Patient safety in orthodontic care: a scoping literature review with proposal for terminology and future research agenda.

BACKGROUND: Knowledge about patient safety in orthodontics is scarce. Lack of standardisation and a common terminology hinders research and limits our understanding of the discipline. This study aims to 1) summarise current knowledge about patient safety incidents (PSI) in orthodontic care by conducting a systematic literature search, 2) propose a new standardisation of PSI terminology and 3) propose a future research agenda on patient safety in the field of orthodontics. METHODS: A systematic literature search was performed in the main online sources of PubMed, Web of Science, Scopus and OpenGrey from their inception to 1 July 2023. Inclusion criteria were based on the World Health Organization´s (WHO) research cycle on patient safety. Studies providing information about the cycle's steps related to orthodontics were included. Study selection and data extraction were performed by two of the authors. RESULTS: A total of 3,923 articles were retrieved. After review of titles and abstracts, 41 articles were selected for full-text review and 25 articles were eligible for inclusion. Seven provided information on the WHO's research cycle step 1 ("measuring harm"), twenty-one on "understanding causes" (step 2) and twelve on "identifying solutions" (step 3). No study provided information on Steps 4 and 5 ("evaluating impact" or "translating evidence into safer care"). CONCLUSION: Current evidence on patient safety in orthodontics is scarce due to a lack of standardised reporting and probably also under-reporting of PSIs. Current literature on orthodontic patient safety deals primarily with "measuring harms" and "understanding causes of patient safety", whereas less attention has been devoted to initiatives "identifying solutions", "evaluating impact" and "translating evidence into safer care". The present project holds a proposal for a new categorisation, terminology and future research agenda that may serve as a framework to support future research and clinical initiatives to improve patient safety in orthodontic care. REGISTRATION: PROSPERO (CRD42022371982).

Interassessor agreement of portfolio-based competency assessment for orthotists/prosthetists in Australia: a mixed method study.

BACKGROUND: Internationally qualified orthotists/prosthetists who want to practice in Australia must pass a portfolio-based competency assessment. Testing the agreement between independent assessors is important to engender confidence in the assessment, and continually improve the processes. OBJECTIVES: To quantify interassessor agreement for all 68 performance indicators in the Australian Orthotic Prosthetic Association's Entry Level Competency Standards and where there was significant disagreement between assessors, to explore the reasons why. STUDY DESIGN: Mixed methods: explanatory sequential. METHOD: Fifteen portfolios were assigned to independent assessors. Assessors determined whether the evidence presented met the requirements of each performance indicator. Interassessor agreement was calculated using Gwet's Agreement Coefficient 1 (AC1), and these data informed semistructured interviews to explore the reasons for disagreement. RESULTS: Most performance indicators (87%) had moderate to substantial agreement (AC1 > 0.71), which could be attributed to a variety of factors including the use of a simple assessment rubric with supporting guidelines and assessor training to establish shared expectations. The remaining performance indicators (13%) had fair to slight agreement (AC1 ≤ 0.7). Interviews with assessors suggested that disagreement could be attributed to the complexity of some performance indicators, unconscious bias, and the appropriateness of the evidence presented. CONCLUSIONS: Although most performance indicators in Australian Orthotic Prosthetic Association's Entry Level Competency Standard were associated with moderate to substantial interassessor agreement, there are opportunities to improve agreement by simplifying the wording of some performance indicators and revising guidelines to help applicants curate the most appropriate evidence for each performance indicator.

Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic.

During the current pandemic scenario, maxillofacial rehabilitation specialists involved with supportive care in cancer must transform its practice to cope with COVID-19 and improve protocols that could quickly return the oral function of complex cancer patients who cannot wait for surgical complex rehabilitation. This includes the role of the maxillofacial prosthodontist for the rehabilitation of surgically treated patients with maxillary cancers by the means of filling obturator prostheses that are considered an optimal scientific-based strategy to reduce hospital stay with excellent pain control, oral function (speech, swallowing, mastication, and facial esthetics), psychologic and quality of life outcomes for the patients following intraoral cancer resection. Therefore, the aim of this commentary was to bring new lights to the strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic as well as to present a protocol for managing such cases.

