Influence of daily usage times on patients' compliance during at-home bleaching: a randomized clinical trial.

The effectiveness of at-home dental bleaching treatments depends on the time that bleaching products are in contact with the teeth surface and, consequently, on the adequate use of associated custom acetate trays. OBJECTIVE: This randomized single-blinded trial aimed to analyze if the daily usage time of these products influences the patient's compliance behavior when submitted to monitored at-home dental bleaching. Secondary outcomes were color change and tooth sensitivity. METHODOLOGY: Sixty-six volunteers were randomly distributed into three groups (n=22): patients were instructed to use the trays for 2 (G2), 4 (G4), and 8 (G8) hours daily. The daily dental bleaching compliance behavior was measured using a microsensor inserted into the trays. Subjective and objective color evaluation assessments were adopted at baseline (T0), one (T1), two (T2), and three weeks (T3) after the beginning of the bleaching treatment, as well as two weeks after the treatment (T4). Tooth sensitivity was analyzed using the VAS scale, ranging from T1 to T4. RESULTS: G2 showed a greater degree of cooperation than G8 and cooperation was inversely proportional to the recommended usage time. Significantly higher color change was observed in the upper arch for G8 when compared to G2 in subjective analysis, from T1 to T4. There were no statistical differences between the groups in objective analysis. CONCLUSION: Shorter recommended usage time of the bleaching product may improve the patient's compliance with at-home dental bleaching treatments. However, increased daily usage time may promote better subjective color change. Bleaching sensitivity was more significant in the first week for a longer time of use.

Influence of daily usage times on patients' compliance during at-home bleaching: a randomized clinical trial

Abstract The effectiveness of at-home dental bleaching treatments depends on the time that bleaching products are in contact with the teeth surface and, consequently, on the adequate use of associated custom acetate trays. Objective This randomized single-blinded trial aimed to analyze if the daily usage time of these products influences the patient's compliance behavior when submitted to monitored at-home dental bleaching. Secondary outcomes were color change and tooth sensitivity. Methodology Sixty-six volunteers were randomly distributed into three groups (n=22): patients were instructed to use the trays for 2 (G2), 4 (G4), and 8 (G8) hours daily. The daily dental bleaching compliance behavior was measured using a microsensor inserted into the trays. Subjective and objective color evaluation assessments were adopted at baseline (T0), one (T1), two (T2), and three weeks (T3) after the beginning of the bleaching treatment, as well as two weeks after the treatment (T4). Tooth sensitivity was analyzed using the VAS scale, ranging from T1 to T4. Results G2 showed a greater degree of cooperation than G8 and cooperation was inversely proportional to the recommended usage time. Significantly higher color change was observed in the upper arch for G8 when compared to G2 in subjective analysis, from T1 to T4. There were no statistical differences between the groups in objective analysis. Conclusion Shorter recommended usage time of the bleaching product may improve the patient's compliance with at-home dental bleaching treatments. However, increased daily usage time may promote better subjective color change. Bleaching sensitivity was more significant in the first week for a longer time of use.

Esthetic recovery of teeth presenting fluorotic enamel stains using enamel microabrasion and home-monitored dental bleaching.

This clinical report describes the enamel microabrasion technique for removing maxillary and mandibular hard fluorotic enamel stains followed by home-monitored home dental bleaching. The removal of fluorotic enamel stains utilized macroabrasion with a water-cooled, fine-tapered 3195 FF diamond bur followed microabrasion with the application of Prema Compound (Premier Dental Products Co, Norristown, PA, USA). Home-monitored dental bleaching was performed 14 days after enamel microabrasion using a 10% carbamide peroxide gel for 2 h/day. The wearing time of the acetate tray/dental bleaching was quantified by a microsensor from TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) that was completely embedded in the acetate trays. The teeth were bleached effectively during 23 days. The mean wearing time of the acetate trays/dental bleaching product was 1.54 h/day, for the upper and lower arches. The patient reported satisfaction with the treatment. The association of enamel microabrasion and home dental bleaching was an excellent clinical treatment for teeth affected with enamel fluorosis.

