Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic.

During the current pandemic scenario, maxillofacial rehabilitation specialists involved with supportive care in cancer must transform its practice to cope with COVID-19 and improve protocols that could quickly return the oral function of complex cancer patients who cannot wait for surgical complex rehabilitation. This includes the role of the maxillofacial prosthodontist for the rehabilitation of surgically treated patients with maxillary cancers by the means of filling obturator prostheses that are considered an optimal scientific-based strategy to reduce hospital stay with excellent pain control, oral function (speech, swallowing, mastication, and facial esthetics), psychologic and quality of life outcomes for the patients following intraoral cancer resection. Therefore, the aim of this commentary was to bring new lights to the strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic as well as to present a protocol for managing such cases.

Accuracy of 3-dimensional printed dental models reconstructed from digital intraoral impressions.

INTRODUCTION: A rapidly advancing digital technology in orthodontics is 3-dimensional (3D) modeling and printing, prompting a transition from a more traditional clinical workflow toward an almost exclusively digital format. There is limited literature on the accuracy of the 3D printed dental models. The aim of this study was to assess the accuracy of 2 types of 3D printing techniques. METHODS: Digital and alginate impressions of the oral environment were collected from 30 patients. Subsequently, digital impressions were used to print 3D models using digital light processing (DLP) and polyjet printing techniques, and alginate impressions were poured up in stone. Measurements for the 3 model types (digital, DLP, and polyjet) were compared with the stone models. Tooth measurements (first molar to first molar) included mesiodistal (crown width) and incisal/occlusal-gingival (crown height). Arch measurements included arch depth and intercanine and intermolar widths. Intraobserver reliability of the repeated measurement error was assessed using intraclass correlation coefficients. RESULTS: The intraclass correlation coefficients were high for all recorded measurements, indicating that all measurements on all model types were highly reproducible. There were high degrees of agreement between all sets of models and all measurements, with the exception of the crown height measurements between the stone and DLP models, where the mean difference was statistically significant. CONCLUSIONS: Both the DLP and polyjet printers produced clinically acceptable models and should be considered viable options for clinical application.

Whither orthodontics?

What is the destiny, the future, for orthodontics and its specialists? It is disappointing that industry is leading our thinking these days. Much of our professional life centers around the device- and machine-based techniques, claims, and marketing of manufacturers. When did our passive role as followers happen and why? We may begin to reclaim control of our specialty by revising some aspects of our training programs and journal formats. Meanwhile, we may go back several decades in the literature and find useful insights from clinical sages-applied scientists-who were clearheaded, truthful, and science-based observers, writing before the industrial manipulation and noise we now have to compete with.

The possibility of modification and improvement of dental services in Poland for children and adolescents with special emphasis on orthodontic service.

AIM: World Dental Federation reveals that dental caries is one of the most common diseases in the world, and as much as 90% of the population is facing oral cavity problems. About 28% of teenagers aged 10 and 15 absolutely needs orthodontic treatment and about another third of this age group represents very serious cases. The aim of this study is to verify the authorial model which modifies and facilitates the system of dental services in Poland with a special emphasis on orthodontic service. MATERIAL AND METHODS: The research was carried out with the method of diagnostic survey through a survey questionnaire. For this study, 1159 people were questioned for the research. In order to check the reliance between the variables Pearson chi-square test and the test of the Highest Reliability were used. Average market prices and the "prices expected" by the Greater Poland Voivodship Department of National Healthcare System were used to price dental services. RESULTS: The research revealed that the highest percentage of people who used only private dental services is between 19 and 64 years of age and the lowest percentage is represented by the elderly, i.e. subjects over 65 years of age. As for the dental services offered by the National Health Fund, the highest percentage of patients are children and adolescents under 18 and the lowest percentage of patients is represented by people in the working age. The tendency towards private healthcare is in direct proportion to parents' increase in the level of education. The main reason why parents take their children to a private dentist is the long waiting time for the visit offered by the National Health Fund as well as better materials and equipment offered by private dentists. The costs connected with extending the basket of guaranteed services for children and youngsters are combined with the increase in National Health Fund expenditure reaching EUR 7,014,151. The lack of refunding dental services for patients aged 19-64 will generate savings reaching about EUR 34,756,765. CONCLUSION: The reduction of public funds allocated for dental treatment of patients aged 19-64 will generate savings which will satisfy the needs connected with the increase in the range of refunded orthodontic treatment with the use of orthodontic permanent braces for patients under 18 years of age. The solution suggested will only slightly affect people in the working age as they reveal a strong tendency for treatment financed with their private funds.

