Motivational factors and future life plans of orthodontic residents in the United States.

INTRODUCTION: The purposes of this study were to investigate factors influencing career choice and identify future life plans of orthodontic residents in the United States. METHODS: Program chairs and directors of all 65 orthodontic residency programs in the United States were contacted by e-mail and telephone for permission to e-mail their residents and invite them to take part in on online survey. A total of 335 residents from 37 programs were invited to complete an anonymous 57-item questionnaire in May 2007. Data were categorized, and basic statistics including chi-square comparative analyses were performed. RESULTS: A total of 136 (40.60%) residents completed the survey. A "passion for orthodontics" emerged as the most important factor (20.29%) influencing the decision to pursue orthodontics as a career, followed by "intellectual stimulation or challenge" (18.12%). Most residents decided to become an orthodontist before they were in dental school (44.93%). Most residents (89.05%) plan to engage in private practice, and only 2 intend to pursue primarily an academic career. The average resident debt was $165,226 at the end of their program. CONCLUSIONS: The decision to become an orthodontist is often made early in life, before dental school, and a passion for orthodontics is the motivational factor. Residents plan to enter private practice and not pursue a career in academia. The current shortage of academics and orthodontic researchers will not be resolved from the current pool of orthodontic residents. A possible solution to the academic crisis is to change the selection criteria in programs to accept orthodontic residents who develop a passion for orthodontics while in dental school or to recruit primary researchers and teachers to the specialty. Residents plan to practice in an urban setting. Rural and underserviced areas will probably continue to experience shortages of orthodontists in the future.

Motivations and future plans of Canadian orthodontic residents.

INTRODUCTION: Our purposes were to investigate factors influencing career choice and to identify future plans of Canadian orthodontic residents. METHODS: All orthodontic residents in the 5 Canadian residency training programs were invited to complete an anonymous online survey in November 2006. Data were categorized by demographic variables, and basic statistics including chi-square comparative analyses were performed. RESULTS: Forty-four of the 54 residents in Canada (81.48%) completed the survey. "Intellectual stimulation/challenge" emerged as the most important factor (40%) influencing the decision to pursue specialty training in orthodontics, followed by a "passion for orthodontics" (29%). The decision to become an orthodontist was made by 42% of respondents while they were in dental school; 33% had decided after completing dental school, and 24% had already decided before starting their dental school studies. Most residents (82%) planned to work in a private practice environment. Only 2 (4.5%) indicated that they will most likely practice primarily in an academic setting. Eighty percent said that they will use self-ligating brackets in private practice, and almost 80% said they will use Invisalign (Align Technology, Santa Clara, Calif). A total of 55% indicated that orthodontic residents should be required to undertake research leading to a masters of science degree as part of their orthodontic program. A total of 77% thought that a 24- to 30-month program was too short to adequately prepare them for private practice. CONCLUSIONS: Intellectual stimulation was the major attraction of most applicants to orthodontic programs, and the decision to become an orthodontist was normally made during dental school or even earlier. Most residents intended to enter an urban or suburban private practice after graduation, with few considering academic career choices. Modern techniques such as self-ligating brackets and Invisalign are expected to be popular among future orthodontists in Canada.

Future practice plans of orthodontic residents in the United States.

INTRODUCTION: The purpose of this study was to investigate the future clinical practice plans of orthodontic residents in the United States. METHODS: All program chairs and directors of the 65 US orthodontic residency programs were contacted by e-mail and telephone and asked for permission to e-mail their residents and invite them to take part in an anonymous 57-item questionnaire online. A total of 335 e-mails from 37 programs were obtained, and the survey was sent in May 2007. Basic statistics including chi-square comparative analyses were performed by sex, age, and year of program. RESULTS: A total of 63.04% of orthodontic residents plan to use self-ligating brackets; 84.06% plan to use Invisalign (Align Technology, Santa Clara, Calif); 92.03% plan to use temporary anchorage devices, and 72.26% plan on placing them themselves; 28.26% plan to use cone-beam computerized tomography; 92.75% plan to use a digital imaging program; 45.65% plan to use indirect bonding; and 10.87% plan to use lingual orthodontics. A total of 70.07% plan to use 2-phase treatment, and 61.59% said they will use functional appliances. A total of 81.16% plan to become certified by the American Board of Orthodontics, but only 18.12% thought certification should be mandatory for licensure; 36.50% indicated that a master of science degree should be required in their program, and 77.94% believe that a 24- to 30-month program adequately prepares them for future orthodontic practice. CONCLUSIONS: Newer orthodontic technologies such as self-ligating brackets, temporary anchorage devices, and Invisalign as well as functional appliances are expected to grow in popularity in the United States because of projected future use by orthodontic residents. Two-phase orthodontic treatment with functional appliance mechanics will continue to be used. Most orthodontic residents will become certified by the American Board of Orthodontics but do not believe it should be necessary for licensure. Orthodontic residents in the United States believe that a 2-year program adequately prepares them for private practice.

