Post-treatment stability after 5 years of retention with vacuum-formed and bonded retainers-a randomized controlled trial.

BACKGROUND: Retention after orthodontic treatment is still a challenge and more evidence about post-treatment stability and patients' perceptions of different retention strategies is needed. OBJECTIVES: This trial compares removable vacuum-formed retainers (VFR) with bonded cuspid-to-cuspid retainers (CTC) after 5 years of retention. TRIAL DESIGN: A single centre two-arm parallel-group randomized controlled trial. METHODS: This trial included 104 adolescent patients, randomized into two groups (computer-generated), using sequentially numbered, opaque, and sealed envelopes. All patients were treated with fixed appliances in both jaws with and without tooth extractions. Patients in the intervention group received a VFR in the mandible (n = 52), and patients in the active comparator group received a CTC (n = 52). Both groups had a VFR in the maxilla. Dental casts at debond (T1), after 6 months (T2), after 18 months (T3), and after 5 years (T4) were digitized and analysed regarding Little's Irregularity Index (LII), overbite, overjet, arch length, and intercanine and intermolar width. The patients completed questionnaires at T1, T2, T3, and T4. RESULTS: Post-treatment changes between T1 and T4 in both jaws were overall small. In the maxilla, LII increased significantly (median difference: 0.3 mm), equally in both groups. In the mandible, LII increased significantly in the group VFR/VFR (median difference: 0.6 mm) compared to group VFR/CTC (median difference: 0.1 mm). In both groups, overjet was stable, overbite increased, and arch lengths decreased continuously. Intercanine widths and intermolar width in the mandible remained stable, but intermolar width in the maxilla decreased significantly. No differences were found between groups. Regardless of retention strategy, patients were very satisfied with the treatment outcome and their retention appliances after 5 years. LIMITATIONS: It was not possible to perform blinded assessments of digital models at follow-up. CONCLUSIONS: Post-treatment changes in both jaws were small. Anterior alignment in the mandible was more stable with a bonded CTC retainer compared to a removable VFR after 5 years of retention. Patients were equally satisfied with fixed and removable retention appliances. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03070444).

Vacuum-formed retainers and bonded retainers for dental stabilization-a randomized controlled trial. Part II: patients' perceptions 6 and 18 months after orthodontic treatment.

OBJECTIVE: To compare removable vacuum-formed Essix C retainers with bonded cuspid-to-cuspid retainers (CTCs) regarding patients' perceptions after debonding and 6 and 18 months of retention. TRIAL DESIGN: A single-centre two-arm parallel-group randomized controlled trial. METHODS: This trial included 104 adolescent patients, computer-generated randomized, with sequentially numbered, opaque and sealed envelopes, into two groups and stratified by gender. They were treated with fixed appliances with and without tooth extractions in both jaws and were ready for debond. Patients in the intervention arm received a vacuum-formed retainer (VFR) in the mandible (n = 52), and patients in the active comparator arm received a CTC (n = 52). Both groups had a VFR in the maxilla. Treatment outcome satisfaction, quality of care and attention, side-effects during the retention phase, and retainer acceptance and compliance were assessed with questionnaires at baseline (T1, 2 weeks after debond) and after 6 (T2) and 18 months (T3) of retention. Operator was blinded to group assignment during measurements. RESULTS: Ninety-five patients completed the questionnaires at all three time points. Patients were overall satisfied with treatment outcome, quality of care and attention, and how their retainers worked at all three time points, with no differences between groups. At T1 and T3, the VFR group reported significantly more pain and discomfort (T1: P = 0.005, T3: P < 0.0001) and soreness (T1: P = 0.001, T3: P = 0.011) in the mandible compared to the CTC group. The CTC group found it easier to get used to their retainers. After 18 months, 70.5 per cent in the VFR group and 73.9 per cent in the CTC group reported the recommended wear-time of the VFRs. Decreased wear-time was correlated to perceived pain and discomfort (rs = -0.421, P < 0.0001). LIMITATIONS: The results were limited by our retainer design and recommended wear regimen. CONCLUSIONS: Both groups reported high treatment outcome satisfaction and low levels of side-effects during the retention phase. Nevertheless, the VFR group reported more pain and discomfort at T1 and at T3. Self-reported compliance was the same in both groups. The VFR group was more concerned about relapse. TRIAL REGISTRATION: NCT03070444 (https://clinicaltrials.gov).