Measuring the effectiveness of patient-chosen reminder methods in a private orthodontic practice.

OBJECTIVE: To evaluate the effectiveness of patient-chosen appointment reminder methods (phone call, e-mail, or SMS text) in reducing no-show rates. MATERIALS AND METHODS: This was a retrospective case study that determined the correlation between patient-chosen appointment reminder methods and no-show rates in a private orthodontic practice. This study was conducted in a single office location of a multioffice private orthodontic practice using data gathered in 2015. The subjects were patients who self-selected the appointment reminder method (phone call, e-mail, or SMS text). Patient appointment data were collected over a 6-month period. Patient attendance was analyzed with descriptive statistics to determine any significant differences among patient-chosen reminder methods. RESULTS: There was a total of 1193 appointments with an average no-show rate of 2.43% across the three reminder methods. No statistically significant differences ( P = .569) were observed in the no-show rates between the three methods: phone call (3.49%), e-mail (2.68%), and SMS text (1.90%). CONCLUSIONS: The electronic appointment reminder methods (SMS text and e-mail) had lower no-show rates compared with the phone call method, with SMS text having the lowest no-show rate of 1.90%. However, since no significant differences were observed between the three patient-chosen reminder methods, providers may want to allow patients to choose their reminder method to decrease no-shows.

Socioeconomic disparities in orthodontic treatment outcomes and expenditure on orthodontics in England's state-funded National Health Service: a retrospective observational study.

BACKGROUND: This study aimed to assess whether there are potential areas for efficiency improvements in the National Health Service (NHS) orthodontic service in North West England and to assess the socioeconomic status (SES)-related equity of the outcomes achieved by the NHS. METHODS: The study involved a retrospective analysis of 2008-2012 administrative data, and the study population comprised patients aged ≥10 who started NHS primary care orthodontic treatment in North West England in 2008. The proportions of treatments that were discontinued early and ended with residual need (based on post-treatment Index of Orthodontic Treatment Need [IOTN] scores that met or exceeded the NHS eligibility threshold of 3.6) and the associated NHS expenditure were calculated. In addition, the associations with SES were investigated using linear probability models. RESULTS: We found that 7.6% of treatments resulted in discontinuation (which was associated with an NHS annual expenditure of £2.3 m), and a further 19.4% (£5.9 m) had a missing outcome record. Furthermore, 5.2% of treatments resulted in residual need (£1.6 m), and a further 38.3% (£11.6 m) had missing IOTN data (due to either a missing outcome record or an incomplete IOTN outcome field in the record), which led to an annual NHS expenditure of £13.2 m (44% of the total expenditure) on treatments that are a potential source of inefficiency. Compared to the patients in the highest SES group, those in the lower SES groups were more likely both to discontinue treatment and to have residual need on treatment completion. CONCLUSIONS: Substantial inefficiencies were evident in the NHS orthodontic service, with 7.6% of treatments ending in discontinuation (£2.3 m) and 5.2% ending with residual need (£1.6 m). Over a third of cases had unreported IOTN outcome scores, which highlights the need to improve the outcome monitoring systems. In addition, the SES gradients indicate inequity in the orthodontic outcomes, with children from disadvantaged communities having poorer outcomes compared to their more affluent peers.

Re-shaping NHS orthodontic provision - the North Wales experience.

