Direct-to-consumer orthodontics: Exploring laypeople's perception of orthodontic treatment complexity.

BACKGROUND: The authors aimed to explore the treatment preferences of laypeople regarding direct-to-consumer (DTC) orthodontics and to identify whether case complexity, as perceived by laypeople, is one of the factors influencing interest in DTC orthodontics. METHODS: An online cross-sectional survey was conducted. Data analysis was performed using logistic regression models. RESULTS: A total of 1,362 surveys were completed. A significant inverse association was identified between the complexity of an orthodontic case, as measured using the American Board of Orthodontics' discrepancy index (DI) score, and the likelihood of choosing DTC treatment over an orthodontist. Participants were 3.53 times more likely to choose DTC treatment for a mild case (DI score, 0-10) compared with a complex case (DI score, > 20), although the likelihood of choosing DTC treatment for a moderate case (DI score, 11-20) was only 1.79 times higher than for a complex case. CONCLUSIONS: When laypeople were asked to consider each case as if it were their own dentition, there was a significant inverse association between the complexity of an orthodontic case, as measured using the DI score, and the likelihood of choosing DTC treatment over an orthodontist. Laypeople were seemingly more likely to choose DTC orthodontics for dentitions that did not appear crowded and were well aligned within the arches. Laypeople seemed to have an understanding that there are some limitations to DTC orthodontics. PRACTICAL IMPLICATIONS: Orthodontists should better understand the factors influencing consumers' decisions to select DTC orthodontics and dental organizations should focus their educational campaigns on these factors.

Factors Shaping Occupational Injustice among Resettled Syrian Refugees in the United States.

Background: There have been a limited number of studies that have focused on factors which shape the experiences of resettlement and occupational injustice among refugee populations. Purpose: To explore the factors that shape the living difficulties of Syrian refugees who were lawfully admitted into the United States and ways whereby they might interfere with shaping occupational injustice. Method: Mixed methodologies were incorporated. The living difficulty scale for refugees (LDSR) was disseminated. Semistructured interviews were conducted, and fieldnotes were collected as sources of qualitative data. Results: 254 participants (mean age 36.2 ± 9.6 yrs; 159 females and 95 males) completed the survey, and nine of them participated in the semistructured interviews. Age (p < 0.01), region (p < 0.001), and time in the United States (p < 0.05) had significant effects on the experiences of the participants, but not gender (p = 0.308). Occupational injustice is an outcome of an interaction between interpersonal and contextual factors. Practice Implications. Occupational therapists need to assume a vital role in maximizing opportunities of engagement in meaningful occupations for Syrian refugees to counteract occupational injustice and difficulties associated with resettlement.

Saturdays Orthodontic Appointments, Demand, and Patients' Commitment.

AIM: The purpose of this study was to determine the demand for orthodontic appointments on weekends and the level of commitment the patients have for those appointments. MATERIALS AND METHODS: A survey of 17 questions was created and given to 199 adult patients. The first six questions addressed demographic information, followed by three questions addressing whether coming to their orthodontic appointments required taking time off of work. The remaining questions asked if they would prefer to attend orthodontic appointments on Saturday if they would take advantage of a Saturday appointment, and what their preferred time and level of commitment would be for this appointment. The data were analyzed using the logistic-regression Chi-square test. RESULTS: About 77.4% of the participants indicated that they would take advantage of appointments on Saturdays if available. The most preferred time for Saturday appointments was 7:00 am-10:00 am, followed by 10:00 am-12:00 pm. About 60.6% of the participants reported that they would be willing to sign up for AutoPay in order to be seen on Saturday. Among those who would take advantage of weekend appointments, 82.6% reported that they would likely never miss or reschedule a Saturday appointment, and 75.3% would choose an orthodontist who is open on Saturday over another orthodontist who is not. Among participants who work more than 40 hours per week, 86.1% (106) wanted to take advantage of Saturday appointments. Participants with a high household income are less inclined to take advantage of Saturday appointments compared with those with a low household income. Participants who need to take time off of work are more inclined to take advantage of Saturday appointments [93% (106) favorable vs 7% (8) unfavorable]. Participants who need to take their child out of school early for their orthodontic appointments during the week are more inclined to take advantage of Saturday appointments [87% (97) favorable vs 13% (15) unfavorable] than those who do not need to. CONCLUSION: There is a demand for Saturday orthodontic appointments with a very high commitment level among the majority of those patients. The Saturday demographic tends to be participants with a low household income who work 40 or more hours per week. CLINICAL SIGNIFICANCE: Orthodontic offices may consider working at least one Saturday per month to satisfy patient needs. They can use this survey to explore their own market for Saturday clinical practice.

