Does crown, root, and bone visualization in a clear aligner virtual setup impact treatment decisions?

INTRODUCTION: Clear aligner technology based on a machine learning algorithm is currently available for orthodontic treatment. Treatment planning on the basis of 3-dimensional crown, root, and bone imaging is claimed to provide accurate diagnosis and better treatment outcomes for adult patients with complex needs. This study aimed to answer the following questions: (1) would practitioners modify their original treatment plan once provided with the crown, root, and bone view? and (2) does practitioner satisfaction regarding treatment outcomes change once the crown, root, and bone view is provided? METHODS: An online questionnaire was emailed to members of the American Association of Orthodontists (n = 2300) and the Virginia Orthodontic Education and Research Foundation (n = 211). The survey consisted of videos of 4 patients shown in 2 presentations: crown-only and crown, root, and bone views, generated by artificial intelligence-driven treatment planning software (3D Predict aligner system; 3D Predict, New York, NY). Respondents were asked to answer treatment-related questions and rate the treatment outcomes using a visual analog scale. Statistical analyses were completed to determine the significance of crown, root, and bone view on treatment planning with clear aligners. RESULTS: A total of 70 orthodontists participated in the survey. There were significant differences in responses when viewing patients in crown-only and crown, root, and bone presentations. Across the 4 patients, 33%-43% of practitioners changed their sentiment toward the treatment plan (P <0.001). When rating satisfaction on the 100-point scale, average ratings changed by 10.6 to 21.0 points; both increases and decreases in satisfaction were seen across the patients (P <0.001). CONCLUSIONS: When given 3-dimensional information on the position of a patient's crowns, root, and bone coverage, orthodontists are likely to change their clear aligner treatment plan. This study showed that a confirmation of dehiscence and fenestrations using the root and bone view resulted in practitioner dissatisfaction despite an initial satisfaction with the crown-only view.

The effect of crowding on the accuracy of 3-dimensional printing.

INTRODUCTION: The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) printed aligners compared to conventional vacuum-formed thermoplastic aligners with varying levels of dental crowding. METHODS: Digital intraoral scans of 10 cases were assigned to their respective groups (n = 10, each, 30 total) as follows: no crowding (control), moderate crowding, and severe crowding. Digital images of these models were created in standard tessellation language (STL) file format using 3Shape software and randomly 3D printed. The STL files of each case were also sent to a dental laboratory to fabricate vacuum-formed samples, the current technology used for manufacturing aligners. The intaglio surfaces of fabricated aligners in both groups were scanned using cone beam computed tomography to create STL files, which were then compared to the original STL files of the cases using Geomagic Control X software. Absolute deviations from the original file and root mean square values were recorded. A Kruskal-Wallis test was conducted to analyze the difference in average deviation, and a t-test was repeated for the RMS measure. The significance level was set at 0.05. RESULTS: The crowding did not affect the trueness of aligners manufactured using 3D printing or conventional vacuum-forming techniques (P = 0.79). 3D-printed aligners showed less deviation than the vacuum-formed samples (0.1125 mm vs 0.1312 mm; P <0.01). Aligners manufactured with the vacuum-forming technique had significantly higher variation than those with the 3D printing process (P = 0.04). CONCLUSIONS: 3D aligners printed directly from an STL file exhibited better precision and trueness than those fabricated using the conventional vacuum-forming technique. Since accuracy is defined as a combination of precision and trueness, it is concluded that direct printing from an STL file can be used to manufacture aligners.

ICP-MS measurements of elemental release from two palladium alloys into a corrosion testing medium for different solution volumes and agitation conditions.