Atención de Pacientes en Tratamiento de Ortodoncia Durante la Pandemia COVID-19 (SARS-CoV-2). Presentación de un Algoritmo / Care of Patients in Orthodontic Treatment During the Covid-19 Pandemic (SARS-CoV-2). Algorithm Presentation

RESUMEN: Los coronavirus son una familia de virus que se encuentran ampliamente distribuidos en la naturaleza en animales y humanos. El nuevo coronavirus (SARS-CoV-2) causa la enfermedad COVID-19, la cual se originó en Wuhan, China y se caracteriza por su alta tasa de contagio entre personas, por lo cual se declaró emergencia de salud pública de importancia internacional en enero de 2020 y pandemia global en marzo 2020, dada la alta propagación del virus a nivel internacional. Los pacientes que se encuentran en tratamiento de ortodoncia pueden presentar diferentes situaciones que requieran de atención por parte de la especialidad, suscitando un contacto cercano entre tratante y paciente, por ende, un alto e inminente riesgo de contagio por SARS-CoV-2. Ante esto, es fundamental para la práctica ortodóncica la implementación de protocolos de prevención, que permitan realizar inicialmente una correcta anamnesis del paciente vía remota, para establecer una clasificación de la urgencia, que en el caso de no poder ser diferida deberá realizarse bajo estrictas medidas de protección personal según el riesgo del paciente. El objetivo de este artículo es dar a conocer un algoritmo que entregue las recomendaciones actualizadas en la atención a pacientes en tratamiento de ortodoncia durante la pandemia COVID-19, a fin de disminuir la posibilidad de contagio y propagación de esta enfermedad.

ABSTRACT: The coronaviruses are an extensive family of viruses that can cause infections both in humans as in animals. The new coronavirus (SARS-CoV2) can cause the disease COVID-19, that was originated in Wuhan, China and it characterizes because of its high rate of contagion among people, which led to the declaration of emergency in public health of international concern in January 2020. The patients who are under orthodontic treatment can present different situations that require attention from this specific area, therefore producing a situation of close contact between patient and dentist with high risk of eminent contagion of SARS-CoV-2. Under this situation, it is necessary that the practice of orthodontics implements prevention protocols, that lead to a correct anamnesis of the patient remotely in order to establish the level of urgency in orthodontics. In case that it cannot be deferred it should be done under strict personal protection measures. The aim of this article is to disclose an algorithm that gives update recommendations for the attention of patients under orthodontic treatment during the COVID-19 pandemic, in order to reduce the possibility of contagion and spread of the disease.

Profound approach to check legitimacy of an old technique used to gauge palatal rugae.

AIMS: The present study aimed at assessing two fixed points of reference from where the mesial and distal point of all rugae can be measured so that the exact movement of particular rugae in any direction can be evaluated and assessing the changes in the palatal rugae after orthodontic treatment. METHODS: A longitudinal study conducted among a sample of 20 (8 male and 12 female) adult patients. Pre- and post-orthodontic treatment casts of patients were obtained from the Department of Orthodontics College of Dentistry Jazan University. Antero-posterior linear distances (Technique I) between medial and lateral points of primary, secondary and tertiary rugae were measured. Also, the transverse linear distance (Technique II) between medial and lateral points of right and left rugae were measured. Technique III involved marking two fixed points and using these two points a third point is located on the medial or lateral end of rugae of right and left side in pre and post-treatment orthodontic casts. The independent sample t-test was employed to compare gender. Difference between the pre- and post-treatment mean values were checked by the paired t-test. RESULTS: Technique III successfully showed the statistically significant difference (P ≤ 0.05, 95% CI) in the overall pre and post-treatment values on the patients' cast (N = 20) which was not observed with a technique I and technique II. CONCLUSION: The triangle created by the three reference points in the technique III was able to identify the changes in the palatine rugae more precisely than the technique I and Technique II.

Systematic reviews in orthodontics: Impact of the PRISMA for Abstracts checklist on completeness of reporting.

