Is motor-driven insertion of orthodontic miniscrews more advantageous than manual insertion? A micro-CT evaluation of bone miniscrew contact surface area and cortical microcracks in rabbits.

AIM: This in vitro study aimed to evaluate and compare the bone-miniscrew contact surface area (BMC) and the cortical bone microcracks (CM) resulting from manual (hand-driven) and automated (motor-driven) orthodontic miniscrew (OM) insertion methods. METHODS: Thirty-three OM were inserted in the femurs of nine New Zealand rabbits using manual (n = 16) and automated (n = 17) insertions. After euthanizing the rabbits, bone blocks, each including one OM, were sawed. Micro-CT scanning was performed, and data analysis included reconstruction, binarization and quantification of morphometric parameters of BMC and the number and length of CM. Means and standard deviations for complete BMC, complete BMC proportion, cortical BMC, cortical BMC proportion, and length and number of CM were calculated. Mixed model analysis was used to adjust for more than one sample/CM per animal. A paired t-test was used to compare the number of CM between the two groups. RESULTS: Compared to the automated insertion, manually inserted miniscrews had significantly lower complete BMC (7.54 ± 1.80 mm2 vs. 11.99 ± 3.64 mm2), cortical BMC (5.91 ± 1.48 mm2 vs. 8.48 ± 1.90 mm2) and cortical BMC proportion (79.44 ± 5.84% vs. 87.94 ± 3.66%). However, it was not statistically significant in complete BMC proportion (p = .052). The automated insertion also resulted in a significantly lower mean number of CM than the manual method (p = .012). However, the length of the cracks was shorter in the manual group but with no significant difference (p = 0.256). CONCLUSION: Motor-driven OM insertion results in superior BMC and reduction in the number of CM, which may lead to better miniscrew stability.

Why do patients transition between orthodontic appliances? A qualitative analysis of patient decision-making.

OBJECTIVES: To gain an in-depth understanding of patients' decision-making processes when choosing to transition to a different orthodontic appliance (OA). METHODS: This was a retrospective qualitative study using one-on-one in-depth semi-structured interviews. Patients were recruited through purposive convenience sampling. Participants who had elected to transition from and to one of these OAs: metal brackets, tooth-coloured brackets, or clear aligners before the end of treatment were recruited. Recruitment ceased when data saturation was achieved. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Twenty-three adult participants (12 males, 11 females) with their ages ranging from 18 to 52 years were interviewed. The analysis of the data revealed that participants perceived two reasons for the transition: (1) insufficient initial information and (2) evolving life circumstances and personal style. Data analysis of participants who expressed a notable discrepancy between their expectations and the reality of the OA they chose revolved around three themes: (a) health benefits and threats, (b) personal control, and (c) financial considerations. Data analysis of participants who described transitioning between OAs due to changes in personal circumstances and style, revealed two themes: (a) change in personal values and motivations and (b) change in social and psychological influence. CONCLUSIONS: This qualitative study highlighted the complex multifactorial nature of patient decision-making when choosing and transitioning OAs. Orthodontists can benefit from understanding these factors to engage in thorough patient-centered counselling, provide tailored treatment recommendations, and optimize the choice of appliances.

What do you think of when you hear the word 'feedback'? A reflective thematic analysis study of interviews.

PURPOSE: Although most teaching around feedback focuses on the delivery, one must consider that the word 'feedback' is not a neutral word. It inflicts a range of emotions that, when used, may influence the effectiveness of the feedback process. A more profound understanding of health professions educators' perceptions regarding the word 'feedback' can help explain discrepancies between the provision, reception and acceptance of feedback. METHODS: This is a qualitative inductive, reflective thematic analysis study. The authors interviewed 22 health professions educators participating in an online workshop to develop their feedback giving skills on their initial perspectives of the word 'feedback'. RESULTS: We found four major themes: (1) Can I tell you a little story about my feedback experience? (2) It is probably going to be negative. (3) There is always something to learn if you are willing to hear the message. (4) It is like getting a report card. From the data, we suggest one key antecedent and two practical approaches one could take when giving feedback. CONCLUSION: In this article, the authors highlight barriers during the feedback process due to the mere perception of the nature of feedback and the connotations associated with the term itself and suggest approaches that can refocus conversations towards a shared meaning and purpose of improvement, despite the preconceptions of the word 'feedback'.

The art of empathy: Teaching empathy through art.

