Comparison of two survey instruments measuring quality of life in pediatric dentofacial patients.

OBJECTIVES: (1) To assess the effectiveness of the Orthognathic Quality of Life Questionnaire (OQLQ) and the Child Oral Health Impact Profile (COHIP) to detect differences in Oral Health-Related Quality of Life (OHRQoL) between pediatric patients with dentofacial deformities and controls. (2) To assess for correlations between scores from the OQLQ and COHIP domains with the type and severity of the skeletal mal-relationship. (3) To assess if the COHIP and OQLQ were identifying unique or overlapping OHRQoL concerns. MATERIALS AND METHODS: Subjects were under age 18, presented with a dentofacial deformity, and completed both surveys. Matched controls completed the same. Severity for conditions was recorded via overjet, overbite, and ANB values and subjects were classified as skeletal Class I, II, or III. RESULTS: Enrollment yielded 30 subjects and 31 controls. For the OQLQ, significant differences between subjects and controls were found for the Facial Esthetics domain, Oral Function domain, and total score. For the COHIP, significant differences were found for the Social/Emotional Well-Being and Self-Image domains plus total score. There were no significant correlations between the severity of the condition as measured by overjet and reported OHRQoL for any domains. CONCLUSIONS: The OQLQ and COHIP are effective at detecting significant OHRQoL differences between pediatric patients with dentofacial deformities and controls. Although there is some overlap in the results, the instruments appear to identify different OHRQoL concerns.

Effects of orthognathic surgery on quality of life compared with nonsurgical controls in an American population.

INTRODUCTION: To determine the psychosocial effects of a facial skeletal mal-relationship with its subsequent surgical correction in a group of patients treated using surgical orthodontics compared with a matched group of nontreated controls. METHODS: This study was approved by The Ohio State University Institutional Review Board. Subjects were patients presenting with facial skeletal mal-relationships whose proposed treatment plans included orthognathic surgery. This study used valid and reliable questionnaires: Orthognathic Quality of Life Questionnaire (OQLQ), Beck Depression Inventory II (Children's Depression Inventory - 2), Satisfaction with Life Scale, and State Trait Anxiety Inventory (State Trait Anxiety Inventory for Children), administered at 3 different stages of treatment (time 1 = initial pretreatment, time 2 = before oral surgery, and time 3 = at completion of treatment). Matched controls recruited at each time point completed the same questionnaires. RESULTS: A total of 267 subjects were recruited to participate in this study. There were no significant differences between treatment and control groups in age, sex, education level, or employment status at any of the 3 time points. The randomization test was used to compare values for all outcome variables between groups at the 3 stages of treatment. For the pretreatment period, T1, there were significant differences between patients and controls in domains 1 (P = 0.0126), 2 (P = 0.0000), and 3 (P = 0.0000) of the OQLQ (social aspects, facial esthetics, and oral function, respectively) as well as total OQLQ (P = 0.0000). For the presurgery period, T2, there were significant differences between patients and controls in domains 2 (P = 0.0136) and 3 (P = 0.0001) of the OQLQ (facial esthetics and oral function) as well as total OQLQ (P = 0.0291). Finally, for the posttreatment period, T3, there was a significant difference between patients and controls only in domain 3 (P = 0.0196) of the OQLQ (oral function). CONCLUSIONS: The psychosocial profile of patients with a facial skeletal mal-relationship does not differ from the general population in depression, anxiety, and overall satisfaction with life. However, these patients do report a reduced quality of life based on condition-specific measures in social aspects, facial esthetics, and oral function. Concerns about oral function remain even up to 2 years after treatment is completed.

Diagnostic testing of cervical vertebral maturation staging: An independent assessment.