INTRODUCTION: This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A). METHODS: Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores. RESULTS: Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting. CONCLUSIONS: The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.

Characteristics of an excellent orthodontic residency program.

INTRODUCTION: Although unquantifiable features, such as faculty passion and dedication to teaching, play a vital role in defining the quality of residency education, determinable features that are fundamental to the definition of a "top tier" orthodontic residency program also exist. The objective of this study was to identify those features. METHODS: A survey with 32 items was developed and validated to assess the features of an excellent orthodontic program based on the following 3 major domains: faculty, education, and resident/graduate student/alumni. The survey was sent to 62 orthodontic residency programs in the United States. RESULTS: Thirty-nine programs (63%) completed the survey. Recurring attributes that were identified in what constitutes an excellent program included the following: an adequate number of full-time clinical orthodontic faculty, with each member providing 1 day per week clinic coverage. The average of all respondents was 4, and the range was 1-6; a healthy mix of part-time faculty members with ≥1 full-time faculty member who monitors every clinical session; 80% full-time faculty members who are American Board of Orthodontics (ABO) certified; a craniofacial faculty member; 4 residents/graduate students per each faculty member who covers a clinical session; resident/graduate student exposure to a wide range of treatment modalities and appliances; approximately 70 new case starts per resident/graduate student (50%-60% of patients who are started are debonded by the starting resident/graduate student); patients with craniofacial anomalies and orthognathic surgery patients should be started by each resident/graduate student; 1.5 operatory chairs per resident or graduate student; 1 dental assistant per 4 residents/graduate students; 1 laboratory person; 1 receptionist/secretary per 4 residents; 100% of residents/graduate students successfully completing ABO written examination upon graduation; 60% of residents/graduate students obtaining ABO certification within 5 years of graduation; 50% of residents/graduate students presenting at national meetings would be ideal; and 50% of living alumni contributing financially to the department during the past 5 years. CONCLUSIONS: Based on the responses from the majority of the US orthodontic residency programs, this study has identified certain features that educators feel are ideal for an excellent orthodontic program.

Accuracy of Dental Monitoring 3D digital dental models using photograph and video mode.

INTRODUCTION: This study aimed to test the accuracy of the 3-dimensional (3D) digital dental models generated by the Dental Monitoring (DM) smartphone application in both photograph and video modes over successive DM examinations in comparison with 3D digital dental models generated by the iTero Element intraoral scanner. METHODS: Ten typodonts with setups of class I malocclusion and comparable severity of anterior crowding were used in the study. iTero Element scans along with DM examination in photograph and video modes were performed before tooth movement and after each set of 10 Invisalign aligners for each typodont. Stereolithography (STL) files generated from the DM examinations in photograph and video modes were superimposed with the STL files from the iTero scans using GOM Inspect software to determine the accuracy of both photograph and video modes of DM technology. RESULTS: No clinically significant differences, according to the American Board of Orthodontics-determined standards, were found. Mean global deviations for the maxillary arch ranged from 0.00149 to 0.02756 mm in photograph mode and from 0.0148 to 0.0256 mm in video mode. Mean global deviations for the mandibular arch ranged from 0.0164 to 0.0275 mm in photograph mode and from 0.0150 to 0.0264 mm in video mode. Statistically significant differences were found between the 3D models generated by the iTero and the DM application in photograph and video modes over successive DM examinations. CONCLUSIONS: 3D digital dental models generated by the DM smartphone application in photograph and video modes are accurate enough to be used for clinical applications.

Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper.

The Board of Trustees of the American Association of Orthodontists asked a panel of medical and dental experts in sleep medicine and dental sleep medicine to create a document designed to offer guidance to practicing orthodontists on the suggested role of the specialty of orthodontics in the management of obstructive sleep apnea. This White Paper presents a summary of the Task Force's findings and recommendations.

[The satisfaction with rendering medical services of orthodontic profile to children of junior school age].