BACKGROUND: The instruction of empathy is challenging. Although several studies have addressed how art-based education can foster empathy, there is a need for more evidence showing its impact and students' perceptions, especially in graduate education. APPROACH: We designed and implemented a virtual art-based curriculum focused on fostering empathy-The Art of Empathy. This novel curriculum used diverse art-based education methodologies to promote meticulous and collaborative observation and reflection, building on constructivism. Thirty-six interns at the Brigham and Women's Hospital were invited to participate in the curriculum, while 34 served as control. EVALUATION: We used mixed methods to explore interns' perceptions of the curriculum and assess its impact on their empathy. We used two quantitative instruments with known psychometric characteristics: the Toronto Empathy Questionnaire (TEQ) and the Jefferson Scale of Physicians Empathy (JSPE), which were distributed in a survey and completed by 31/99 (31.3%). We collected qualitative data from four interns using semi-structured interviews. Thematic analysis showed how The Art of Empathy promoted interns' reflections and actions toward empathy. This was partially supported by the quantitative data that showed significantly higher scores on the 'Compassionate Care' subscale of the JSPE (p = 0.039) when compared with interns in the control group. The thematic analysis showed that interns appreciated the curriculum and valued its benefits while highlighting the limitations of the virtual delivery approach. IMPLICATIONS: Our curriculum was well received by interns and showed the potential of art-based methodology to promote empathic capacities in graduate students.

Parents' Awareness of Malocclusion and Orthodontic Consultation for Their Children: A Cross-Sectional Study.

Parents' awareness of malocclusion and the appropriate timing to seek orthodontic consultation for their children has a substantial impact on children's orthodontic treatment. This cross-sectional study aims to investigate parents' awareness of malocclusion and orthodontic consultation of their children and the influence of parents' demographics on their awareness level. An electronic survey collected information about participants' demographics and awareness about malocclusion and orthodontic consultation of children. A total of 473 parents living in Jeddah, Saudi Arabia, participated in the study. The average awareness level among parents was moderate (3.09 ± 1.4). Male gender and unemployment were associated with low orthodontic awareness levels relative to moderate awareness (OR = 3.3, 95% CI = 1.8-5.8 and OR = 2.1, 95% CI = 1.1-3.8, respectively). Former or current orthodontic treatment was associated with high awareness levels (OR = 3.9, 95% CI = 2.4-6.5). There is still a need to raise the awareness of Saudi parents about malocclusion and orthodontic consultations for their children. Orthodontic awareness-raising campaigns should be designed to include fathers and parents with low socioeconomic status. The findings of this study also suggest that orthodontists can enhance their patient's awareness of malocclusion and orthodontic consultation for their children.

The role of orthodontics in management of obstructive sleep apnea.

Dental sleep medicine is the field of dental practice that deals with the management of sleep-related breathing disorders, which includes obstructive sleep apnea (OSA) in adults and children. Depending on the developmental age of the patient and the cause of the apnea dental treatment options may vary. For adult patients, treatment modalities may include oral appliance therapy (OAT), orthognathic surgery and surgical or miniscrew supported palatal expansion. While for children, treatment may include non-surgical maxillary expansion and orthodontic functional appliances. Many physicians and dentists are unaware of the role dentistry, particularly orthodontics, may play in the interdisciplinary management of these disorders. This review article is an attempt to compile evidence-based relevant information on the role of orthodontists/sleep dentists in the screening, diagnosis, and management of sleep apnea. Oral sleep appliance mechanisms of action, selective efficacy, and the medical physiological outcomes are discussed. The purpose of this review is to provide a comprehensive understanding of how orthodontists and sleep physicians can work in tandem to maximize the benefits and minimize the side effects while treating patients with OSA.

Ectopic Eye Tooth Management: Photobiomodulation/Low-Level Laser Emission Role in Root Resorption after Fixed Orthodontic Treatment.

Aim: This study evaluates the role of low-level laser emission/photobiomodulation (LE/P) in quantitative measurements of root resorption (QRR). The application of LE/P performed after each orthodontic activation with four types of treatment intervention (TI) on the root resorption (RR) after fixed orthodontic treatment (FOT) of the upper arch with ectopic eye tooth/teeth [EET] was investigated. Materials and Methods: Thirty-two orthodontic patients scheduled for FOT were selected and assigned to the four groups. These were LE/P + Self ligating bracket (SLB), LE/P + Conventional bracket (CB), non-photobiomodulation (non-LE/P) + SLB and non-LE/P + CB. Standard management stages of FOT were followed in the maxilla. Each patient received a single application of LE/P labially/buccally and palatally, a total of five different points were used during each activation or appointment. The main outcome measure was QRR in maxillary anteriors before and after FOT, assessed via cone-beam computed tomography (CBCT) using 3D OnDemand software. Results: Insignificant QRR was found between before and after FOT in SLB, CLB, and LE/P, non-LE/P groups (p > 0.05). QRR in the SLB vs. CB and LE/P vs. non-LE/P group was significantly different in 11, 13, and 23 (p < 0.05). QRR in the LE/P + SLB group (p < 0.05) was significantly different in 11, 13, and 23 than that in the other groups. The most severe QRR was found on 13 (0.88 ± 0.28 mm and 0.87 ± 0.27 mm) and 23 (1.19 ± 0.14 mm and 1.16±0.13 mm) in the CB and non-LE/P group (p < 0.001). LE/P + SLB showed a highly significant superior outcome (p < 0.001) in relation to non-LE/P + CB, the QRR of 23 were 0.813 ± 0.114 mm and 1.156 ± 0.166 mm, respectively. Conclusion: Significantly higher amounts of QRR were found in EET patients after FOT treated with the CB, non-LE/P, and non-LE/P + CB system and warrant further investigation to explore potential specific causes.