STATEMENT OF PROBLEM: The in vivo release of Pd from palladium alloys into the oral environment and sensitivity reactions by patients has been of concern. However, little information is available about the variation in elemental release from different palladium alloys. PURPOSE: The purpose of this in vitro study was to compare the elemental release into a corrosion-testing medium from a high-palladium alloy (Freedom Plus, 78Pd-8Cu-5Ga-6In-2Au) and a Pd-Ag alloy (Super Star, 60Pd-28Ag-6In-5Sn) under different conditions. MATERIAL AND METHODS: Alloys were cast into Ø12×1-mm-thick disks, subjected to simulated porcelain-firing heat treatment, polished, and ultrasonically cleaned in ethanol. Three specimens of each alloy were immersed for 700 hours in a solution for in vitro corrosion testing (ISO Standard 10271) that was maintained at 37 °C. Two solution volumes (125 mL and 250 mL) were used, and the solutions were subjected to either no agitation or agitation. Elemental compositions of the solutions were analyzed by using inductively coupled plasma-mass spectroscopy (ICP-MS). Concentrations of released elements from each alloy for the 2 solution volumes and agitation conditions were compared by using the restricted maximum likelihood estimation method with a 4-way repeated-measures ANOVA, the Satterwhite degrees of freedom method, a lognormal response distribution, and the covariance structure of compound symmetry. RESULTS: For the 4 combinations of solution volume and agitation conditions, the mean amount of palladium released was 3 orders of magnitude less for the Pd-Ag alloy (0.009 to 0.017 µg/cm2 of alloy surface) compared with the Pd-Cu-Ga alloy (17.9 to 28.7 µg/cm2). Larger mean amounts of Sn, Ga, Ag, and In (0.29 to 0.39, 0.57 to 0.83, 0.71 to 1.08, and 0.91 to 1.25 µg/cm2, respectively) compared with Pd were released from the Pd-Ag alloy. Smaller amounts of Cu, Ga, and In (4.8 to 9.9, 5.9 to 12.8, and 4.2 to 9.5 µg/cm2, respectively) compared with Pd were released from the Pd-Cu-Ga alloy. The Ru released was much lower for the Pd-Ag alloy (0.002 µg/cm2) than the Pd-Cu-Ga alloy (0.032 to 0.053 µg/cm2). Statistically significant differences (P<.001) in elemental release were found for the factors of alloy and element and the alloy×element interaction. Significant differences were found for the solution volume (P=.022), solution volume×element interaction (P=.022), and alloy×solution volume×element interaction (P=.004). No significant effect was found for agitation condition. CONCLUSIONS: The relative amounts of released elements from each alloy were not proportional to the relative amounts in the composition. The amounts of Pd and Ga released from the Pd-Cu-Ga alloy were consistent with the breakdown of a Pd2Ga microstructural phase and perhaps some dissolution of the palladium solid solution matrix. Precipitates, rather than the palladium solid solution matrix, appeared to undergo greater dissolution in the Pd-Ag alloy. The Pd-Ag alloy should have lower risk of adverse biological reactions than the Pd-Cu-Ga alloy.

Effect of print angulation on the accuracy and precision of 3D-printed orthodontic retainers.

INTRODUCTION: The study aimed to (1) compare the accuracy and precision of 3-dimensional (3D) printed retainers at various angulations and (2) evaluate the effect of angulation on printing time and the amount of resin consumed. METHODS: Using a stereolithography 3D printer, 60 clear retainers were printed at 5 angulations (n = 12, each): 15°, 30°, 45°, 60°, and 90°. Samples for each group were randomly printed in a batch of 6 retainers at all print angulations as print 1 and print 2 cycles. Digital images of the original and printed samples were superimposed. Discrepancies on 8 landmarks were measured by 2 independent examiners, and 0.25 mm was set as the clinically acceptable threshold to determine the accuracy of the retainers. RESULTS: Deviations ranged from 0.074 mm to 0.225 mm from the reference retainer at the cusp tips and incisal edges at all angulations, falling within the threshold of clinical acceptance. However, smooth surface measurements with deviations up to 0.480 mm were deemed clinically not acceptable. Three-dimensional printing at 15° was estimated to be the most time-efficient, whereas 3D printing at 45° was shown to be the most cost-effective setting. CONCLUSIONS: Three-dimensional printed retainers, using a stereolithography printer, were found to be accurate within 0.25 mm at all print angulations at the cusp tips and incisal edges compared with the digital reference file. Smooth facial surfaces did not meet clinical acceptability. Print angulations were shown to affect the cost and amount of resin used.