Cone-beam Computed Tomography Analysis of the Relationship between the Curve of Spee and the Collum Angle of Mandibular Anterior Teeth.

AIMS AND OBJECTIVES: To evaluate the correlation between the curve of Spee (COS) of a patient and the Collum angle of mandibular anterior dentition using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This cross-sectional study was based on the analysis of 100 CBCTs of patients divided sagittally into two separate subjects. The Collum angles of the mandibular central incisor, mandibular lateral incisor, and the mandibular canine were measured along with the COS of that quadrant using Dolphin Imaging. A multivariate linear regression and Pearson correlation coefficients were conducted to measure the correlation between the COS and the Collum angle of mandibular anterior dentition. RESULTS: The total number of participants in the cohort was 200 samples out of 100 patients as this was a split mouth study. The mean COS was 2.09 ± 1.239 mm. The mean Collum angle of the mandibular central incisor (L1) was found to be 6.50 ± 3.002 degrees. The mean Collum angle of the mandibular lateral incisor (L2) was 7.19 ± 2.554 degrees and the mean Collum angle of the mandibular canine (L3) was 7.03 ± 2.907 degrees. There was a statistically significant moderate correlation between L1, L2, and L3 and the COS with the Collum angle of the mandibular central incisor most highly correlated to the COS (0.42), followed by the mandibular lateral incisor (0.35) and then the mandibular canine (0.30). CONCLUSIONS: There is a statistically significant low to moderate correlation between the COS and the Collum angles of the mandibular anterior dentition.

Correlation between adolescent orthodontic quality of life and ABO Discrepancy Index in an orthodontic treatment-seeking population: A cross-sectional study.

OBJECTIVE: To evaluate the association between adolescents' orthodontic quality of life before initiating orthodontic treatment and their objective case complexity as measured by the American Board of Orthodontics' Discrepancy Index (DI). DESIGN AND SETTING: A single-centre, cross-sectional survey study. METHODS: The Orthodontic Quality of Life Assessment Survey (OQoLAS) was administered to 240 adolescents (aged 11-14 years) during their record-gathering appointment. After completion of the survey, a DI score was calculated for each patient based on pretreatment measurements. Pearson correlation coefficients, r, were used to assess the association of DI scores with OQoLAS total and subdomain scores. A multiple linear regression of OQoLAS total scores adjusting for age, gender and DI scores was conducted. RESULTS: The study did not find a strong correlation between OQoLAS and DI scores (r = 0.10; P = 0.6497). On average, the OQoLAS scores (functional, emotional and social subdomains of OQoLAS) were slightly higher among girls than among boys but there was no statistical difference for total OQoLAS score between boys and girls (42.4 vs. 45.4, P = 0.2005). However, there was a significant difference in oral health perception rating between boys and girls, with girls being more likely to rate their oral health positively (adjusted P = 0.0226). The total DI scores of boys with respect to girls were not statistically different (P = 0.4256). The components of the DI that showed highest score were for cephalometric measures, followed by overjet; and the lowest scores were for lateral open bite and buccal posterior crossbite. The measure of association analysis did not show any strong correlation between the OQoLAS (total score and subdomain scores), and DI score or any of its components. CONCLUSION: Malocclusion severity was not found to be correlated with orthodontic quality of life in adolescents aged 11-14 years seeking orthodontic treatment.

Direct to consumer orthodontics: Exploring patient demographic trends and preferences.

