Quality of occlusal outcome in adult Class II patients treated with completely customized lingual appliances and Class II elastics compared to adult Class I patients.

OBJECTIVES: The aim of this investigation was to evaluate whether Class II malocclusion in adult patients can be successfully corrected using a completely customized lingual appliance (CCLA) in combination with Class II elastics. METHODS: In order to detect differences in the final treatment outcome, two groups were matched for age and gender. Treatment results of 40 adult orthodontic patients with a Class I malocclusion (Group 1) were compared to 40 adults with a Class II malocclusion (Group 2). All patients had completed treatment with a CCLA (WIN, DW Lingual Systems, Bad Essen, Germany) without known centric occlusion-centric relation discrepancies, issues of compliance, or overcorrection in the individual treatment plan which was defined by a target set-up. In order to compare the treatment results of the two groups, 7 measurements using the American Board of Orthodontics Model Grading System (ABO MGS) and linear measurements for anterior-posterior (AP) and vertical dimensions were assessed at the start of lingual treatment (T1), after debonding (T2B) and compared to the individual target set-up (T2A). RESULTS: A statistically significant AP correction was achieved in Group 2 which represented 95% of the planned amount. The planned overbite correction was fully achieved in the Class I and Class II group. In both groups, there was a statistically significant improvement in the ABO scores, with no significant difference between the two groups at T2. 100% of the patients in Group 2 and 92.5% in Group 1 would meet the ABO standards after CCLA treatment. LIMITATIONS: The main limitation of this study is that only patients who were wearing the elastics as prescribed were retrospectively included. Therefore, the results of this study may have limited generalizability. CONCLUSIONS: Completely customized lingual appliances in combination with Class II elastics can correct a Class II malocclusion successfully in adult patients. The final treatment outcome can be of a similar high quality in Class I and Class II patients.

Factors influencing treatment outcomes assessed by the American Board of Orthodontics Objective Grading System (ABO-OGS).

BACKGROUND: Treatment outcomes can be influenced by various factors. This study aimed to determine the association between predisposing patient- and treatment-related factors (demographic, cephalometric parameters, skeletal relationships, Discrepancy Index (DI), extractions, treatment type and duration) and treatment outcomes measures according to the American Board of Orthodontics Objective Grading System index (ABO-OGS). METHODS: Completed cases (N = 100) were included in this cross-sectional study. One calibrated examiner assessed DI, pretreatment lateral cephalometric parameters and ABO-OGS. Patient data, including sex, age, types of malocclusion, extractions, treatment type, and duration, were also collected. Intraexaminer reliability for each measurement was evaluated using the intraclass correlation coefficients. Multiple linear regression analysis, using the backward elimination method with a significance level (α) of 0.05, was used to determine which factors significantly influenced the ABO-OGS score. RESULTS: From the study, the overall mean ABO-OGS score was 11.36 points. Factors influencing the ABO-OGS score were pretreatment Wits values (p value = .000), L1-NB (°) (p value = .023) and treatment duration (p value = .019). Subjects with lower negative values of Wits and L1-NB (°) tended to have higher ABO-OGS scores. Additionally, the ABO-OGS score tended to be higher for subjects with longer treatment times. CONCLUSIONS: The majority of treated subjects had satisfactory orthodontic treatment outcomes assessed by the ABO-OGS. The pretreatment severity of skeletal discrepancies determined by the Wits parameter, the degree of retroclined lower incisors and longer treatment duration negatively impacted the treatment outcomes.

Treatment effectiveness of young adults using clear aligners versus buccal fixed appliances in class I malocclusion with first premolar extraction using the ABO-Objective Grading System: A randomized controlled clinical trial.