Vacuum-formed retainer versus bonded retainer for dental stabilization in the mandible-a randomized controlled trial. Part I: retentive capacity 6 and 18 months after orthodontic treatment.

BACKGROUND: Evidence concerning the most appropriate retention strategy after orthodontic treatment is still inconclusive. OBJECTIVE: This trial compares the retentive capacity of vacuum-formed Essix C-retainers (VFR) and bonded cuspid-to-cuspid retainers (CTC) in the mandible 6 and 18 months after orthodontic treatment. TRIAL DESIGN: A single-centre two-arm parallel-group randomized controlled trial. METHODS: This study included 104 adolescent patients, computer-generated randomized with sequentially numbered, opaque, and sealed envelopes into two groups and stratified by gender (52 females and 52 males). The patients were treated with fixed appliances with and without tooth extractions in both jaws and were ready for debond. In the intervention arm, patients received a VFR (n = 52); in the active comparator arm, patients received a CTC (n = 52). Dental casts were obtained at debond (T1), after 6 months (T2), and after 18 months (T3). The casts were digitized. The retentive capacity was evaluated on digital three-dimensional models using Little's Irregularity Index (LII), overbite, overjet, arch length, and intermolar and intercanine width. RESULTS: Baseline values were similar for both groups. Statistically significant increases were noted in LII and overbite, mainly between T1 and T2, but also between T1 and T3 in the VFR group (LII = 0.52 mm, P < 0.001, overbite = 0.51 mm, P < 0.001) and in the CTC group (LII = 0.45 mm P < 0.001, overbite = 0.36 mm, P < 0.001). There were no significant differences between groups. Overjet showed small variations during the observation periods but was overall stable within and between groups after 18 months. Arch length decreased slightly in both groups after 6 and 18 months. Intermolar and intercanine widths remained stable after debond. LIMITATIONS: Patients, operator, and outcome assessor could not be blinded due to the study design. CONCLUSIONS: VFR and CTC have the same retention capacity in the mandible after 6 and 18 months. Relapse mainly occurs during the first 6 months of retention, but the post-treatment changes are generally small. Shorter VFRs in the mandible do not cause negative vertical effects. Part-time wear regimen is not associated with increased relapse. TRIAL REGISTRATION: NCT03070444.

A cost-effectiveness analysis of anchorage reinforcement with miniscrews and molar blocks in adolescents: a randomized controlled trial.

OBJECTIVE: To analyse cost-effectiveness of anchorage reinforcement with buccal miniscrews and with molar blocks. We hypothesized that anchorage with miniscrews is more cost-effective than anchorage with molar blocks. TRIAL DESIGN: A single-centre, two-arm parallel-group randomized controlled trial. METHODS: Adolescents (age 11-19 years) in need of treatment with fixed appliance, premolar extractions, and en masse retraction were recruited from one Public Dental Health specialist centre. The intervention arm received anchorage reinforcement with buccal miniscrews during space closure. The active comparator received anchorage reinforcement with molar blocks during levelling/alignment and space closure. The primary outcome measure was societal costs defined as the sum of direct and indirect costs. Randomization was conducted as simple randomization stratified on gender. The patients, caregivers, and outcome assessors were not blinded. RESULTS: Eighty patients were randomized into two groups. The trial is completed. All patients were included in the intention-to-treat analysis. The median societal costs for the miniscrew group were €4681 and for the molar block group were €3609. The median of the difference was €825 (95% confidence interval (CI) 431-1267). This difference was mainly caused by significantly higher direct costs consisting of material and chair time costs. Differences in chair time costs were related to longer treatment duration. No serious harms were detected, one screw fractured during insertion and three screws were lost during treatment. GENERALIZABILITY AND LIMITATIONS: The monetary variables are calculated based on a number of local factors and assumptions and cannot necessarily be transferred to other countries. Variables such as chair time, number of appointments, and treatment duration are generalizable. Owing to the study protocol, the benefit of miniscrews as a stable anchorage has not been fully utilized. CONCLUSIONS: When only moderate anchorage reinforcement is needed, miniscrews are less cost-effective than molar blocks. The initial hypothesis was rejected. Miniscrews provide better anchorage reinforcement at a higher price. They should be used in cases where anchorage loss cannot be accepted. TRIAL REGISTRATION: NCT02644811.