Resident evaluation of orthodontic programs in Canada.

The purpose of this study was to investigate the satisfaction of Canadian orthodontic residents with their programs and determine the scope of their training. An anonymous online questionnaire was sent to all Canadian orthodontic residents in November 2006. Data were assembled and categorized by different variables, and chi-square comparative analyses were performed. Forty-four out of fifty-four residents responded, giving a participation rate of 81.48 percent. Overall, 86.36 percent of responding residents were satisfied with their program. Respondents said they felt they received the appropriate amount of formal didactic teaching sessions and dedicated and protected academic time. All residents indicated their programs offered training in numerous treatment philosophies: 93.18 percent said they have sufficient clinically based training, and 72.73 percent indicated that their research-based training was sufficient. All responding residents indicated they will complete more than thirty patients from start to finish, and 25 percent estimated completion of more than seventy patients by graduation. Residents said they will complete on average five orthognathic surgery, twenty-four extraction, thirty-one non-extraction, eight adult, and thirteen patients in the mixed dentition. Only 50 percent said their programs contained care for disabled or underserved patients. Most (86.36 percent) said they feel they will be adequately prepared to provide unsupervised orthodontic care after graduation. These orthodontic residents indicated they collaborate most with the disciplines of oral surgery, periodontics, and prosthodontics. However, only 52.27 percent indicated they have a formal interdisciplinary program for treating patients. We conclude from the study that Canadian orthodontic residents are satisfied with the didactic, clinical, and research aspects of their programs. They receive comprehensive instruction with the opportunity to complete a significant number of patients, employing a variety of treatment approaches.

In vivo bonding of orthodontic brackets to fluorosed enamel using an adhesion promotor.

OBJECTIVES: To determine the success of bracket retention using an adhesion promoter with and without the additional microabrasion of enamel. MATERIALS AND METHODS: Fifty-two teeth with severe dental fluorosis were bonded in vivo using a split-mouth design where the enamel surfaces of 26 teeth were microabraded with 50 microm of aluminum silicate for 5 seconds under rubber dam and high volume suction. Thirty-seven percent phosphoric acid was then applied to the enamel, washed and dried, and followed by placement of Scotchbond Multipurpose Plus Bonding Adhesive. Finally, precoated 3M Unitek Victory brackets were placed and light cured. The remaining teeth were bonded using the same protocol but without microabrasion. RESULTS: After 9 months of intraoral service, only one bond failure occurred in the control group where microabrasion was used. Chi-square analysis revealed P = .31, indicating no statistical significance between the two groups. CONCLUSIONS: Bonding orthodontic attachments to fluorosed enamel using an adhesion promoter is a viable clinical procedure that does not require the additional micro-mechanical abrasion step.

Diagnosis and clinical management of patients with skeletal Class III dysplasia.

This paper summarizes the current literature on the diagnosis and treatment of a patient with Class III skeletal dysplasia. It also includes a report of two siblings with Class III skeletal dysplasia, although each received different treatment due to different causes of the condition. This review illustrates that early appropriate diagnosis, including cephalometric analysis, is important for identifying the location of the dysplasia. If the dysplasia is in the maxilla, treatment may prevent the need for future orthognathic surgery. Treatment for mandibular prognathism usually involves waiting for the patient's growth to complete (this could occur past the age of 18 in women and the age of 20 in men) and performing orthognathic surgery at that time.

Preventive and interceptive orthodontic treatment needs of an inner-city group of 6- and 9-year-old Canadian children.

