Maxillary Changes Following Facial Bipartition - A Three-Dimensional Quantification.

INTRODUCTION: Children with Apert syndrome have hypertelorism and midfacial hypoplasia, which can be treated with facial bipartition (FB), often aided by rigid external distraction. The technique involves a midline osteotomy that lateralizes the maxillary segments, resulting in posterior cross-bites and midline diastema. Varying degrees of spontaneous realignment of the dental arches occurs postoperatively. This study aims to quantify these movements and assess whether they occur as part of a wider skeletal relapse or as dental compensation. METHODS: Patients who underwent FB and had high quality computed tomography scans at the preoperative stage, immediately postsurgery, and later postoperatively were reviewed. DICOM files were converted to three-dimensional bone meshes and anatomical point-to-point displacements were quantified using nonrigid iterative closest point registration. Displacements were visualized using arrow maps, thereby providing an overview of the movements of the facial skeleton and dentition. RESULTS: Five patients with Apert syndrome were included. In all cases, the arrow maps demonstrated initial significant anterior movement of the frontofacial segment coupled with medial rotation of the orbits and transverse divergence of the maxillary arches. The bony position following initial surgery was shown to be largely stable, with primary dentoalveolar relapse correcting the dental alignment. CONCLUSIONS: This study showed that spontaneous dental compensation occurs following FB without compromising the surgical result. It may be appropriate to delay active orthodontic for 6-months postoperatively until completion of this early compensatory phase.

Challenges and opportunities facing contemporary orthognathic surgery.

Here, we provide a brief overview of the challenges, innovations and potential opportunities facing contemporary management of individuals requiring orthognathic care.

Facial feminisation: an overview of the role of the surgeon and orthodontist.

Facial feminisation surgery (FFS) aims to feminise the face by changing masculine facial features to feminine ones. It is commonly undertaken for transsexual individuals who are transitioning from male to female or for women who wish to further feminise their facial appearance. Assessment and treatment planning by a multidisciplinary team is essential for any patient considering FFS. Orthodontists have an important role within this team as patients may first present to an orthodontist expressing concerns about the appearance of their jaws. Therefore, it is important that orthodontists have a detailed understanding of FFS procedures, to enable good patient communication, thorough patient assessment and onwards referral where required. This article reviews the common FFS procedures, their indications, and the benefits and risks of each procedure and highlights the role of the orthodontist.

Mind the gap: A novel technique for space closure - a case report.

Patients presenting with severe hypodontia can be challenging to manage. They often present with significant spaces within the dental arches and the lack of permanent teeth can make anchorage control difficult. This case report demonstrates a novel technique for diastema closure in a 14-year-old with severe hypodontia. The technique allows maintenance of root parallelism during space closure in cases with reduced anchorage support. The treatment plan was agreed on a multidisciplinary hypodontia clinic and involved an upper sectional fixed orthodontic appliance to close a 7-mm midline diastema aiding subsequent partial denture provision. Treatment commenced by bonding upper primary canines and central incisors. However, attempting space closure on a 0.019 × 0.025-inch stainless-steel working archwire resulted in tipping of the incisor crowns. Two brackets were therefore placed on the labial surface of each central incisor (one incisal and one gingival). Subsequently two stainless steel working archwires and elastomeric chain were used for diastema closure. This four-bracket system provided superior control allowing space closure by bodily tooth movement. Excellent root parallelism was achieved with this innovative technique.

Treatment Outcomes and Assessment of Oral Health Related Quality of Life in Treated Hypodontia Patients.

OBJECTIVES: 1. Assess treatment outcomes and oral health related quality of lifeM (OHRQoL) of hypodontia patients after completing dental treatment at the Eastman Dental Hospital and compare it with British public norms. 2. Assess factors which have an association with patients' reported OHRQoL. METHODS: Hypodontia patients who finished their treatment completed a 16-item questionnaire (UK oral health related quality-of-life measure), a list of four questions about their satisfaction with treatment received and a clinical assessment using modified USPHS criteria. RESULTS: The sample included 52 participants; median age 28 years (range 16 - 61 years). All participants had completed treatment for at least 6 months (range 6-60 months). Clinical assessment revealed 4 of the participants had complications requiring treatment. The OHRQoL mean scores of the sample were statistically significantly higher than the mean scores of the British public norms for most age groups (P⟨0.05). Factors which revealed association with OHRQoL scores were: gender (P=.047) and satisfaction with dental aesthetics (P=.006). CONCLUSIONS: Hypodontia patients following treatment reported higher OHRQoL average scores compared to the British population. Higher OHRQoL scores were related to patients' satisfaction with dental aesthetics after treatment. Females tended to report higher OHRQoL scores than males.