INTRODUCTION: The reliability of the cervical vertebral maturation (CVM) method has been questioned. The objective of this research was to evaluate the diagnostic reliability of the CVM method to diagnose the mandibular growth spurt using longitudinal records from an alternative database (Iowa Facial Growth Study [IFGS]) using established diagnostic testing methods. METHODS: Cephalometric films from 43 subjects (males = 20, females = 23) with Class I or Class II skeletal pattern from the IFGS were scanned, digitized, and adjusted for magnification. At least 5 consecutive, annual films were digitized. For each subject, mandibular length (Co-Gn) was measured for each film, and the growth increment between films was calculated. The largest growth increment was the growth spurt. For each subject, the film displaying CVM stage 3 was identified by a blinded examiner viewing the films in random order. Interrater and intrarater repeatability for Co-Gn (intraclass correlation) and CVM staging (weighted kappa) were calculated. Diagnostic tests, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were carried out. The present data were compared with data previously derived from samples of the University of Michigan, Oregon, and Burlington Growth studies (UMGS, OGS, and BGS, respectively). A multilevel logistic regression analysis was also run with the mandibular growth peak as the response variable. RESULTS: Interrater repeatability for mandibular measurements (intraclass correlation coefficient [ICC] = 0.91) and CVM staging (k = 0.88) were excellent. Intrarater repeatability for mandibular measurements (ICC = 0.98) and CVM staging (kw = 0.55) were excellent to moderate. The UMGS data demonstrated higher sensitivity with comparable specificity. Accuracy was largely similar. Their PPV and NPV had larger ranges. The OGS and BGS data, compared with the IFGS data, showed that our sensitivity and PPVs were higher, that their specificity was higher, and that the NPV and accuracy were very similar. The regression analysis was applied to age groups 10-11 years through 13-14 years. Only chronological age was significant (P = 0.04). CONCLUSIONS: Agreement between CVM stage 3 and the maximum mandibular growth spurt is inconsistent. The diagnostic capability of CVM for the mandibular growth spurt is questionable.

The effect of dental and background facial attractiveness on facial attractiveness and perceived integrity and social and intellectual qualities.

INTRODUCTION: The purposes of this study were to assess the role of dental attractiveness in background facial attractiveness and to evaluate how facial and dental attractiveness influenced raters' opinions of the integrity, social attractiveness, and intellectual attractiveness of the models. METHODS: Photographs of male and female individuals rated by peers as unattractive, average, and attractive were combined with oral images of 4 different levels of dental attractiveness (Index of Orthodontic Treatment Need [IOTN] 1, 5, 7, and 10). Sixty-seven participants meeting the inclusion criteria were recruited as raters. Raters viewed closed-lip smile and open-lip, posed smile of 24 models and rated them for facial attractiveness and integrity and multiple social/intellectual attractiveness dimensions using a Visual Analog Scale. RESULTS: Intrarater reliability was fair to excellent. Analysis of variance showed significant 3-way interactions (P < 0.0001=aim 1; P < 0.005=aim 2) for model sex, facial attractiveness, and dental attractiveness. The contribution of dental attractiveness to facial attractiveness was not fixed or linear, but dependent on dental attractiveness level, background facial attractiveness, and model sex. For both sexes, dental impact on facial attractiveness was neutral or negative when teeth were less than ideal, beginning at IOTN 5 for all background facial attractiveness levels. The impact of dental attractiveness on integrity and social and intellectual attractiveness was also dependent on dental attractiveness level, background facial attractiveness, and model sex. Dental attractiveness can make dramatic differences in Average and Attractive male individuals. CONCLUSIONS: The impact of dental attractiveness on facial attractiveness and integrity and social and intellectual attractiveness was dependent on dental attractiveness level, background facial attractiveness, and model sex. The effect of dental esthetics on facial attractiveness was neutral or negative for both male and female individuals when there was a need for treatment (IOTN 5 or higher) for all levels of facial attractiveness. For both male and female models, lower dental esthetics had a greater effect on more attractive faces. Judgments about integrity and social and intellectual attractiveness were strongly affected by dental esthetics, and these effects were more dramatic and consistent for male faces.

Expression of cornulin in oral premalignant lesions.

