Irma Thesleff-Orthodontist who became a developmental biologist.

Irma Thesleff is one of the leading scholars in developmental biology. She and her research group have clarified the mysteries of tooth development. For several decades, her research of very high quality has focused on morphogenesis and resulted in an understanding of the highly complex signaling networks. Irma Thesleff has been duly recognized both in the domestic and international context. Her research continues despite her retirement.

Comparing the Salzmann Index to automatic qualifying conditions when selecting medically necessary orthodontic patients.

INTRODUCTION: This study compared the Salzmann Index (SI) to the American Association of Orthodontists-proposed Automatic Qualifying Conditions (AQC) list in determining eligibility for medically necessary orthodontic care (MNOC). In Pennsylvania, The SI must reflect a score of ≥25, whereas the AQCs are considered binary indicators of a treatment need-the presence of any AQC qualifies a patient for treatment under Medicaid. This study was designed to determine whether the same patients are selected as eligible for MNOC regardless of which selection method is used. METHODS: The orthodontic records of 139 participants aged 10-17 years were used to calculate SI scores and identify any AQCs present. McNemar's test of agreement was used to compare patients selected for treatment needs on the basis of SI to those selected on the basis of the presence of an AQC. RESULTS: The mean SI score was 14.7. Twelve patients (8.6%) were selected for treatment needs because of an SI of ≥25, whereas 44 patients (31.7%) were deemed to have at least 1 AQC present. Of the 44 patients with AQCs, only 11 had SI scores of ≥25. McNemar's test of agreement found that SI score and AQC presence did not select patients similarly (P <0.001). CONCLUSIONS: The SI and AQCs do not appear to select the same patients for MNOC, suggesting that replacing the SI with a list of AQCs would significantly impact which patients are selected for Medicaid-funded orthodontic care in Pennsylvania.

Consistency of orthodontists' clinical decisions: A systematic review, meta-analysis, and theory development.

INTRODUCTION: The purpose of this systematic review and meta-analysis is to provide a literature-based estimate of the consistency of orthodontists' clinical decisions. METHODS: A systematic review of the literature using a modified Reporting Items for Systematic Reviews and Meta-Analyses approach identified 20 articles, representing 53 unique datasets, reporting kappa statistics and standard errors for situations allowing intrarater or interrater comparison on decisions such as the need for treatment, extraction, surgery, and various specific treatment approaches. Meta-regression based on random effect models was used to explore the shape of the underlying distribution, the prevalence of the target condition in the data set, and the professional experience of raters as covariables. RESULTS: No evidence of publication bias was found. Common patient records accounted for approximately 25% of the variance between orthodontists and 33% of the variance within orthodontists making the same decision from the same records. Random and representative samples were judged more consistently than were samples chosen to contain borderline cases. (P <0.001). Raters were in greater agreement on the presence of target conditions than their absence (P <0.001). Residents were more consistent than were practicing orthodontists or dental students (P <0.006). CONCLUSIONS: Low consistency was found among orthodontists making clinical decisions from common records. Factors associated with samples and raters suggest an underlying pattern of orthodontists viewing cases through personal mental frameworks.

Developing safeguarding skills and competencies.

Safeguarding is an important part of an orthodontist's working life, as such there are several organisations and a plethora of legislation. These strive to ensure orthodontists implement the safeguarding agenda in their working environment. This article will provide background information on safeguarding. It then focuses on the development and training of dentists. The article looks at approaches that have been used in a hospital setting to engage staff and to generate clinical implementation.

Restricted posture in dentistry - a kinematic analysis of orthodontists.

BACKGROUND: This study aims at identifying orthodontic activities with the highest frequency of unfavorable/awkward and static postures held over a period of more than 4 s based on kinematic analysis. Moreover, a separate analysis of static postures for orthodontic and non-orthodontic activities serves to evaluate the duration for which these particular postures are assumed. METHODS: In total, 21 (13f/8 m) orthodontists (age: 31.5 ± 3.8 years) participated in this study. CUELA, a personal measurement system, was used to collect kinematic data for all orthodontic activities in a working day. Angle values of the head and torso were evaluated in accordance with ergonomic standards. Only those postures that were held statically for 4 s and longer were selected for further analysis. Alongside the kinematic analysis, the activities performed on-site were also subject to a detailed computerized analysis. The synchronization of data collected from both measurements arranges the patterns of posture found chronologically and in conjunction with the orthodontic activities performed ((I) "treatment" (II) "office" and (III) "other activities"). RESULTS: For (I) we observed an anterior inclination of the head and torso area as well as a twist of the head and neck area to the right. We found anterior back inclination and lateral back torsion to the right for (II) and (III). If, furthermore, we differentiate the duration of static postures, there are primarily short to medium-term (4-30s) static postures identified for (I). Also, categories (II) and (III) predominantly demonstrate static back postures with a duration of up to 30 s. With regard to (II) we observed that the back is ventrally inclined for 10.1% of the total activity duration. CONCLUSIONS: During treatment static strains are observed in the entire head and torso area. On the contrary, static postures prevalent in the torso area are essential for activities of the other categories, particularly office work. These findings allow for a careful selection of unfavorable and static postures for each of the activities performed and help to develop specific preventive measures.