The dental development in patients with Aperts syndrome.

OBJECTIVES: The aim of this retrospective study was to quantify the level of dental developmental delay in a group of patients with Aperts syndrome when compared to matched controls. METHODS: Twenty-six Dental Panoramic Tomographic (DPT) radiographs of patients with Apert syndrome attending Great Ormond Street Hospital were compared to controls (n = 29) from the Eastman Dental Hospital, UK. Dental development was assessed using the staging systems of Demirjian and Haavikko, and dental age (DA) was estimated using the weighted averages method. RESULTS: Dental age, as estimated using the 12 stages of Haavikko and eight stages of Demirjian, suggested no statistical evidence of developmental delay between the Aperts and control group. CONCLUSIONS: The hypothesis 'that there is no difference in the dental development of subjects with Apert syndrome, when compared to a group of matched controls', was accepted.

Effect of social media in improving knowledge among patients having fixed appliance orthodontic treatment: A single-center randomized controlled trial.

INTRODUCTION: Research has shown that orthodontic patients are more likely to retain information presented in an audiovisual format. However, there has been little research on the effectiveness of audiovisual information provided through different routes such as the Internet. This parallel-group randomized controlled trial assessed whether provision of audiovisual information on the YouTube (Google, San Bruno, Calif) Web site to orthodontic patients undergoing fixed appliance treatment results in improved patient knowledge when compared with conventional methods of information provision. The effects of sex and ethnicity were also investigated. METHODS: Participants were recruited from the Department of Orthodontics of the Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust, United Kingdom. The patients were 13 years of age and over, with no history of orthodontic treatment, and patient and parental (where appropriate) consent were obtained. The participants were randomized into control (n = 34) and intervention (n = 33) groups using a random number table; there was stratification based on age group, with permuted blocks of 10 patients. Both groups were given routine verbal and written patient information related to fixed appliances, and the participants in the intervention group were sent 3 e-mails over 6 weeks requesting that they view a 6-minute YouTube video containing similar information but in audiovisual format. Patient knowledge was measured using identical questionnaires answered on the day of recruitment (baseline) and again 6 to 8 weeks later. The researchers were unaware of group allocations when enrolling patients and scoring questionnaires. RESULTS: Sixty participants (89.55%) completed the study. Those who completed the trial in the intervention group (n = 30) demonstrated significantly greater improvements in knowledge than did those in the control group (n = 30), scoring, on average, almost 1 point more (95% CI for the difference, 0.305-1.602; P = 0.005) on the final questionnaire. Ethnicity had a statistically significant effect on improvement in knowledge, but sex did not. No harm to any patient was noted during the trial. CONCLUSIONS: Presenting audiovisual information through the YouTube Web site to orthodontic patients resulted in a significant improvement in patient knowledge. Supplementation of verbal and written patient information with audiovisual information via the Internet is therefore worthy of consideration. REGISTRATION: National Research and Ethics Service (REC number 12/LO/0863), United Kingdom. PROTOCOL: The protocol was not published before trial commencement. FUNDING: No funding or conflict of interest to be declared.

A study to investigate the bond strengths of orthodontic brackets bonded to prosthetic acrylic teeth.

INTRODUCTION: In this study, we compared the shear bond strengths of five different adhesive techniques for attaching metal orthodontic brackets onto acrylic pontics. MATERIALS AND METHODS: Two hundred upper left lateral incisor acrylic teeth with bonded brackets were divided into five groups - composite alone (control), composite following sandblasting, composite held with a mechanical undercut, cyanoacrylate adhesive and Panavia(®). The initial bond strength was tested using the Instron Universal Testing Machine. The fatigue bond strength was tested by subjecting each bracket to 5000 repetitive low-load cycles at 50% of the mean shear bond strength using the Dartec machine at 2 Hz. RESULTS: Cyanoacrylate adhesive statistically exhibited the highest mean bond strength (19·82 MPa). This was followed by the mechanical undercut group (17·69 MPa) and the sandblasted group (17·18 MPa). There was no statistically significant difference when considering the effect of fatiguing (p = 0·238) as well as the interaction between the adhesive technique and the effect of fatiguing on the bond strength (p = 0·440). CONCLUSION: The initial and fatigue bond strengths of the cyanoacrylate adhesive, sandblasted and undercut groups were significantly higher than the control and Panavia(®) groups when tested under laboratory conditions.

