Mandibular second molar extraction: A retrospective cohort study of spontaneous occlusal changes in adolescent patients.

OBJECTIVES: Evaluate long-term spontaneous occlusal changes following L7 extraction in adolescent patients. MATERIALS AND METHODS: Study models of 144 participants (63 males, 81 females) retrospectively assessed prior to L7 extraction (9-16 years old; T1) and following L8 eruption (14-25 years old; T2). All received upper fixed appliances. A sub-group (n = 86) received no lower fixed appliances and acted as controls. Occlusal changes were compared between treatment (lower fixed appliance) and control (no lower fixed appliance) groups using PAR index. At T2, L8 occlusal outcome was assessed using ABO grading system. RESULTS: Mean follow-up period 6 (SD 2) years. At T1, lower scores observed in control group for Lower Anterior (P < .001), Midline (P = .033) and Lateral Segments (P = .040) components. At T2, lower scores continued being observed in control group for Midline (P < .001) and Lateral segment (P = .019) components. Higher decrease in Lower Anterior PAR scores observed in treatment group (<.001) with comparable scores between groups at T2 (P = .057). Similar PAR score changes between groups for Lateral Segments, Overjet and Overbite components. At T2, no significant difference observed in Total PAR score reduction between control (83%) and treatment (82%) groups. Good-to-acceptable occlusal outcome of the L8 observed in 81.55% of cases at T2 with no difference between groups. CONCLUSION: In growing patients with mild mandibular crowding, extraction of L7 followed by upper fixed appliance therapy, leads to favourable occlusal changes over a 6-year follow-up period, with or without lower fixed appliance therapy, being an alternative extraction protocol where lower fixed appliance therapy is not recommended.

Adult orthodontics, motivations for treatment, choice, and impact of appliances: A qualitative study.

INTRODUCTION: Understanding the rationale for adult patients undertaking orthodontic treatment and the impact of appliances on their quality of life has become increasingly important to research efforts and clinical care. This study aimed to understand why adult patients undergo orthodontic treatment and their overall experience with the choice of appliance. METHODS: A cross-sectional qualitative study using semistructured interviews with adult patients from 4 private specialist orthodontic practices in the London region involving a purposive homogeneous sampling technique to obtain variation regarding gender, treatment modalities (fixed ceramic [FC], removable aligner [RA], and fixed lingual [FL] appliances), and stages of treatment (early, late, and posttreatment stage) was undertaken. A piloted topic guide was used to standardize data collection. Interviews were audio recorded, and field notes were taken. Data were transcribed verbatim and analyzed using framework methodology until data saturation was reached. RESULTS: A total of 22 participants (FC, 8; RA, 8; and FL, 6), with a mean age of 38.9 ± 11.7 years, with the majority being female (n = 13; 59.1%), were interviewed. Psychosocial and dental health-related factors were reported as the main reasons to seek orthodontic treatment. Social factors and appliance features influence an adult's decision-making in selecting a specific orthodontic appliance. Wearing FC, RA, and FL was seen to have both positive and negative impacts on an adult's quality of life. Functional and psychological factors were the strong influencers on patients' treatment experience. CONCLUSIONS: The study highlighted the influence of psychosocial factors and dental health concerns in the decision-making processes of adults seeking orthodontic treatment. FC, RA, and FL appear to affect an adult's quality of life, with functional and psychosocial factors being commonly reported.

The skeletal and dental effects of Hanks Herbst versus twin block appliances for class II correction in growing patients: a randomized clinical trial.