Anchorage reinforcement with miniscrews and molar blocks in adolescents: A randomized controlled trial.

INTRODUCTION: Anchorage can be reinforced in many ways. Due to the variety of anchorage concepts, only a few general conclusions can be drawn. Therefore, more research is needed to investigate specific concepts with specific indications. The objective of this trial was to compare the anchorage capacities of miniscrews and molar blocks. METHODS: This randomized controlled trial was conducted on 2 parallel arms. The trial was conducted at the Public Dental Service Orthodontic Clinic in Gävle, Sweden. Participants were adolescents who needed orthodontic treatment with a fixed appliance, extraction of the maxillary first premolars, and anchorage reinforcement. In group A, miniscrews were used as direct anchorage during space closure. In group B, molar blocks were used as anchorage reinforcement during leveling and alignment and space closure. The primary outcome was loss of anchorage assessed as maxillary first molar movement. Random allocation was maintained with a simple randomization stratified by sex. The observer was blinded to the allocations during the measurements. RESULTS: Forty participants each were randomized to groups A and B. Results were analyzed on an intention-to-treat basis, meaning that all participants, successful or not, were included in the analysis. Group A showed a mean anchorage loss of 1.2 mm during leveling and alignment. During space closure with miniscrews, no significant anchorage loss was found. Group B showed mean anchorage losses of 1.4 mm during leveling and alignment and 2.4 mm during space closure. No serious harms were detected. The first molar rotation, torque, and tipping showed different characteristics during the treatment phases. CONCLUSIONS: Miniscrews can be recommended for anchorage reinforcement. Depending on the need for anchorage reinforcement, miniscrews can be inserted at the beginning of treatment or when space closure starts. Molar blocks cannot be recommended for anchorage reinforcement. REGISTRATION: This trial was registered at www.clinicaltrials.gov (NCT02644811). PROTOCOL: The protocol was published after trial commencement. FUNDING: This trial received funding from the Center for Research and Development, Uppsala University/Region Gävleborg; Thuréus Foundation for the Promotion of Dental Science; and the Swedish Dental Associations Scientific Funds.

A novel method for superimposition and measurements on maxillary digital 3D models-studies on validity and reliability.

Background: Serial 3D models can be used to analyze changes, but correct superimposition is crucial before measurements can be assessed. Earlier studies show that every palatal structure changes due to growth or treatment. Here, we describe a new method that uses an algorithm-based analysis to perform superimpositions and measurements in maxillary 3D models. This method can be used to identify deformations. In a second step, only unchanged areas are used for superimposition. Objectives: This study investigates the validity and reliability of this novel method. Methods: Digital 3D models from 16 cases were modified by an independent 3D engineer to simulate space closure and growth. True values for tooth movements were available as reference. Measurements and repeated measurements were performed by four observers. Results: The total tooth movement had an absolute mean error of 0.0225 mm (SD 0.03). The intraclass correlation coefficient (ICC) was 0.9996. Rotational measurements had an absolute mean error of 0.0291 degrees (SD 0.04 degrees) and an ICC of 0.9999. Limitations: Serial models need to be taken with a moderate interval (1 to 2 years). Obvious changed areas in the palate need to be cropped before processing the models. Conclusion: The tested method is valid and reliable with excellent accuracy and precision even when changes through growth or orthodontic treatment occur.

Pain and discomfort during the first week of rapid maxillary expansion (RME) using two different RME appliances: A randomized controlled trial.

