Diagnostic accuracy of intraoral photographic orthodontic records.

OBJECTIVE: The aims of this study were (1) to investigate how relevant intraoral photographs are to contemporary orthodontic diagnosis and (2) to assess orthodontists' ability to accurately diagnose angle classification and dental midlines using standardized intraoral photographs. METHODS: Study participants were orthodontists who completed a survey regarding photography protocols and their use of intraoral photographs for diagnosis. Each participant was randomized to complete 1 visual diagnostic task regarding either angle classification or midlines. Accuracy was compared across groups and camera angulations. RESULTS: In all, 80% of 192 respondents reported using photographs and clinic notes to plan orthodontic treatment; 50% also included dental casts. For the angle task, accuracy judging molar and canine classification was 79.9% and 51.3%, respectively with ideal standardized photographs. As camera angulation deviated, accuracy decreased significantly (P < 0.0001). For the midline task, accuracy judging the direction of deviation decreased with a small camera angulation change yet increased with a large change (P < 0.001). CONCLUSIONS: When using ideal intraoral photographs alone to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to significantly decrease. CLINICAL SIGNIFICANCE: For the clinician who wants to have the most accurate and complete records, our results suggest that intra-oral photos alone may not be adequate when it comes to judging occlusal relationships such as angle classification and esthetic parameters like midlines. When using ideal intraoral photographs to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by as little as 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to decrease significantly. Understanding these limitations will allow clinicians to improve both their clinical photography technique and their diagnostic skills.

Executive Function as a Risk Factor for Incisor Trauma.

BACKGROUND/AIM: Executive function is the ability to guide behavior to achieve goals or complete tasks. This study explored the relationship between executive function, as assessed by the Behavior Rating Inventory of Executive Function Parent Form Questionnaire (BRIEF® ) and incisor trauma. MATERIAL AND METHODS: This study included children in the mixed dentition with recent incisor trauma (n=28) and a control group (n=30) without recent incisor trauma. Subjects' parents completed the BRIEF® , while a clinical examination assessed subjects' occlusal relationships. Parents also completed a custom questionnaire that investigated their child's medical history and daily activities. Fisher Exact and unpaired t-tests compared BRIEF® scores, occlusal characteristics, medical history, and reported daily activities of the two groups. RESULTS: The trauma group had a greater percentage of participants with a Class II dental relationship (p=0.01). There was no significant difference between groups with respect to mean BRIEF® t-scores within the Global Executive Composite. There was a statistically significant difference between groups with respect to the percentage of subjects with clinically significant (≥65) BRIEF® t-scores within the Inhibit (p=0.05) and Emotional Control (p=0.02) subscales and Behavioral Regulation Index (p=0.02). There were no statistically significant differences between groups with respect to age, gender, overbite, overjet, medical history, body mass index, or daily activities. CONCLUSIONS: Children in the mixed dentition with a Class II dental relationship are at greater risk for incisor injury, as well as those involved in outdoor activities. Specific executive dysfunctions such as impulsivity and poor emotional control may increase the risk for incisor trauma. This article is protected by copyright. All rights reserved.

Characterizing the orthodontic patient's purchase decision: A novel approach using netnography.

INTRODUCTION: A deeper and more thorough characterization of why patients do or do not seek orthodontic treatment is needed for effective shared decision making about receiving treatment. Previous orthodontic qualitative research has identified important dimensions that influence treatment decisions, but our understanding of patients' decisions and how they interpret benefits and barriers of treatment are lacking. The objectives of this study were to expand our current list of decision-making dimensions and to create a conceptual framework to describe the decision-making process. METHODS: Discussion boards, rich in orthodontic decision-making data, were identified and analyzed with qualitative methods. An iterative process of data collection, dimension identification, and dimension refinement were performed to saturation. A conceptual framework was created to describe the decision-making process. RESULTS: Fifty-four dimensions captured the ideas discussed in regard to a patient's decision to receive orthodontic treatment. Ten domains were identified: function, esthetics, psychosocial benefits, diagnosis, finances, inconveniences, risks of treatment, individual aspects, societal attitudes, and child-specific influences, each containing specific descriptive and conceptual dimensions. A person's desires, self-perceptions, and viewpoints, the public's views on esthetics and orthodontics, and parenting philosophies impacted perceptions of benefits and barriers associated with orthodontic treatment. CONCLUSIONS: We identified an expanded list of dimensions, created a conceptual framework describing the orthodontic patient's decision-making process, and identified dimensions associated with yes and no decisions, giving doctors a better understanding of patient attitudes and expectations.