Pulp volume changes after piezocision-assisted tooth movement: a randomized clinical trial.

BACKGROUND: Orthodontic treatment may result in undesirable side effects, such as root resorption and a decrease in the size of the pulp tissue which could be associated with the duration of the orthodontic treatment. Piezocision-assisted tooth movement was introduced as a minimally invasive surgical procedure to shorten orthodontic treatment time. This prospective randomized clinical trial was aimed to compare the pulp volume changes of maxillary anterior teeth after en-masse retraction with or without piezocision-assisted orthodontics. METHODS: Patients who required orthodontic treatment with bilateral maxillary first premolar extractions and en-masse retraction were recruited. Patients were randomly divided into extraction with piezocision, or only extraction, serving as controls. Pulp volume and root length changes of the maxillary six anterior teeth were measured and compared between the two groups using a 3-Dimensional analytical software. Paired and independent sample t-tests were used to compare within and between groups. Bivariate correlation was done between the mean change in pulp volume and its corresponding root length. The significance level was set at α = 0.05. RESULTS: A total of 23 patients were included, 12 in the piezocision, and 11 in the control group. At the end of the en-masse retraction phase, (mean = 122.74 ± 3.06 days) pulp volume was significantly decreased in all six anterior teeth in both groups (P < 0.01). The decrease in pulp volume was not statistically different between both groups, (P > 0.05). There was a statistically significant but moderate correlation only between the pulp volume change of the right canine and its root length, r = 0.44, P = 0.034. CONCLUSIONS: The effect of piezocision-assisted orthodontic tooth movement on the pulp volume was comparable to the conventional orthodontic treatment. The degree of change in pulp volume does not appear to be related to the amount of root resorption. Trial registration NCT03180151. Registered December 25, 2016, retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT03180151 .

Youth Perception of Different Orthodontic Appliances.

PURPOSE: To explore youth perception of the esthetics of different orthodontic appliances measured using different concepts of esthetics. PATIENTS AND METHODS: A questionnaire was answered by 194 youth participants (35.5% were 9-11 years old; 32.5% were 12-14 years old; and 32% were 15-17 years old). Participants evaluated and compared the attractiveness of images of different orthodontic appliances using a Likert scale. They indicated the acceptability of the appliances with a yes/no answer. They then chose which appliance to rank as their most preferred. RESULTS: The highest median attractiveness rating was for clear aligners (Mdn= 8, IQR= 4.25), followed by lingual and standard ceramic brackets (Mdn= 7, IQR= 6). The lowest median attractiveness rating was for hybrid brackets (Mdn= 4, IQR= 4). Clear aligners were significantly more attractive than all other orthodontic appliances (P<0.0001). Clear aligners also had the highest percentage of acceptability (80%), while hybrid brackets scored the lowest (42%). Ceramic and metal brackets fell in the middle range of attractiveness and acceptability but were chosen by male middle schoolers as their preferred appliances. Clear aligners were ranked the highest by this cohort. CONCLUSION: This study demonstrates the widespread preference and acceptability of clear aligners among the youth. Other orthodontic appliances were acceptable but to a lesser extent than clear aligners. This study informs orthodontists about their youth consumers' behavior and may help inform treatment discussions in the orthodontic clinic.

Knowledge of Signs, Symptoms, Risk Factors, and Complications of Obstructive Sleep Apnea among Dental Interns.

Dentists are uniquely positioned to identify patients at risk of obstructive sleep apnea (OSA) and its complications. However, previous reports have shown that the average general dentist possesses insufficient knowledge about the clinical manifestations and complications of OSA. AIM: The purpose of this study was to examine Saudi dental interns' knowledge related to the clinical manifestations and impact of OSA. MATERIALS AND METHODS: This was a cross-sectional study using a self-administered questionnaire to assess the interns' knowledge related to the symptoms, signs, diagnosis, risk factors, and complications of OSA in adults and children. RESULTS: The average of the proportions of factually correct participant responses of the questionnaire categories was 47%. Participants did best in the category of questions related to predisposing factors (50% of questions were answered correctly), but less than 50% of questions were answered correctly in other OSA-related areas. Most participants scored 49% or lower in this questionnaire. CONCLUSION: Saudi dental interns had poor knowledge related to OSA. This may relate to the insufficiency of teaching sleep-related topics in dental curricula, among other reasons. CLINICAL SIGNIFICANCE: Given the potential impact of OSA on cardiovascular health, metabolic syndrome, and other public health problems, it is important to remedy this knowledge gap and empower future physicians with the knowledge required to participate in detecting OSA patients and referring them for evaluation.

