Social, intellectual, psychological, and attractiveness judgements of lay people about patients before and after combined orthodontic-orthognathic surgical treatment.

BACKGROUND: Facial appearance plays a significant role in the success of social interactions. There is a limited amount of evidence investigating the influence of combined orthodontic-orthognathic surgical treatment on the social judgments of lay people. OBJECTIVE: The aim of this study was to investigate whether changes in facial appearance following orthognathic surgery alter the social judgements made by lay people. ETHICAL APPROVAL: Ethical approval was granted from the University of Sheffield School of Clinical Dentistry Research Ethics Committee on 17th August 2020 (Reference: 033775). MATERIALS AND METHODS: This cross-sectional, web-based survey involved clinical photographs of six Caucasian female patients pre- and post-combined orthodontic-orthognathic treatment. Three patients had a pre-treatment class 2 skeletal pattern, and three patients had a pre-treatment class 3 skeletal pattern. Staff and students at the University of Sheffield, UK were invited to evaluate five personality traits: (i) friendliness, (ii) intelligence, (iii) attractiveness, (iv) self-confidence, and (5) trustworthiness using a 5-point Likert scale. The trait scores were summed to obtain a total social judgement score, and a paired t-test was used to compare the total scores from pre- and post-treatment images. RESULTS: There were 261 responses to the survey of which 181 (75%) were completed fully. The total social judgement scores from after treatment images were higher compared with the pre-treatment images (mean diff 1.6; P < .001) indicating more positive social judgements. The improvements in perceived social judgments were more notable for class 3 patients (mean diff 2.7) compared to class 2 patients (mean diff 0.7). CONCLUSION: Social judgement scores were higher (more positive) from post-treatment images of patient faces than their pre-treatment images. The findings highlight the possible indirect benefits combined orthodontic-orthognathic surgical treatment may have on an individual in a social setting.

"Over-reviewing" of research? An analysis of orthodontic reviews.

INTRODUCTION: Research overviews may be undertaken to identify gaps in the literature, evaluate existing systematic reviews (SRs), and summarize evidence. This paper aims to profile overviews that have been conducted in orthodontics and related interventions since 2012 and to evaluate the degree of overlap among these overviews. METHODS: Overviews published between January 1, 2012 and June 20, 2023 were identified using an electronic search involving Google Scholar and PubMed. A descriptive summary was produced, and citation matrices were used to evaluate the percentage of overlap between overviews using corrected covered area and covered area. This was classified as slight, moderate, high, or very high. RESULTS: A total of 35 overviews were identified across a wide range of topics. Eight overviews included <10 SRs; 21 had 10-20 SRs; and 6 included >20 SRs (median no. of SRs per overview, 15; range, 3-62). Meta-analysis was conducted in only 5 overviews. Overlap between overviews on the same topic ranged from slight (2.7%) to very high (53.8%). CONCLUSIONS: Almost all overview topics address treatments and their effects, with a wide variation in the number and quality of SRs included. There is considerable overlap in some orthodontic overviews, suggesting unnecessary duplication and research waste. Researchers should be encouraged to focus on primary data collection to add more high-quality data to SRs, which will ultimately enhance the yield from secondary and tertiary orthodontic research.

Extraction vs nonextraction of premolars for orthodontic treatment: A scoping review examining the extent, range, and characteristics of the literature.