Comparison of 3-dimensional printing technologies on the precision, trueness, and accuracy of printed retainers.

INTRODUCTION: This study aimed to evaluate the differences in the precision, trueness, and accuracy of 3-dimensional (3D) printed clear orthodontic retainers fabricated using printer systems with different printing technologies. METHODS: Retainers (n = 15) were 3D printed using 4 different printers: stereolithography (SLA), digital light processing (DLP), continuous DLP, and polyjet photopolymer (PPP) printers. Printed retainers were transformed into a digital image through a cone-beam computed tomography scan and compared with the original image using 3D superimposition analysis software. At previously chosen landmarks (R6, L6, R3, L3, R1, and L1), intaglio surfaces of the retainers were compared to that of the reference model. The intercanine and the intermolar width measurements were also assessed. A discrepancy of up to 0.25 mm between the printed retainer and the reference retainer intaglio surfaces indicated accuracy and clinical acceptability. Precision and trueness were also determined. Root mean square and percent of points within the tolerance level were calculated for precision and trueness for each retainer. Statistical significance was set at P <0.05. RESULTS: Interrater correlation coefficient indicated good agreement. Statistically significant differences were found between printer types among the 6 landmarks and the arch width measurements. When evaluating tolerance level and root mean square, statistically significant differences in median precision and trueness among each printer type were found. CONCLUSION: Retainers fabricated by SLA, DLP, continuous DLP, and PPP technologies were shown to be clinically acceptable and accurate compared to the standard reference file. Based on both high precision and trueness, SLA and PPP printers yielded the most accurate retainers.

Recognition of the Asymmetrical Smile: A Comparison of Orthodontists, Oral and Maxillofacial Surgeons, and Laypersons.

PURPOSE: Studies have shown that an asymmetrical smile is a relatively common problem. Yet, many patients are unaware of having this condition. Because having an asymmetrical smile can affect the final esthetic result of orthodontic therapy or orthognathic surgery, such patients need to be aware of the problem. The purpose of this study was to determine what amount of smile asymmetry is clinically evident to orthodontists, oral and maxillofacial surgeons (OMSs), and the lay public. MATERIALS AND METHODS: A total of 56 OMSs, 117 orthodontists, and 123 laypersons participated in the study. They were asked to view a randomly arranged series of computer-generated male and female facial photographs with the smile symmetrical or altered in 0.5-mm increments from 1 to 4 mm and to indicate whether the person had an asymmetrical smile. RESULTS: The OMSs and orthodontists were able to recognize relatively smaller amounts of asymmetry than the laypersons (2 mm vs 3 to 3.5 mm). CONCLUSIONS: Although the clinicians performed better than the laypersons, both groups were able to recognize relatively small amounts of asymmetry. Because such a condition is generally not correctable and can affect the esthetic result, patients undergoing orthodontic therapy or orthognathic surgery need to be made aware of the situation before treatment.

Evaluation of fit for 3D-printed retainers compared with thermoform retainers.