Smile analysis: what to measure.

UNLABELLED: Patients seek dental treatment to improve oral function as well as their attractiveness. In order to improve smile attractiveness, clinicians need to carry out a comprehensive smile assessment. The aim of this paper is to help clinicians to adopt a systematic approach toward smile assessment by introducing a smile assessment form. CLINICAL RELEVANCE: Smile analysis is an essential part of smile diagnosis. A smile assessment form will assist clinicians in identifying and recording smile features for diagnosis and treatment planning.

A comparison of skeletal maturation in patients with tooth agenesis and unaffected controls assessed by the cervical vertebral maturation (CVM) index.

OBJECTIVE: The aims of this study were to (1) investigate if there is a difference in skeletal maturation between tooth agenesis and control patients and (2) whether skeletal maturation is affected by the severity of tooth agenesis. The cervical vertebral maturation (CVM) index can be used to assess skeletal maturation. DESIGN: A retrospective cross-sectional study. SETTING: Eastman Dental Hospital, London, UK. METHODS AND MATERIALS: A total of 360 cephalograms of patients aged 9-17 years (164 males and 196 females) allocated to four subgroups (mild, moderate and severe tooth agenesis patients, and controls) were assessed retrospectively. There were 90 patients in each of the four subgroups. The skeletal maturation of each subject was assessed both quantitatively and qualitatively using the CVM index. All patients in the study were either currently receiving treatment or had been discharged from the hospital. RESULTS: There was no statistically significant relationship between skeletal maturation and the presence of tooth agenesis. Furthermore, there was no statistically significant relationship between the skeletal maturity of patients and different severities of tooth agenesis. CONCLUSIONS: The data obtained from this group of patients and using this measurement tool alone does not supply sufficient reason to reject the null hypothesis. However, it suggests that it is possible that no difference exists between the groups.

Radiographic study of delayed tooth development in patients with dental agenesis.

INTRODUCTION: The aims of this study were to compare the radiographic development of permanent teeth in a group of children affected by dental agenesis with an unaffected control group and to determine the effects of confounding factors including the severity of the dental agenesis, age, sex, ethnicity, and the number of stages used to estimate dental age. METHODS: A single-center retrospective cross-sectional study of dental panoramic tomographs was undertaken between July 2007 and April 2008 in a postgraduate teaching school. A total of 139 patients (aged 9-18 years) were recruited from the orthodontic clinic on the basis of predetermined inclusion and exclusion criteria to either a dental agenesis group or a control group. Dental panoramic tomograms were assessed, and the stages of development of the permanent teeth in the left maxillary and left mandibular regions were scored by using the 12 stages of Haavikko and the 8 stages of Demirjian and Goldstein. For each tooth scored, the mean dental age and standard error were determined by using the dental age assessment method, and an estimated dental age for each subject was derived by using the weighted average method. RESULTS: A statistically significant delay in dental age was found in the patients with dental agenesis compared with the control group. The dental age assessment method of Haavikko showed a delay of 1.20 years (SD, 1.74), and the method of Demirjian and Goldstein showed a delay of 1.64 years (SD, 1.75). It was also observed that older patients with dental agenesis had greater delays in tooth formation (P <0.001). With the Haavikko method, for every year of chronologic age, the delay in dental age increased by 0.53 year; with the Demirjian and Goldstein method, the delay increased by 0.48 year. A significant association was seen between the severity of dental agenesis and the delay in dental age (P <0.01). With both methods, for each additional developmentally absent tooth, the dental age was delayed by 0.13 year (lower confidence interval, -0.22; upper confidence interval, 0.35). There was no evidence that sex or ethnicity has an effect on the delay in dental age in patients with dental agenesis. CONCLUSIONS: The development of permanent teeth in children with dental agenesis is delayed when compared with a matched control group. The severity of dental agenesis affected the magnitude of the delay (P <0.01). This delay has implications in orthodontic treatment planning and in the estimation of age for legal, immigration, archaeological, and forensic purposes.