The orthodontic service provision within North Wales, in common with many areas of the United Kingdom, was experiencing increasing waiting times for assessment and treatment. Reasons for this included an increasing population, patient demand and fixed NHS contracted orthodontic provision. In addition to these universal challenges, the geography of North Wales contributed to difficulties in accessing care. It was felt that with a reshaping of the orthodontic services there was potential to enhance the quality of orthodontic care available to patients and deliver prudent NHS orthodontic services. Three distinct, but inter-related steps, were identified to progress the reshaping of the service with the intended outcome of achieving an improved co-ordinated service. Initially, this involved the re-commissioning of the primary care specialist service through a formal retendering process. Following this, a standardised orthodontic referral form was developed, to be used for all orthodontic referrals regardless of whether their destination was a primary or secondary care provider. Finally, a formal accreditation process for all non-specialist dentists who were undertaking NHS orthodontic treatment was developed and implemented. The successful outcome of this process was only possible because of the close working partnership between the North Wales Orthodontic Managed Clinical Network (OMCN) and Betsi Cadwaladr University Health Board.

[How to manage with rigour but flexibility an orthodontic practice]. / Gérer son cabinet d'orthodontie entre rigueur et flexibilité.

INTRODUCTION: An orthodontic office owner must understand the context and then combine logic, emotion, intuition and common sense. The productivity approach is no longer acceptable. It is necessary to combine rigour, flexibility and pragmatism. DISCUSSION: The obsessive perfectionism is ineffective. In fact, there are four ways to demonstrate a flexible determination: persevere when appropriate, win the support of your entourage, back on some decisions, appeal to the collective will. Another needed feature is to have the flexibility to change its own habits and change the ones of others. Some practical examples based on the five available resources (time, money, people, training and equipment) illustrate the concepts discussed. CONCLUSION: Both qualities are necessary for the orthodontic business manager today: strong leadership and flexibility. The best attitude lies in the combination of these two seemingly contradictory requirements.

Infiltrante resinoso vs Microabrasão no manejo de lesões de mancha branca: relato de caso / Resin infiltration vs microabrasion in white-spot lesions treatment: case report

Objetivo: Apresentar caso clínico de tratamento estético das lesões de mancha branca após tratamento ortodôntico nos dentes superiores anteriores através de duas técnicas minimamente invasivas usando o sistema de infiltração de resina e microabrasão. Relato de caso: Paciente com 18 anos de idade apresentava lesões de manchas brancas inativas nos dentes 11, 12, 13, 21, 22, 23. O sistema de infiltrante de resina Icon (DMG, Hamburgo, Alemanha) foi utilizado nos dentes 11, 12, 13, enquanto os dentes 21, 22, 23 foram submetidos à microabrasão com Whiteness RM (FGM, Joinville, Santa Catarina, Brasil).Ambos os protocolos foram utilizados de acordo com as recomendações do fabricante.Nos dentes 21 e 22, o produto para microabrasão foi aplicado com espátula que acompanha o kit, enquanto que no dente 23 utilizou-se o mesmo produto aplicado com taça de borracha em baixa rotação, todos os procedimentos executados por um único operador. A microabrasão com taça de borracha proporcionou uma superfície mais lisa e homogênea.Ambos os produtos tiveram resultados satisfatórios na resolução estética das lesões de mancha branca após um ano de acompanhamento. Conclusão: Os dois produtos apresentam bom desempenho e resolutividade para os problemas estéticos de lesões de manchas brancas inativas, entretanto deve-se levar em conta o tempo clínico, toxicidade, a atividade da lesão e a possibilidade de desgaste da estrutura dentária.

Objective: To present a case report of aesthetic treatment of post orthodontic white--spot lesions in the anterior superior teeth through two minimally invasive technique susing resin infiltration system or microabrasion. Case report: Patient 17 years of age had inactive white-spots lesions on teeth 11, 12, 13, 21, 22, 23. The teeth 11, 12, 13 received the resin infiltrating system Icon (DMG, Hamburg, Germany) while the teeth 21, 22, 23were submitted to microabrasion with Whiteness RM (FGM, Joinville, Santa Catarina, Brazil). Both protocols were used according to manufacturer’s recommendations. In the teeth 21 and 22, the product of the microabrasion was applied with a spatula that accompanied the kit, while the tooth 23 received the same product applied with a rubbercup at low speed turbine, all by a single operator. The microabrasion with rubber cupoccasioned a more smooth and homogeneous surface. Both products had satisfactory results in aesthetic resolution of the white-spots lesions, for a 1-year follow-up. Conclusion:Although both products are able to resolve aesthetic problems of inactive white-spots lesions, it should be taken into account the clinical time, toxicity, the activity ofthe lesion and the possibility of wear of the tooth structure.