OBJECTIVE: The aim of this study was to evaluate expression of cornulin in oral mucosa as an adjunct to histopathologic grading of oral epithelial dysplasia (OED). STUDY DESIGN: Biomarker expression was assessed in normal oral mucosa, low-grade OED (LD), high-grade OED (HD), and oral squamous cell carcinoma (OSCC) by using immunohistochemistry. Photomicrographs were evaluated with Aperio Imagescope using a positive-pixel-counting algorithm. A histo-score (H-score) was calculated on the basis of staining intensity and the percentage of positive cells (%-staining). Intrarater reliability for H-score and %-staining was determined by calculating interclass correlation coefficients. Mean differences in H-scores and %-percent staining values were each analyzed by using an analysis of variance and Tukey's post hoc procedure. RESULTS: Cornulin expression progressively diminished with increasing grades of dysplasia and OSCC. Interclass correlation coefficients for H-score and %-staining were each greater than 0.99. Except for OSCC versus HD, all other pairwise comparisons were statistically significant (P < .0001) for H-score and %-staining. CONCLUSIONS: Cornulin expression helped differentiate between low-grade and high-grade oral epithelial dysplasia, making it a potential adjunct for grading oral OEDs and a potential biomarker for risk of lesion progression. Longitudinal studies evaluating risk stratification based on cornulin expression may be warranted.

The Effects of Primary Canine Loss on Permanent Lower Dental Midline Stability.

Purpose: The purpose of this study was to compare changes in the lower dental midline position after premature unilateral loss of a primary mandibular canine with dental midline position after normal primary mandibular canine exfoliation. Methods: Dental casts were identified from growth studies at the University of Iowa and the University of Toronto. Two groups of dental casts were identified: (1) premature unilateral loss; and (2) normal asymmetric exfoliation of a single primary mandibular canine. The first set of casts displaying unilateral primary canine loss (time one) and the second set of casts displaying full permanent dentition (time two) were collected. The palatal rugae and palatal raphe were used to construct a median palatal plane (MPP). Dental midline position at each time point was measured from the MPP. Results: A total of 56 cases (15 premature, 41 normal) were identified. The mean lower dental midline changes from time one to time two for the premature and normal loss groups were 1.32±0.83 mm and 0.97±0.91 mm, respectively. This difference was not statistically significant regarding group (P=0.62), gender (P=0.91), or the interaction effect of group and gender (P=0.85). Conclusions: There was no significant difference in midline shift between the 15 individuals with premature unilateral primary canine loss and the 41 individuals with normal, asymmetric unilateral loss of a primary canine.

Effect of guided bone regeneration on bone quality surrounding dental implants.

Bone quality as well as its quantity at the implant interface is responsible for determining stability of the implant system. The objective of this study is to examine the nanoindentation based elastic modulus (E) at different bone regions adjacent to titanium dental implants with guided bone regeneration (GBR) treated with DBM and BMP-2 during different post-implantation periods. Six adult male beagle dogs were used to create circumferential defects with buccal bone removal at each implantation site of mandibles. The implant systems were randomly assigned to only GBR (control), GBR with demineralized bone matrix (DBM), and GBR with DBM + recombinant human bone morphogenetic protein-2 (rhBMP-2) (BMP) groups. Three animals were sacrificed at each 4 and 8 weeks of post-implantation healing periods. Following buccolingual dissection, the E values were assessed at the defects (Defect), interfacial bone tissue adjacent to the implant (Interface), and pre-existing bone tissue away from the implant (Pre-existing). The E values of BMP group had significantly higher than control and DBM groups for interface and defect regions at 4 weeks of post-implantation period and for the defect region at 8 weeks (p < 0.043). DBM group had higher E values than control group only for the defect region at 4 weeks (p < 0.001). The current results indicate that treatment of rhBMP-2 with GBR accelerates bone tissue mineralization for longer healing period because the GBR likely facilitates a microenvironment to provide more metabolites with open space of the defect region surrounding the implant.

Objective assessment of the contribution of dental esthetics and facial attractiveness in men via eye tracking.