[The Use of a Microsensor in Therapy of Amblyopia]. / Der Einsatz eines Mikrosensors in der Amblyopietherapie.

Amblyopia is one of the most common visual disorders in children. Current therapy of amblyopia is an occlusion therapy of the stronger eye with an occlusion patch until the best corrected visual acuity is achieved. The success of occlusion therapy essentially depends on the compliance of the children and their parents. There is a commercially available 8 × 12 mm small TheraMon microsensor (TheraMon-Chip, MC Technology GmbH). This sensor allows a simple objective documentation of the therapy compliance of patches and glasses. It samples the surrounding temperature in regular intervals. Due to the specific temperatures, it is possible to detect the time of application and, therefore, the compliance. Therefore, TheraMon microsensor could be a study-related approach for monitoring the compliance and further leading to possible improvement of application time protocols in amblyopia therapy.

Dental bleaching on teeth submitted to enamel microabrasion 30 years ago-a case report of patients' compliance during bleaching treatment.

OBJECTIVES: The present dental bleaching case report describes a new method that precisely quantifies the daily wearing-times of the bleaching product by inserting a microsensor in the acetate custom tray. The bleaching efficacy was also discussed since the patient was previously submitted to enamel microabrasion. METHODS: The patient was submitted to enamel microabrasion in 1987, and bleaching treatment was performed in 2005. In 2017, re-bleaching was executed using 10% peroxide carbamide. The electronic microsensor, TheraMon (TheraMon® microelectronic system; Sales Agency Gschladt, Hargelsberg, Austria), was embedded in the labial region of the upper and lower acetate trays to evaluate the wearing-times of the acetate trays/bleaching product. The patient was instructed to wear the tray for 6 to 8 h/day while sleeping. After 24 days of bleaching treatment, the data obtained from the TheraMon electronic devices was collected and interpreted. RESULTS: The patient did not entirely follow the bleaching treatment as recommended, as there was no evidence of use of the upper and lower trays for some days; additionally, the bleaching product was used for shorter and longer periods than was instructed. CONCLUSIONS: The TheraMon microeletronic device precisely measured the wearing-times of the acetate tray/bleaching product during the bleaching treatment. Teeth submitted to enamel microabrasion presented with a healthy clinical appearance after 30 years. CLINICAL SIGNIFICANCE: Measuring the length and frequency of use of an acetate tray/bleaching product can be important to clinicians and patients for obtaining a controlled and adequate bleaching treatment.

Quantifying patient adherence during active orthodontic treatment with removable appliances using microelectronic wear-time documentation.

OBJECTIVES: The aim of this study was to quantify the wear times of removable appliances during active orthodontic treatment. MATERIALS AND METHODS: The wear times of 141 orthodontic patients treated with active removable appliances in different locations were documented over a period of 3 months using an incorporated microsensor. Gender, age, treatment location, health insurance status, and type of device were evaluated with respect to wear time. Significant associations between wear times and patient factors were calculated using non-parametric tests. RESULTS: The median daily wear time was 9.7 hours/day for the entire cohort, far less than the 15 hours/day prescribed. Younger patients wore their appliances for longer than older patients (7-9 years 12.1 hours/day, 10-12 years 9.8 hours/day, and 13-15 years 8.5 hours/day; P < 0.0001). The median wear time for females (10.6 hours/day) was 1.4 hours/day longer than males (9.3 hours/day; P = 0.017). Patients treated at different locations wore their devices with a difference of up to 5.0 hours/day. Privately insured patients had significantly longer median wear times than statutorily insured patients. No significant difference in wear time was noted according to device type. CONCLUSIONS: The daily wear time of removable appliances during the active phase of orthodontic therapy can be routinely quantified using integrated microelectronic sensors. The relationship between orthodontist and patient seems to play a key role in patient adherence. Wear-time documentation provides the basis for more individualized wear-time recommendations for patients with removable appliances. This could result in a more efficient, shorter, and less painful orthodontic therapy.