INTRODUCTION: This study aimed to evaluate market trends on the demographics most likely to select direct to consumer orthodontics and the reasoning behind their decisions. METHODS: An internet-based cross-sectional survey was conducted. Data analysis was carried out using logistic regression models. RESULTS: Total of 1573 surveys were completed. While 32.2% of those surveyed selected direct to consumer orthodontics over conventional orthodontics, 10.8% would select direct to consumer orthodontics for their children. Among parents who would seek direct to consumer orthodontics, only 27.8% would consider the same treatment for their children. The odds of seeking direct to consumer orthodontic treatment for divorced participants was 2.52 times higher than that for single participants, for participants with 4 children or more was 2 times higher than that for participant with no children, and in age group 46-59 years was 2.23 times higher than that for age group 18-26 years. Seventy three percent of consumers who selected direct to consumer orthodontics selected cost as an influencing factor. Convenience was also a major determining factor at 69.6%. CONCLUSIONS: Cost, convenience, and perceived simplicity all appear to factor into a consumer's consideration of direct to consumer orthodontics. As annual household income, age, and education increases consumers are more likely to consider direct to consumer orthodontic treatment.

Effects of Invisalign® treatment on speech articulation.

OBJECTIVES: To determine the effects of Invisalign® aligners on patients' abilities to articulate consonants. MATERIALS AND METHODS: Thirty patients undergoing active two-arch Invisalign® treatment were examined. Patients were recorded reading the rainbow passage (a passage with every phoneme represented), once with the trays inserted and once with the trays removed. The recordings were analysed by a speech pathologist for misarticulation of consonant phonemes. RESULTS: Misarticulation of consonants was significantly associated with the Invisalign® aligners inserted as based on the McNemar's statistical test (P=0.008). The fricative alveolar consonant /z/ was found to be the most impacted by the trays, followed by the consonant /s/ (P=0.016). The consonant /sh/ was not shown to be affected by the Invisalign® aligners. CONCLUSIONS: Invisalign® aligners do have an impact on the articulation of consonants. Fricative alveolar consonants were the primary phonemes impacted. Due to the fact that the efficacy of Invisalign® treatment is based primarily on compliance and that speech impairment may interfere with compliance, the information presented in this study should be conveyed to the patient before the initiation of Invisalign® treatment.

A CBCT Investigation of the Association between Sella-Turcica Bridging and Maxillary Palatal Canine Impaction.

OBJECTIVES: To investigate the association between unilateral/bilateral maxillary canine impaction and sella-turcica bridging using CBCT imaging. METHODS: This retrospective comparative study analyzed 76 CBCT images of the craniofacial complex including sella-turcica. The impacted cuspid group consisted of thirty-eight subjects (7 males, 31 females; mean age, 14.6 ± 3.2 years) diagnosed with unilateral (left n = 14, right n = 11) or bilateral (n = 13) palatal canine impaction. The control group included thirty-eight subjects matched by sex (7 males, 31 females; mean age, 19.5 ± 3.6 years) with no impaction. Multinomial logistic regression analysis was used to determine the association between unilateral/bilateral canine impaction and right and left sella-turcica bridging. RESULTS: The prevalence of sella-turcica bridging was 59.3% and 50% in the impacted canine and control groups, respectively. Although the odds for unilateral canine impaction were increased in the right and left sella-turcica bridging groups compared to the controls, the difference was not statistically significant. The risk of bilateral impaction was different between the two sides of sella-turcica bridging, but, again, the findings were not statistically significant. CONCLUSION: Contrary to previous 2D studies, there is no statistically significant association between unilateral/bilateral palatal canine impaction and sella-turcica bridging when using 3D CBCT.

Patient compliance with Hawley retainers fitted with the SMART(®) sensor: a prospective clinical pilot study.

OBJECTIVE: To evaluate the compliance of patients while wearing maxillary Hawley retainers embedded with SMART microsensors. METHODS: The sample population consisted of 22 patients who were divided into an experimental (group A) and a control group (group B). Group A was informed that they would be monitored through the use of SMART microsensors, while group B was not informed that they would be monitored. After the delivery of the retainers (T0), the patients were evaluated at T1 and T2, represented by 6- and 12-week follow-up visits, respectively. At T1, group B was informed of our ability to monitor their compliance. Both groups continued wearing their retainers during T1 to T2. RESULTS: During T0-T1, Group A wore their retainers for an average of 16.3 hours (SD 4.39), while group B wore their appliances for an average of 10.6 hours (SD 5.36, t  =  2.426, P  =  .027). Although group B increased their retainer wear by 0.5 hours/day from T1 to T2, this increase was not statistically significant. CONCLUSIONS: Despite significant differences being noted between the two groups at T1, group B did not show significant mean changes in their wear time before and after becoming aware of the use of the SMART microsensor.