Effectiveness and efficiency of a CAD/CAM orthodontic bracket system.

INTRODUCTION: The first straight-wire appliance was introduced over 40 years ago to increase the consistency and efficiency of orthodontic treatment. More recently, computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been used to create individualized orthodontic appliances. The purpose of this study was to investigate the clinical effectiveness and efficiency of CAD/CAM customized orthodontic appliances compared with direct and indirect bonded stock orthodontic brackets. METHODS: This retrospective study included 3 treatment groups: group 1 patients were direct bonded with self-ligating appliances, group 2 patients were indirect bonded with self-ligating appliances, and group 3 patients were indirect bonded with CAD/CAM self-ligating appliances. Complete pretreatment and posttreatment records were obtained for all patients. The American Board of Orthodontics (ABO) Discrepancy Index was used to evaluate the pretreatment records, and the posttreatment outcomes were analyzed using the ABO Cast-Radiograph Evaluation. All data collection and analysis were completed by 1 evaluator. RESULTS: There were no statistically significant differences in the ABO Discrepancy Index or the ABO Cast-Radiograph Evaluation among the groups. Treatment times for the 3 groups were significantly different; the CAD/CAM group was the shortest at 13.8 ± 3.4 months, compared with 21.9 ± 5.0 and 16.9 ± 4.1 months for the direct bonded and indirect bonded groups, respectively. The number of treatment appointments for the CAD/CAM group was significantly fewer than for the direct bonded group. CONCLUSIONS: The CAD/CAM orthodontic bracket system evaluated in this study was as effective in treatment outcome measures as were standard brackets bonded both directly and indirectly. The CAD/CAM appliance was more efficient in regard to treatment duration, although the decrease in total archwire appointments was minimal. Further investigation is needed to better quantify the clinical benefits of CAD/CAM orthodontic appliances.

Effect of quality of life measures on the decision to remove third molars in subjects with mild pericoronitis symptoms.

PURPOSE: To assess how quality of life (QoL) measures affect the decision for third molar (3M) removal in patients with mild symptoms of pericoronitis. PATIENTS AND METHODS: Healthy subjects, aged 18 to 35 years, with mild symptoms of pericoronitis were enrolled in an institutional review board-approved study. The demographic, clinical, and QoL data were collected at enrollment. The subjects voluntarily scheduled surgery for 3M removal. The principal outcome variable was their decision to undergo or not undergo surgery within 6 months of enrollment. The possible predictor variables in a multivariate logistic regression analysis were the demographic characteristics, dental insurance, and QoL measures. RESULTS: The mean age of the 113 subjects was 23.2 ± 3.8 years. Of the 113 subjects, 79 elected to undergo 3M removal within 6 months of enrollment (removed group) and 34 elected to retain their 3M at 6 months after enrollment (retained group). A significantly greater proportion of the removed group were white (58% vs 35%; P = .03) and reported having at least "a little trouble" with opening their mouths (38% vs 18%; P = .04) and taking part in social life (27% vs 6%; P = .01). The multivariate logistic regression model suggested the odds of electing 3M removal within 6 months of enrollment were greater for those who were white (odds ratio [OR] 2.69, 95% confidence interval [CI] 1.14 to 6.32) and those who had at least "a little trouble" with interactions in their social life (OR 3.22, 95% CI 1.08 to 9.58). CONCLUSIONS: In subjects with mild pericoronitis symptoms, experiencing problems with oral function and lifestyle, factors not often considered by clinicians, were significantly associated with subjects' decision for early 3M removal.