Evaluation of orthodontists' experience with the surgery first protocol in orthodontic-surgical management.

AIM OF THE STUDY: The aim of this study was to analyze the popularity of surgery first among orthodontists as well as the protocols used for its implementation and to collect the opinions (favorable or unfavorable) of practitioners and patients regarding it. MATERIALS AND METHODS: A questionnaire was sent to a population of dental surgeons qualified in Dentofacial Orthopedics or in the process of specialization (residents) practicing in France. The questionnaire consisted of a total of 27 questions. There were 10 open-ended questions and 17 closed-ended questions (8 binary and 9 multiple choices). The conditional pathway allows the respondent's path through the form to be modified based on their answers. This survey was conducted using Google Forms online survey software. RESULTS: On average, the responding practitioners had 15.9 years of experience, and most of them (78.2%) work in private practice. Most treated between 200 and 400 cases per year, of which 7% were surgical cases. Orthodontists who are familiar with and practice the surgery first protocol use it on average for 7 cases per year. The most frequent indication for the surgery first protocol was: transverse maxillary defects. CONCLUSIONS: Surgery first protocol is a preferred option in cases of high severity since it prevents respiratory worsening during the pre-surgical orthodontic phase. The lack of a standardized protocol for this approach, at the pre-surgical and post-surgical levels, requires an increase in the number of high-level evidence publications to clarify the methods of application of this protocol.

Quantitative evaluation of implemented interproximal enamel reduction during aligner therapy.

OBJECTIVES: To investigate the correspondence between programmed interproximal reduction (p-IPR) and implemented interproximal reduction (i-IPR) in an everyday-practice scenario. The secondary objective was to estimate factors that might influence i-IPR to make the process more efficient. MATERIALS AND METHODS: Fifty patients treated with aligner therapy by six orthodontists were included in this prospective observational study. Impressions were taken at the beginning of treatment and after the first set of aligners. Data on p-IPR, i-IPR and technical aspects of IPR were gathered for 464 teeth. Statistical analyses included the Wilcoxon signed-rank test, Kruskal-Wallis, and multilevel mixed regression. RESULTS: Mean difference between p-IPR and i-IPR was 0.15 mm (SD: 0.14 mm; P = .0001), with lower canines showing the highest discrepancy. Use of burs and measuring gauges resulted in a smaller difference (respectively: coeff.: 0.09, P = .029; coeff.: -0.06, P = .013). IPR was performed more accurately on the mesial surface of teeth than on the distal surface. Round tripping before IPR resulted in a slightly more precise i-IPR compared to the previous alignment (coeff.: -0.021, P = .041). CONCLUSIONS: Implemented IPR tends to be less than p-IPR, especially for lower canines and distal surfaces of teeth. Burs tend to provide more precise i-IPR, especially compared to manual strips; however, there is variation between the techniques. Using a measuring gauge tends to increase the precision of i-iPR. As several factors influence the implementation of IPR, particular attention must be paid during the procedure to maximize its precision.

[Perpetrator or victim? The orthodontist Gustav Korkhaus (1895-1978) and his actual role in the Third Reich]. / Täter oder Opfer? Der Kieferorthopäde Gustav Korkhaus (1895­1978) und seine tatsächliche Rolle im "Dritten Reich".

PURPOSES: Gustav Korkhaus is widely regarded as the most important German orthodontist of the post-war period; in contrast, his relationship to National Socialism is much less well defined. Against this background, this article sheds light on the concrete scientific and (professional) political significance of Korkhaus; special attention is paid to his role in the Third Reich. METHODS: The study is based on primary sources from the Federal Archives Berlin, the State Archives North Rhine-Westphalia (Department Rhineland), and the University Archives Bonn. Contemporary publications were also included, as well as secondary literature on Korkhaus. RESULTS: Korkhaus was an international pioneer of orthodontics in many respects-as a scientist, expert politician, and developer of orthodontic innovations. During the Third Reich, he joined numerous Nazi organizations and enjoyed the backing of the "Reichszahnärzteführer" (Reich dentist leader) Ernst Stuck. After 1945, however, he portrayed himself as a political victim. CONCLUSION: Korkhaus did not commit Nazi crimes, but contrary to his claims, he was not a victim of the Nazi regime either. Rather, he served the Nazi state for career reasons and contributed to the omnipotence of the regime. He thus belongs to the group of political opportunists.

John Herbert Hovell (1910-1988), TD, MRCS, LRCP, FRCS, FDSRCS (Eng), FFD (Ire), DOrth.

When the author studied at the Royal Dental Hospital from 1957 to 1961, John Hovell was a highly respected teacher and consultant, very popular with both patients and undergraduates. Hovell uniquely practised two widely different specialties at consultant level: oral surgery and orthodontics. Moreover, his story is one of a great dental clinician, a dental politician and a charismatic and caring man.