The article considers the results of complex medical sociological study including questionnaire survey of schoolchildren of junior age and their parents concerning issues of satisfaction with stomatological services. The data is presented concerning subjective opinions about quality and accessibility of stomatological care of orthodontic profile. The causes of dissatisfaction are established and ranged. The criteria of predominant visits to medical organizations of state and private forms of property. The study established demographic and financial characteristics of families, professional characteristics of parents, their subjective opinions about particular aspects of quality of life. The level of sanitary hygienic knowledge and medical activity, including issues of prevention of stomatological diseases and dental maxillary anomalies in children aged 6-11 years was determined. The summary social portrait of family fostering child-patient of children stomatological polyclinic was composed.

Prevention and caries risk management in teenage and orthodontic patients.

As patients progress from childhood through to teenage years, they progress through periods of high caries risk as they undergo changes in lifestyle and oral microflora. Removable or fixed orthodontic treatment also alters the oral microflora and can dramatically increase caries risk. This paper outlines ways to identify the transition to higher caries risk, and practical ways to lower the risk of hard tissue loss from dental caries during orthodontic treatment across the teenage years, including tooth surface protection, optimised use of mechanical and chemical plaque control, and appropriate delivery of remineralising agents over time.

Seeking adverse effects in systematic reviews of orthodontic interventions: protocol for a cross-sectional study.

BACKGROUND: Before implementing healthcare interventions, clinicians need to weigh the beneficial and adverse effects of interventions. However, a large body of evidence has demonstrated that seeking and reporting of adverse effects is suboptimal in clinical trials and in systematic reviews of interventions. This cross-sectional study will investigate the status of this problem in orthodontics. This study will assess whether adverse effects were sought and whether findings related to adverse effects were reported in systematic reviews of orthodontic interventions in the five leading orthodontic journals and in the Cochrane Database of Systematic Reviews. METHODS: Systematic reviews of clinical orthodontic interventions published between 01 August 2009 and 31 July 2019 in the five leading orthodontic journals and in the Cochrane Database will be included. Empty reviews will be excluded. The reporting of outcomes on adverse effects will not determine eligibility, i.e., reviews will not be excluded, because they did not report usable data. Study selection and data extraction will be conducted independently by two authors. Our primary outcome will be the prevalence of systematic reviews of orthodontic interventions that sought any findings related to adverse effects in the included studies. Additional prevalence statistics will be calculated on a series of items related to seeking of adverse effects in the eligible reviews. All statistics will be calculated for (1) all journals together, (2) the group of five orthodontic journals and the Cochrane Database of Systematic Reviews separately, and (3) each individual journal separately. Chi-square tests of independence will be used to compare these groups. DISCUSSION: This study will assess whether adverse effects were sought in systematic reviews of orthodontic interventions. This knowledge is important, because reviews that present an incomplete picture on adverse effects can have unfavorable consequences for the end-users. Also not reporting that no adverse effects were assessed in eligible studies included in a systematic review can mislead pertinent stakeholders. Our findings could have policy implications for making judgments on accepting or rejecting an intervention systematic review for publication, for example, by directing editors and peer-reviewers to adopt the various items on adverse effects defined in the MECIR standards and in the PRISMA harm checklist.

The reporting of blinding in orthodontic randomized controlled trials: where do we stand?

Objective: To analyse in 10 orthodontic journals how many randomized controlled trials (RCTs) performed 'single-', 'double-', 'triple-', or 'outcome assessors blinding' and to evaluate, from the number of RCTs that did not conduct blinding, how many could actually have achieved it. Material and methods: Randomized controlled trials published in 10 orthodontic journals between 1 September 2012 and 28 February 2018 were included. A search was performed in PubMed and conducted for publication type 'randomized controlled trial' for each journal. Two reviewers independently analysed each RCT and registered that blinding was performed and included which specific type. It was also evaluated whether misclassifications of blinding items occurred and whether it was possible to achieve blinding among the RCTs that did not perform blinding. Results: After applying the inclusion criteria, 203 RCTs were assessed, and 61.6 per cent of them had used blinding, with the main type being 'outcome assessors blinding' (40.4%) followed by 'single-blinding' (15.3%), 'double-blinding' (2.5%), and 'triple-blinding' (3.4%). In 38.4 per cent of the trials, no blinding was performed; however, 79.4 per cent of them could have achieved blinding. Fifteen RCTs (7.3%) misclassified the blinding in relation to single-, double-, or triple-blinding. Journals followed the CONSORT (AJODO, EJO, JO, OCR) published together significantly more RCTs that performed blinding than journals not following the CONSORT. Conclusions: Blinding of outcome assessors was the most frequent type, as orthodontic trials are often of intervention design and thereby difficult to mask for patients and trial staff. The misclassifications of blinding items may indicate suboptimal knowledge among researchers and peer-reviewers regarding the definitions for diverse blinding types.

