Aligning orthodontic education: Investigating the use of a digital app to improve the performance in managing orthodontic problems.

INTRODUCTION: General dentists are qualified to manage orthodontic emergencies within their scope of practice. This may involve advice, hands-on intervention or referral to a specialist orthodontist. This study aimed to assess the effect of an orthodontic app on dental undergraduates' ability to manage common orthodontic issues. In addition, this study aimed to determine the confidence of dental students in finding information related to orthodontic emergencies (CFI) as well as their confidence in managing orthodontic emergencies (CMOE). MATERIALS AND METHODS: Students were randomised into one-of-three groups, an app group, an internet group and a closed-book, exam-style group. All participants self-reported their CFI and CMOE. Following this, all participants were asked to complete a multiple-choice question (MCQ) paper based on clinical orthodontic scenarios. In addition, the app group were instructed to complete an app usability questionnaire (MAUQ). RESULTS: Approximately, 91.40% of students (n = 84) had not received clinical training in managing orthodontic emergencies, and 97.85% (n = 91) had not managed an orthodontic emergency clinically within the last 6 months of their training. The mean score for CFI was 0.10 out of 1.0 (SD 0.11) and CMOE was 0.28 out of 1.0 (SD 0.23). Statistically significant better MCQ scores were found in the app group, and no statistically significant difference was found between the internet and exam-style group. CONCLUSIONS: This study is the first to consider the use of an orthodontic app to aid in the management of orthodontic issues. It has practical implications for how mobile apps can aid in learning and can be incorporated into the wider dental field.

The effect of viewing idealised smile images versus nature images via social media on immediate facial satisfaction in young adults: A randomised controlled trial.

INTRODUCTION: The objective of this randomised controlled trial (RCT) is to investigate the effect of a social networking site (SNS) on body dissatisfaction, facial and smile dissatisfaction, and face-related discrepancy, and whether these effects differ from the use of appearance-neutral Instagram images. We also aimed to investigate whether there are trends in increased self-reported use of social media and increased body dissatisfaction, facial and smile dissatisfaction, and face-related discrepancy. METHODS: Undergraduate students were randomly allocated to an experimental group with idealised smile images or to a control group with neutral nature images. They completed pre-exposure questionnaires, then perused for 5 min their allocated images on individual Apple iPads via the Instagram application. Participants then completed the post-exposure surveys. The main outcome was facial dissatisfaction. Body dissatisfaction and total facial and body dissatisfaction were secondary outcomes. Simple randomisation was achieved with a computerised random number generator. Data were analysed using repeated measures ANOVA and multivariate regression analyses. RESULTS: A total of 132 participants (mean age = 20.50 ± 2.21 years) were randomised to either the experimental group with idealised smile images (n=71) or the control group with neutral nature images (n=61). Baseline characteristics were similar between groups and no participants were lost. Exposure to 'ideal' facial images on social media decreases facial satisfaction (95% confidence interval [CI] = 0.85-1.05; P < 0.0001). Individuals with high baseline self-discrepancy scores are less satisfied with their facial features and body appearance (95% CI = 0.04-1.16; P = 0.036). CONCLUSION: This study shows that viewing SNSs with high visual media reduces satisfaction with facial appearance in the short term in men and women. This effect is greater in those with high self-discrepancy scores. Increased media usage was not correlated with increased dissatisfaction. Wearing braces or having had braces was shown not to influence post-exposure dissatisfaction.

The effect of malocclusion on dating prospects.