OBJECTIVE: To compare the effectiveness of the clear aligners with the traditional fixed appliances in the treatment of premolars extraction complex cases using the American Board of Orthodontics Objective Grading System (ABO-OGS). MATERIAL AND METHODS: A single-centre, 2-parallel groups RCT with two arms. Forty severe crowding patients (14 males, 26 females; mean age: 21.40±2.42) who required four first premolars extraction were included and randomly allocated into two treatment groups: clear aligners therapy group (CAT), and fixed appliances therapy group (FAT). Cases complexities were measured on pre-treatment records using the Discrepancy index (DI). Post-treatment records were evaluated using the American Board of Orthodontics Objective Grading System (ABO-OGS). Two sample t-tests and Fisher's Exact tests were used to test for significant differences between the two groups. The statistical significance was set at P < 0.006 using Bonferroni's correction. RESULTS: For the DI, the mean scores were 32.25 (± 4.33) in the CAT group and 33 (± 7.92) in the FAT group. In the CAT group, the total OGS score ranged between 6-33 points with an average of 17.50(± 7.41), whereas the total score in the FAT group went between 4-30 points with an average of 12.89 (± 6.31) with no significant differences between the two groups (P=0.05). When comparison of the successful cases between the two groups was made, 11 cases received passing scores, and 9 cases received failing scores in the CAT group. Whereas in the FAT group, 17 cases received passing scores, and 3 received a failing score. No statistically significant differences were found in the passing rates between of the CAT and FAT groups (P = 0.421). CONCLUSIONS: According to the ABO-OGS total scores, there was no significant difference between the clear aligners and fixed appliances in the treatment of class I severe crowding cases with first premolars extraction in young adults. There were no differences between the two techniques in the OGS components scores except for the occlusal contacts, which were significantly better with the fixed appliances. When comparing the number of successful and failed cases between the two groups, no significant differences were noted, with the fixed appliances having a 30% higher success rate than the clear aligners, which must be considered clinically when choosing between these two techniques in the complex orthodontic cases treatment.

Objective treatment outcome assessment of a completely customized lingual appliance: A retrospective study.

OBJECTIVE: To assess the outcome quality of subjects treated with a completely customized lingual appliance (CCLA) in a postgraduate university program, using the ABO Objective Grading System (OGS), by testing the null-hypothesis of a significant proportion of post-treatment cases exceeding an adjusted 'exam failure' threshold value of OGS=24. MATERIALS AND METHODS: This retrospective single-arm study included 66 consecutively debonded CCLA cases (m/f 19/47; mean age: 25.1±9 years) treated at Hannover Medical School (MHH, Hannover, Germany). The discrepancy index (DI) was assessed on initial plaster casts. The OGS of the cast-radiograph evaluation was scored for both set-up and post-treatment casts, including the seven components of alignment/rotation, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationships and interproximal contacts, to parameterize differences between those. RESULTS: DI score distribution (≥20, <20) was 25 (37.9%)/41 (62.1%) subjects. Mean initial DI was 17.3±8.5. Mean set-up OGS was 10.4±4.4 (min-max: 3-21), mean final OGS was 17.7±5.9 (min-max: 7-33), and the difference 7.3 (post-treatment - set-up) was statistically significant (p<0.0001; 95% CI [5.8, 8.7]). The null-hypothesis was rejected: A statistically significant proportion of the final casts (n=58; 87.8%) scored below OGS=24 by exact binomial test (P<0.0001; 95% CI [77.5%, 94.6%]). The rate of a final OGS score<24 was not significantly different (P=0.98) between both DI (≥20, <20) groups. CONCLUSIONS: The outcome quality of the CCLA treatment in this postgraduate university setting was high and therefore sufficient for a vast majority of treated cases to pass the ABO-OGS clinical examination.

The Relationship between Posttreatment Smile Esthetics and the ABO Objective Grading System: Class I Extraction versus Non-Extraction Cases.

OBJECTIVE: This study aimed to evaluate the relationship between the components of the objective grading system developed by the American Board of Orthodontics (ABO) and smile esthetics in Class I extraction vs non-extraction cases. METHODS: A total of 40 extraoral smile images of orthodontically treated (20 extraction and 20 non-extraction) cases in the age group of 13-30 years and Class I skeletal malocclusion with an average mandibular plane angle were selected. Smile images were rated only by the orthodontist, and this panel included 12 members. Scoring of post-treatment dental casts and panoramic radiographs of each patient was performed by 1 investigator per the guidelines of the ABO grading system. The Pearson correlation coefficient and logistic regression analysis were used to ascertain whether the scores of the ABO grading system could foretell whether a smile would be "attractive" or "unattractive." RESULTS: The correlation between all the criteria of the ABO grading system and attractiveness of the smile was extremely weak. The r values ranged from -0.53 to 0.37 for extraction cases and -0.63 to 0.003 for non-extraction cases (p>0.05). Neither individual parameters nor total scores of the ABO grading system could predict whether the smile was attractive or unattractive in either group. CONCLUSION: No correlation was found between post-treatment ABO grading and smile esthetics in patients with extraction or non-extraction. Hence, this study recommends that ancillary soft tissue variables have to be incorporated into the grading system to evaluate a smile.

An objective, markerless videosystem for staging facial palsy.