Statistical testing against baseline in orthodontic research: a meta-epidemiologic study.

BACKGROUND/OBJECTIVES: To assess the prevalence of within-group comparisons from baseline to follow-up in published orthodontic articles and to identify potential associations between this statistical problem and a number of study characteristics. MATERIALS/METHOD: The most recent 24 issues of four leading orthodontic journals with highest impact factor (American Journal of Orthodontics and Dentofacial Orthopedics; AJODO, European Journal of Orthodontics; EJO, Angle Orthodontist; ANGLE, Orthodontics and Craniofacial Research; OCR) were electronically searched until December 31st 2017. The proportion of articles using comparisons against baseline and interpretation of findings according to within-group comparisons were recorded. The association of this practice with journal, year of publication, study design, continent of authorship, number of centres and researchers, statistical significance of results, and statistical analysis was tested. Univariable and multivariable modified Poisson regression were used to identify significant predictors. RESULTS: Overall, 339 articles were eligible for inclusion with the majority published in ANGLE (n = 157, 46%), followed by AJODO (n = 75, 22%), and EJO (n = 75, 22%). A total of 60 studies (18%) presented interpretation of their findings based on within-group comparisons against baseline in isolation. Statistical significance of the primary outcome was a very strong predictor of the prevalence of this flawed approach (RR: 2.33, 95% CIs: 1.22, 4.43; P = 0.01). LIMITATIONS: The effect of time since publication was not addressed. CONCLUSIONS/IMPLICATIONS: Statistical testing and interpretation within groups is prevalent in orthodontic research. Endorsement of accurate conduct and reporting of statistical analyses and interpretation of research findings is important in order to promote optimal inferences to support clinical decision-making.

Clinical considerations and potential liability associated with the use of ionizing radiation in orthodontics.

Ionizing radiation is a known carcinogen. Its damaging effects can be deterministic or stochastic. Deterministic effects occur only after radiation exposure thresholds are reached, but stochastic effects are random, and there is no known threshold below which harmful effects will not occur. Therefore, the use of ionizing radiation in orthodontic treatment should bring a benefit to the patient that outweighs the risks. No legally binding statutes, rules, or regulations provide explicit radiographic prescription protocols for orthodontic practice. The objective of this article was to discuss guidelines and risk management strategies for appropriate and defensible use of ionizing radiation in orthodontics. Guidelines are discussed for radiographic acquisition at different points along the orthodontic treatment timeline. In addition, risk management strategies and best practices are presented regarding adequate and defensible radiographic interpretation. These guidelines are not rigid and do not establish standards of care; they should be modified as necessary for each patient and each clinical encounter.

American Board of Orthodontics: Time for change.

The American Board of Orthodontics (ABO) works to certify orthodontists in a fair, reliable, and valid manner. The process must examine an orthodontist's knowledge, abilities, and critical thinking skills to ensure that each certified orthodontist has the expertise to provide the highest level of patient care. Many medical specialty boards and 4 American Dental Association specialty boards use scenario-based testing for board certification. Changing to a scenario-based clinical examination will allow the ABO to test more orthodontists. The new process will not result in an easier examination; standards will not be lowered. It will offer an improved testing method that will be fair, valid, and reliable for the specialty of orthodontics while increasing accessibility and complementing residency curricula. The ABO's written examination will remain as it is.