OBJECTIVE: To establish whether the appearance of malocclusion affected dating prospects. The secondary objective was to identify any significant predictors relating to likelihood of dating. DESIGN: Cross-sectional study. SETTING: King's College London. PARTICIPANTS: A total of 232 undergraduate students. METHODS: Participants were shown images of either one man or one woman. The images had been manipulated using computer software to represent one of three differing dental appearances: post-orthodontic aligned teeth; pre-orthodontic crowded teeth; or pre-orthodontic missing teeth (developmentally absent maxillary lateral incisors). Sealed envelopes were randomly assigned to participants, who rated the individual in the image in relation to: attractiveness; intelligence; happiness; nervousness; and how much they would want to go on a date with them. The response format was a 100-mm visual analogue scale. RESULTS: The aligned dental appearance received statistically significant higher ratings of attractiveness (P < 0.001), intelligence (P = 0.031), likelihood of dating (P = 0.017) as well as lower ratings of nervousness (P = 0.020). There was no statistically significant difference in relation to happiness (P = 0.43), neither were there any statistically significant differences between the crowded and missing dental appearances. Regression analysis revealed that rated attractiveness was the most significant predictor in relation to likelihood of dating (P < 0.001). CONCLUSION: Malocclusion did influence dating prospects. Photographs of individuals with aligned teeth were more likely to be rated highly in relation to attractiveness, intelligence and likelihood of dating, when compared with images of malocclusions. The most significant predictor of likelihood of dating was rated attractiveness.

Does dental appearance affect employment prospects: a prospective cross-sectional study.

OBJECTIVE: The principal aim was to establish whether dental appearance affects employment prospects, and if so a secondary aim was to ascertain whether there is a difference between public-facing and non-public-facing jobs. DESIGN: A prospective cross-sectional experimental analogue study. PARTICIPANTS: Ninety undergraduates studying at London Metropolitan University School of Business. METHODS: Vignettes comprising curriculum vitae (CV) with a single photograph of the applicant attached formed the experimental manipulation. For each job application, the written information on the CV remained constant, but the attached photograph had one of three altered dental appearances: (1) aligned teeth, (2) maxillary stainless steel labial fixed appliance and (3) an absent maxillary left lateral incisor. To ascertain whether there are differences between public- and non-public-facing jobs, two different job descriptions with matching CVs were designed. Each participant was randomly assigned an envelope containing one CV with one photograph and asked if they would shortlist the candidate for an interview. Likert scales were used with higher scores indicating greater likelihood to shortlist. A Multivariate Analysis of Variance was conducted with Photo (three levels) and Job Type (two levels) as independent variables, and gender as a covariate. RESULTS: A trend was found for the candidate with an absent maxillary lateral incisor to be less likely to be shortlisted for the public-facing job, compared to both candidates with aligned teeth and with fixed appliances. There were no significant main effects and the interaction was not significant. The effect of gender was not significant. CONCLUSIONS: In this study, dental appearance did not influence employment prospects. When a photograph is attached to a CV, the dental appearance of the photograph did not influence whether a candidate was shortlisted for a job interview or their anticipated job performance. There were no differences between public-facing and non-public-facing jobs.

Supernumeraries in Nicolaides-Baraitser Syndrome.

BACKGROUND: Nicolaides-Baraitser Syndrome(NCBRS) is an extremely rare condition which has been reported in only a few cases. NCBRS is a distinct clinical condition with typical clinical features of pre- and post-natal global developmental delay, impaired speech, and seizures. Microcephaly, sparse hair, anteverted alae nasi, undefined philtrum, prominence of distal phalanges and interphalangeal joints, and short metacarpals are also typical of NCBRS. CASE REPORT: There are no reported cases in the literature of patients with NCBRS presenting with multiple dental impactions, and to the authors' knowledge, this is the 28th fully documented case of NCBRS and only 75 cases identified as potentially having NCBRS. The clinical features, diagnosis, and course of management are also described. CONCLUSION: Although NCBRS is very rare, it is important to assess dental development in view of the possibility of multiple supernumerary teeth which can have detrimental effects on the occlusion.

A Novel Cephalometric Approach Aiming to Quantify a Normal Range of Bony Chin Protrusion.