O desafio do tratamento ortodôntico do paciente com fenótipo facial hiperdivergente / The challenge of the orthodontic treatment of the hyperdivergent facial phenotype patient

Objetivo: o artigo visa informar aos profissionais da área de Ortodontia os desafios de se diagnosticare tratar pacientes que apresentem fenótipo facial hiperdivergente. Materiais e métodos: através de revisão sistemática da literatura, via PubMed e Google Acadêmico, identificou-se os melhores artigos, descritivos e experimentais, nas áreas relacionadas. Dessa seleção, 30 artigos foram revisados e discutidos. Resultados: embora a prevalência de fenótipos faciais hiperdivergentes na população dos EUA (por falta de dados referentes à população brasileira) seja bastante pequena, seu diagnóstico e tratamento são desafiadores. Os principais fatores causais envolvidos em seu desenvolvimento são:a) genéticos; b) epigenéticos e; c) ambientais. A postura mandibular tem um papel fundamental no estabelecimento deste tipo facial, e algumas características morfológicas são patognomônicas: a)excessiva altura facial anterior inferior; b) falta de altura facial posterior; c) ângulo goníaco aberto;d) rotação mandibular desfavorável; e) plano oclusal inclinado anteriormente para baixo; f) sínfisementoniana aumentada e fina e; g) ossos corticais mais delgados, tanto na maxila como na mandíbula.Além disso, esses indivíduos apresentam funções respiratória e mastigatória deficientes. Em geral, apresentam mordida aberta anterior e possivelmente mordida cruzada posterior. Conclusão: o estabelecimento do fenótipo facial hiperdivergente é complexo e multifatorial. A ocorrência de fenômenos morfofuncionais severos sequenciais é difícil de ser controlada ou revertida e as possibilidades terapêuticas são, na melhor das hipóteses, limitadas e ainda experimentais.

Goal: the goal of the paper is to inform orthodontic professionals about the challenges to diagnose and to treat patients presenting hyperdivergent facial phenotype. Materials and methods: a systematic review of the literature was conducted using PubMed and Google Academics, and the best descriptive and experimental studies in the related areas were identified. From the initial selection, 30 papers were revised and discussed. Results: although the prevalence of individuals presenting hyperdivergent facial phenotype in the USA population (since no Brazilian epidemiologic is available) is considerably low, diagnosis and treatment are challenging. The major causal factors involved in its development are: a)genetic; b) epigenetic and; c) environmental. The mandibular posture has a fundamental role in the establishment of such facial type, and some morphological features are pathognomonic: a) excessive inferior anterior facial height; b) lack of posterior facial height; c) increased goniac angle; d) un favorable mandibular rotation; e) occlusal plane anterior ly tilted down; f) higher and thinner mandibular symphysisand; g) thinner maxillary and mandibular cortical bones. Furthermore, these individuals present respiratory and masticatory functions deficiences. In general, they present anterior open bite and possibly posterior cross bite. Conclusion: settling of the hyperdivergent facial phenotype is complex and multifactorial. The occurrence of sequential severe morphofunctional phenomena is hardly controlledor reverted, while therapeutic options are limited and still experimental.

The European Board of Orthodontists.

The multiplicity of nations, languages and differing ways and levels of specialized orthodontic education in Europe lead to the need for an objective review of the quality of orthodontic care. To this purpose, The European Board of Orthodontists (EBO) was introduced. This article gives an overview of the objectives of the EBO, its development and the requirements for membership.