INTRODUCTION: In the literature, there is little information available on 3D-printed orthodontic retainers. This study examined the accuracy of 3D-printed retainers compared with conventional vacuum-formed and commercially available vacuum-formed retainers. METHODS: Three reference models (models 1, 2, and 3) were used to fabricate traditional vacuum-formed, commercially available vacuum-formed, and 3D-printed retainers. For each model, retainers were made using the 3 methods (a total of 27 retainers). To determine the trueness, ie, closeness of a model to a true model, the distance between the retainer and its digital model at reference points were calculated with the use of engineering software. The measurements were reported as average absolute observed values and compared with those of the conventional vacuum-formed retainers. RESULTS: Average differences of the conventional vacuum-formed retainers ranged from 0.10 to 0.20 mm. The commercially available and 3D-printed retainers had ranges of 0.10 to 0.30 mm and 0.10 to 0.40 mm, respectively. CONCLUSIONS: The conventional vacuum-formed retainers showed the least amount of deviation from the original reference models and the 3D-printed retainers showed the greatest deviation. However, all 3 methods yielded measurements within 0.5 mm, which has previously been accepted to be clinically sufficient.

Comparison of intraoral and extraoral scanners on the accuracy of digital model articulation.

Digital dental technology is increasingly becoming an integral part of the modern orthodontic practice. The accuracy of digitally articulated models is critical when developing orthodontic treatment plans. OBJECTIVE: to determine the accuracy of model articulation generated by extraoral and intraoral scanners. DESIGN: One extraoral scanner with a wax (EOW) or vinyl polysiloxane bite registration (EOVPS), and three intraoral digital scanners utilizing confocal static (IOCS), confocal continuous (IOCC), and blue LED light technologies (IOLED) were used. METHODS: On each scanned image (n = 25 per group), measurements between the maxillary and mandibular molars and canines were performed and then compared to the gold standard values. A deviation of ± 0.5 mm from the gold standard value was considered acceptable. The significance level was kept at 0.05. RESULTS: IOCS and IOCC were accurate for all six interarch measurements. IOLED and EOVPS groups produced the next most accurate articulation of the digital models. EOW group resulted in the least accurate articulation. Also, of the software platforms used, the OrthoCAD™ was found to be the most accurate system for making measurements on digital casts. CONCLUSIONS: Only the scanners with the confocal imaging technology produced accurately articulated models. Differences between the scanners may be related to measurement errors inherent to the technologies employed and the software systems used to process the images.

Color Properties of Demineralized Enamel Surfaces Treated with a Resin Infiltration System.

OBJECTIVE: To assess color properties of white spot lesions (WSLs) following resin infiltration treatment in vitro. MATERIALS AND METHOD: WSLs were artificially created on 30 extracted human teeth. Two groups were formed: (a) control, and (b) resin infiltrant group (n = 15, each). Instrumental color measurements were performed using a spectrophotometer and visual color evaluation was performed by three independent evaluators. Color assessment was determined at three time points: baseline (T0), after WSL formation (T1), and after resin infiltrant or control treatment (T2). CIELAB color coordinates were determined and the resultant color difference (ΔE*) was calculated between the time points. Two-way repeated measures analysis of variance (ANOVA) and One-way ANOVA analyses were used to evaluate the color changes. Pearson chi-square analysis was performed to evaluate the visual ratings between treatment and control groups. Level of significance was set p <0.05. RESULTS: After treatment of WSLs there was a significant color change (ΔE*) between treatment and control groups (p <0.05). Resin infiltration group showed a regression of all values toward the pretreatment levels. There was a significant difference in visual evaluation ratings between groups after treatment; treatment group had all surfaces receive a rating of being clinically acceptable, with 73% of these surfaces having no perceptible color difference to adjacent sound enamel. Meanwhile, control group received ratings of all surfaces having a visual color difference that was deemed as unacceptable (p < 0.05). CONCLUSION: In-vitro resin infiltration for the treatment of enamel WSLs produced a significant improvement in color, reverting L*, a*, and b* values back toward baseline values. CLINICAL SIGNIFICANCE: Resin infiltration of enamel white spot lesions on teeth is capable of managing the esthetic problem by reverting the L*, a*, and b* color coordinates back to their baseline values. (J Esthet Restor Dent 28:339-346, 2016).

Efficacy of a fluoride-releasing orthodontic primer in reducing demineralization around brackets: an in-vivo study.