In-vivo force decay of nickel-titanium closed-coil springs.

INTRODUCTION: Nickel-titanium closed-coil springs are purported to deliver constant forces over extended ranges of activation and working times. In-vivo studies supporting this claim are limited. The objective of this study was to evaluate changes in force-decay properties of nickel-titanium closed-coil springs after clinical use. METHODS: Pseudoelastic force-deflection curves for 30 nickel-titanium coil springs (used intraorally) and 15 matched laboratory control springs (simulated intraoral conditions: artificial saliva, 37°C) were tested before and after retrieval via dynamic mechanical analysis and a testing machine, respectively, to evaluate the amounts of force-loss and hysteresis change after 4, 8, or 12 weeks of working time (n = 10 per group). The effects of the oral environment and clinical use on force properties were evaluated by comparing in-vivo and in-vitro data. RESULTS: The springs studied showed a statistically significant decrease in force (approximately 12%) after 4 weeks of clinical use (P <0.01), with a further significant decrease (approximately 7%) from 4 to 8 weeks (P = 0.03), and force levels appearing to remain steady thereafter. Clinical space closure at an average rate of 0.91 mm per month was still observed despite this decrease in force. In-vivo and in-vitro force-loss data were not statistically different. CONCLUSIONS: Nickel-titanium closed-coil springs do not deliver constant forces when used intraorally, but they still allow for space-closure rates of approximately 1 mm per month.

Relationship between body mass index percentile and skeletal maturation and dental development in orthodontic patients.

INTRODUCTION: The rate of obesity in children and adolescents is a current public health concern. The aim of this study was to investigate the relationship between body mass index (BMI) percentile and skeletal and dental maturity in adolescent orthodontic patients. METHODS: Orthodontic patients between 8 and 17 years of age were assessed with a retrospective chart review. Skeletal maturation was assessed by using the cervical vertebral method, dental age with the Demirjian assessment method, and weight status with the BMI percentile. Linear regression and logistic regression models were used to assess the effect of the BMI percentile on dental age and cervical vertebral stage, respectively. RESULTS: For this study, 540 subjects met the inclusion criteria; 27% of the boys and 32% of the girls were either overweight or obese. Cervical vertebral stage and dental age were more advanced in subjects with increased BMI percentiles. For dental age, the coefficient for the BMI percentile was 0.005 year per 1 unit of increase (P <0.001), and the odds ratio for the effect of the BMI percentile on the cervical vertebral method was 1.02 (P <0.001). CONCLUSIONS: Orthodontists should consider weight status when evaluating growing children and adolescents because it can affect skeletal and dental development.

Interactive distance learning for orthodontic residents: utilization and acceptability.

INTRODUCTION: Sharing resources through distance education has been proposed as 1 way to deal with a lack of full-time faculty in orthodontic residency programs. To keep distance education for orthodontic residents as cost-effective as possible while retaining interaction, we developed a "blended" interactive distance learning approach that combines observation of Web-based seminars with live postseminar discussions. For the 2009-2010 academic year, a grant from the American Association of Orthodontists opened access to the blended learning experience to all orthodontic programs in the United States and Canada. The specific aims of this project were to (1) measure programmatic interest in using blended distance learning, (2) determine resident and faculty interest, (3) determine the seminars' perceived usefulness, and (4) elicit feedback regarding future use. METHODS: Participants in this project were expected to (1) read all assigned articles before viewing a recorded seminar, (2) watch a 1 to 1.5 hour recording of an actual interactive seminar on a Web site, and (3) participate in a 30-minute follow-up discussion immediately after watching the recorded seminar either with a faculty member at the participating institution or via a videoconference with the leader of the Web-based seminar. The residents and faculty then completed surveys about the experience. RESULTS: Half (52%) of the 63 orthodontic programs in the United States fully participated in this project. The blended approach to distance learning was judged to be effective and enjoyable; faculty members were somewhat more enthusiastic about the experience than were residents. Most residents were not adequately prepared for the seminars (only 14% read all preparatory articles in depth); this impacted their perception of the effectiveness and enjoyability of the experience (P = 0.0016). Prepared residents reported a greater ability to learn from the seminars (P = 0.0035) than those who did not read, and also indicated that they were more likely to use the seminars again (P = 0.0018). Despite feedback regarding the need for technologic improvements of the recorded seminars, such as better editing, more frequent slides, quicker pace, and improved sound quality, most residents and faculty agreed that they would like to use this approach to distance learning again. CONCLUSIONS: Blended distance learning is an acceptable method of instruction that allows residents to access various experts, supplement traditional instructor-led training, and ease the strain of current faculty shortages. The content of the recorded seminars needs to remain evidence-based, and some technologic aspects of the recordings should be improved.