OBJECTIVES: To evaluate and compare perceived pain intensity, discomfort, and jaw function impairment during the first week with tooth-borne or tooth-bone-borne rapid maxillary expansion (RME) appliances. MATERIALS AND METHODS: Fifty-four patients (28 girls and 26 boys) with a mean age of 9.8 years (SD 1.28 years) were randomized into two groups. Group A received a conventional hyrax appliance and group B a hybrid hyrax appliance anchored on mini-implants in the anterior palate. Questionnaires were used to assess pain intensity, discomfort, analgesic consumption, and jaw function impairment on the first and fourth days after RME appliance insertion. RESULTS: Fifty patients answered both questionnaires. Overall median pain on the first day in treatment was 13.0 (range 0-82) and 3.5 (0-78) for groups A and B, respectively, with no significant differences in pain, discomfort, analgesic consumption, or functional jaw impairment between groups. Overall median pain on the fourth day was 9.0 (0-90) and 2.0 (0-71) for groups A and B, respectively, with no significant differences between groups. There were also no significant differences in pain levels within group A, while group B scored significantly lower concerning pain from molars and incisors and tensions from the jaw on day 4 than on the first day in treatment. There was a significant positive correlation between age and pain and discomfort on the fourth day in treatment. No correlations were found between sex and pain and discomfort, analgesic consumption, and jaw function impairment. CONCLUSIONS: Both tooth-borne and tooth-bone-borne RME were generally well tolerated by the patients during the first week of treatment.

Success rate, costs and long-term stability of treatment with activator/headgear combinations.

The aims of this study were to evaluate treatment outcome with activator-headgear combinations carried out by general dental practitioners, overall costs, long-term stability and patients' satisfaction with treatment outcome. Patients who were recommended to start treatment in 2006 were included in this study (n = 97). Inclusion criteria were: Class II Division 1 with at least half a cusp width distal molar relationship, overjet ≥ 6 mm and presence of dental records. Data were collected, pre-treatment, post-treatment and 3 years after treatment for those with favorable outcome. Patients at follow-up completed a questionnaire about satisfaction with treatment outcome, perceived pain and discomfort during treatment, and subjective need for additional treatment. Eighty-five patients were analyzed, 52 boys and 33 girls (mean age 11.2 years SD 1.39). Thirty-five patients had successful treatment outcome, 15 partially successful and 35 had an unsuccessful outcome. Total costs for all 85 patients amounted to SEK 1 405 000 including both direct and indirect costs. Thirty-eight patients participated in the 3-year follow-up. Treatment outcomes were then categorized as successful in 28 patients, partially successful in 9 patients and 1 patient was judged as unsuccessful. Median values on VAS (0-100) for overall satisfaction with treatment and treatment outcome were high, 78 and 84 respectively. Median value for perceived pain and discomfort during treatment was 42. Just over half of the patients had a favorable treatment outcome. Patients with favorable outcome were stable over time and satisfied with treatment.

Pain and discomfort following insertion of miniscrews and premolar extractions: A randomized controlled trial.

OBJECTIVE: To investigate and compare the experience of pain and discomfort between insertion of miniscrews and premolar extractions in adolescent patients. MATERIALS AND METHODS: A total of 80 adolescents were recruited and randomized into groups A and B. Both groups were treated with extraction of the upper first premolars and fixed appliance. Beyond the fixed appliance, patients in group A received anchorage reinforcement with miniscrews. Miniscrews were inserted buccally between the second premolar and first molar when space closure started. Space closure was performed as en masse retraction with immediate loading by 150-g coil springs. Pain, discomfort, impact on daily activities, and functional jaw impairment were assessed with patient-reported questionnaires. Questionnaires were filled in at baseline, the evening after tooth extraction, 1 week after tooth extraction, the evening after screw placement, and 1 week after screw placement. RESULTS: Patients reported significantly lower levels of pain (P < .001) and discomfort (P = .012) after screw placement compared with premolar extractions. The ability to drink (P = .035) and the ability to take a big bite (P < .001) were also significantly less disturbed in the evening after screw placement. During the first week after screw placement, the impact on leisure time activities was significantly lower (P = .015) compared with premolar extractions. CONCLUSION: The use of miniscrews in adolescents can be recommended from a pain and discomfort perspective.

Satisfaction with orthodontic treatment outcome.