INTRODUCTION: Recently, greater emphasis has been placed on smile esthetics in dentistry. Eye tracking has been used to objectively evaluate attention to the dentition (mouth) in female models with different levels of dental esthetics quantified by the aesthetic component of the Index of Orthodontic Treatment Need (IOTN). This has not been accomplished in men. Our objective was to determine the visual attention to the mouth in men with different levels of dental esthetics (IOTN levels) and background facial attractiveness, for both male and female raters, using eye tracking. METHODS: Facial images of men rated as unattractive, average, and attractive were digitally manipulated and paired with validated oral images, IOTN levels 1 (no treatment need), 7 (borderline treatment need), and 10 (definite treatment need). Sixty-four raters meeting the inclusion criteria were included in the data analysis. Each rater was calibrated in the eye tracker and randomly viewed the composite images for 3 seconds, twice for reliability. RESULTS: Reliability was good or excellent (intraclass correlation coefficients, 0.6-0.9). Significant interactions were observed with factorial repeated-measures analysis of variance and the Tukey-Kramer method for density and duration of fixations in the interactions of model facial attractiveness by area of the face (P <0.0001, P <0.0001, respectively), dental esthetics (IOTN) by area of the face (P <0.0001, P <0.0001, respectively), and rater sex by area of the face (P = 0.0166, P = 0.0290, respectively). For area by facial attractiveness, the hierarchy of visual attention in unattractive and attractive models was eye, mouth, and nose, but for men of average attractiveness, it was mouth, eye, and nose. For dental esthetics by area, at IOTN 7, the mouth had significantly more visual attention than it did at IOTN 1 and significantly more than the nose. At IOTN 10, the mouth received significantly more attention than at IOTN 7 and surpassed the nose and eye. These findings were irrespective of facial attractiveness levels. For rater sex by area in visual density, women showed significantly more attention to the eyes than did men, and only men showed significantly more attention to the mouth over the nose. CONCLUSIONS: Visual attention to the mouth was the greatest in men of average facial attractiveness, irrespective of dental esthetics. In borderline dental esthetics (IOTN 7), the eye and mouth were statistically indistinguishable, but in the most unesthetic dental attractiveness level (IOTN 10), the mouth exceeded the eye. The most unesthetic malocclusion significantly attracted visual attention in men. Male and female raters showed differences in their visual attention to male faces. Laypersons gave significant visual attention to poor dental esthetics in men, irrespective of background attractiveness; this was counter to what was seen in women.

Comparison of digital intraoral scanners and alginate impressions: Time and patient satisfaction.

INTRODUCTION: Recent technological advances have made intraoral scans and digital models a possibility and a promising alternative to conventional alginate impressions. Several factors should be examined when considering an intraoral scanner, including patient acceptance and efficiency. The objectives of this study were to assess and compare patient satisfaction and time required between 2 intraoral scanners and conventional alginate impressions. METHODS: An initial pilot study was completed to create a valid and reliable survey instrument that would measure 3 areas of patient satisfaction with the impression experience. A visual analog scale survey was developed and administered to 180 orthodontic patients receiving 1 of 3 types of impressions: (1) iTero Element intraoral scan (Align Technologies, San Jose, Calif), n = 60; (2) TRIOS Color intraoral scan (3Shape, Copenhagen, Denmark), n = 60; and (3) conventional alginate impression (imprEssix Color Change; Dentsply Sirona, York, Pa), n = 60, and the time required to obtain the impressions was recorded. RESULTS: Reliability was evaluated with intraclass correlation coefficient values for 17 paired questionnaires, and all questions were found to be reliable (intraclass correlation coefficient, ≥0.65). For the main study, 180 subjects completed timed impressions and surveys. Data indicated that subjects receiving intraoral scans preferred the digital impressions, and subjects receiving alginate impressions were neutral regarding impression preference, and that efficiency varied based on the impression method. CONCLUSIONS: Intraoral scanners are accepted by orthodontic patients, and they have comparable efficiency with conventional impression methods depending on the type of scanner.

Comparison of changes in irregularity and transverse width with nickel-titanium and niobium-titanium-tantalum-zirconium archwires during initial orthodontic alignment in adolescents: A double-blind randomized clinical trial.

OBJECTIVES: The purpose of this prospective, double-blind, randomized clinical trial was to compare the clinical efficiency of nickel-titanium (NiTi) and niobium-titanium-tantalum-zirconium (TiNbTaZr) archwires during initial orthodontic alignment. MATERIALS AND METHODS: All subjects (ages between 12 and 20 years) underwent nonextraction treatment using 0.022-inch brackets. All patients were randomized into two groups for initial alignment with 0.016-inch NiTi archwires (n = 14), or with 0.016-inch TiNbTaZr archwires (n = 14). Digital scans were taken during the course of treatment and were used to compare the improvement in Little's Irregularity Index and the changes in intercanine and intermolar widths. RESULTS: There was approximately a 27% reduction in crowding during the first month with the use of 0.016-inch TiNbTaZr (Gummetal) wire, and an additional 25% decrease in crowding was observed during the next month. There was no significant difference between the two treatment groups in the decrease in irregularity over time ( P = .29). There was no significant difference between the two groups in the changes in intercanine and intermolar width ( P = .80). CONCLUSIONS: It can be concluded that Gummetal wires and conventional NiTi wires possess a similar ability to align teeth, and Gummetal wires have additional advantages over conventional NiTi, such as formability and use in patients with nickel allergy.

Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index.

INTRODUCTION: The purpose of this retrospective case-control study was to compare the treatment effectiveness and efficiency of the Invisalign system with conventional fixed appliances in treating orthodontic patients with mild to moderate malocclusion in a graduate orthodontic clinic. METHODS: Using the peer assessment rating (PAR) index, we evaluated pretreatment and posttreatment records of 48 Invisalign patients and 48 fixed appliances patients. The 2 groups of patients were controlled for general characteristics and initial severity of malocclusion. We analyzed treatment outcome, duration, and improvement between the Invisalign and fixed appliances groups. RESULTS: The average pretreatment PAR scores (United Kingdom weighting) were 20.81 for Invisalign and 22.79 for fixed appliances (P = 1.0000). Posttreatment weighted PAR scores between Invisalign and fixed appliances were not statistically different (P = 0.7420). On average, the Invisalign patients finished 5.7 months faster than did those with fixed appliances (P = 0.0040). The weighted PAR score reduction with treatment was not statistically different between the Invisalign and fixed appliances groups (P = 0.4573). All patients in both groups had more than a 30% reduction in the PAR scores. Logistic regression analysis indicated that the odds of achieving "great improvement" in the Invisalign group were 0.329 times the odds of achieving "great improvement" in the fixed appliances group after controlling for age (P = 0.0150). CONCLUSIONS: Our data showed that both Invisalign and fixed appliances were able to improve the malocclusion. Invisalign patients finished treatment faster than did those with fixed appliances. However, it appears that Invisalign may not be as effective as fixed appliances in achieving "great improvement" in a malocclusion. This study might help clinicians to determine appropriate patients for Invisalign treatment.

Role of facial attractiveness in patients with slight-to-borderline treatment need according to the Aesthetic Component of the Index of Orthodontic Treatment Need as judged by eye tracking.

INTRODUCTION: Previous eye-tracking research has demonstrated that laypersons view the range of dental attractiveness levels differently depending on facial attractiveness levels. How the borderline levels of dental attractiveness are viewed has not been evaluated in the context of facial attractiveness and compared with those with near-ideal esthetics or those in definite need of orthodontic treatment according to the Aesthetic Component of the Index of Orthodontic Treatment Need scale. Our objective was to determine the level of viewers' visual attention in its treatment need categories levels 3 to 7 for persons considered "attractive," "average," or "unattractive." METHODS: Facial images of persons at 3 facial attractiveness levels were combined with 5 levels of dental attractiveness (dentitions representing Aesthetic Component of the Index of Orthodontic Treatment Need levels 3-7) using imaging software to form 15 composite images. Each image was viewed twice by 66 lay participants using eye tracking. Both the fixation density (number of fixations per facial area) and the fixation duration (length of time for each facial area) were quantified for each image viewed. Repeated-measures analysis of variance was used to determine how fixation density and duration varied among the 6 facial interest areas (chin, ear, eye, mouth, nose, and other). RESULTS: Viewers demonstrated excellent to good reliability among the 6 interest areas (intraviewer reliability, 0.70-0.96; interviewer reliability, 0.56-0.93). Between Aesthetic Component of the Index of Orthodontic Treatment Need levels 3 and 7, viewers of all facial attractiveness levels showed an increase in attention to the mouth. However, only with the attractive models were significant differences in fixation density and duration found between borderline levels with female viewers. Female viewers paid attention to different areas of the face than did male viewers. CONCLUSIONS: The importance of dental attractiveness is amplified in facially attractive female models compared with average and unattractive female models between near-ideal and borderline-severe dentally unattractive levels.

Conditions and calibration to obtain comparable grey values between different clinical cone beam computed tomography scanners.

