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

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

Gender dysphoria: An overview for orthodontists.

Among non-gender conforming populations, there is a subgroup of individuals who experience significant distress associated with their gender incongruity, commonly referred to as gender dysphoria (GD). In the UK, there is a recognised pathway for individuals experiencing GD. This has traditionally been initiated by a referral to the Gender Identity Development Service (GIDS) for children and adolescents or to a Gender Identity Clinic (GIC) for adults. This pathway can potentially involve several specialties and treatment modalities, including the prescription of various hormones. It is important for orthodontists to have an understanding of this field, as well as the potential treatment modalities, so that they can support this often marginalised patient group. Inherent differences between male and female facial features may also lead patients with GD to present to orthodontists, wishing to change their facial appearance. This article highlights the current national pathway for GD and the orthodontic considerations for these individuals.

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

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

Young people's experiences of orthodontic retainers: A qualitative study.

OBJECTIVE: To investigate young people's experiences of retainers, the associated impact of retainers on their lives and their perceptions of what influences their own co-operation. DESIGN: Qualitative, cross-sectional study. SETTING: An orthodontic department in a UK dental hospital. PARTICIPANTS: Purposive sampling was used to recruit young people, aged 11-17 years, wearing a range of different types of retainers. METHODS: Semi-structured interviews were conducted and transcribed. The resultant data were analysed using codebook thematic analysis. RESULTS: Ten patients were recruited before thematic saturation was achieved. Four themes were identified: impact and experiences of wearing retainers; facilitators and barriers to retainer adherence; finding out about retainers; and, finally, involvement in decisions about retainers. Although some initial negative impacts were described, participants generally adapted quickly to retainers. Several factors were perceived to influence co-operation with removable retainers, including concerns about relapse and the associated waste of personal effort and wider resources. There were perceived deficiencies in the information provided by clinicians, which led participants to seek advice from other sources, including social media. Some young people wanted to be more involved in decisions about their retainers. CONCLUSION: While patients perceived retainers to be easier to wear than active appliances, some transient negative impacts occurred, largely related to initial periods of full-time wear. There were a range of factors which patients perceived to influence their adherence with removable retainers.

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

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

Head and neck nonmelanoma cutaneous malignancy treatment in a skin cancer referral center.

OBJECTIVE: The purpose of our study was to determine the level of accuracy provided by clinical diagnosis in head and neck cutaneous malignancy as confirmed by histopathologic examination of the specimen in a skin cancer referral center. Positive predictive value was selected as a reliable measure of diagnostic accuracy. We also aimed to audit our surgical outcomes and record and present the completeness of excision, the rates of recurrence and metastasis, and the reconstructive method. STUDY DESIGN: We reviewed the electronic charts of 867 consecutive patients with skin tumors and calculated the positive and negative predictive values of clinical diagnosis. RESULTS: The positive predictive value was 91% for basal cell carcinoma and 78.8% for squamous cell carcinoma. Of the 178 histologically diagnosed squamous cell carcinomas, 15 were metastatic. CONCLUSIONS: In a skin cancer referral center, expert clinical diagnosis may safely overcome the need for preoperative biopsy. Relying on clinical diagnosis to formalize a treatment plan for head and neck nonmelanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma compared with suspected squamous cell carcinomas.