A comparison of orthodontic treatment outcomes using the Objective Grading System (OGS) and the Peer Assessment Rating (PAR) index.

INTRODUCTION: The use of objective criteria is essential to uniformly quantify and measure the severity of malocclusions and the efficacy of different treatment modalities. The Peer Assessment Rating (PAR) index and, more recently, the American Board of Orthodontics Objective Grading System (OGS) were developed to fulfill this need. AIM: The aim of this retrospective study was to assess and compare treatment outcomes using the UK and US weighted PAR and the OGS. MATERIALS AND METHODS: The sample consisted of randomly selected records of 50 patients treated by residents in one postgraduate orthodontic clinic. UK and US weightings for the PAR index were applied and compared with OGS. RESULTS: There was no statistically significant association between the OGS and the PAR index grading systems. Neither the UK nor the US PAR weightings showed statistically significant correlation with the OGS. All cases were 'greatly improved' or 'improved' according to the PAR index, while most cases (62%) failed according to OGS. There was a statistically significant correlation between the unweighted PAR index and the OGS (r = -0.32, p = 0.024). The US and the UK weightings for the PAR were highly correlated (r = 0.90, p < 0.001). Both weighting systems were also highly correlated with the unweighted PAR (p < 0.001). There were no gender differences found in any of the scoring systems. CONCLUSIONS: The current PAR index cannot replace the OGS for evaluating treatment outcomes. The current OGS cannot detect the improvement achieved in a treated case.

A comparison of the treatment effects of the Forsus Fatigue Resistance Device and the Twin Block appliance in patients with class II malocclusions.

OBJECTIVES: We evaluated the skeletal and dentoalveolar effects of the Forsus Fatigue Resistance Device (FRD) and the Twin Block appliance (TB) in comparison with nontreated controls in the treatment of patients with class II division 1 malocclusion. MATERIALS AND METHODS: THIS RETROSPECTIVE STUDY INCLUDED THREE GROUPS: TB (n=37; mean age, 11.2 years), FRD (n=30; mean age, 12.9 years), and controls (n=25; mean age, 12.6 years). Lateral cephalograms were evaluated at T1 (pretreatment) and at T2 (postappliance removal/equivalent time frame in controls). Cephalometric changes were evaluated using the Clark analysis, including 27 measurements. RESULTS: Sagittal correction of class II malocclusion appeared to be mainly achieved by dentoalveolar changes in the FRD group. The TB was able to induce both skeletal and dentoalveolar changes. A favorable influence on facial convexity was achieved by both groups. Significant upper incisor retroclination occurred with the TB (-12.42°), whereas only -4° was observed in the FRD group. The lower incisors proclined more in the FRD group than the TB group. Incisor overjet reduction was 62% in the TB group versus 56% in the FRD group. Molar relation was corrected in both functional groups, resulting in a class I relation, although no change appeared in the control sample. CONCLUSION: Both appliances were effective in correcting the class II malocclusion. Both the FRD and the TB induced significant maxillary and mandibular dentoalveolar changes; skeletal changes were induced by TB but not FRD therapy.

Long-term occlusal changes assessed by the American Board of Orthodontics' model grading system.

INTRODUCTION: The purpose of this study was to assess the long-term posttreatment changes in all criteria of the American Board of Orthodontics' (ABO) model grading system. METHODS: We used plaster models from patients' final and posttreatment records. Thirty patients treated by 1 orthodontist using 1 bracket prescription were selected. An initial discrepancy index for each subject was performed to determine the complexity of each case. The final models were then graded using the ABO's model grading system immediately at posttreatment and postretention. Statistical analysis was performed on the 8 criteria of the model grading system, including paired t tests and Pearson correlations. An alpha of 0.05 was considered statistically significant. RESULTS: The average length of time between the posttreatment and postretention records was 12.7 ± 4.4 years. It was shown that alignment and rotations worsened by postretention (P = 0.014), and a weak statistically significant correlation at posttreatment and postretention was found (0.44; P = 0.016). Both marginal ridges and occlusal contacts scored less well at posttreatment. These criteria showed a significant decrease in scores between posttreatment and postretention (P <0.001), but the correlations were not statistically significant. The average total score showed a significant decrease between posttreatment and postretention (P <0.001), partly because of the large decrease in the previous 2 criteria. CONCLUSIONS: Higher scores for occlusal contacts and marginal ridges were found at the end of treatment; however, those scores and the overall scores for the 30 subjects improved in the postretention phase.