Introduction: Cephalometric analysis is an essential tool in the diagnostics and planning of orthognathic surgery. No objective criterion exists to facilitate decision making regarding genioplasties. Differing opinions amongst clinicians therefore leads to wide variability amongst treatment options offered to potentially suitable patients. This study has three aims. The first was to quantify the distribution of chin morphology amongst the average population using cephalometric analysis. Secondly, we sought to determine whether cephalometric parameters could be used to predict overlying soft tissue changes. Lastly, we consider the use of a new cephalometric angle, BNPg, for pre- and post-operative assessment of genioplasty patients. Methods: This study retrospectively analysed 231 lateral cephalograms. The angle between the landmarks: B point, Nasion and Pogonion was measured to generate 'BNPg' a novel unit to quantify bony chin protrusion. Results: The mean BNPg from all 231 samples was 1.12 degrees with a standard deviation of ± 1.35. Comparison between sexes showed no significant differences between male and females (P = 0.108). Furthermore, bony chin protrusion was found to strongly positively correlate with soft tissue chin appearance (r = 0.731), however, BNPg was found not to correlate with skeletal malocclusion (ANB, r = 0.085). Conclusion: The novel unit BNPg may serve as a useful tool in contributing to the determination of treatment thresholds in osseous genioplasty for desirable aesthetic outcomes and may be used post-operatively to assess outcomes also. As this is a pilot study, further clinical studies would be required to validate this parameter in genioplasty patients, both pre- and post-operatively. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-022-01784-5.

Treatment time and occlusal outcome of orthognathic therapy in the East of England region.

OBJECTIVES: To evaluate the process of combined orthognathic and orthodontic care. To identify factors that affect treatment time and percentage Peer Assessment Rating (PAR) reduction, and the PAR efficiency factor for such cases. DESIGN AND SETTING: Retrospective multi centre study of patients who underwent orthognathic treatment in the East of England region. METHODS: Analysis of consecutive cases that underwent orthognathic surgery in 2008. Inclusion criteria included pre- and post-surgery orthodontic treatment. RESULTS: Ten orthodontic units submitted data for a total of 118 patients. Within the sample, 64% were class III, 35% class II/1 and 1% class II/2. Overall extraction rate, excluding third molars, was 58%. Median age at bond up was 17 years. Mean total number of orthodontic attendances was 23. Median length of pre-surgical orthodontics was 23 months and post-surgical orthodontics was 7 months. Median length of total treatment was 29 months. Mean wait for surgery was 3·6 months. Diagnosis of incisor relationship and skeletal base, transfer of operator, total number of visits, tooth extraction and treatment unit affected treatment duration. Median pre- and post-treatment PAR scores were 43 and 4, respectively. Median change in PAR score was 38·5. Median per cent reduction in PAR was 90·6%. The median PAR efficiency factor (reduction in PAR score divided by treatment time in months) was 1·24. Diagnosis of incisor relationship and skeletal base correlated with percentage reduction in PAR score. CONCLUSIONS: Combined orthognathic treatment was effective. Factors affecting treatment duration and percentage reduction in PAR have been established.

Assessment of orthodontic borderline treatment need: A comparison of two aesthetic indices.

OBJECTIVE: To compare a new "guide for borderline orthodontic need" (GBON) with the "aesthetic component" (AC) of the IOTN in assessing borderline cases (dental health component DHC 3), and to compare reliability and opinions of orthodontists on the use of each index. MATERIALS AND METHODS: Cross-sectional population descriptive study. Ninety-four qualified orthodontists assessed 30 borderline malocclusions according to the GBON and AC indices and completed a questionnaire. RESULTS: Kappa analysis showed GBON and AC to have similar intra-examiner reliability (K = 0.64 and 0.60 ,respectively). Cronbach's alpha inter-examiner reliability analysis showed GBON and AC to have similar, acceptable reliability (α = 0.7 and 0.9 ,respectively). There was only fair agreement between GBON and AC in terms of the number of malocclusions deemed as needing treatment (AC threshold 6). Analysis of specific occlusal traits revealed that reverse overjets were deemed as needing treatment according to AC but not anterior open bites. Both traits were assessed as needing treatment according GBON. Despite a lack of familiarity with GBON, assessors found GBON easier to use and more appropriate in assessing borderline malocclusions. CONCLUSIONS: Both GBON and AC had good and similar inter- and intra-examiner reliability. There was substantial agreement on treatment need between GBON and AC but only when the AC threshold is reduced to 4. GBON was more able to identify malocclusal traits in need of treatment than AC. GBON was found to be easier to use and considered more appropriate than AC in judging DHC 3 malocclusions.

The development of a guide to borderline orthodontic need.