Association between childhood obesity and dental caries.

PURPOSE: The purpose of this study was to investigate dental caries and body mass index (BMI percentile) in pediatric dental patients. METHODS: A 3-year retrospective review of patient records included all 6- to 9-year-olds seen for a new patient examination who had at least 1 recall examination. Decayed permanent teeth (DT) and primary teeth (dt), plaque score, gingival score, height, and weight were recorded at the initial examination and each recall visit. BMI percentile was categorized into underweight/healthy weight (UH), overweight (OW), and obese (OB). RESULTS: A total of 230 subjects were seen for the initial examination: approximately 13% were OB, 15% were OW, and 72% were UH, while approximately 12% had permanent caries and 46% had primary caries. The presence of caries in permanent teeth at the initial exam was not significantly different between BMI groups (P=.41). OW and OB children had less primary tooth caries than UH children. (P=.04) The presence of new carious lesions at recall exams in primary teeth (P=.35) and permanent teeth (P=.96) was not significantly different between BMI groups. CONCLUSIONS: A smaller proportion of obese and overweight children initially presented with primary tooth caries than underweight/healthy weight children.

Efficiency of serial extraction and late premolar extraction cases treated with fixed appliances.

INTRODUCTION: Severe crowding can be treated with serial extraction (SE) in the mixed dentition or with late premolar extraction (LPE) in the permanent dentition. The aim of this study was to investigate the efficiency of orthodontic treatment in SE patients and LPE patients. METHODS: Retrospective chart review identified 51 SE patients and 49 LPE patients treated with fixed appliances. Number of appointments, length of time, and estimated total chair time were determined prior to the placement of fixed appliances and during fixed appliance treatment. Peer assessment rating (PAR) scores were obtained at T1 (start of fixed appliances) and T2 (removal of fixed appliances) for both groups, and at T0 (prior to extraction of the first premolars) for the SE group. RESULTS: The mean T1 PAR score for SE patients was significantly lower than LPE patients (P <0.001); mean T2 PAR scores were not significantly different (P = 0.27). Active treatment time (T1 to T2) was significantly (P <0.001) less for SE patients than LPE patients. Total time (T0 to T2) and total number of appointments were significantly greater for the SE group compared with the LPEgroup (P <0.001). CONCLUSIONS: SE and LPEresulted in similar final occlusal outcomes. SEs might reduce active treatment time, but significant observation time precedes active treatment.

Traumatic dental injuries in preschool-age children: Prevalence and risk factors.

This study examined the prevalence, socio-demographic correlates, and clinical predictors of traumatic dental injuries (TDIs) in the primary dentition among a community-based sample of preschool-age children. The sample comprised 1,546 preschool-age children (mean age 49 [range: 24-71] months) in North Carolina public preschools, enrolled in a population-based investigation among young children and their parents in North Carolina. Information on socio-demographic, extraoral, and intraoral characteristics was collected and analyzed with bivariate and multivariate methods, including logistic regression modeling and marginal effects estimation. The prevalence of dental trauma was 47% and 8% of TDI cases were "severe" (pulp exposure, tooth displacement, discolored or necrotic tooth, or tooth loss). In bivariate analyses, overjet and lip incompetence were significantly associated with TDI. Overjet remained positively associated with severe trauma in multivariate analysis, OR = 1.4, 95% confidence interval (CI) [1.2, 1.6], corresponding to an absolute 1.3%, 95% CI [0.7, 1.8], increase in the likelihood of severe trauma, per millimeter of overjet. Children with increased overjet (>3 mm) were 3.8, 95% CI [2.0, 7.4], times as likely to have experienced severe TDI compared with those with ≤3 mm. Overjet is a strong risk factor for TDIs in the primary dentition. Incorporating and operationalizing this information may help TDI prevention and related anticipatory guidance for families of preschool-age children.

