients, scrubs were still most often selected, but at a lower rate (43 percent), and the white coat remained the second most preferred (37 percent). CONCLUSIONS: Children and parents have strong perceptions and preferences regarding their dentists' attire.

Twitter analysis of the orthodontic patient experience with braces vs Invisalign.

OBJECTIVE: To examine the orthodontic patient experience having braces compared with Invisalign by means of a large-scale Twitter sentiment analysis. MATERIALS AND METHODS: A custom data collection program was created that collected tweets containing the words "braces" or "Invisalign" for a period of 5 months. A hierarchal Naïve Bayes sentiment analysis classifier was developed to sort the tweets into five categories: positive, negative, neutral, advertisement, or not applicable. Each category was then analyzed for specific content. RESULTS: A total of 419,363 tweets applicable to orthodontics were collected. Users posted significantly more positive tweets (61%) than they did negative tweets (39%; P ≤ .0001). There was no significant difference in the distribution of positive and negative sentiment between braces and Invisalign tweets (P = .4189). Positive orthodontics-related tweets often highlighted gratitude for a great smile accompanied with selfies. Negative orthodontic tweets frequently focused on pain. CONCLUSION: Twitter users expressed more positive than negative sentiment about orthodontic treatment with no significant difference in sentiment between braces and Invisalign tweets.

Treatment management between orthodontists and general practitioners performing clear aligner therapy.

OBJECTIVE: To investigate differences in case selection, treatment management, and aligner treatment expertise between orthodontists and general practitioners. MATERIALS AND METHODS: A parallel pair of original surveys with three sections (case selection, treatment management, and demographics) was sent to orthodontists (N = 1000) and general dentists (N = 1000) who were providers of aligner treatment. RESULTS: Orthodontists had treated significantly more patients with aligners, had treated more patients with aligners in the previous 12 months, and had received more aligner training than general dentists (P < .0001). In general, case confidence increased with increasing experience for both orthodontists and general dentists. After adjusting for experience, there was a significant difference in aligner case confidence between orthodontists and general dentists for several malocclusions. General dentists were more confident than orthodontists in treating deep bite, severe crowding, and Class II malocclusions with aligners (P ≤ .0001). Significant differences were also found for all treatment management techniques except interproximal reduction. CONCLUSION: There was a significant difference in case selection, treatment management, and aligner expertise between orthodontists and general dentists, although the differences in case selection were small. Overall, it was shown that orthodontists and general dentists elected to treat a variety of moderate to severe malocclusions with aligners but with different utilization of recommended auxiliaries, perhaps demonstrating a difference in treatment goals.

Orthodontic marketing through social media networks: the patient and practitioner's perspective.

OBJECTIVE: To (1) assess orthodontic patient and practitioner use of and preferences for social media and (2) investigate the potential benefit of social media in marketing and communication strategies in orthodontic practices. MATERIALS AND METHODS: A survey was developed and randomly distributed to orthodontists via the American Association of Orthodontists and to patients/parents via private practices throughout the United States. Participants were asked to answer questions related to their use of social media and their perceptions of the use of social media in the orthodontic practice. RESULTS: Of the participants, 76% of orthodontists and 89% of patients/parents use social media. Furthermore, Facebook was the social media platform that was most preferred. Social media use was more common in female and younger adult participants. Orthodontists posted information more often in the morning (40%) and afternoon (56%), and patients/parents used social media mainly in the evening (76%). The most commonly used marketing strategies in the orthodontic practices were social media (76%) and a practice website (59%). Social media and practice websites were positively related with new patient starts (P  =  .0376, P  =  .0035, respectively). CONCLUSIONS: Most orthodontists and patients/parents used social media. Social media may be an effective marketing and communication tool in an orthodontic practice.