PURPOSE: To propose a new objective, video recording method for the classification of unilateral peripheral facial palsy (UPFP) that relies on mathematical algorithms allowing the software to recognize numerical points on the two sides of the face surface that would be indicative of facial nerve impairment without positioning of markers on the face. METHODS: Patients with UPFP of different House-Brackmann (HB) degrees ranging from II to V were evaluated after video recording during two selected facial movements (forehead frowning and smiling) using a software trained to recognize the face points as numbers. Numerical parameters in millimeters were obtained as indicative values of the shifting of the face points, of the shift differences of the two face sides and the shifting ratio between the healthy (denominator) and the affected side (numerator), i.e., the asymmetry index for the two movements. RESULTS: For each HB grade, specific asymmetry index ranges were identified with a positive correlation for shift differences and negative correlation for asymmetry indexes. CONCLUSIONS: The use of the present objective system enabled the identification of numerical ranges of asymmetry between the healthy and the affected side that were consistent with the outcome from the subjective methods currently in use.

Curative effect evaluation by using Andrews' six elements for completed orthodontic treatment cases.

OBJECTIVES: To assess the treatment outcome of patients who completed their orthodontic treatment by using Andrews' six elements and the American Board of Orthodontic (ABO) objective grading system (OGS); to determine whether Andrews' six elements can be used as a new assessment system for patients who completed their orthodontic treatment. METHODS: A total of 160 patients who completed their orthodontic treatment were included in the study. The participants were randomly selected from patients who completed their orthodontic procedures in Kunming Medical University Affiliated Stomatological Hospital during the period of 2015 to 2019. The retrospective completed cases were examined in accordance with the Andrews' six elements and ABO measuring scales. Scores were assigned to each tooth in each category. All the measurement items in both evaluation criteria, the composite category score, and the total score were calculated. The passing and potential passing rates of the completed cases were compared with two measuring scales via the Chi-square test. RESULTS: The passing rate for the evaluation of cases by using the Andrews' six elements measuring scale was 83.8%, and that for the evaluation of cases by using the ABO measuring scale was 86.3%. The differences in achieving the standard between the cases of Andrews' six elements and ABO-OGS via the Chi-square test were statistically insignificant (P>0.05). The mean Andrews' six elements score for the completed cases: the category of the anteroposterior change in position of the incisors contributed the most, whereas the core discrepancy presented the least percentage in total scores. In ABO-OGS, alignment and marginal ridges contributed the most, whereas interproximal contacts exhibited the least percentage in total scores. CONCLUSIONS: The performance of Andrews' six elements was comparable with that of ABO-OGS in assessing the treatment outcome of patients who completed their orthodontic treatment. Andrews' six elements can be used as a new system for assessing the treatment outcome of patients who completed their orthodontic treatment. It demonstrated particular advantage in controlling facial profile, and had just completed material of patients who completed their orthodontic treatment it can measure. The Andrews' six elements measuring scale is convenient to disseminate and use.

Clinical outcomes of lingual fully customized vs labial straight wire systems : Assessment based on American Board of Orthodontics criteria.

PURPOSE: To evaluate orthodontic treatment outcome in patients treated with a lingual appliance (Incognito™ Appliance System, 3M Unitek, Monrovia, CA, USA) versus patients treated with a labial appliance (Victory series™, 3M Unitek, Monrovia, CA, USA). METHODS: A total of 72 patients were retrospectively analyzed. The complexity of each case was evaluated using the American Board of Orthodontics (ABO) Discrepancy Index (DI), and orthodontic clinical outcomes were evaluated using the ABO Objective Grading System (cast-radiograph evaluation: C­R Eval). RESULTS: The mean total ABO C­R Eval score was 16 ± 9.1 in the labial appliance group and 12.7 ± 5.4 in lingual appliance group (p = 0.152). The mean total ABO-DI scores were 16.3 ± 7.3 and 15.4 ± 6.6 in the labial and lingual appliance groups, respectively (p = 0.445). A significant correlation was observed between the total DI and total C­R Eval scores. CONCLUSIONS: In this particular study and in the hands of two experienced orthodontists, no differences in the finishing quality of orthodontic treatments using the lingual technique or the buccal appliance technique were found. However, further prospective studies with larger sample sizes are necessary in order to generalize these results.

The Herbst appliance combined with a completely customized lingual appliance: A retrospective cohort study of clinical outcomes using the American Board of Orthodontics Objective Grading System.