OBJECTIVES: The objective of the present study was to examine the grey value parameters and their magnitudes produced by CBCT and whether they are influenced by different scanners with various scanning conditions. METHODS: An ATOM Max dental and diagnostic artificial head was scanned by two CBCT scanners (Planmeca and iCAT). Under full field of view with normal dose and ultralow-dose (ULD) conditions, the Planmeca scanner was examined for three scanning resolutions (200, 400, and 600 micron voxel sizes) and the iCAT scanner was tested for four scanning resolutions (200, 250, 300 and 400 micron voxel sizes). After 9 weeks, the artificial head was scanned again by the Planmeca scanner with the same scanning conditions. In addition, two hydroxyapatite phantoms (1220 and 1540 mg cm-3) were adhered on the artificial head and scanned using normal and ULD scanning conditions of 400 micron voxel size with both scanners. The grey value histogram of each region, which is proportional to the bone mineral density (BMD) histogram, was utilized to determine grey value distribution parameters and compare scanners (ANOVA, p < 0.05). RESULTS: The different scanning conditions and the bilateral locations of the artificial head did not have significant effects on measurements of the grey value parameters (p > 0.436) with excellent repeatability. However, the iCAT scanner produced significantly different grey values from the Planmeca scanner (p < 0.001). CONCLUSIONS: CBCT can assess BMD, while calibration of absolute measures is necessary to obtain comparable values between different scanners that are currently used to assess oral bone quantity and quality.

Contribution of malocclusion and female facial attractiveness to smile esthetics evaluated by eye tracking.

INTRODUCTION: There is disagreement in the literature concerning the importance of the mouth in overall facial attractiveness. Eye tracking provides an objective method to evaluate what people see. The objective of this study was to determine whether dental and facial attractiveness alters viewers' visual attention in terms of which area of the face (eyes, nose, mouth, chin, ears, or other) is viewed first, viewed the greatest number of times, and viewed for the greatest total time (duration) using eye tracking. METHODS: Seventy-six viewers underwent 1 eye tracking session. Of these, 53 were white (49% female, 51% male). Their ages ranged from 18 to 29 years, with a mean of 19.8 years, and none were dental professionals. After being positioned and calibrated, they were shown 24 unique female composite images, each image shown twice for reliability. These images reflected a repaired unilateral cleft lip or 3 grades of dental attractiveness similar to those of grades 1 (near ideal), 7 (borderline treatment need), and 10 (definite treatment need) as assessed in the aesthetic component of the Index of Orthodontic Treatment Need (AC-IOTN). The images were then embedded in faces of 3 levels of attractiveness: attractive, average, and unattractive. During viewing, data were collected for the first location, frequency, and duration of each viewer's gaze. RESULTS: Observer reliability ranged from 0.58 to 0.92 (intraclass correlation coefficients) but was less than 0.07 (interrater) for the chin, which was eliminated from the study. Likewise, reliability for the area of first fixation was kappa less than 0.10 for both intrarater and interrater reliabilities; the area of first fixation was also removed from the data analysis. Repeated-measures analysis of variance showed a significant effect (P <0.001) for level of attractiveness by malocclusion by area of the face. For both number of fixations and duration of fixations, the eyes overwhelmingly were most salient, with the mouth receiving the second most visual attention. At times, the mouth and the eyes were statistically indistinguishable in viewers' gazes of fixation and duration. As the dental attractiveness decreased, the visual attention increased on the mouth, approaching that of the eyes. AC-IOTN grade 10 gained the most attention, followed by both AC-IOTN grade 7 and the cleft. AC-IOTN grade 1 received the least amount of visual attention. Also, lower dental attractiveness (AC-IOTN 7 and AC-IOTN 10) received more visual attention as facial attractiveness increased. CONCLUSIONS: Eye tracking indicates that dental attractiveness can alter the level of visual attention depending on the female models' facial attractiveness when viewed by laypersons.

Orthodontic informed consent considering information load and serial position effect.