Quantification of wear-time adherence of removable appliances in young orthodontic patients in relation to their BMI: a preliminary study.

PURPOSE: The relationship between unhealthy body mass index (BMI) and adherence to orthodontic treatment with removable appliances has not previously been evaluated. OBJECTIVE: The aim of this study was to quantify the association between BMI and wear time of removable orthodontic appliances and to evaluate BMI changes during orthodontic treatment. PATIENTS AND METHODS: Fifty-three normal-weight and 39 overweight/obese children and adolescents (7-15 years old) undergoing orthodontic treatment with removable appliances were enrolled into the study. BMI categories were determined using standardized age-specific and sex-specific BMI criteria, using data measured at the beginning of therapy and once during orthodontic treatment. Wear times of removable appliances were measured at 15-minute intervals over a period of 5 months using implanted microelectronic sensors. Median wear-time values were used in the analysis with the Mann-Whitney U-test used to test statistical differences between groups. RESULTS: The median wear time of removable orthodontic appliances was 9.3 hours for normal-weight patients and 9.2 hours for overweight/obese patients. No statistically significant (P>0.05) or clinically relevant differences in usage or adherence were detected between normal-weight and overweight/obese patients. BMI did not influence wear time or behavior of removable orthodontic appliances by young patients. The majority of patients showed qualitative decreases in BMI during therapy. CONCLUSION: The orthodontic treatment of young patients with removable devices does not require BMI-dependent changes in the treatment strategy. However, the use of removable appliances during meal times raises the possibility of reducing food intake, and in this way the orthodontist may have an active role to play in weight reduction.

Microelectronic wear-time documentation of removable orthodontic devices detects heterogeneous wear behavior and individualizes treatment planning.

INTRODUCTION: The aim of this study was to investigate whether microelectronic wear-time documentation can contribute to individualized orthodontic management. METHODS: The wear times and behaviors of 281 patients undergoing orthodontic treatment with removable appliances were quantified and analyzed using the TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) over a 6-month treatment period. RESULTS: The 281 study participants wore their removable appliances for a median of 9.0 hours per day, compared with the 12 to 15 hours per day prescribed. Wear behavior was variable and heterogeneous in patients with almost identical median wear times, with fluctuating and numerous zero wear-time periods observed. CONCLUSIONS: Both the duration of daily wear time and the wear behavior need to be considered to individualize the prescription for wear time; this is made possible with microelectronic wear-time documentation. Individual prescription changes based on the wear-time documentation can be arranged with patients in a shared decision-making process to achieve effective and successful treatment progress.

Quantification of patient compliance with Hawley retainers and removable functional appliances during the retention phase.

INTRODUCTION: The success of retention with removable retainers is highly dependent on efficient patient compliance. The aim of this study was to quantify patient compliance with removable retainers using microelectronic wear-time documentation during the retention phase. METHODS: One hundred patients, between 13 and 20 years of age, were retained with removable Hawley retainers and functional appliance retainers after successful multibracket treatment at the University Hospital of Tübingen, Germany, and in 4 private practices in Germany. Microsensors were incorporated into the orthodontic retainers by polymerization, and daily wear time was documented in 15-minute intervals during the retention phase for up to 15 months. Patient compliance was quantified with wear-time documentation. Additionally, the influences of age, sex, place of treatment, device type, and health insurance status on compliance were determined and statistically evaluated. RESULTS: Most study participants complied with the prescribed wear time of 8 hours or more per day. Combined patient data indicated a median wear time of 7.0 hours per day over the evaluation period. Wear-time documentation showed either regular or irregular patterns of compliance. Initial compliance did not usually alter over the retention phase. Compliance was not influenced by device type, but age, sex, place of treatment, and insurance status produced changes in the median wear time of up to 50%. CONCLUSIONS: Electronic wear-time documentation of patients' compliance is an easily comprehensible measurement that allows orthodontists to examine the patient's contribution to the success of retention and personalize treatment accordingly. Place of treatment and health insurance status are more closely associated with compliance than are basic patient demographics.