INTRODUCTION: The debate about whether malocclusion can or should be treated with or without extraction of premolars continues. This scoping review quantifies the literature, summarizes the outcomes researched and methods, and proposes a way to reduce uncertainty in this area. METHODS: Electronic and gray literature searches were undertaken without language restriction, but non-English language titles and abstracts were not translated. A minimum of 2 people independently screened the titles and abstracts. RESULTS: Searches identified 9010 articles, of which 3851 were duplicates; 5159 were screened, and 4617 were excluded (1092 laboratory or animal studies, 1219 case reports or series, 2306 with no information). By consensus, 399 articles contained information concerning differences between orthodontic patients treated with or without premolar extractions (143 were unclear). The majority (n = 372) reported outcomes in 8 areas. Fifty-seven were review articles (32 systematic reviews and 25 nonsystematic reviews or opinions). The most common research design in the remainder was a cohort (n = 280, 82% of 342 articles reporting primary data), of which a very large majority were considered retrospective (n = 249, 89% of articles reported for subjects over ≥2 time points). Only 28 (8% of articles reporting primary data) were judged to involve prospective data collection (4 randomized controlled trials [RCTs], 23 cohorts, 1 unclear design). Excluding reviews and unclear articles, 99% (332 out of 336) were considered observational research and only 1% were interventional. CONCLUSIONS: There was limited low-quality evidence that extracting premolars in orthodontic patients have a possible negative effect in 2 outcome areas and a positive effect in 1 outcome area. Most study reports were of low methodological quality, and further reviews are unlikely to provide new information. Investigators should concentrate on collecting primary data of outcomes important to patients. A protocol has been made available to help reduce methodological differences, assist future meta-analyses and increase the generalizability of findings: https://doi.org/10.17605/OSF.IO/CQ49Y.

A qualitative evaluation of attitudes toward extractions among primary care orthodontists in Great Britain.

INTRODUCTION: The need to extract permanent teeth as part of orthodontic treatment has been keenly debated over many decades. Changes in the frequency of extraction have been well documented; however, we continue to lack an understanding of what influences clinicians' decisions regarding extracting permanent teeth. METHODS: Purposive sampling was undertaken to obtain representative views from primary care practitioners across Great Britain with a range of experience representing genders and wide geographic distribution. Twenty participants (9 female, 11 male) took part in in-depth, qualitative, 1-to-1 interviews based on a piloted topic guide. Interviews were conducted via video conferencing software with audio recording and verbatim transcription. Thematic analysis was performed with discussion and agreement to identify the main themes. RESULTS: Five main themes were identified: (1) patient-related factors, such as age and features of the malocclusion, (2) operator factors, including the level of experience, (3) setting, with regard to geographic location and method of remuneration, (4) mechanical approaches, including variations in appliance systems; and (5) self-directed ongoing education, including both formal continuing professional development and informal learning from peers. These factors acted as barriers, enablers, or both in relation to nonextraction treatment. CONCLUSIONS: Five key influences on extraction decisions among orthodontists in Great Britain were identified. Extraction choices appear to be influenced by various interrelated factors, evolving over time and with increased experience.

Fifty years of the British / Journal of Orthodontics.

BACKGROUND: It is 50 years since publication of the first volume of the British Journal of Orthodontics (BJO). Now known as the Journal of Orthodontics (JO), the official journal of the British Orthodontic Society strives to published high quality, evidence-based research. AIM: To compare the content of articles published by the BJO in 1973-1974 with those in the JO in 2022-2023 to identify any changes over 50 years. METHODS: BJO volume 1 issues 1-5 and JO volume 49 issues 2-4 and volume 50 issues 1-2 were hand-searched and full articles obtained. Some articles were excluded. The included reports were assessed using objective criteria (see Supplemental materials). RESULTS: Similar proportions of articles reporting the results of studies collecting data directly from participants of orthodontic interest were published (BJO: n = 12, 26%; JO: n = 15, 23%); however, there was an increase in the proportion of articles reporting studies that collected data from a non-orthodontic patient sample (BJO: n = 5, 11%; JO: n = 15, 23%). There was also an increase in the reporting of prospective data collection (BJO: n = 1; 6%; JO: n = 23, 79%), but much of this research was cross-sectional (BJO: n = 8, 50%; JO: n = 20, 69%), using convenience sampling (BJO: n = 13, 81%; JO: n = 23, 79% of articles reporting the results of data collected from human participants). Most research was non-experimental (BJO: n = 16, 100%; JO: n = 26, 90%). CONCLUSIONS: Some similarities in the types of reports published were found, as well as some encouraging differences. Decreasing retrospective data reports and increasing prospective data reports is welcome, but many are still non-experimental and cross-sectional. There is a need to publish more longitudinal, experimental clinical data to enhance knowledge and understanding of the effects of orthodontic treatment.

Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial.

BACKGROUND: Failure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla. METHODS: This protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment). DISCUSSION: There is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children. TRIAL REGISTRATION: ISRCTN Registry ISRCTN12709966 . Registered on 16 June 2022.

Development of the Orthodontic Treatment Impact Questionnaire: Cross-sectional validation.

INTRODUCTION: The need to involve patients in developing and evaluating health care interventions is now well-recognized. This study assesses and refines the Orthodontic Treatment Impact Questionnaire for use as a patient-reported outcome in an interventional clinical trial to evaluate and compare any orthodontic interventions. METHODS: The face and content validity of a previously developed questionnaire were tested in 2 focus groups involving adolescents aged 11-17 years. They were wearing a range of orthodontic appliances and at different treatment stages. A similar cross-sectional convenience sample completed the questionnaire during routine appliance adjustment appointments. A Rasch model, using item response theory, was used for item reduction, assessment of the response format, and differential item functioning. Spearman's rank correlation was used to assess construct validity, Cronbach α for internal consistency and reliability, and intraclass correlation coefficient for test-retest reliability. RESULTS: Seven adolescents (4 females, 3 males) were involved in the initial testing; 181 (117 females, 64 males; mean age, 14.7 ± 1.5 years) completed the questionnaire once and 41 twice. The initial measure demonstrated a misfit to the Rasch model. Ten of the original 31 items had disordered thresholds and were removed. The 5-point scale was changed to a 3-point scale. None of the participants demonstrated a misfit to the model. Construct validity (P = 0.480), internal consistency (Cronbach α = 0.827) and test-retest reliability (intraclass correlation coefficient = 0.85; 95% confidence interval, 0.73-0.92) were good. CONCLUSIONS: The initial Orthodontic Treatment Impact Questionnaire was tested and modified using item response theory. The modified questionnaire demonstrated good construct validity, reliability, and internal consistency. Further testing to assess generalizability and longitudinal responsiveness is required.

Interventions for promoting the eruption of palatally displaced permanent canine teeth, without the need for surgical exposure, in children aged 9 to 14 years.