INTRODUCTION: Previous research has demonstrated that current methods of informed consent are relatively ineffective as shown by poor recall and comprehension by adolescent patients and their parents. The purpose of this study was to determine whether adding a short videotape presentation reiterating the issues related to informed consent to a modified informed consent document that emphasizes a limited number of core and patient-specific custom "chunks" at the beginning of an informed consent presentation improved the recall and comprehension of the risks, benefits, and alternatives of orthodontic treatment. A second objective was to evaluate the current related data for recommendable practices. METHODS: Seventy patient-parent pairs were randomly divided into 2 groups. The intervention group (group A) patients and parents together reviewed a customized slide show and a short videotape presentation describing the key risks of orthodontic treatment. Group B followed the same protocol without viewing the videotape. All patients and parents were interviewed independently by research assistants using an established measurement tool with open-ended questions. Interviews were transcribed and scored for the appropriateness of responses using a previously established codebook. Lastly, the patients and parents were given 2 reading literacy tests, 1 related to health and 1 with general content followed by the self-administered demographic and psychological state questionnaires. RESULTS: There were no significant differences between the groups for sociodemographic variables. There were no significant differences between the groups for overall recall and comprehension; recall and comprehension for the domains of treatment, risk, and responsibility; and recall and comprehension for core, general, and custom items. The positional effects were limited in impact. When compared with previous studies, these data further demonstrate the benefit of improved readability and audiovisual supplementation with the addition of "chunking." CONCLUSIONS: There is no benefit to adding a short video to the previously established improved readability and audiovisual supplementation. There is a significant benefit of improved readability and audiovisual slide supplementation with the addition of "chunking" over traditional informed consent methods in terms of patient improvement in overall comprehension, treatment recall, and treatment comprehension. The treatment domain is the most affected.

The prevalence of pseudoxanthoma elasticum-like connective tissue changes in an oral biopsy service and review of the literature.

OBJECTIVE: The objective of this pilot study is to determine the prevalence of pseudoxanthoma elasticum (PXE)-like connective changes in an oral biopsy service and compare it with the estimated prevalence of PXE as well as to the prevalence of the mutated PXE gene ABCC6. STUDY DESIGN: This prevalence study utilized 500 oral mucosal biopsy specimens received from the biopsy service of the Oral Pathology Consultants at the Ohio State University. Each specimen was microscopically evaluated using hematoxylin and eosin, Verhoeff-van Gieson and von Kossa stains. RESULTS: A prevalence of 9.8% was identified for PXE-like changes in the connective tissue of oral biopsy specimens submitted to this service. CONCLUSIONS: The overall prevalence of PXE-like connective tissue changes found in routine oral mucosal biopsy specimens (9.8%) was much higher than either the suspected prevalence of PXE (0.001%-0.004%) or the estimated prevalence of the mutated gene ABCC6 (0.625%-1.25%).

Bone damage associated with orthodontic placement of miniscrew implants in an animal model.

INTRODUCTION: The purposes of this study were to quantify bone damage associated with insertion of 2 types of miniscrew implants and to relate the amount of bone damage to monocortical plate thickness. METHODS: Nondrilling (n = 28) and self-drilling (n = 28) miniscrew implants (6 × 1.6 mm, Dentaurum, Newtown, Pa), and pilot holes (n = 26) were placed bilaterally in the maxillae and the mandibles of 5 adult dogs immediately after death. Bone blocks were cut, bulk stained with 1% basic fuchsin, embedded in methyl methacrylate, sectioned, and mounted. Monocortical plate thickness was measured adjacent to the miniscrew implant insertion site. Damage amounts were quantified at distances of 0 to 0.5 mm (adjacent region) and 0.5 to 1 mm (distant region) from the bone-implant interface. Total fractional damaged area (%), fractional microcracked area (%), and fractional diffuse damaged area (%) were quantified by using standard histomorphometric methods. RESULTS: The mean monocortical plate thickness of the specimens from the mandible (2.2 mm) was significantly (P <0.001) greater than that of the maxillary specimens (0.9 mm). In the mandible, the 3 damage parameters were greater with self-drilling miniscrew implants than with nondrilling miniscrew implants; however, there were no differences in the damage parameters in the maxilla. CONCLUSIONS: Bone damage accumulation is related to the type of miniscrew implant and the thickness of the bone.

Impact of verbal explanation and modified consent materials on orthodontic informed consent.