Spontaneous re-eruption of a permanent maxillary central incisor after 15 years of ankylosis--a case report.

Intrusion injuries are considered among the most severe forms of dental trauma, potentially leading to ankylosis as a late consequence. In 1991, a 7-year-old boy suffered a traumatic intrusion leading to an infraposition of tooth 21 along with its immobility. Based on the clinical findings, including bright-sounding percussion testing, disappearance of the periodontal space and a failed attempt at orthodontic movement, a diagnosis of ankylosis was made. Following prosthetic restoration of the infrapositioned tooth, spontaneous re-eruption occurred 15 years later. With the help of a partial multibracket appliance, the tooth could be adjusted to occlusal level and was then restored to the patient's satisfaction. Radiographically, it was demonstrated that extrusion of the tooth had been accompanied by a significant gain in local alveolar bone volume. While a wait-and-see strategy cannot be recommended as a treatment option following ankylosis, considering that spontaneous re-eruption after several years is an extremely rare finding, elucidating the mechanisms at work in spontaneous re-eruption at a cellular level might create an opportunity for iatrogenic triggering of re-eruption, thus paving the way to new forms of therapy.

Comparison of estimated and actual changes in gap widths of expansion screws in plate appliances with 7- and 14-day activation.

OBJECTIVE: To determine how gap opening is affected by the activation intervals of expansion screws in removable orthodontic appliances and which gap widths are achievable during therapy. MATERIALS AND METHODS: In this retrospective study, the increases in gap widths for transverse and distalizing screws activated at 7- and 14-day intervals were calculated. These estimates were based on measurements taken with a caliper of the gap widths of 242 screws integrated in the plates of 137 patients examined during 4-5 follow-up visits over a 6- to 7-month therapy period. RESULTS: A comparison of the theoretical gap widths that we had estimated with those actually measured revealed for the first time that differences in activation intervals have a statistically significant effect on gap width. The 7- and 14-day activation intervals can lead to a linear or nonlinear increase in gap width that greatly depends on the type of expansion screw. Within the therapy period, transverse screws achieved gap widths as much as twice as wide as those achieved with the distalizing screw. CONCLUSION: The gap widths are illustrated in graphs and summarized in tables. These values offer practical orientation for clinicians planning and controlling the therapy course, and they can help to prevent "overactivation" with removable expansion plates.

Wearing times of orthodontic devices as measured by the TheraMon® microsensor.

BACKGROUND: The objective measurement of wearing times, a task attempted for decades without success, is examined for the first time in a clinical study using the newly-developed TheraMon® system. MATERIALS AND METHODS: A prototype of the new TheraMon® sensor was embedded in the acrylic of various removable orthodontic devices worn by a group of 20 patients and assessed over a 5-month treatment period. RESULTS: Daily wearing times (hours) were recorded every day throughout the treatment period by means of a wearing-time graph printed out from a computer by the TheraMon® system. In an additional analysis, the length of time the device was worn on each date, as well as any relevant temperature deviations, were also determined. Using a representative sample, we assessed the time during which a 10-year-old patient had worn his upper plate over a 5-month period in relation to treatment progression. CONCLUSION: The objective measurement of wearing times, in the sense of a patient's "electronic intensive care", may lead to a paradigm shift in how wearing times are prescribed, thus contributing to better patient compliance.

Color fading of the blue compliance indicator encapsulated in removable clear Invisalign Teen® aligners.