INTRODUCTION: A new, highly filled primer is currently marketed as a fluoride delivery system effective in reducing white spot lesions in orthodontic patients. However, no studies in the literature support this claim. The purpose of this in-vivo study was to investigate the retention and the efficacy of this primer in reducing the formation of white spot lesions. METHODS: In each patient for whom premolar extractions were planned (n = 22), 1 premolar was randomly chosen as the experimental tooth for the application of the fluoride delivery system (Opal Seal; Ultradent Products, South Jordan, Utah), and the contralateral tooth was assigned as the control to receive the standard treatment (Transbond XT; 3M Unitek, Monrovia, Calif). After the bonding procedures, separators were placed around the premolar brackets to encourage plaque retention over 8 weeks. After the extractions, the tooth surfaces were evaluated visually and with microhardness techniques for demineralization. Primer retention was also investigated. RESULTS: There were no statistically significant differences in the numbers of white spot lesions between the 2 groups. The primer retention was calculated as 50%. CONCLUSIONS: The results indicated no significant difference between the efficacies of the fluoride-releasing primer and the control primer in reducing demineralization over the duration of the study.

White spot lesions in orthodontics: consensus statements for prevention and management.

OBJECTIVE: To establish consensus recommendations for clinicians to manage white spot lesions (WSLs) during orthodontic treatment. MATERIALS AND METHODS: Three task force members reviewed the literature to identify best practices for minimizing WSLs during orthodontic treatment. Each draft statement was read to the task force members by a facilitator, followed by voting, accepting, or editing if necessary. The statements were then sent electronically by an independent third party (Magellan Medical Technology Consultants Inc, Minneapolis, Minn) to a previously formed content validation panel consisting of 20 independent private practitioners and clinical academicians for validation. RESULTS: Twenty-one statements were developed and sent for content validation. While 19 statements achieved a content validation index (CVI) of 0.78, two items did not. These items were edited by the task force members based on qualitative feedback from content validation participants. Each of these revised statements did achieve a CVI of 0.78 on second evaluation from the content validation panelists and therefore were included in this document. CONCLUSION: To reduce the risk of WSLs, it is essential to implement individualized caries management measures based on a comprehensive assessment of the patient's oral and systemic health. Effective at-home and professional mechanical and chemical plaque control should be implemented for high-risk orthodontic patients. Fluoride to support prevention and materials such as orthodontic sealants should also be used to provide a physical barrier around the brackets in high-risk patients. By following these guidelines, orthodontic professionals can help promote oral health and minimize the need for restorative treatment.

Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists.

INTRODUCTION: Despite the many advances to improve the practice of orthodontics, white spot lesions, or decalcifications, remain a common complication in patients with poor oral hygiene. The purpose of this study was to assess the perceptions and level of awareness of patients, parents, orthodontists, and general dentists toward the development of white spot lesions during orthodontic treatment. METHODS: This was a prospective epidemiologic survey of the perceptions of orthodontic patients (n = 315), parents (n = 279), orthodontists (n = 305), and general dentists (n = 191) regarding the significance, prevention, and treatment of white spot lesions. RESULTS: All surveyed groups indicated that white spot lesions detracted from the overall appearance of straight teeth, attributed primary responsibility for the prevention of white spot lesions to the patients themselves, and thought that the general dentist should be responsible for treating white spot lesions. Patients regarded themselves as ultimately responsible for the prevention of white spot lesions (P <0.05). CONCLUSIONS: The patients, parents, orthodontists, and general dentists had similar perceptions regarding the significance, prevention, and treatment of white spot lesions. All groups indicated that patients were the most responsible for the prevention of white spot lesions. Communication among patients, parents, orthodontists, and general dentists needs to improve to decrease the incidence of white spot lesions in the orthodontic population.

Influence of dental esthetics on social perceptions of adolescents judged by peers.