INTRODUCTION: Comprehension of informed consent information has been problematic. The purposes of this study were to evaluate the effectiveness of a shortened explanation of an established consent method and whether customized slide shows improve the understanding of the risks and limitations of orthodontic treatment. METHODS: Slide shows for each of the 80 subject-parent pairs included the most common core elements, up to 4 patient-specific custom elements, and other general elements. Group A heard a presentation of the treatment plan and the informed consent. Group B did not hear the presentation of the informed consent. All subjects read the consent form, viewed the customized slide show, and completed an interview with structured questions, 2 literacy tests, and a questionnaire. The interviews were scored for the percentages of correct recall and comprehension responses. Three informed consent domains were examined: treatment, risk, and responsibility. These groups were compared with a previous study group, group C, which received the modified consent and the standard slide show. RESULTS: No significant differences existed between groups A, B, and C for any sociodemographic variables. Children in group A scored significantly higher than did those in group B on risk recall and in group C on overall comprehension, risk recall and comprehension, and general risks and limitations questions. Children in group B scored significantly higher than did those in group C on overall comprehension, treatment recall, and risk recall. Elements presented first in the slide show scored better than those presented later. CONCLUSIONS: This study suggested little advantage of a verbal review of the consent (except for patients for risk) when other means of review such as the customized slide show were included. Regression analysis suggested that patients understood best the elements presented first in the informed consent slide show. Consequently, the most important information should be presented first to patients, and any information provided beyond the first 7 points should be given as supplemental take-home material.

Bone remodeling surrounding primary teeth in skeletally immature dogs.

OBJECTIVE: To quantify remodeling in the bone surrounding fully erupted primary teeth and to compare bone remodeling in the primary and permanent dentitions. MATERIALS AND METHODS: Two bone sections were obtained bilaterally from the maxilla and mandible of the primary molar region of approximately 5-month-old male beagle dogs. Histomorphometric methods were used to estimate the osteonal remodeling in the alveolar and basal regions of the tooth supporting bone. The following variables were calculated: mineral apposition rate (MAR, µm/d), mineralizing surface/bone surface (MS/BS, %), bone formation rate (BFR, %/y), and erosion surface/bone surface (ES/BS, %). Comparisons were made between jaws (maxilla vs mandible) and bone types (alveolar vs basal), and data analyzed by analysis of variance (ANOVA) and Tukey-Kramer tests. Remodeling (BFR) surrounding primary teeth was compared to existing data from bone surrounding permanent teeth. RESULTS: The mean and standard deviation BFR values (%/y) were as follows: mandibular alveolar, 44.10 (±26.89); maxillary alveolar, 3.54 (±3.57); mandibular basal, 22.65 (±14.65); and maxillary basal, 12.33 (±7.11). The mandibular BFR was significantly (P < .05) higher than the maxillary bone. The BFR of the alveolar bone of primary teeth was not significantly (P = .48) different from the alveolar bone supporting permanent teeth. CONCLUSIONS: The remodeling rate of alveolar bone in skeletally immature dogs was greater in the mandible than in the maxilla and remained unaltered between primary and permanent dentitions.

Dental and skeletal outcomes for Class II surgical-orthodontic treatment: A comparison between novice and experienced clinicians.

INTRODUCTION: The information that details dental changes accompanying presurgical and postsurgical orthodontic treatment during orthognathic surgery treatment is disappointing and results in less than ideal surgical change, but it is largely derived from university clinic samples with patients treated by residents (clinical novices). In this study, we examined similar treatments performed by experienced practitioners and compared them with the novices' results. METHODS: A sample of 72 Class II subjects treated by practitioners with a mean of 26.7 years of experience was selected. Inclusion criteria were consecutively treated surgical-orthodontic patients with mandibular advancement, rigid fixation, and good-quality lateral cephalograms. Pretreatment skeletal and dental variables were compared with those from a sample treated by novices in a previous study. Presurgical and final analyses were performed with analysis of covariance (ANCOVA), with pretreatment values as the covariate. An efficacy analyses for treatment phase and study comparisons was the final component. RESULTS: The novices treated patients with significantly more severe Class II skeletal problems. For both studies, there were significant positive changes in the position of the mandible. The ANCOVA analysis showed that the experienced practitioners managed the bodily position of the maxillary incisors more effectively. The efficacy analysis showed no statistically significant differences between novices and experienced practitioners. For both novices and experienced practitioners, according to the ANB changes, nonideal incisor decompensation led to less than ideal final mandibular positions. CONCLUSIONS: The dental and skeletal mean changes and efficacy analysis for both novices and experienced practitioners showed that presurgical orthodontic treatment often does not fully decompensate the incisors; this then limits the surgical outcome.