BACKGROUND: Despite the popularity of the Twin Block (TB) and the Hanks Herbst (HH) functional appliances, there is limited prospective research comparing these removable and fixed designs, respectively. OBJECTIVES: To evaluate and compare the skeletal and dental effects associated with TB and HH functional appliances as well as to detect factors that might influence the success or failure of treatment in adolescents with Class II malocclusion. DESIGN AND SETTING: A parallel-group randomized controlled trial was undertaken in a single-centre hospital in the United Kingdom. METHODS: A total of 80 participants (aged 10-14 years) with overjet of 7 mm or more were randomized to receive either the HH or TB appliance. Cephalometric radiographs were collected at the start of the study and immediately after the withdrawal of the functional appliances and measured using Pancherz analysis. Participants were allocated to the TB or HH group, based on an electronic randomization, stratified for gender and allocation concealed. Blinding to the allocated arm was not possible. However, all data were coded and anonymized to ensure that assessors were blinded to the group allocation. The main outcome was the anterior-posterior skeletal and dento-alveolar changes at the end of the functional phase. RESULTS: Fifteen (37.5%) participants from the TB group and 7 (15.5%) from HH failed to achieve full overjet reduction (<4 mm) after 12 months of treatment. Overjet reduction was 2 mm greater with HH compared to TB (P = .05; 95% CI: 0.2, 3.2). No significant differences regarding skeletal and dental changes were reported, with the exception that participants in HH group experienced greater lower molar protraction (P = .002; 95% CI: -2.8, -0.8) and mandibular incisors advancement (P = .001; 95% CI: -2.9, -1), indicating greater dental than skeletal effects. CONCLUSION: The TB appliance was associated with a higher rate of treatment discontinuation. No significant clinical differences were observed in the skeletal and dental effects, although the HH may be associated with more pronounced effects on the mandibular dentition. CLINICAL TRIAL REGISTRATION: The protocol was registered online before the start of the trial (ISRCTN11717011).

Long-term comparison of the efficacy of manual versus powered tooth brushing in adolescent orthodontic patients: a single-centre, parallel design randomized clinical trial.

BACKGROUND AND OBJECTIVES: To-date, there is no evidence comparing the long-term efficacy of powered and manual toothbrushes in adolescents undergoing fixed appliance treatment. The trial compared the efficacy of manual versus powered toothbrush in controlling plaque and gingival health in patients undergoing fixed treatment in respect of both the short- and long-term. TRIAL DESIGN: This was a randomized, parallel, controlled single-blind clinical trial, undertaken in a hospital setting, for which the consolidated standards of reporting trials guidelines were followed. METHODS: Ninety-two adolescent participants planned to undergo fixed appliance therapy, were randomly assigned to either a manual or powered toothbrush, with allocation concealment. The outcome measures were plaque and gingival indices and bleeding on probing, assessed at baseline (prior to fixed appliance), one-, six- and 12-months. RESULTS: The final sample included 84 participants, aged 12-18 (M=14.1, SD=1.93) years, with 40 (47%) were using a manual and 44 (52%) a powered toothbrush. The intervention (powered vs. manual toothbrush) itself appeared insignificant with regards to the gingival index (GI) (95%CI -0.1 - 0.03; P=0.26), plaque index (PI) (95%CI -0.13 - 0.14; P=0.93) and bleeding on probing (BoP) (95%CI -0.03 - 0.03; P=0.98) at any of the time points assessed. However, periodontal health indicators and plaque control significantly worsened (p<0.01), over the 12-month follow-up period, following placement of the fixed appliances placement. CONCLUSION: Whilst no differences were found between manual and powered toothbrushes in controlling plaque and gingival health, in participants undergoing fixed orthodontic treatment, both were suboptimal and highlighted the need for greater patient support and monitoring. TRIAL REGISTRATION DETAILS: https://doi.org/10.1186/ISRCTN74268923 Trial funding: Colgate-Palmolive (USA).

The impact of orthodontic treatment on a young person's quality of life, esthetics, and self-esteem in hypodontia: A longitudinal study.

INTRODUCTION: This research aimed to evaluate the impact of orthodontic treatment on a young person's oral health-related quality of life, self-esteem, and esthetics concerning hypodontia. METHODS: A prospective longitudinal hospital-based study recruited 97 participants with hypodontia, aged 11-18 years. Forty-one participants (42%) originally planned to have space closure and the remainder space opening, with subsequent prosthetic replacement. The following questionnaires were completed before and after orthodontic treatment: the child perception questionnaire, Bristol condition-specific questionnaire for hypodontia (BCSQ), the child health questionnaire, and the Oral Aesthetic Subjective Impact Scale (OASIS). The Wilcoxon and matched pairs t tests approach was applied to compare before and after orthodontic treatment for significant testing (P <0.05). RESULTS: Fifteen participants were lost to follow-up, resulting in 82 participants completing orthodontic treatment, with an average age of 13.8 ± 1.71 years. A total of 282 teeth were missing in the sample. Treatment resulted in significantly lower indexes (P <0.001) to overall BCSQ, OASIS, appearance, and how others would treat them. In comparing the 2 subgroups, those treated with space closure had significantly reduced functional limitations (child perception questionnaire), appearance concerns, self-esteem (child health questionnaire), OASIS, and overall BCSQ scores. CONCLUSIONS: Orthodontic treatment in participants with hypodontia appears to significantly impact a range of psychological and esthetic scales. In particular, space closure appears to significantly improve the quality of life of participants compared with those undergoing space opening.