OBJECTIVES: To examine factors associated with treatment outcome satisfaction in a group of adolescent patients. MATERIALS AND METHODS: One hundred and twenty patients (60 girls and 60 boys; mean age, 14.3 years; standard deviation [SD], 1.73 years) were consecutively recruited. The inclusion criteria for all patients were as follows: adolescents with a permanent dentition in need of orthodontic treatment and a treatment plan involving extractions (two or four premolars) followed by fixed appliances in both jaws. Questionnaire 1, concerning treatment motivation and expectations, was assessed prior to treatment start. Questionnaire 2 was assessed after active treatment and included questions about satisfaction with treatment outcome, quality of care and attention, and perceived pain and discomfort during active treatment. RESULTS: One hundred and ten patients completed the trial (54 boys and 56 girls; mean age, 16.9 years; SD, 1.78 years). Median values for satisfaction with treatment outcome were generally high. There was a clear correlation (P ≤ .001) between satisfaction with treatment outcome and patients' perception of how well they had been informed and cared for during treatment. Pain and discomfort during treatment also strongly affected treatment satisfaction. Sex, treatment time, and Peer Assessment Rating index pre- and posttreatment as well as expectations for future treatment showed no correlation with treatment satisfaction. CONCLUSIONS: Care and attention was the variable showing the highest correlation with satisfaction with treatment outcome. Patients' perceptions of pain and discomfort during treatment had an overall negative correlation with treatment satisfaction. Satisfaction with treatment outcome is a complex issue and requires further exploration in future research.

Three-dimensional analysis of effects of rapid maxillary expansion on facial sutures and bones.

OBJECTIVE: To evaluate the evidence on three-dimensional immediate effects of rapid maxillary expansion (RME) treatment on growing patients as assessed by computed tomography/cone beam computed tomography (CT/CBCT) imaging. MATERIALS AND METHODS: The published literature was searched through the PubMed, Embase, and Cochrane Library electronic databases from January 1966 to December 2012. The inclusion criteria consisted of randomized controlled trials, prospective controlled studies, and prospective case-series. Two reviewers extracted the data independently and assessed the quality of the studies. RESULTS: The search strategy resulted in 73 abstracts or full-text articles, of which 10 met the inclusion criteria. When treating posterior crossbites with a RME device, the existing evidence points out that the midpalatal suture opening is around 20%-50% of the total screw expansion. There seems to be no consistent evidence on whether the midpalatal sutural opening is parallel or triangular. The effect on the nasal cavity dimensions after RME seems to be apparent and indicates an enlargement between 17% and 33% of the total screw expansion. Circummaxillary sutures, particularly the zygomaticomaxillary and frontomaxillary sutures and also spheno-occipital synchondrosis, appear to be affected by the maxillary expansion. Overall, however, the changes were small and the evidence not conclusive. CONCLUSIONS: CT imaging proved to be a useful tool for assessment of treatment effects in all three dimensions. The majority of the articles were judged to be of low quality, and therefore, no evidence-based conclusions could to be drawn from these studies.

Orthodontic anchoring techniques and its influence on pain, discomfort, and jaw function--a randomized controlled trial.

The aim of this trial was to evaluate and compare perceived pain, discomfort, and jaw function impairment between orthodontic treatments combined with skeletal anchorage and treatment using conventional anchorage with headgear or transpalatal bar. A total of 120 adolescent patients in order to start orthodontic treatment were consecutively recruited and randomized into three groups with different anchorage. Group A underwent installation of a skeletal anchorage (Onplant or Orthosystem implant), group B received headgear, and group C a transpalatal bar. Questionnaires were used to assess pain intensity, discomfort, analgesic consumption, and jaw function impairment from baseline to the end of treatment. Pain scores overall peaked on day 2 and were almost back to baseline on day 7. The site with the highest pain scores during treatment was incisors in contact but with no differences between groups. Pain intensity from molars was significantly less in the skeletal anchorage group A compared to the transpalatal bar group C the first 4 days in treatment and with no sign differences compared to headgear. The results confirm that there were very few significant differences between patients' perceptions of skeletal and conventional anchorage systems during orthodontic treatment. Consequently, these new appliances were well accepted by the patients in a long time perspective and can thus be recommended.

Removable thermoplastic appliances as orthodontic retainers--a prospective study of different wear regimens.