BACKGROUND: A permanent upper (maxillary) canine tooth that grows into the roof of the mouth and frequently does not appear (erupt) is called a palatally displaced canine (PDC). The reported prevalence of PDC in the population varies between 1% and 3%. Management of the unerupted PDC can be lengthy, involving surgery to uncover the tooth and prolonged orthodontic (brace) treatment to straighten it; therefore, various procedures have been suggested to encourage a PDC to erupt without the need for surgical intervention. OBJECTIVES: To assess the efficacy, safety and cost-effectiveness of any interceptive procedure to promote the eruption of a PDC compared to no treatment or other interceptive procedures in young people aged 9 to 14 years old. SEARCH METHODS: An information specialist searched four bibliographic databases up to 3 February 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised controlled trials (RCT) involving at least 80% of children aged between 9 and 14 years, who were diagnosed with an upper PDC and undergoing an intervention to enable the successful eruption of the unerupted PDC, which was compared with an untreated control group or another intervention. DATA COLLECTION AND ANALYSIS: Two review authors, independently and in duplicate, examined titles, keywords, abstracts, full articles, extracted data and assessed risk of bias using the Cochrane Risk of Bias 1 tool (RoB1). The primary outcome was summarised with risk ratios (RR) and 95% confidence intervals (CI). We reported an intention-to-treat (ITT) analysis when data were available and a modified intention-to-treat (mITT) analysis if not. We also undertook several sensitivity analyses. We used summary of findings tables to present the main findings and our assessment of the certainty of the evidence. MAIN RESULTS: We included four studies, involving 199 randomised participants (164 analysed), 108 girls and 91 boys, 82 of whom were diagnosed with unilateral PDC and 117 with bilateral PDC. The participants were aged between 8 and 13 years at recruitment. The certainty of the evidence was very low and future research may change our conclusions. One study (randomised 67 participants, 89 teeth) found that extracting the primary canine may increase the proportion of PDCs that successfully erupt into the mouth at 12 months compared with no extraction (RR 2.87, 95% CI 0.90 to 9.23; 45 participants, 45 PDCs analysed; very low-certainty evidence), but the CI included the possibility of no difference; therefore the evidence was uncertain. There was no evidence that extraction of the primary canine reduced the number of young people with a PDC referred for surgery at 12 months (RR 0.61 (95% CI 0.29 to 1.28). Three studies (randomised 132 participants, 227 teeth) found no difference in the proportion of successfully erupted PDCs at 18 months with a double primary tooth extraction compared with extraction of a single primary canine (RR 0.68, 95% CI 0.35 to 1.31; 119 participants analysed, 203 PDCs; mITT; very low-certainty evidence). Two of these studies found no difference in the proportions referred for surgical exposure between the single and the double primary extraction groups data at 48 months (RR 0.31, 95% CI 0.06 to 1.45).  There are some descriptive data suggesting that the more severe the displacement of the PDC towards the midline, the lower the proportion of successfully erupted PDCs with or without intervention. AUTHORS' CONCLUSIONS: The evidence that extraction of the primary canine in a young person aged between 9 and 14 years diagnosed with a PDC may increase the proportion of erupted PDCs, without surgical intervention, is very uncertain. There is no evidence that double extraction of primary teeth increases the proportion of erupted PDC compared with a single primary tooth extraction at 18 months or the proportion referred for surgery by 48 months. Because we have only low to very low certainty in these findings, future research is necessary to help us know for sure the best way to deal with upper permanent teeth that are not erupting as expected.

Development of a core outcome set for use in routine orthodontic clinical trials.

INTRODUCTION: A diverse range of outcomes is used in orthodontic research with a focus on measuring outcomes important to clinicians and little consistency in outcome selection and measurement. We aimed to develop a core outcome set for use in clinical trials of orthodontic treatment not involving cleft or orthognathic patient groups. METHODS: A list of outcomes measured in previous orthodontic research was identified through a scoping literature review. Additional outcomes of importance to patients were obtained using qualitative interviews and focus groups with adolescents aged 10-16 years. Rating of outcomes was carried out in a 2-round electronic Delphi process involving health care professionals and patients using a 9-point scale. A face-to-face meeting was subsequently held with stakeholders to discuss the results before refining the core outcome set. RESULTS: After triangulation, a final list of 34 outcomes grouped under 10 domains was obtained for rating in the e-Delphi surveys. Fifteen outcomes were voted "in" after the second Delphi round involving 274 participants with a further outcome being included after the consensus meeting. These were subsequently refined into a final set of 7 core outcomes, including the impact of self-perceived esthetics, alignment and/or occlusion, skeletal relationship, stability, patient-related adherence, breakages, and adverse effects on teeth or teeth-supporting structures. CONCLUSIONS: A bespoke orthodontic core outcome set encompassing both clinician- and patient-focused outcomes was developed. Incorporating this is the first step into providing a more holistic assessment of the impact of treatment while allowing for meaningful comparisons and synthesis of results from individual trials.

Managing orthodontic appliances in everyday life: A qualitative study of young people's experiences with removable functional appliances, fixed appliances and retainers.

OBJECTIVE: To compare young people's experiences of wearing a range of orthodontic appliances. DESIGN: A cross-sectional, qualitative study with purposive sampling. SETTING: UK dental teaching hospital. PARTICIPANTS: Twenty-six orthodontic patients aged 11-17 years. METHODS: Patients participated in in-depth semi-structured interviews. All interviews were transcribed verbatim and analysed thematically. RESULTS: Young people reported physical, practical and emotional impacts from their appliances. Despite these reported impacts, participants described 'getting used' to and, therefore, not being bothered by their appliance. Framework analysis of the data identified a multi-dimensional social process of managing everyday life with an appliance. This involves addressing the 'dys-appearance' of the body through physically adapting to an appliance. This process also includes psychological approaches, drawing on social networks, developing strategies and situating experiences in a longer-term context. Engaging in this process allowed young people to address the physical, practical and emotional impacts of their appliances. CONCLUSION: This qualitative research has identified how young people manage everyday life with an appliance. Understanding this process will help orthodontists to support their patients.

