The Improvement and Completion of Outcome index: A new assessment system for quality of orthodontic treatment.

OBJECTIVE: Given the considerable disagreement between the Peer Assessment Rating (PAR) index and the American Board of Orthodontics Cast-Radiograph Evaluation, we aimed to develop a novel assessment system-the Improvement and Completion of Outcome (ICO) index-to evaluate the outcome of orthodontic treatment. METHODS: Sixteen criteria from 4 major categories were established to represent the pretreatment malocclusion status, as well as the degree of improvement and level of completion of outcome during/after treatment: dental relationship (arch length discrepancy, irregularity, U1-SN, and IMPA); anteroposterior relationship (overjet, right and left molar position, ANB); vertical relationship (anterior overbite, anterior open-bite, lateral open-bite, SN-MP); and transverse relationship (dental midline discrepancy, chin point deviation, posterior cross-bite, occlusal plane cant). The score for each criterion was defined from 0 or -1 (worst) to 5 (ideal value or normal occlusion) in gradations of 1. The sum of the scores in each category indicates the area and extent of the problems. Improvement and completion percentages were estimated based on the pre- and post-treatment total scores and the maximum total score. If the completion percentage exceeded 80%, treatment outcome was considered successful. RESULTS: Two cases, Class I malocclusion and skeletal Class III malocclusion, are presented to represent the assessment procedure using the ICO index. The difference in the level of improvement and completion of treatment outcome can be clearly explained by using 2 percentage values. CONCLUSIONS: Thus, the ICO index enables the evaluation of the quality of orthodontic treatment objectively and consecutively throughout the entire treatment process.

Dentistry in the 21st century: challenges of a globalising world.

Oral health is - literally - vital to good general health, not least because the mouth is the sentinel of the body. Dentistry, the Cinderella of health care, faces immense challenges of globalisation. Governments, having spent freely on everything from defence to social security, face mountains of debts which make budget cutbacks essential. Simultaneously, most developed countries have to pay increasing costs of caring for rapidly ageing populations. Dentistry is being pulled two ways: wealthy members of society demand high-end expensive treatment, much of it cosmetic rather than necessary to deal with disease, whereas many millions of poor people in developing countries cannot afford basic dental treatment and may never see a dentist. Too many governments and dentists persist with the expensive and destructive regime of 'drill and fill (and bill)'. International advances in care may not reach the clinician's chair because treatment guidelines and payments are set locally. An international symposium to celebrate Mikako Hayashi becoming Professor of Restorative Dentistry and Endodontology at Osaka University concluded that dentistry should move from an increasingly un-affordable curative model to a cost-effective evidence-based preventive model. The goal is to help people retain healthy natural teeth throughout their lives, as an essential part of enhancing their general health.

Establishment of efficacy and safety assessment of human adipose tissue-derived mesenchymal stem cells (hATMSCs) in a nude rat femoral segmental defect model.

Human adipose tissue-derived mesenchymal stem cell (hATMSC) have emerged as a potentially powerful tool for bone repair, but an appropriate evaluation system has not been established. The purpose of this study was to establish a preclinical assessment system to evaluate the efficacy and safety of cell therapies in a nude rat bone defect model. Segmental defects (5 mm) were created in the femoral diaphyses and transplanted with cell media (control), hydroxyapatite/tricalcium phosphate scaffolds (HA/TCP, Group I), hATMSCs (Group II), or three cell-loading density of hATMSC-loaded HA/TCP (Group III-V). Healing response was evaluated by serial radiography, micro-computed tomography and histology at 16 weeks. To address safety-concerns, we conducted a GLP-compliant toxicity study. Scanning electron microscopy studies showed that hATMSCs filled the pores/surfaces of scaffolds in a cell-loading density-dependent manner. We detected significant increases in bone formation in the hATMSC-loaded HA/TCP groups compared with other groups. The amount of new bone formation increased with increases in loaded cell number. In a toxicity study, no significant hATMSC-related changes were found in body weights, clinical signs, hematological/biochemical values, organ weights, or histopathological findings. In conclusion, hATMSCs loaded on HA/TCP enhance the repair of bone defects and was found to be safe under our preclinical efficacy/safety hybrid assessment system.