Self-Directed Digital Learning: When Do Dental Students Study?

The Growth and Development (G&D) curriculum at the University of North Carolina at Chapel Hill School of Dentistry uses self-directed web-based learning modules in the place of lectures and includes scheduled self-study times during the 8 am-5 pm school hours. The aim of this study was to use direct observation to evaluate dental students' access patterns with the self-directed, web-based learning modules in relation to planned self-study time allocated across the curriculum, proximity to course examinations, and course performance. Module access for all 80 students in the DDS Class of 2014 was recorded for date and time across the four G&D courses. Module access data were used to determine likelihood of usage during scheduled time and frequency of usage in three timeframes: >7, 3 to 7, and 0 to 2 days before the final exam. The results showed a statistically significant difference in the likelihood of module access during scheduled time across the curriculum (p<0.0001). Among the students, 64% accessed modules at least once during scheduled time in G&D1, but only 10%, 19%, and 18% in G&D2, G&D3, and G&D4, respectively. For all courses, the proportion of module accesses was significantly higher 0-2 days before an exam compared to the other two timeframes. Module access also differed significantly within each timeframe across all four courses (p<0.001). There was no association between module access and course performance. In this non-traditional, non-lecture, self-directed curriculum, students rarely accessed learning modules during syllabus-budgeted self-study time and accessed modules more frequently as course exams approached.

Influence of sex and ethnic tooth-size differences on mixed-dentition space analysis.

INTRODUCTION: Most mixed-dentition space analyses were developed by using subjects of northwestern European descent and unspecified sex. The purpose of this study was to determine the predictive accuracy of the Tanaka-Johnston analysis in white and black subjects in North Carolina. METHODS: A total of 120 subjects (30 males and 30 females in each ethnic group) were recruited from clinics at the University of North Carolina School of Dentistry. Ethnicity was verified to 2 previous generations. All subjects were less than 21 years of age and had a full complement of permanent teeth. Digital calipers were used to measure the mesiodistal widths of all teeth on study models fabricated from alginate impressions. The predicted widths of the canines and the premolars in both arches were compared with the actual measured widths. RESULTS: In the maxillary arch, there was a significant interaction of ethnicity and sex on the predictive accuracy of the Tanaka-Johnston analysis (P = .03, factorial ANOVA). The predictive accuracy was significantly overestimated in the white female group (P <.001, least square means). In the mandibular arch, there was no significant interaction between ethnicity and sex (P = .49). CONCLUSIONS: The Tanaka-Johnston analysis significantly overestimated in females (P <.0001) and underestimated in blacks (P <.0001) (factorial ANOVA). Regression equations were developed to increase the predictive accuracy in both arches.

Relationship between adjusted body mass index percentile and decayed, missing, and filled primary teeth.

PURPOSE: The purpose of this study was to determine if there was a significant relationship between adjusted body mass index (BMI) percentiles and the frequency of decayed, missing, and filled primary teeth (dmft) in a retrospective cohort of 3- to 5-year-old children. METHODS: Data was collected from 215 3- to 5-year old children with an American Society of Anesthesiologists class I or II physical status who had received dental treatment under general anesthesia at a university hospital between 2007 and 2008. The diagnosis of dental caries and dmft scores were confirmed by oral and radiographic examination. RESULTS: BMI percentile was a statistically significant explanatory variable for dmft after controlling for race, gender, and age ( P<.001). When BMI percentile increased by 10 units, the dmft score increased by an estimated 1.1 after adjusting for the other covariates. CONCLUSIONS: Young children with elevated BMI percentiles who have caries may be at risk for an increased number of carious teeth in the future. Providing nutritional and weight counseling may potentially lower the risk for dental caries in young children while improving their general health.