The aim of this prospective study was to evaluate and compare stability after 6 months of Essix retainer use. Patients' perceptions of wearing the retainer were also evaluated. A total of 69 patients, 53 girls and 16 boys [mean age 15.7 years, standard deviation (SD) 1.96], were included in the study and randomized into two groups with different wear regimens; full-time wear for 3 months and thereafter at night (group A) compared to full-time wear for 1 week and thereafter at night only (group B). Sixty patients completed the study and thus, group A comprised 30 maxillary retainers and 18 mandibular retainers and group B 30 maxillary and 18 mandibular retainers. Little's irregularity index (LII), overjet, and overbite were measured at debond (T(1)) and after 6 months (T(2)). Differences within and between groups were analysed with a Mann-Whitney test. At T(2), all patients completed a questionnaire in order to evaluate their experience of wearing an Essix retainer and how they complied with the given instructions. Differences in LII during T(1)-T(2) were 0.44 and 0.49 mm for group A and B, respectively, but with no significant difference between the groups. There were also no significant changes in overjet and overbite within or between the groups during T(1)-T(2). According to the responses to the questionnaire, the retainer was well tolerated by the patients. It was therefore concluded that the Essix retainer is sufficient for maintaining the results after orthodontic treatment and that night-time wear is adequate.

Anchorage capacity of osseointegrated and conventional anchorage systems: a randomized controlled trial.

INTRODUCTION: Our aim in this investigation was to evaluate and compare orthodontic anchorage capacity of 4 anchorage systems during leveling/aligning and space closure after maxillary premolar extractions. METHODS: One hundred twenty patients (60 girls, 60 boys; mean age, 14.3 years; SD 1.73) were recruited and randomized into 4 anchorage systems: Onplant (Nobel Biocare, Gothenburg, Sweden), Orthosystem implant (Institut Straumann AG, Basel, Switzerland), headgear, and transpalatal bar. The main outcome measures were cephalometric analysis of maxillary first molar and incisor movement, sagittal growth changes of the maxilla, and treatment time. The results were also analyzed on an intention-to-treat basis. RESULTS: The maxillary molars were stable during the leveling/aligning in the Onplant, Orthosystem implant, and headgear groups, but the transpalatal bar group had anchorage loss (mean, 1.0 mm; P <.001). During the space-closure phase, the molars were still stable in the Onplant and Orthosystem groups, whereas the headgear and transpalatal bar groups had anchorage loss (means, 1.6 and 1.0 mm, respectively; P <.001). Thus, the Onplant and the Orthosystem implant groups had significantly higher success rates for anchorage than did the headgear and transpalatal bar groups. Compared with the Orthosystem implant, there were more technical problems with the Onplant. CONCLUSIONS: If maximum anchorage is required, the Orthosystem implant is the system of choice.

Pain intensity and discomfort following surgical placement of orthodontic anchoring units and premolar extraction: a randomized controlled trial.

OBJECTIVE: To evaluate and compare perceived pain intensity and discomfort between the placement of two different orthodontic anchoring units designed for osseointegration and premolar extraction in adolescent patients. MATERIALS AND METHODS: A total of 120 adolescent patients (60 girls and 60 boys) were recruited and randomized into three groups. Group A underwent installation of an onplant, group B installation of an Orthosystem implant, and group C premolar extraction. Pain intensity and discomfort, analgesic consumption, limitations in daily activities, and functional jaw impairment were evaluated the first evening and one week after the intervention. RESULTS: Pain intensity following surgical installation of an onplant was comparable to the pain intensity experienced after premolar extraction, but there was significantly less pain after surgical installation of an Orthosystem implant compared to installation of an onplant (P = .002) or premolar extraction (P = .007). The protective, vacuum-formed stent caused great discomfort, even more discomfort than the surgical sites following installation of the onplant or the Orthosystem implant. CONCLUSION: The Orthosystem implant was better tolerated than the onplant in terms of pain intensity, discomfort, and analgesic consumption and was, therefore, the anchorage system of choice in a short-term perspective.

Reliability of a questionnaire assessing experiences of adolescents in orthodontic treatment.