OBJECTIVE: To evaluate the color fading in aqueous solutions of the blue dot wear-compliance indicators of the Invisalign Teen® System outside the oral cavity. MATERIALS AND METHODS: The compliance indicators in the Invisalign Teen aligners were tested for color resistance in various aqueous models with no saliva involved. RESULTS: Color fading was observed as a function of time, pH, and temperature while compliance indicators were stored in drinking water or sour soft drinks and in conjunction with the use of cleaning tablets and a dishwasher. The findings of color fading were consistent with the color changes observed when the aligners were being worn by patients. Color fading, notably as observed in connection with acidic soft drinks and cleaning techniques, introduces uncertainty into the assessment of actual patient compliance, as reflected by the fading colors of compliance indicators. CONCLUSION: Compliance indicators are not immune to simple intentional or unintentional manipulations. Therefore, they can best show an estimate of wear time but cannot be recommended as objective wear-time indicators.

Applicative characteristics of new microelectronic sensors Smart Retainer® and TheraMon® for measuring wear time.

OBJECTIVE: To ascertain the extent to which the new microelectronic sensors Smart Retainer® and TheraMon® are suitable for measuring wear times in orthodontic treatment. MATERIALS AND METHODS: The Smart Retainer® wear-time sensor and a prototype of the TheraMon® microsensor were each polymerized into upper plates. The orthodontic appliances were exposed to periodically altered temperatures in a thermostatic water bath. RESULTS: The wear-time sensors recorded the changes in water temperatures as "wear time" (~35 °C) or "non-wear time" (room temperature). The wear times stored in the sensors were displayed and printed outside the water bath as "wear-time graphs" via readout stations and computers. To be better able to predict their reliability and applicability in orthodontic treatment, we measured the accuracy of the two wear-time sensors by comparing the wear times recorded by the Smart Retainer® and TheraMon® with the programmed water temperatures. CONCLUSION: Both microelectronic sensors fulfilled the basic requirements for use as objective wear-time sensors in orthodontic appliances in clinical trials and routine orthodontic practice. As it can be incorporated into different orthodontic appliances, the smaller TheraMon® system offers greater versatility than the Smart Retainer®. The TheraMon® also permits the accurate documentation and analysis of wear times down to the minute.

Young patients' attitudes toward removable appliance wear times, wear-time instructions and electronic wear-time measurements--results of a questionnaire study.

OBJECTIVE: To determine the attitude of young patients to removable appliance wear times, wear-time instructions and electronic wear-time measurement. PATIENTS AND METHODS: 140 patients (mean age 11.97 years) undergoing orthodontic treatment with removable appliances expressed their wishes about wear times and wear-time instructions in a questionnaire. The questionnaires were analyzed by means of descriptive statistical analysis. RESULTS: Analysis of this questionnaire investigation according to gender revealed that the majority of the respondents preferred wearing their appliances overnight only, and that they did not want their practitioners determining the length of the appliance wear. We observed gender-specific differences in the acceptance of wear times as determined by the dental practitioner, which were accepted by 58% of the girls but only 28% of the boys. Willingness to wear a removable appliance increased markedly when the orthodontic objectives included offering patients the prospect of an improvement in their appearance from wearing a removable appliance. A recently-developed removable appliance with an integrated microsensor on the market that provides an objective measure of appliance wear times would only be worn without reservations by about 21% of boys and 32% of girls. 41-45% of the respondents only agreed to treatment using this kind of microsensor provided the treatment period would be thereby shortened. CONCLUSIONS: The extent to which the clinician can respond to the wishes and requirements of young patients in terms of removable appliance wear is crucial to the compliance necessary for success. Acceptance of a removable appliance with an integrated electronic wear-time recorder can be enhanced if the practitioner explains to the patient in a simple, straightforward manner the therapeutic advantage of this new generation of appliances. Society's growing openness towards electronic devices does not yet appear to be reflected in the desire of young patients for braces with an integrated microsensor.