OBJECTIVE: To produce a guide for dentists and orthodontists to determine orthodontic treatment need in borderline cases (dental health component DHC 3) and to compare views of different panels of judges on treatment need. MATERIALS AND METHODS: Prospective, observational study. Photographs of one hundred subjects displaying borderline occlusal traits (DHC3) were collected. Three panels of judges consisting of 25 orthodontists, 25 dentists and 25 lay persons assessed photographs based on orthodontic treatment need on aesthetic grounds. RESULTS: Spearman's correlation coefficient showed no statistical difference between the panels of judges (p < 0.001). The judges identified a 'high need' for treatment on aesthetic grounds for those with anterior open bites and reverse overjets. Kappa analysis showed moderate intra-rater agreement for the orthodontic and dental panels of judges (k = 0.47 and 0.45, respectively) and fair agreement (k = 0.26) for the lay panel, highlighting the intrinsic difficulty of assessing borderline malocclusions. CONCLUSION: There was no statistical difference in the way the orthodontic, dental and lay panels of judges perceived treatment need for DHC 3 cases. Anterior open bites and reverse overjets were predominantly found to be in high need of treatment by all panels of judges. A 'Guide to Borderline Orthodontic Need' (GBON) is proposed consisting of 8 photographs of subjects with borderline occlusal traits (DHC3) determined unambiguously by lay, dental and orthodontic panels as either 'needing' or 'not needing' orthodontic treatment on aesthetic grounds. It is anticipated that this will assist users to make judgments on aesthetic grounds on the need for treatment in borderline cases.

The effect of social media on patient acceptance of temporary anchorage devices.

OBJECTIVES: To investigate the relationship between the use of social networking sites (SNSs) on patient perceptions, acceptance, and expectations of treatment using temporary anchorage devices (TADs) and to compare differences between patients from the United Kingdom and Brazil. MATERIALS AND METHODS: Cross-sectional questionnaires were administered to 39 participants at orthodontic practices in the United Kingdom and Brazil about patients' use of SNSs, exposure to TADs on SNSs, and thoughts on extractions, jaw surgery, or TADs as treatment options. RESULTS: UK patients prefer for clinicians to have SNS profiles (P = .022). Most UK and Brazilian patients want to see their clinician's work online (76.7%) and use SNSs to get information about treatment options (76.6%). There was a statistically significant difference in Brazilian patients' acceptance of TADs as a treatment option compared with UK patients, particularly if it meant avoiding extractions (P = .002), avoiding jaw surgery (P = .004), or reducing treatment time (P = .010). Knowledge of TADs was greater in Brazilian patients (P < .001). CONCLUSIONS: Patients use SNSs to obtain information about treatments and prefer clinicians to have social media accounts. Patients exposed to TADs on SNSs are more likely to accept them as an orthodontic treatment option. UK patients have less knowledge of TADs and are therefore less sure to consider TADs as an option. Brazilian patients are more confident in considering the use of TADs. Clinicians should consider increasing their social media presence to accommodate patients' expectations and acceptance of TADs.

Reliability of recording static and dynamic occlusal contact marks using transparent acetate sheet.

STATEMENT OF PROBLEM: Inaccuracy in the transfer of information between clinician and technician regarding occlusal contacts can cause problems when fabricating indirect restorations, which can result in frustration for the dentist, technician, and patient. Few studies have considered the reproducibility of recording marked occlusal contacts. PURPOSE: This study aimed to test the reproducibility of a quick and simple means of recording marked occlusal contacts. MATERIAL AND METHODS: The static and dynamic occlusal contacts of 29 subjects, with no missing functional units, were marked using articulating paper. Three clinicians with varying clinical experience (3-10 years after graduation from dental school) were asked to independently record the marked occlusal contacts using a transparent acetate sheet. The results were analyzed for Kappa agreement. RESULTS: For the static occlusion, Kappa values of agreement between pairs of examiners were 0.88, 0.86, and 0.85, respectively, all indicating "almost perfect agreement." For the dynamic occlusion, the range of Kappa agreement between pairs of examiners produced a median of 0.91, 0.88, and 0.85, respectively, indicating almost perfect strength of agreement. CONCLUSIONS: The results suggest that marking occlusal contacts on a transparent acetate sheet provides a simple means of recording static and dynamic occlusal contacts with a high degree of reproducibility.