Rasch model of the child perceptions questionnaire in multi-country data.

OBJECTIVE: To be fit-for-purpose, oral health-related quality of life instruments must possess a range of psychometric properties which had not been fully examined in the 16-item Short Form Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14 ISF-16). We used advanced statistical approaches to determine the CPQ's measurement accuracy, precision, invariance and dimensionality and analyzed whether age range could be extended from 8 to 15 years. METHODS: Fit to the Rasch model was examined in 6648 8-to-15-year-olds from Australia, New Zealand, Brunei, Cambodia, Hong Kong, Malaysia, Thailand, Germany, United Kingdom, Brazil and Mexico. RESULTS: In all but two items, the initial five answer options were reduced to three or four, to increase precision of the children's selection. Items 10 (Shy/embarrassed) and 11 (Concerned what others think) showed an 'extra' dependency between item scores beyond the relationship related to the underlying latent construct represented by the instrument, and so were deleted. Without these two items, the CPQ was unidimensional. The three oral symptoms items (4 Food stuck in teeth, 3 Bad breath and 1 Pain) were required for a sufficient person-item coverage. In three out of 14 items (21 %), Europe and South America showed regional differences in the patterns of how the answer options were selected. No differential item functioning was detected for age. CONCLUSION: Except for a few modifications, the present analysis supports the combination of items, the cross-cultural validity of the CPQ with 14 items and the extension of the age range from 8 to 15 years. CLINICAL SIGNIFICANCE: The valid, reliable, shortened and age-extended version of the CPQ resulting from this study should be used in routine care and clinical research. Less items and a wider age range increase its usability. Symptoms items are needed to precisely differentiate between children with higher and lower quality of life.

Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment.