INTRODUCTION: The relationship between physical appearance and social attractiveness is well established in the literature. The purpose of this study was to determine whether dental esthetics influenced the perceptions of teens when judging a peer's athletic, social, leadership, and academic abilities. METHODS: The frontal-face smiling photographs of 10 teenage volunteers were each altered to create 1 image with an ideal arrangement of teeth and 1 with a nonideal arrangement. Two parallel surveys were constructed with 1 photo displaying either an ideal or a nonideal smile image of each subject. If the ideal smile image appeared in 1 survey, then the nonideal smile appeared in the other. Two hundred twenty-one peer evaluators successfully rated the pictures in 1 of the surveys by indicating their perception of each subject's athletic, social, leadership, and academic abilities. RESULTS: The subjects' photographs with ideal smile esthetics were consistently rated higher on average than the same subjects' images with nonideal smile esthetics. The differences in ratings between ideal and nonideal smiles were significant for perceptions of athletic performance (P = 0.0141), popularity (P <0.0001), and leadership ability (P <0.0001), but not for academic performance (P = 0.0548). CONCLUSIONS: On average, ratings for the ideal smiles in perceived athletic, social, and leadership skills were about 10% higher than those given for images with nonideal smiles. Based on these findings, it would be expected that orthodontic treatment resulting in improved smile esthetics can provide modest social benefits for adolescent patients.

Influence of patient financial account status on orthodontic appointment attendance.

OBJECTIVE: To test the null hypothesis that the financial status of a patient's orthodontic contract and other patient and appointment characteristics have no influence on appointment attendance. MATERIALS AND METHODS: During a 6-week period, the last appointment of each active, non-Medicaid patient (n = 538) was recorded as either kept or missed. The financial status of the patient's contract, age, sex, method by which the appointment was made, and the type of appointment scheduled were recorded. Associations between each of these factors and appointment attendance were evaluated using chi(2) analysis. In the case of patients who missed their appointment, attendance at the subsequent reappointment was also evaluated. RESULTS: The overall appointment failure rate was 12.3%. Males (16.2%) were significantly more likely than females (9.5%) to miss appointments (P = .02). Also, appointments made by postcard (28.2%) were more likely to be missed than those made in person (11.8%) or by phone (6.5%) (P = .003). The most significant factor affecting appointment attendance was the patient's financial status (P = .0001). Patients with accounts that were overdue (33.3%) or in collections (28.6%) were more likely to miss appointments than those whose accounts were current (10.5%). Of patients who missed their appointment (n = 66), 30% also missed the subsequent reappointment. CONCLUSIONS: The null hypothesis was rejected. Patients with delinquent financial accounts were three times as likely to miss an orthodontic appointment as those whose contracts were current. Increased rates of missed orthodontic appointments were also found for males, patients scheduled by mailing a postcard, and patients who had missed their previous appointment.

Accuracy of a smartphone-based orthodontic treatment-monitoring application: A pilot study.

OBJECTIVES: To investigate the reliability and accuracy of a monitoring system in patients undergoing orthodontic treatment with a rapid maxillary expander. Specifically, the amount of tooth movement calculated by the software was compared with the actual measurements taken on plaster models obtained during an in-office visit. MATERIALS AND METHODS: Patients took intraoral video scans using the monitoring software's smartphone application (Dental Monitoring, Paris, France), immediately followed by impressions for plaster models. Intercanine and intermolar width measurements were calculated by the software and compared with those made on the plaster models. Data were analyzed using two one-sided t-tests for equivalence with equivalence bounds of ±0.5 mm. The significance level was set at .05. RESULTS: Thirty sets of measurements were compared. The intercanine and intermolar measurement differences were on average 0.17 mm and -0.02 mm, respectively, and were deemed equivalent. CONCLUSIONS: The monitoring software seems to provide an accurate assessment of linear tooth movements.

Importance of pumice prophylaxis for bonding with self-etch primer.