The use of the Hanks Herbst vs Twin-block in Class II malocclusion: A randomized controlled trial.

INTRODUCTION: This 2-arm parallel study aimed to compare and evaluate the efficiency of Hanks Herbst (HH) and Twin-block (TB) functional appliances in treating adolescents with Class II malocclusion. METHODS: A parallel-group randomized controlled trial was undertaken in a single United Kingdom hospital. Eighty participants were recruited and randomized in a 1:1 ratio to receive either the HH or TB appliance. Eligibility criteria included children aged 10-14 years with an overjet of ≥7 mm without dental anomalies. The primary outcome was the time (in months) required to reduce overjet to normal limits (<4 mm). Secondary outcomes included treatment failure rates, complications and their impact on oral health-related quality of life (OHRQOL). Randomization was accomplished using electronic software with allocation concealed using sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for outcome assessment. Data were analyzed using descriptive statistics and regression analyses to detect between-group differences, including Cox regression for time to treatment success. RESULTS: HH was significantly faster than TB in reducing the overjet to within normal limits (95% confidence interval [CI], -3.00 to -0.03; P = 0.046). Mean overjet reduction was more efficient with the HH than the TB appliance (ß = 1.3; 95% CI, 0.04-2.40; P = 0.04). Fifteen (37.5%) of the participants in the TB group and 7 (17.5%) in the HH group failed to complete the treatment (hazard ratio = 0.54; 95% CI, 0.32-0.91, P = 0.02). However, TB was associated with fewer routine (incidence rate ratio = 0.81; 95% CI, 0.7-0.9; P = 0.004) and emergency (incidence rate ratio = 0.1; 95% CI, 0.1-0.3; P = 0.001) visits. Chairside time was greater with the HH (ß = 2.7; 95% CI, 1.8-3.6, P = 0.001). Participants in both groups experienced complications with similar frequency. A greater deterioration in OHRQOL was found during treatment with the TB. CONCLUSIONS: Treatment with HH resulted in more efficient and predictable overjet reduction than TB. More treatment discontinuation and greater deterioration in OHRQOL were observed with the TB. However, HH was associated with more routine and emergency visits. REGISTRATION: ISRCTN11717011. PROTOCOL: The protocol was not published before trial commencement. FUNDING: No specific external or internal funding was provided. Treatment for participants was provided as part of routine orthodontic treatment in the hospital.

The role of oral appliance therapy in obstructive sleep apnoea.

There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the "gold standard" in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-made versus noncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.

A comparison of children's experiences with fixed and removable functional appliances: A qualitative study.

INTRODUCTION: The objective of this study was to compare children's experiences and perceptions of treatment with Hanks-Herbst (HH) and modified Twin-block (MTB) functional appliances. METHODS: A pragmatic nested qualitative study was undertaken in a single hospital setting. Participants from a randomized controlled trial (International Standard Randomised Controlled Trial Number 11717011) wearing HH and/or MTB appliances were interviewed using a topic guide in a one-to-one, semistructured format. Interviews were recorded and transcribed verbatim for framework methodology analysis until data saturation was reached. RESULTS: Eighteen participants (HH, 7: MTB, 4; switched group, 7) were interviewed. Thirteen codes were constructed and grouped into 3 themes: (1) functional impairment and symptoms, (2) psychosocial factors and impacts, and (3) feedback on appliances and patient care. Both appliances had a negative impact on quality of life, with disruption to children's daily routines and psychological well-being. Speaking was more problematic for MTB participants, whereas HH participants encountered mastication and breakage issues. HH was preferred by most participants, as its nonremovable feature meant less managing and self-discipline was required. MTB was considered a suitable option for children with good self-discipline and who preferred a versatile lifestyle. Feedback included wishes for the availability of multiple appliance options and a degree of autonomy in decision-making processes. CONCLUSIONS: HH and MTB can negatively affect children's quality of life. Participants preferred HH over MTB because of its nonremovable feature, and children requested to be empowered during decision-making processes.