Smile esthetics: the influence of posterior maxillary gingival margin position.

PURPOSE: Successful replacement of posterior teeth using contemporary prosthodontic techniques in esthetically demanding cases relies upon visual replication of the natural posterior dentition and surrounding gingival architecture. There is currently little in the way of guidance for creating ideal or acceptable gingival relationships for posterior teeth. MATERIALS AND METHODS: A cross-sectional study was conducted comparing perceptions of four groups of individuals to six digitally manipulated images with various posterior teeth gingival margin position configurations. A total of 120 volunteers aged 12 years to 80 years, comprising 30 patients diagnosed with hypodontia, 30 patients diagnosed with periodontal disease, 30 patients without either condition, and 30 qualified dentists were recruited from the Eastman Dental Institute & Hospital, London. A ranked order of preference for each set was obtained, and this was repeated after a minimum time interval of 10 minutes. RESULTS: Posterior gingival margin configurations from 0 mm to 2 mm (measured at the first premolar) were deemed most esthetic by the majority of the patient groups; dentists had a strong preference for the 1 mm configuration. Dentists appeared to be more perceptive to the alterations in gingival positions. CONCLUSIONS: Posterior gingival margin configurations where the first premolar margins were 1 mm lower than the canine margins were deemed the most esthetically pleasing; however, it is likely that a range of acceptability of 1 mm deviations from this ideal exists.

Is self-harm among orthodontic patients related to dislike of dentofacial features and oral health-related quality of life?

OBJECTIVES: To investigate the relationship between self-reported self-harm and dislike of dentofacial features and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Anonymous, self-reporting questionnaires were completed by 699 school children (aged 13-14 years), representing over 1% of the age group in Amman, Jordan. Participants were invited from 23 randomly selected schools in 10 educational directorates. OHRQoL was assessed using the Child Perception Questionnaire (CPQ 11-14). Self-harm was assessed using a constructed self-reporting questionnaire. The relationship between OHRQoL and self-harm was assessed and significant findings were identified at probability of α = 0.05. RESULTS: Over one-quarter of schoolchildren (26.9%, n = 88) admitted self-harming behavior. Self-harm was reported to be due to dislike of dentofacial appearance among 12.9% of participants (n = 90). Higher CPQ 11-14 total scores and individual dimension scores were associated with the presence of self-harm (P < .001). High self-harm incidence was reported among participants who had dentofacial features that affected appearance (P < .001). Among subjects admitting self-harm, the frequency of self-harming behavior ranged from once to over 10 times per year. CONCLUSIONS: Significant relationships were found between self-harm and dislike of dentofacial features and OHRQoL.

Pyogenic granuloma: a rare side complication from an orthodontic appliance.

This case report discusses a rare side effect associated with the use ofa fixed quad helix orthodontic appliance. A 14-year-old healthy girl presented with a painful enlarging mass on her tongue, which was causing distress to both her and her parents. Investigations confirmed that the mass was a pyogenic granuloma and management involved surgical excision of the mass and removal of the quad helix appliance. At least once previous case associated with an orthodontic quad helix appliance has been reported in the literature.

A new style of orthognathic clinic.

The Orthognathic Team at the Eastman Dental Hospital has developed a new style of multidisciplinary clinic to supplement the traditional orthognathic consultation. The aim of the new clinic is to increase patient satisfaction and involvement in the consent and decision making process, as well as optimizing the information given to prospective patients regarding all aspects of this complex elective treatment. Results of a survey of patients attending the clinic found that 80% thought that the information given was 'just the right amount' and 96% were satisfied with the new structure. They particularly found it useful to meet a patient who had completed treatment. All of those who attended said that they understood the information given to them and would recommend the clinic to those considering orthognathic treatment. They also liked having other patients there with them on the clinic.

Psychosocial impact of hypodontia in children.