OBJECTIVE: Early recognition of developing malocclusions and the potential for uncomplicated orthodontic treatment procedures can minimize or eliminate future costly treatment. This study was designed to assess the potential for this approach in children living in a limited-income environment. A modified index for preventive and interceptive orthodontic needs (IPION) was used to determine the need for such treatment in schoolchildren aged 6 and 9 years. METHODS: Two calibrated examiners examined each child independently and assessed several components of his or her occlusion, including molar relationship, crossbite, open bite, overbite and overjet. Dental variables such as presence of caries and early loss of teeth were also noted. Informed consent was obtained and all children present at school on the day of the field study were included. A total of 395 children were divided into 2 groups, aged 6 and 9 years. RESULTS: A high prevalence of caries in the deciduous dentition (30.4% for 6 year olds; 20.6% for 9 year olds) and early loss of primary teeth (11.9% for 6 year olds; 29.4% for 9 year olds) was observed. A large percentage of children had crossbite in the anterior or posterior segments, or both. Open bites were also a common finding. Future orthodontic problems were identified in 28% of this population by using the modified IPION. No statistically significant differences (p > 0.05) were found between sexes or age groups using the chi2 test. CONCLUSIONS: Most of the developing malocclusions identified in this study would be amenable to interceptive orthodontics, consisting of space maintenance, crossbite correction and arch expansion.

Future provision of orthodontic care for patients with craniofacial anomalies and cleft lip and palate.

OBJECTIVE: To determine whether Canadian and United States (US) orthodontic programs provide training in treating patients with cleft lip and palate (CLP) and craniofacial anomalies (CFA) and whether residents will treat these patients in their future practices. METHODS: An email with a personalized link to an anonymous, multi-item, online questionnaire was sent to all 54 Canadian and 335 of the approximately 700 US orthodontic residents. The two questions asked were: "Do you plan to include the treatment of CLP and CFA patients in your practice?" and "Does your program contain formal training in treating patients with CLP and CFA?" RESULTS: A total of 44 Canadian and 136 US residents responded. In Canada, 30% plan to treat patients with CLP and CFA after graduation, 14% said no, 48% said maybe, and 9% were unsure. In the US, 53% said yes, 7% said no, 36% said maybe, and 4% were unsure. When asked if their program offers formal training in the treatment of these patients, 45% of Canadian residents said yes, 34% said no, and 20% were unsure, whereas 82% of US residents said yes, 12% said no, and 5% were unsure. CONCLUSION: Most programs in the US and approximately half in Canada provide training in CLP and CFA, and more than half of US and almost one-third of Canadian residents plan to be involved in the care of patients with CLP and CFA, which is considerably less than those receiving training. Orthodontic programs need to increase the number of postgraduate students who are interested in providing care to CLP and CFA patients after becoming orthodontists.

Resident evaluation of orthodontic programs in the United States.

The objective of this study was to investigate the satisfaction of orthodontic residents in the United States with their programs and determine the scope of their training. Program chairs/directors of all sixty-five U.S. orthodontic graduate programs were contacted for permission to email their residents. A total of 335 residents from thirty-seven programs were invited to complete an anonymous, online, fifty-seven-item survey in May 2007. Data were categorized, and basic statistics were performed. A total of 136 (40.60 percent) residents completed the survey. Overall, 75.74 percent were satisfied with their program. Residents said they feel they receive appropriate didactic teaching sessions and dedicated academic time (60.29 percent). Most residents (92.70 percent) indicated their program offers training in numerous philosophies, while 80.29 percent said they have sufficient clinically based training and 59.85 percent said they have sufficient research-based training. A total of 57.66 percent said they will not complete more than thirty cases from start to finish and on average treat two orthognathic surgery, thirteen extraction, twenty-four nonextraction, and nine adult patients. Most (92.70 percent) said their program contains care for disabled or underserved patients; most (92.70 percent) said they feel they will be adequately prepared to provide unsupervised orthodontic care after graduation; and 54.41 percent said they think other specialties have a positive view of orthodontics. Only 58.09 percent indicated they have a formal interdisciplinary program for treating patients. We conclude that U.S. orthodontic residents are satisfied with their programs. They receive training in a variety of approaches; however, inadequacies in exposure to interdisciplinary teaching and a limitation of the number of cases started and completed were identified. These observations may be a result of program length due to the preponderance of twenty-four- to thirty-month programs.