BACKGROUND: Early dental decay or demineralised lesions (DLs, also known as white spot lesions) can appear on teeth during fixed orthodontic (brace) treatment. Fluoride reduces decay in susceptible individuals, including orthodontic patients. This review compared various forms of topical fluoride to prevent the development of DLs during orthodontic treatment. This is the second update of the Cochrane Review first published in 2004 and previously updated in 2013. OBJECTIVES: The primary objective was to evaluate whether topical fluoride reduces the proportion of orthodontic patients with new DLs after fixed appliances. The secondary objectives were to examine the effectiveness of different modes of topical fluoride delivery in reducing the proportions of orthodontic patients with new DLs, as well as the severity of lesions, in terms of number, size and colour. Participant-assessed outcomes, such as perception of DLs, and oral health-related quality of life data were to be included, as would reports of adverse effects. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 1 February 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 1 February 2019), MEDLINE Ovid (1946 to 1 February 2019), and Embase Ovid (1980 to 1 February 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Parallel-group, randomised controlled trials comparing the use of a fluoride-containing product versus a placebo, no treatment or a different type of fluoride treatment, in which the outcome of enamel demineralisation was assessed at the start and at the end of orthodontic treatment. DATA COLLECTION AND ANALYSIS: At least two review authors independently, in duplicate, conducted risk of bias assessments and extracted data. Authors of trials were contacted to obtain missing data or to ask for clarification of aspects of trial methodology. Cochrane's statistical guidelines were followed. MAIN RESULTS: This update includes 10 studies and contains data from nine studies, comparing eight interventions, involving 1798 randomised participants (1580 analysed). One report contained insufficient information and the authors have been contacted. We assessed two studies as at low risk of bias, six at unclear risk of bias, and two at high risk of bias. Two placebo (non-fluoride) controlled studies, at low risk of bias, investigated the professional application of varnish (7700 or 10,000 parts per million (ppm) fluoride (F)), every six weeks and found insufficient evidence of a difference regarding its effectiveness in preventing new DLs (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.14 to 1.93; 405 participants; low-certainty evidence). One placebo (non-fluoride) controlled study, at unclear risk of bias, provides a low level of certainty that fluoride foam (12,300 ppm F), professionally applied every two months, may reduce the incidence of new DLs (12% versus 49%) after fixed orthodontic treatment (RR 0.26, 95% CI 0.11 to 0.57; 95 participants). One study, at unclear risk of bias, also provides a low level of certainty that use of a high-concentration fluoride toothpaste (5000 ppm F) by patients may reduce the incidence of new DLs (18% versus 27%) compared with a conventional fluoride toothpaste (1450 ppm F) (RR 0.68, 95% CI 0.46 to 1.00; 380 participants). There was no evidence for a difference in the proportions of orthodontic patients with new DLs on the teeth after treatment with fixed orthodontic appliances for the following comparisons: - an amine fluoride and stannous fluoride toothpaste/mouthrinse combination versus a sodium fluoride toothpaste/mouthrinse, - an amine fluoride gel versus a non-fluoride placebo applied by participants at home once a week and by professional application every three months, - resin-modified glass ionomer cement versus light-cured composite resin for bonding orthodontic brackets, - a 250 ppm F mouthrinse versus 0 ppm F placebo mouthrinse, - the use of an intraoral fluoride-releasing glass bead device attached to the brace versus a daily fluoride mouthrinse. The last two comparisons involved studies that were assessed at high risk of bias, because a substantial number of participants were lost to follow-up. Unfortunately, although the internal validity and hence the quality of the studies has improved since the first version of the review, they have compared different interventions; therefore, the findings are only considered to provide low level of certainty, because none has been replicated by follow-up studies, in different settings, to confirm external validity. A patient-reported outcome, such as concern about the aesthetics of any DLs, was still not included as an outcome in any study. Reports of adverse effects from topical fluoride applications were rare and unlikely to be significant. One study involving fluoride-containing glass beads reported numerous breakages. AUTHORS' CONCLUSIONS: This review found a low level of certainty that 12,300 ppm F foam applied by a professional every 6 to 8 weeks throughout fixed orthodontic treatment, might be effective in reducing the proportion of orthodontic patients with new DLs. In addition, there is a low level of certainty that the patient use of a high fluoride toothpaste (5000 ppm F) throughout orthodontic treatment, might be more effective than a conventional fluoride toothpaste. These two comparisons were based on single studies. There was insufficient evidence of a difference regarding the professional application of fluoride varnish (7700 or 10,000 ppm F). Further adequately powered, randomised controlled trials are required to increase the certainty of these findings and to determine the best means of preventing DLs in patients undergoing fixed orthodontic treatment. The most accurate means of assessing adherence with the use of fluoride products by patients and any possible adverse effects also need to be considered. Future studies should follow up participants beyond the end of orthodontic treatment to determine the effect of DLs on patient satisfaction with treatment.

Surgical exposure and orthodontic alignment of palatally displaced canines: can we shorten treatment time?

This review will discuss the influence of various factors on the time taken to orthodontically align a palatally displaced maxillary permanent canine following surgical exposure. Previously unpublished data from a clinical trial, involving participants with unilateral PDC randomly allocated to either a closed or open surgical exposure, will be included to strengthen the debate.

PLATOON: Premature Loss of bAby Teeth and its impact On Orthodontic Need - protocol.