The quality and reliability of the Internet as a source of information for hypodontia patients.

OBJECTIVES: The aim of this study was to determine the quality, reliability and usability of information on the Internet regarding hypodontia. METHOD: A survey of patients with hypodontia revealed seven key search terms favoured by patients: Hypodontia; Congenitally missing teeth; Missing teeth; Gaps in teeth; Cure of missing teeth; Information on missing teeth; and Treatment of missing teeth. These were entered into four search engines: Google; Ask; Wikipedia; and NHS Choices. Relevant websites were assessed for their overall demographics, author type, country of origin and rank within the search engine. They were then analysed using five validated assessment tools. Intra-examiner reliability was assessed, and statistical analysis of the data was undertaken. RESULTS: Good intra-examiner reliability was observed. A total of 48 websites were included for analysis from an initial 1718. There was no relationship between the ranking of a website on a search engine and the quality of information it contained. When medical search terminology was used, it resulted in websites of better quality than layperson search terms. Most websites were produced by general dental or specialist dental practices but the quality of these was poorer than those developed by private companies and medical organisations. The country of origin was primarily the USA and UK; however, this had no relationship to website quality. Overall, the majority of websites scored poorly for the validated tools and none scored well across multiple tools. A statistical analysis showed a positive relationship between the LIDA and DISCERN instruments but no other correlation between other validated tools was found. CONCLUSION: The quality and reliability of information on the Internet regarding hypodontia is generally poor. There is a need for a reliable online hypodontia resource that can be recommended for patient use.

The Tip and Torque adjustable bracket as a new concept in design.

OBJECTIVES: To test a new concept in bracket design-the tip and torque adjustable bracket (TTAB)-to identify its integral ability to change both tip and torque. MATERIALS AND METHODS: The newly designed TTAB underwent independent testing using the orthodontic measurement and simulation system. The TTAB incorporated Roth tip and torque prescription values, with the unique quality of the bracket to enhance or reduce the innate prescribed values of tip (by either +10° or -10°) and torque (by either +7.5° or -7.5°). The TTAB was tested using both the incorporated standard Roth prescription on the rate of canine retraction (sliding mechanics), using 0.018-inch stainless-steel (SS) arch wire, and with alteration of tip values (-10° and +10°). Similarly, frictional measurements and torque evaluations using 0.019 × 0.025-inch SS arch wire were undertaken with the standard prescription and altered torque (+7.5° and -7.5°). In addition, a number of control investigations were performed. Differences were analyzed using analysis of variance. RESULTS: The rate of observed tooth movement for the TTAB with its prescribed baseline values was comparable to that of the control brackets. Importantly, the alteration of TTAB tip to -10° and +10° significantly (P < .001) increased and reduced, respectively, the rates of canine retraction. In the alteration of torque, at +7.5° and -7.5°, the bracket delivered a moment of +9.3 (2.8) Nmm and -11.9 (3.8) Nmm, respectively, to the lateral incisor (P < .001). CONCLUSIONS: This in vitro study demonstrates a new concept in preadjusted edgewise bracket design, offering adjustable tip and torque, with the potential for expanded clinical scope.

Hypodontia and its impact on a young person's quality of life, esthetics, and self-esteem.