OBJECTIVES: In this retrospective study we aimed to evaluate the quality of treatment outcomes using the American Board of Orthodontics (ABO) scoring system with a completely customized lingual appliance used in combination with a Herbst appliance for Class II correction. MATERIALS AND METHODS: Patient selection criteria for this study were Class II division 1, II/2 or subdivision treated with a WIN® lingual appliance combined with an L-pin Herbst device. Thirty-two consecutively debonded cases were included in this retrospective case series. Pre- and post- treatment dental casts, dental set-ups, panoramic X-rays, cephalometric analysis, photographs and clinical files were available for data collection. The primary outcome was the ABO score based on the Discrepancy Index (ABO DI) including: overjet, overbite, anterior open bite, lateral open bite, crowding, occlusion (Angle class), lingual posterior crossbite, buccal posterior crossbite, ANB, IMPA and SN-GoGN angles and the Cast-Radiograph Evaluation (ABO CR-Eval) comprising of alignment/rotations, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationship (Angle class), interproximal contacts and root angulation. In addition, overjet, overbite and Class II correction were also evaluated on pre- and post-treatment models. The secondary outcome was bracket failure and complications related to the Herbst device. RESULTS: The study cohort included 18 female and 12 male patients with a mean age of 15.8 (range 12, 6- 18, 5). Twenty patients were Class II division 1 and ten were Class II division 2. The mean pre-treatment value of ABO DI was 20.8 (range 10-39); more than two-thirds of the sample were rated as being either of moderate difficulty (ABO DI: 16-24) or severe (ABO DI: over 25). The average post-treatment ABO Cast-Radiograph Evaluation score was 15.0 (SD=4.4), which is considered a passing score. Twenty-six patients had a score equal or lower than 20 (undisputed passing score). The Class II discrepancy was effectively corrected from a score of 16.83 penalty points (SD: 3.65) pre-treatment to a score of 1.57 (SD: 1.70) post-treatment. No association was found between initial and final Class II occlusal relationships (P=0.42), indicating that regardless of the initial discrepancy, no difference in the success of Class II correction was observed. The mean bracket failure rate was 3.8 per patient. Herbst related complications were few: 1.6 per patient, with the majority of complications being of little consequence and with 43% of the patients having no breakages. CONCLUSION: The completely customized lingual appliance assessed in this study combined with an L-pin Herbst led to effective Class II correction regardless of the initial severity of the sagittal discrepancy. The average ABO CR-Eval score for this sample was well below the undisputed passing score indicating a high quality of treatment outcomes.

Treatment outcome differences between pass and fail scores and correlation between cephalometric changes and cast-radiograph evaluation of the American Board of Orthodontics.

OBJECTIVE: Using the cast-radiograph evaluation (CRE) score of the American Board of Orthodontics (ABO), the purpose of this study was 1) to find the post-treatment discrepancies that contributed to low-quality outcomes and 2) to identify if there might be any correlation between cephalometric changes and post-treatment discrepancies. MATERIALS AND METHODS: About 200 records submitted for the Thai Board of Orthodontics examination were analyzed. Overall, 23 parameters of the CRE scores and 12 cephalometric changes were collected. Based on the total CRE score, the cases were classified into three categories: pass (score <20), undetermined (score 20-30), and fail (score >30). Kruskall-Wallis was used to analyze the differences of mean CRE scores among these three categories. In addition, the cases were further classified into fixed appliance, two-phase and orthognathic surgery groups. Correlation tests were carried out to determine if there might be any association between cephalometric changes and CRE parameters. RESULTS: Significant differences of mean CRE scores were found for all CRE components except interproximal contacts. Significant correlation coefficients with the total CRE scores were found for all parameters except interproximal contacts. Significant moderate association was found between lower incisor changes and CRE scores in the two-phase and orthognathic surgery group. CONCLUSIONS: In order to improve treatment outcome quality, the top four parameters that orthodontists should pay attention to are occlusal contacts, occlusal relationship, marginal ridges, and alignment and rotations. Cephalometric changes were not suitable as weighting factors for total CRE scores.

Predicted and actual end-of-treatment occlusion produced with aligner therapy.

OBJECTIVE: To compare three-dimensional (3D) ClinCheck™ models with the subjects' actual 3D posttreatment models using the American Board of Orthodontics Objective Grading System (OGS). MATERIALS AND METHODS: This prospective, within-subject study included 27 consecutive cases treated with aligner therapy. The posttreatment plaster models taken immediately after treatment were scanned and converted to stereolithography (STL) files; the ClinCheck models were also converted to STL format. MeshLab software was used to measure the seven components of the OGS, including alignment, marginal ridges, buccolingual inclinations, occlusal contacts, occlusal relationships, overjet and interproximal contacts. An overall OGS deduction score was also calculated. RESULTS: Compared with the posttreatment models, the ClinCheck models showed significantly (P  =  .016) fewer overall OGS point deductions (24 vs 15). These overall differences were due to significantly (P < .05) more deductions among the posttreatment models than the ClinCheck models for alignment (4.0 vs 1.0 deductions), buccolingual inclinations (4.0 vs 3.0 deductions), occlusal contacts (3.0 vs 2.0 deductions), and occlusal relations (4.0 vs 2.0 deductions). CONCLUSION: The ClinCheck models do not accurately reflect the patients' final occlusion, as measured by the OGS, at the end of active treatment.