INTRODUCTION: The purpose of this cross-sectional study was to determine the psychosocial impact of hypodontia (multiple dental agenesis) in children and the influence of factors such as severity of hypodontia, number of retained deciduous teeth, age, and sex. The implications of hypodontia for affected patients have been poorly investigated; this, in part, relates to the lack of appropriate measurements to assess the impact of oral conditions on quality of life, particularly among children and adolescents. METHODS: A total of 123 children (49.6% boys, 50.4% girls; mean age, 13.6 years; SD, 1.6 years) were recruited on the basis of predetermined inclusion criteria to either a hypodontia group or a routine orthodontic group of similar treatment need (index of orthodontic treatment need, dental health component 4 or 5) but without hypodontia. Each patient completed the child perceptions questionnaire and 2 visual analog scales to determine the global effects of hypodontia on esthetics and function. RESULTS: The mean number of missing teeth in the hypodontia group was 4.52 (SD, 3.33). There were no statistically significant differences in child perceptions questionnaire scores (overall or at domain level) or visual analog scores between the hypodontia and the routine orthodontic groups (P >0.05). Univariable linear regression analyses provided some evidence that difficulty with chewing was associated with the severity of hypodontia (P = 0.030). CONCLUSIONS: In this sample, hypodontia did not appear to affect the psychosocial status of patients any more than other features of a malocclusion measured with the index of orthodontic treatment need, dental health component 4 or 5. Patients with hypodontia did, however, have more difficulty in chewing when the deciduous teeth associated with the missing permanent teeth had been exfoliated. This highlights the possible importance of retaining deciduous teeth in patients with severe hypodontia.

Retrospective study to determine the change in referral pattern to St George's Hospital Orthodontic Department before and after the 2006 NHS Dental Contract changes.

AIM: The aim of this study was to determine the possible effects of the 2006 National Health Service General Dental Services contract changes on the referral pattern to the orthodontic department at St George's Hospital, South West London. METHOD: This study was carried out on a retrospective basis. The notes of consecutive patients referred between 1st May and 30th September in 2005 and 2008 were assessed, and the patient's Index of Orthodontic Treatment Need (IOTN) and the source of referral noted. RESULTS: The total numbers of referrals increased from 260 in 2005 to 405 in 2008. The number of referrals from general dental practitioners decreased slightly from 165 to 156, as did the numbers of referrals from other sources, such as tertiary referrals. The number of referrals made by specialist practitioners increased from 41 in 2005 to 207 in 2008, representing an increase from 16% to 51% of overall referrals. Overall, the number of patients being referred with an IOTN dental health component grade of 5 increased from 27% to 55%. CONCLUSION: The increase in referrals from specialist practitioners may be partly due to the changes brought to the commissioning of orthodontic services for specialist practitioners. Overall, the number of cases being referred with IOTN grades 4 and 5 remains high at St George's Hospital, indicating that appropriate referrals are being made.

A study to assess the quality of information in referral letters to the orthodontic department at Kingston Hospital, Surrey.

AIM: To assess the quality of information included in referral letters sent to the orthodontic department at Kingston Hospital, Surrey, UK. METHODS: Referral letters sent by both general dental practitioners (GDPs) and specialist orthodontists were analysed retrospectively in order to ascertain the percentage meeting the inclusion criteria as suggested by Mossey (2006) and the British Orthodontic Society (2008) for the quality of information included in an ideal orthodontic referral letter. Thirty-five consecutive letters sent between May and September 2005 and 206 letters sent in the same period in 2008 were collected by hand and analysed against the inclusion criteria. The numbers of referral letters received from GDPs, specialist orthodontists, and others sources were also determined. RESULTS: Most of the referrals sent in 2005 and 2008 included 40-50% of the referral inclusion points. This was despite an almost twofold increase in the number of referral letters received from specialist orthodontic practitioners in 2008. The majority of the letters, from both GDPs and specialists, did not include details of the oral hygiene or caries status of the patient, or an indication of their motivation towards treatment. None of the referral letters included a plaque score. CONCLUSION: The main weaknesses in the quality of information provided in referral letters were that in more than 80% of the letters there was no mention of the patient's medical history and no comment on caries status, the standard of oral hygiene, patient motivation for treatment, or an Index of Orthodontic Treatment Need score. The quality of information included in referral letters sent to Kingston Hospital orthodontic department needs to be improved.