OBJECTIVE: To investigate the impact of premature extraction of primary teeth (PEPT) on orthodontic treatment need in a cohort of children participating in the Born in Bradford (BiB) longitudinal birth cohort. DESIGN: Observational, cross-sectional cohort. PARTICIPANTS: We aim to recruit 1000 children aged 7-11 years: 500 with a history of PEPT and 500 matched non-PEPT controls. METHODS: After informed consent/assent, orthodontic records will be collected, including extra and intra-oral photographs and alginate impressions for study models. Participants will also complete a measure of oral health-related quality of life (COHIP-SF 19). The records will be used to quantify space loss, identify other occlusal anomalies and assess orthodontic treatment need using the Index of Orthodontic Treatment Need. For each outcome, summary statistics will be calculated and the data for children with and without PEPT compared. The records of the children identified to be in need of orthodontic treatment will be examined by an expert orthodontic panel to judge if this treatment should be undertaken at the time of the records or delayed until the early permanent dentition. Collecting robust records in the mixed dentition provides the clinical basis to link each stage of the causal chain and enable the impact of PEPT on orthodontic need to be characterised. This study is the first to provide the foundations for future longitudinal data collection allowing the long-term impact of PEPT to be studied.

The Malocclusion Impact Questionnaire (MIQ): Cross-Sectional Validation in a Group of Young People Seeking Orthodontic Treatment in New Zealand.

The aim of the study was to test the validity of the Malocclusion Impact Questionnaire (MIQ) in a NZ sample and to evaluate possible cross-cultural differences in MIQ data between a NZ and a UK sample. A cross-sectional, non-random sample of young people, aged 10⁻16 years, attending their first appointment at the orthodontic clinic of New Zealand's National Centre for Dentistry were asked to complete a questionnaire. This consisted of the 17 item MIQ, the short form CPQ11-14-ISF16 and two global questions. Some basic demographic and clinical data were collected. Sixty-six participants completed the questionnaire; however, the data for 2 were excluded due to the number of incomplete responses. MIQ was found to have excellent internal consistency (Cronbach's alpha 0.924), good construct validity (Spearman's rho, 0.661 global Q1 'Overall, how much do your teeth bother you?'; 0.583 global Q2 'Overall, how much do your teeth affect your life?'). MIQ also demonstrated good criterion validity with CPQ11-14-ISF16 (Pearson rho, 0.625). The Rasch analysis confirmed that the questionnaire performed similarly and there was no differential item functioning between the two populations. The main differences between the samples were that the young people in NZ were less concerned about their malocclusion and reported lower item-impact scores compared with the young people in the UK.

Resin-modified glass ionomer cement vs composite for orthodontic bonding: A multicenter, single-blind, randomized controlled trial.

INTRODUCTION: In this study, we aimed to compare the incidence of new demineralized lesions and bond failures between 2 groups of participants wearing fixed orthodontic appliances bonded with either light-cured resin-modified glass ionomer cement or light-cured composite. METHODS: This trial was a multicenter (6 centers: 2 teaching hospitals, 4 specialist orthodontic practices), single-blinded, randomized controlled trial with 2 parallel groups. Patients aged 11 years or older, in the permanent dentition, and about to start fixed orthodontic treatment in these 6 centers were randomly allocated to have either resin-modified glass ionomer cement or light-cured composite for bonding brackets, forward of the first molars. Pretreatment and day-of-debond digital photographic images were taken of the teeth and assessed by up to 5 clinical and 3 lay assessors for the presence or absence of new demineralized lesions and the esthetic impact. The assessors were masked as to group allocation. RESULTS: We randomized 210 participants, and 197 completed the trial. There were 173 with complete before-and after-digital images of the teeth. The incidence of new demineralized lesions was 24%; but when the esthetic impact was taken into account, this was considerably lower (9%). There was no statistically significant difference between the bracket adhesives in the numbers with at least 1 new demineralized lesion (risk ratio,1.25; 95% confidence interval, 0.74-2.13; P = 0.403) or first-time bracket failure (risk ratio,0.88; 95% confidence interval, 0.67-1.16; P = 0.35). There were no adverse effects. CONCLUSIONS: There is no evidence that the use of resin modified glass ionomer cement over light-cured composite for bonding brackets reduces the incidence of new demineralized lesions or bond failures. There might be other reasons for using resin modified glass ionomer cement. REGISTRATION: This trial was registered at ClinicalTrials.govNCT01925924. PROTOCOL: The protocol is available from the corresponding author on request.