INTRODUCTION: Self-etching primers (SEP) have simplified the orthodontic bonding process, but questions have arisen regarding their reliability and efficiency. The goal of this study was to assess the importance of a pumice prophylaxis before bonding in reducing bond failures. METHODS: Thirty orthodontic patients volunteered to participate in this prospective clinical trial. A split-mouth design was used; in each patient, 1 quadrant was randomly assigned to the pumice prophylaxis experimental group and the contralateral quadrant to the nonpumice group. A total of 508 teeth were bonded with SEP (Transbond Plus; 3M Unitek, Monrovia, Calif) and monitored for 3 months for bond failures. RESULTS: Thirty-five failures (6.9%) were recorded, with 6 (2.4%) in the pumice group and 29 (11.4%) in the nonpumice group. Chi-square analysis was used to compare bond failures as a total number between groups and also as the number of patients who experienced bond failures with each method. Statistically significant differences were found both in the total number of bond failures (P <.001) and in the number of patients with bond failures between groups (P <.01). A significantly lower and clinically acceptable bond failure rate was demonstrated with Transbond Plus SEP after pumice prophylaxis. CONCLUSIONS: This study produced strong evidence suggesting the need for pumice prophylaxis when using SEP for orthodontic bonding.

Perception of profile among laypeople, dental students and orthodontic patients.

OBJECTIVE: To determine whether there are differences in self-awareness and perception of an individual's own profile among various groups. MATERIALS AND METHODS: Laypeople, orthodontic patients, and first (D1) and third-year dental (D3) students were surveyed (n = 75 each). The participants answered a questionnaire regarding how they felt about their own profile and teeth. They also chose from among various silhouettes the one that most resembled their own profile. Profile photos of participants were analyzed by two orthodontists who matched the individual to the depicted silhouettes. Agreement between participants and experts was evaluated using the Kappa statistic. Differences among groups in identifying their own profiles and differences among profile types in satisfaction with their appearance were compared using chi2. RESULTS: Overall agreement between the individuals' perceptions of their own profiles and evaluation by orthodontists was 53% (kappa = .15). The four groups were different in their ability to recognize their own profile (P < .05). D3s were most accurate (64%, kappa = .28), followed by D1s (57%, kappa = .10), orthodontic patients (48%, kappa = .19), and laypeople (43%, kappa = .04). Individuals who considered themselves as having a Class II or III profile were less satisfied with the appearance of their profiles (P < .05). Those who considered themselves as having a Class III profile were also less happy with the appearance of their teeth (P < .05). CONCLUSIONS: This study suggests that about half the population cannot characterize their own profile. However, subjects who perceived their own profiles as being different from average were more likely to be unhappy with their facial appearance.

Media advertising effects on consumer perception of orthodontic treatment quality.

OBJECTIVE: To determine the effect of media advertising on consumer perception of orthodontic treatment quality. MATERIALS AND METHODS: A survey instrument was designed to evaluate factors influencing consumer selection of an orthodontist and consumer perception of different forms of media advertising (radio, television, newspaper, magazine, direct mail, and billboard) by orthodontic practices. The surveys were distributed by eight orthodontic offices in and around the Richmond, Virginia area. The survey return rate was 97%. RESULTS: Respondents most often cited dentist and patient referrals as how they learned of the orthodontic practices they visited (50% to 57%). A caring attitude and good practitioner reputation were the top reasons influencing actual selection of an orthodontist (53% and 49%, respectively). Of respondents, 14% to 24% felt that advertising orthodontists would offer a lower quality of care than nonadvertising orthodontists. Newspaper, magazine, and direct mail advertisements were viewed more favorably than radio, television, and billboard advertisements. Chi-square analyses revealed few statistically significant differences in perception between different income and education groups. CONCLUSIONS: The majority of patients do not perceive advertising to reflect poorly on the quality of orthodontic care. However, patients with different income and education levels perceive media advertising differently.