Adult Perceptions of Different Orthodontic Appliances.

Introduction: Pursuing an esthetically-pleasing orthodontic outcome, orthodontic patients must consider and choose from the different available options of orthodontic appliance. Practitioners need to be better informed of their customers' preferences to make better practice management decisions and satisfy their patients' needs. PURPOSE: To explore adult laypeople's perceptions of the attractiveness, acceptability, preference and economic value of different orthodontic appliances when they consider these appliances for themselves and for their children. PATIENTS AND METHODS: This cross-sectional survey included 199 adults (110 females). The average age of participants was 27.7 years. Participants answered a questionnaire evaluating and comparing multiple smiling images of an adult wearing different orthodontic appliances. Participants rated each appliance for: (1) attractiveness on a Likert scale; (2) acceptability of having the appliance placed for themselves and their children (with a yes/no response); (3) preference (by ranking all appliances in order); and (4) economic value (by providing the additional amount they are willing to pay for each appliance for themselves and their children). RESULTS: We found a statistically significant difference in the attractiveness scores between the different orthodontic appliances (p< 0.0001). The most attractive appliances were clear aligners and lingual brackets. The least attractive appliances were colored o-tied-brackets followed by shaped-brackets. Clear aligners were the most acceptable appliances among our participants to have placed on themselves (86.9%) and their children (84.9%). Shaped brackets were the least acceptable appliances among our participants to have placed on themselves (24.1%) and their children (36.2%). The most preferred appliances were lingual brackets (39.2%), followed by clear aligners (34.17%). The least preferred appliances were colored o-tied-brackets (4%). Participants varied with regards to how much more they were willing to pay for each of the different orthodontic appliances. The majority were willing to pay more for clear aligners and lingual brackets to have them placed on themselves but not to have them placed on their children. CONCLUSION: Adults preferred more innovative esthetic appliances over traditional ones and were willing to pay more to have them placed on themselves but not on their children.

Diagnostic performance of eruption stages for identification of skeletal maturity.

OBJECTIVES: To investigated the diagnostic performance of circumpubertal eruption stages which identify skeletal maturity stages using the cervical vertebral maturation (CVM) method in a Saudi population. METHODS: This is a retrospective cross-sectional study. Lateral cephalograms, panoramic radiographs, and intraoral pictures of 600 orthodontic patients (284 boys, 316 girls) who met inclusion criteria were assessed. Records were retrieved between January 2016 and April 2018. The diagnostic performance of eruption stages for identifying skeletal maturity was tested with positive likelihood ratios (LHR+). RESULTS: Prevalence of each CVM stage in the eruption stages was reported. For every eruption stage, LHR+ was reported in order to identify every CVM stage. The majority of the LHR+ values were ≤3.5, with a significant value of ≥10 for the identification of the post-pubertal growth stage. The other eruptions stages did not strongly predict skeletal maturity. CONCLUSION: In treatment planning for cases that require identifying the growth peak, the use of eruption stages is not recommended as an indicator of skeletal maturity except for the early permanent dentition stage where strong diagnostic performance for identifying post-pubertal skeletal growth stage has been shown.

Living with cleft lip and palate: the treatment journey.

OBJECTIVE: To better understand how individuals with cleft lip and palate (CLP) perceive and experience their treatment process and how these perceptions and experiences change over the life course. DESIGN: Qualitative in-depth semistructured interviews with 11 adults with nonsyndromal complete CLP. PARTICIPANTS/SETTING: Individuals from three Canadian cities were recruited by convenience and theoretical sampling through AboutFace International. The number of participants was determined by the principle of theoretical saturation. RESULTS: The experience of individuals with CLP through the treatment process changes over the life course. In childhood and early adolescence, most individuals experience stigma, negative self-perception, and as a result were more prone to perceiving the treatment process not only as unbearably burdensome but also as fueling their feeling of "defectiveness." In adulthood, participants' self-perception improved, partly because of definitive surgical correction, leading them to realize treatment benefits and reappraise the treatment process as satisfactory rather than burdensome. Subsequently, some individuals pursued further surgeries hoping for additional psychological gains, in lieu of psychosocial interventions addressing the underpinnings of residual feelings of "defectiveness." This led to dissatisfaction and frustration when the procedures did not lead to the hoped-for psychological gains. CONCLUSIONS: The results emphasize the importance of self-perception in determining how participants perceive several important aspects of the treatment experience throughout the life course. Further studies should focus on how to incorporate self-perception as an important variable and outcome in the treatment process.