INTRODUCTION: The impact of hypodontia on quality of life is a relatively unexplored area. The limited research shows that the issues of importance for people with hypodontia can vary from those of patients undergoing routine orthodontic treatment. This research aimed to use generic and condition-specific scales to evaluate the impact of hypodontia on a young person's oral health-related quality of life, self-esteem, and aesthetics. METHODS: This prospective cross-sectional hospital-based study recruited 97 participants with hypodontia, aged 11-18 years. The following questionnaires were completed before the start of any planned treatment: child perception questionnaire, Bristol condition-specific questionnaire for hypodontia, child health questionnaire, and Oral Aesthetic Subjective Impact Scale. A priori sample size calculation determined a minimum of 65 participants were required, at the 5% level of significance, and with a power of 80%. The number was inflated to allow for dropouts/loss to follow-up by 30%. RESULTS: A total of 323 teeth were missing; 58 subjects (36 female) showed mild (2 absent teeth), and 39 subjects (25 female) showed moderate to severe (>2 absent teeth) hypodontia. Forty-one (42%) patients were missing anterior teeth, with absent maxillary lateral incisors predominating. Significant differences were found for the overall child perception questionnaire (P = 0.01), emotional (P = 0.005), and social (P = 0.003) well-being; scores were highest in the moderate to severe hypodontia group, revealing the greatest negative impact. Similarly, overall Bristol condition-specific questionnaire for hypodontia (P <0.001), treatment (P = 0.001), appearance (P = 0.013), and other people's reaction (P <0.001) domains were all significant, with the moderate to severe group reporting higher levels of negative impact. No significant differences were observed in self-esteem or esthetics. CONCLUSIONS: Hypodontia in young people appear to have a negative psychosocial impact, both in terms of its presentation and planned care.

Intervention to enhance adherence to mandibular advancement appliance in patients with obstructive sleep apnoea: study protocol for a randomised clinical trial.

BACKGROUND: Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder characterised by the repeated episodic collapse of the upper airway during sleep, resulting in sleep deprivation, giving rise to apnoeas and hypopnoeas. Based on the severity of OSA, there are two primary treatment modalities, continuous positive airway pressure (CPAP) and mandibular advancement appliances (MAA); both are adherence-dependent. MAA is offered to those with mild to moderate OSA and is prescribed as an alternative to patients intolerable to CPAP. However, adherence to MAA treatment is variable and declines over time. Hence, the current study aims to assess the effectiveness of the stage-matched intervention, the Health Action Process Approach (HAPA), on adherence to MAA in patients with OSA. METHODS: A single-centre randomised clinical trial will be undertaken at Bart's Health NHS Trust. Fifty-six participants with newly diagnosed OSA are planned to be enrolled in the study and randomised to intervention care (IC) and standardised care (SC) groups. Participants in the SC group will receive routine care whilst participants in the IC group will receive the stage-matched intervention, developed using the HAPA model. Data indicating MAA adherence will be collected both objectively and subjectively, from micro-sensors embedded in the MAA design and sleep diaries, respectively at 3, 6, 18 and 36 months. In addition, a range of questionnaires designed to assess risk perception, outcome expectancy, and self-efficacy (SEMSA) and quality of sleep (PSQI and ESS) and life (EQ-5DL), socio-economic and social support scales will be used. DISCUSSION: The currently available treatments for obstructive sleep apnoea depend entirely on the patient's acceptance and use. There are several factors that affect cooperation and wear for example patients' awareness of their condition, social support and psychological behaviour. In addition, mood, such as anxiety, stress, and depression, may affect wear. At the same time, we know that interventions involving more education and behaviour approaches can help patients adapt more easily to some treatments. As a result, the present trial aims to explore the potential role of these factors to maximise treatment success and minimise side effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT04092660 . Registered on September 6, 2019.

Clear aligner orthodontic treatment: Angle Society of Europe consensus viewpoint.

Orthodontics has witnessed not only an exponential rise in demand from adult patients but accompanying this, the emergence of alternate aesthetic treatment options to the more traditional fixed labial appliance. The concept of using clear aligners as a means of achieving tooth movement has increased in popularity among both patients and clinicians alike. However, the question over best research evidence as to their clinical effectiveness to treat a range of malocclusion traits remains elusive and controversial among the profession.In an attempt to offer the profession some clear guidance, The Angle Society of Europe reviewed and discussed the current published evidence (2005-2018) on their clinical use, during the annual meeting in January 2020, to help formulate a consensus viewpoint on the clinical applications.

Factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea: a systematic review and meta-analysis.