Outcome assessment of lingual and labial appliances compared with cephalometric analysis, peer assessment rating, and objective grading system in Angle Class II extraction cases.

OBJECTIVE: To validate our hypothesis that there would be significant differences in treatment outcomes, including cephalometric values, degree of root resorption, occlusal indices, and functional aspect, between cases treated with labial and lingual appliances. MATERIALS AND METHODS: Twenty-four consecutively treated Class II cases with extractions and lingual appliance were compared with 25 matched cases treated with extraction and labial appliance. Orthodontic treatment outcomes were evaluated by cephalometric analysis, peer assessment rating, and an objective grading system (OGS). Additionally, functional analysis was also performed in both groups after orthodontic treatment. Statistical comparison was performed using the Wilcoxon signed rank test within the groups, and the Mann-Whitney U-test was used to compare between the labial and lingual groups. RESULTS: The only significant difference between the groups was that the interincisal angle was larger in the lingual group than in the labial group. OGS evaluation showed that control over root angulation was significantly worse in the lingual group than in the labial group. There was no significant difference between groups in the amount of root resorption or in functional evaluation. CONCLUSIONS: Generally, lingual appliances offer comparable treatment results to those obtained with labial appliances. However, care should be taken with lingual appliances because they are more prone to produce uprighted incisors and root angulation.

IBC: índice Board CES / The IBC: CES Board Index

Resumen La medición de resultados de los tratamientos de ortodoncia es fundamental para evaluar objetivamente la calidad de la finalización y el éxito logrado por la terapia, y a su vez en la evaluación de los residentes del posgrado de ortodoncia. En la literatura se han reportado varios sistemas que permiten analizar dichos resultados, pero algunos no integran suficientes criterios o ayudas diagnósticas. La Universidad CES, basada en el American Board of Orthodontics-Objetctive Grading System (ABO-OGS), ha desarrollado un índice con 16 criterios analizados en modelos, radiografías y fotografías, que integran una medición objetiva de la finalización de los tratamientos. El propósito de este artículo fue describir el índice Board CES (IBC) como herramienta de evaluación de resultados clínicos de la ortodoncia y generar retroalimentación para el tratamiento de casos futuros mejorando la calidad de los mismos. Dicho índice podría ser empleado en universidades y en prácticas privadas.

The measurement of orthodontic treatment results is crucial to objectively assess the quality of the completion and success of therapy, and in turn in the evaluation of graduate orthodontic residents. The literature has reported several systems that analyze these results, but some do not integrate sufficient criteria or diagnostic aids. CES University, based on the American Board of Orthodontics - Objective Grading System (ABO - OGS), has developed an index with 16 criteria analyzed in models, radiographs and photographs, which allow an objective measurement of the completion of treatments. The purpose of this article was to describe the CES Board Index (IBC) as a tool for assessing clinical outcomes in orthodontics and generate feedback for the treatment of future cases improving their quality. This index could be used in Universities and in private practices.

Assessment of clinical outcomes of Roth and MBT bracket prescription using the American Board of Orthodontics Objective Grading System.

BACKGROUND: There is always a need to assess whether small changes in bracket prescription can lead to visually detectable differences in tooth positions. However, with little clinical evidence to show advantages of any of the popularly used bracket systems, orthodontists are forced to make clinical decisions with little scientific guidance. AIM: To compare the orthodontic cases finished with Roth and MBT prescription using American Board of Orthodontics-Objective Grading System (ABO-OGS). SETTINGS AND DESIGN: Department of Orthodontics, Post-graduate dental college, retrospective cross-sectional study. MATERIALS AND METHODS: Forty patients selected were divided into two groups of 20 patients each finished with straight wire appliance using Roth and MBT prescription, respectively. The examiner ability was assessed and calibrated by one of the ABO certified clinician to grade cases using the OGS. STATISTICAL ANALYSIS: Unpaired student t-test was used and P < 0.05 was accepted as significant. RESULTS AND CONCLUSIONS: MBT bracket group had a lower score of 2.60 points in buccolingual inclination and lower score of 1.10 points in occlusal contact category that was statistically significant when compared with Roth group. The difference in total ABO-OGS score was 2.65 points showing that the outcome for the MBT prescription was better than that of the Roth prescription, which is statistically significant, but with little or no clinical significance. It can be concluded that use of either one of the Roth and MBT bracket prescriptions have no impact to the overall clinical outcome and quality of treatment entirely depends on clinician judgment and experience.