Effectiveness of web-based teaching modules: test-enhanced learning in dental education.

The purpose of our study was to evaluate the effectiveness of self-tests as a component of web-based self-instruction in predoctoral orthodontics and pediatric dentistry. To this end, the usage patterns of online teaching modules and self-tests by students enrolled in three courses at the University of North Carolina at Chapel Hill School of Dentistry were monitored and correlated to final exam grade and course average. We recorded the frequency of access to thirty relevant teaching modules and twenty-nine relevant self-tests for 157 second- and third-year D.D.S. students during the course of our data collection. There was a statistically significant positive correlation between frequency of accessing self-tests and course performance in one course that was totally based on self-instruction with seminars and multiple-choice examination (Level IV): Spearman correlation between frequency of self-test access and final exam grade, rho=0.23, p=0.044; correlation between frequency of self-test access and course average: rho=0.39, p=0.0004. In the other two courses we monitored, which included content beyond self-instruction with self-tests, the correlations were positive but not statistically significant. The students' use of online learning resources varied significantly from one course (Level I) to the next (Level II): Wilcoxon matched pairs signed-rank tests, S=-515.5, p=.0057 and S=1086, p<0.0001. The data from this study suggest that increased use of web-based self-tests may be correlated with more effective learning in predoctoral dental education by virtue of the testing effect and that dental students' usage of resources for learning changes significantly over the course of their education.

Incisor trauma and early treatment for Class II Division 1 malocclusion.

This study investigated incisor trauma in children with overjets greater than or equal to 7 mm who were enrolled in a clinical trial of 2-phase early orthodontic treatment for Class II malocclusion. In phase 1, children were randomly assigned to treatment in the mixed dentition with either modified bionator or combination headgear or to a group in which treatment was delayed until the permanent dentition. All children received comprehensive treatment during phase 2 if necessary. At the start of the trial, 29.1% of the patients had already had some incisor trauma. This was not significantly related to dental developmental age. During the trial, there was an increase in trauma in all 3 groups, but the magnitude of this increase was not significantly greater in the group for which treatment was delayed until the permanent dentition. This might suggest that orthodontic intervention aimed at reducing trauma should begin very soon after the eruption of the maxillary incisors. However, the injuries tended to be minor, and the expected cost of treatment related to incisor trauma was small compared with the expected additional cost of a 2-phase orthodontic intervention.

External apical root resorption in Class II malocclusion: a retrospective review of 1- versus 2-phase treatment.

External apical root resorption (EARR) is an imperfectly understood problem of orthodontic treatment. The records of 138 children with Class II malocclusion (overjet > 7 mm) participating in a randomized clinical trial of early orthodontic treatment were reviewed. The patients were treated in either 1 phase with fixed appliances only (n = 49) or 2 phases with headgear (n = 49) or bionator (n = 40) followed by fixed appliances. The 3 groups were similar in age, sex, and malocclusion severity at enrollment. The records examined included anamnestic data, clinical examination records, panoramic radiographs before and after fixed appliance therapy, and posttreatment periapical radiographs. All radiographs were reviewed and scored independently by 2 examiners for maxillary incisor root development, morphology, and EARR. Of the 532 incisors scored, 11% of central and 14% of lateral incisors demonstrated moderate to severe (>2 mm) EARR. The proportion of incisors with moderate to severe EARR was slightly greater in the 1-phase treatment group. There was no difference in the incidence of EARR between teeth that had had trauma and those that had not, and there was only a slight increase in frequency of root resorption in teeth with unusual root morphology. Significant associations exist among EARR, the magnitude of overjet reduction, and the time spent wearing fixed appliances. However, not all incisors in a child respond in the same way, so other variables must play a role in determining the root response to orthodontic forces.