STUDY OBJECTIVES: The review aimed to identify the factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea. METHODS: The protocol was initially registered with the International Register of Systematic Reviews (Prospero: CRD42019122615) prior to undertaking a comprehensive electronic search of databases and references without language and date restrictions. Quality assessment was undertaken using the Cochrane Collaboration's risk of bias tool and Quality in Prognosis Studies (QUIPS) tool. RESULTS: Studies exhibited low or unclear risk of bias for the domains assessed by the respective quality assessment tools. The influence of independent variables such as disease characteristics, patient characteristics, appliance features, and psychological and social factors on adherence levels was also assessed. There was a total of 31 included studies, which consisted of 8 randomized controlled trials, 2 controlled clinical trial, 7 prospective cohorts, 11 retrospective cohorts, and the remaining 3 studies were a case-series, case-control, and a mixed-methods. All 31 included studies were subject to qualitative analysis, with only 4 studies included in the quantitative analysis. Results of the meta-analysis demonstrated increased adherence with custom-made appliances, with a pooled mean difference of -1.34 (-2.02 to -0.66) and low levels of heterogeneity (I² = 0%). CONCLUSIONS: A weak relationship was observed between objective adherence and patient and disease characteristics, such as age, sex, obesity, apnea-hypopnea index, and daytime sleepiness, to oral appliance therapy. Nonadherent patients reported more side effects with oral appliance therapy than users and tended to discontinue the treatment within the first 3 months. Custom-made oral appliances were preferred and increased adherence reported in comparison to ready-made appliances. Further research is imperative to examine the relationship between psychosocial factors and adherence to oral appliance therapy.

The influence of mild versus severe hypodontia on facial soft tissues? A three-dimensional optical laser scanning-based cohort study.

OBJECTIVE: To determine whether there are differences in the facial soft tissue morphology between participants with mild (up to two) or severe (six or more) hypodontia. DESIGN AND SETTING: A prospective hospital-based cohort study. PARTICIPANTS AND METHODS: Ninety-two participants, aged 11-16 years, with confirmed hypodontia were recruited. Participants were sub-grouped based on the severity (mild, two or less and severe, six or more) and distribution of the missing teeth and age. They underwent a three-dimensional (3D) optical surface scan of the facial soft tissues. Facial surface scans were compared quantitatively, applying landmark measurements and surface-based analysis. RESULTS: In total, 92 participants, with an equal distribution between the mild (n=46) and severe (n=46) categories, were recruited. Patients with severe hypodontia displayed a reduced alar base, lower facial height, nasolabial angle (P = 0.02) and transgonial width (P < 0.001) compared to those with milder hypodontia. Furthermore, significant differences were observed between mild-male and severe-female groups regarding alar base, lower anterior face height and transgonial width and between mild-male and mild-female groups regarding nasolabial angle and transgonial width. CONCLUSION: Significant reductions were seen in the 3D soft tissue morphology of participants with severe hypodontia, in terms of the nasolabial angle, lower facial height, alar base and transgonial widths, emphasising the importance of using facial scanning as a relatively simple non-invasive method of assessment.

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.

Complications, impacts, and success rates of different approaches to treatment of Class II malocclusion in adolescents: A systematic review and meta-analysis.

INTRODUCTION: We aimed to explore the prevalence and nature of complications associated with Class II correctors in adolescents and their impact on the quality of life (QOL), completion of treatment, and success rate. METHODS: The review was registered in PROSPERO, and a comprehensive electronic search was performed without language or date restrictions. Randomized and nonrandomized trials, prospective cohort and cross-sectional studies, case series, and qualitative research were included. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the quality of included studies. Data were grouped according to appliances design: removable functional, fixed functional, hybrid functional, headgear, and fixed maxillary molar distalization appliances. RESULTS: Data from 27 studies were included, of which 11 were deemed eligible for meta-analysis. Overall, 1676 adolescents were included related to fixed functional (n = 682), removable functional (n = 682), hybrid functional (n = 84), headgear (n = 186), and Carriere (n = 42) appliances. The mean number of emergencies was 0.8 (95% confidence interval [CI], 1.1-2.1) and 2 (95% CI, 0.9-3.0) for removable and fixed designs, respectively. However, the rate of discontinuation was 35% (95% CI, 0.28-0.42) and just 1% (95% CI, 0.01-0.1) for removable and fixed designs, respectively. Other QOL dimensions such as eating, sleep, speech, and emotional domains were significantly impaired during treatment with removable functional appliances. CONCLUSIONS: Removable Class II correctors were associated with a high rate of treatment discontinuation, most likely because of the negative impact on QOL and lack of compliance. More complications were observed with fixed designs, although this did not impact the overall success rates. Further prospective studies are needed to explore patient perceptions and cost-effectiveness to inform treatment decisions better.