OBJECTIVE: To evaluate the reliability of a questionnaire that assessed the expectations and experiences of adolescent patients about orthodontic treatment. MATERIALS AND METHODS: The study included two groups of patients: 30 consecutive patients (19 girls and 11 boys, mean age 14.6 years, SD 2.3 years) naïve to orthodontic treatment, and 30 consecutive adolescent patients (17 girls and 13 boys, mean age 15.1 years, SD 2.0 years) in active orthodontic treatment with fixed appliances in both jaws. A questionnaire comprising 46 items was developed, based upon focus group interviews and previous established questionnaires. The questionnaire covered the following domains: Treatment motivation; treatment expectations; pain and discomfort from teeth, jaws, and face; functional jaw impairment; and questionnaire validity. Internal consistency as well as temporal stability with the test-retest method was investigated. RESULTS: A majority of the questions exhibited acceptable test-retest reliability, and composite scores yielded excellent reliability for all domains. Internal consistency was acceptable and good face validity was found for all domains. CONCLUSION: The questionnaire can be recommended for use in the assessment of expectations and experiences of orthodontic treatment.

Orthodontic anchorage--Evidence-based evaluation of anchorage capacity and patients' perceptions.

Orthodontic anchorage is the ability to resist unwanted reciprocal forces and reinforcement of anchorage by supplementary appliances, in or outside the mouth, is often needed to obtain successful results. In the last 10 years, interest in appliances that use implants has been growing. Successful orthodontic treatment demands effective methods and systematic evaluation of different treatment approaches is therefore essential. Several studies on the efficiency of various anchorage systems have been published, but a critical appraisal or interpretation of evidence that systematically considers validity, results, and relevance has not been made. Analysis of treatment modalities must also include patients' perceptions and potential side-effects. The overall aim of this thesis was to evaluate a new anchorage technique that incorporates osseointegration and compare it with conventional methods concerning effects on tooth movements in adolescents and their acceptance and experience of the additional surgical procedures that osseointegration involves. The following anchorage systems were analyzed: Onplant system, Orthosystem implant, headgear and transpalatal bar. This thesis was based on four studies: Paper I systematically reviewed the efficiency of orthodontic anchorage systems and interpreted the methodological quality of the selected studies from an evidence-based perspective. The literature search spanned January 1966 - December 2004 and was later extended to July 2007. Paper II, a methodological study involving 60 adolescent patients, examined the validity and reliability of a new questionnaire for assessing adolescent patients' perceptions of orthodontic treatment. The questionnaire was based on focus group interviews. Papers III and IV were randomized controlled trials involving 120 adolescent patients in orthodontic treatment. Paper III evaluated and compared adolescent patients' perceptions of premolar extractions and surgical placement of Onplants and Orthosystem implants. Paper IV compared anchorage capacities of the four systems. These conclusions were drawn: The scientific evidence, found in the review, was too weak to evaluate the efficiency of various anchorage systems (conventional and osseointegrated) during space closure after premolar extraction, and most studies have quality problems. Future randomized controlled trials are recommended. The new questionnaire, developed from focus group interviews, had overall acceptable to good reliability and high face validity. It can therefore be recommended for use in the assessment of adolescents' experiences of orthodontic treatment. Pain intensity after surgical placement of an Orthosystem implant was less than after Onplant installation and premolar extraction. Pain intensity after Onplant installation and premolar extractions were comparable. With respect to pain intensity, discomfort, and analgesic

Orthodontic anchorage: a systematic review.

The aim of this systematic review was to examine, in an evidence-based way, what kind of orthodontic anchorage systems/applications are evaluated and their effectiveness. A literature survey from the Pub Med and Cochrane databases covering the period from January 1966 to December 2004 was performed. Randomized controlled trials (RCT), prospective and retrospective controlled studies, and clinical trials comparing at least two anchorage situations were included. Two reviewers selected and extracted the data independently and also assessed the quality of the retrieved studies. The search strategy resulted in 494 articles, of which 14 met the inclusion criteria. Two main anchorage situations were identified: anchorage of molars during space closure after premolar extractions and anchorage loss in the incisor or premolar region (or both) during molar distalization. Because of contradictory results and the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate anchorage efficiency during space closure. Intraoral molar distalization leads to anchorage loss in various amounts depending on the choice of distalization unit. Most of the studies had serious problems with small sample size, confounding factors, lack of method error analysis, and no blinding in measurements. To obtain reliable scientific evidence, controlled RCT's with sufficient sample sizes are needed to determine which anchorage system is the most effective in the respective anchorage situation. Further studies should also consider patient acceptance and cost analysis as well as implants as anchorage.