Development of 'My Retainers' mobile application: Triangulation of two qualitative methods.

OBJECTIVE: Diligent wear of removable orthodontic retainers requires prolonged adherence and is invariably necessary to preserve optimal results. Patient-informed behaviour-change interventions represent a promising and novel means of enhancing adherence to removable retainer wear. The aim of this study was to describe the development of a patient-informed mobile application designed to enhance retainer wear. METHODS: App development encompassed consideration of participant preferences, social media posts, available interventions and behaviour change theories. Qualitative methods including analysis of publicly-available retainer-related posts on Twitter (n = 827) and one-to-one interviews were undertaken. Audio-recorded one-to-one interviews were undertaken to identify patient preferences in relation to features, content and design of the application. A criterion-based purposive sample of participants wearing vacuum-formed retainers for at least 4 years was used (n = 15). Thematic analysis of transcribed data was undertaken. These data were triangulated to inform design and content of the application. RESULTS: The need to facilitate communication with the treating clinician, responsive reminder and tracking systems, and access to useful and engaging written and visual information, in addition to other personalised and interactive features were considered important. Concerns related to retainer wear shared on Twitter informed an exhaustive list of frequently-asked questions. Application features were mapped to relevant theoretical constructs. Determinants of existing behavioural change theories were also used to link application features to retainer wear and maintenance. CONCLUSIONS: A holistic process involving both patient and professional input can be useful in informing the development of mobile applications. The orthodontic application ("My Retainers") will undergo further scrutiny in relation to its effectiveness in inducing behavioural change and concerning patient experiences prior to finalisation.

Assessment of Psychological Disturbance in Patients with Tooth Loss: A Systematic Review of Assessment Tools.

PURPOSE: To systematically review the available evidence on screening tools to detect the psychological disturbance in patients with tooth loss and technically successful removable dentures (partial and complete). MATERIALS AND METHODS: The study protocol was registered with the National Institute of Health Research Database (I.D. CRD42017082125). The PICOS tool (patients, intervention, control, outcomes measure, and study design) was used to formulate an effective search strategy. Participants were adults (≥ 18), who were edentulous or had significant tooth loss (< 9 remaining teeth). The intervention included undergoing replacement with technically successful dentures (partial or complete). A control group of adults were either edentulous or had significant tooth loss and without dentures. Outcomes included assessing psychological disturbance due to treatment with dentures or due to no treatment using a validated tool. A structured search strategy was used to complete a standard systematic search of the electronic database without any date limit and/or language restriction. Only quantitative studies using a validated measuring tool to screen for psychological distress in adults with significant tooth loss were included. Two authors independently assessed the risk of bias in the included studies. Data homogeneity was assessed in regards to the screening tools to measure psychological disturbance following the management of tooth loss with dentures. The significant level was set at 0.05, using IBM SPSS Statistics 24.0 (SPSS Inc., New York, NY). The psychometric properties and the validation processes of the screening tools were assessed. RESULTS: From the original 3510 studies identified, only eight studies were found to meet the inclusion criteria. All eight studies used the same questionnaire to screen for the emotional distress of tooth loss. In addition, one study also used the Patient Health Questionnaire-9 (PHQ-9) to screen for the association of depression with tooth loss. Six studies suggested that a significant number of patients have difficulties in accepting tooth loss, were less confident, and had emotional distress related to tooth loss. However, two studies reported no significant link. All studies found a marked impact on functional activities and social interaction. However, four studies had a potentially biased selection process, and the questionnaire used was assessed to be at high-risk of measurement bias, as the development and validation process was not clear. There was also a lack of well-defined control groups in all studies. CONCLUSION: Tooth loss could cause psychological disturbance in some patients. To date, there is a lack of available tools that are suitable to screen and measure psychological disturbance in patients with tooth loss. Additional research is required to develop tools to identify and measure such impact and to recommend suitable interventions when needed.