Le Fort III distraction osteogenesis versus conventional Le Fort III osteotomy in correction of syndromic midfacial hypoplasia: a systematic review.

PURPOSE: It has been debated whether the Le Fort III procedure using distraction osteogenesis (LFIII-DO) reduces the risk of postintervention relapse compared with conventional Le Fort III (LFIII) osteotomy in the correction of syndromic midfacial hypoplasia. Our objective was to evaluate the short- and long-term stability of the bony structures after midfacial advancement using conventional LFIII osteotomy versus LFIII-DO in patients with syndromic midfacial hypoplasia. MATERIALS AND METHODS: We performed a systematic review of the published data. An electronic search of 10 databases was performed from their inception through June 2012. The reference lists of the relevant publications were also reviewed. Studies were considered for inclusion if they were longitudinal clinical studies with follow-up periods of at least 1 year after surgery (LFIII group) or at the end of the consolidation period (LFIII-DO group). Study selection, risk of bias assessment, and data extraction were performed in duplicate. The methodologic and clinical heterogeneity across the studies precluded combining the findings using meta-analyses. RESULTS: A total of 57 reports met the initial search criteria, and 12 reports were finally selected. The studies demonstrated a mean midfacial advancement of 8 to 12 mm in the LFIII group and 9 to 16 mm in the LFIII-DO group. For the LFIII group, horizontal short-term follow-up showed a maximal rate of relapse of 8.7 to 11.9% in 2 studies, with 1 study demonstrating a far more severe rate of maximal relapse of 50%. For the LFIII-DO procedure, the horizontal short-term relapse rate was 14.4% in 1 study, with the remainder demonstrating a rate of relapse of less than 10%. Moreover, 3 studies even showed additional advancement without any rate of relapse. CONCLUSIONS: Current evidence suggests that conventional LFIII and LFIII-DO techniques can effectively advance the midface forward in patients with syndromic midfacial hypoplasia and have good to excellent stability, with a mild rate of relapse. However, the LFIII-DO technique appears to achieve a greater amount of advancement with a lower rate of relapse compared with the conventional LFIII technique.

The prevalence of dental anomalies in orthodontic patients at the State University of New York at Buffalo.

OBJECTIVE: To determine the prevalence of permanent tooth anomalies in patients attending the graduate orthodontic clinic at the State University of New York at Buffalo. MATERIALS AND METHODS: Charts of 496 subjects (310 females and 186 males) met the inclusion criteria for this study. The mean ages were 16 years and 3 months for the combined gender sample that received orthodontic treatment in the graduate orthodontic clinic between 2007 and 2010. Full pretreatment records (intraoral photographs, digital study models, lateral cephalograms and panoramic radiographs) were used for the assessment. Charts were examined for these anomalies: agenesis, supernumerary, impaction and delayed tooth eruption. Subjects were categorized by gender and ethnicity. The percentages of the anomalies were assessed according to type of malocclusion, gender, race, location, tooth class and region in the dental arches. RESULTS: Sixty-four subjects (12.9%) had at least one occurrence of delayed eruption and impaction (DEI), followed by 47 subjects (9.5%) who had at least one occurrence of agenesis, and seven (1.4%) had a supernumerary condition. Approximately 80% of the subjects had no dental anomalies. The presence of more than one anomaly was observed in 61 subjects. Twelve subjects (2.4%) had both agenesis and DEI. Agenesis tended to be more common in class II malocclusions (p=0.012). CONCLUSION: The prevalence of permanent tooth anomalies was (20.4%). The percentage occurrence of DEI was the highest (12.9%) followed by dental agenesis (9.5%) and supernumerary teeth (1.4%) in the orthodontic patients at the State University of New York at Buffalo.

Patient experiences with the Forsus Fatigue Resistant Device.

OBJECTIVE: To investigate patients' experiences with the Forsus Fatigue Resistant Device (FFRD). METHODS: This was a survey focused on patient's comprehensive experience with FFRD, both initially and after several months of wear, including the patient's overall impression of the appliance. The survey was administered to 70 patients wearing FFRD in both university and private practice settings. RESULTS: A high percentage (81.5%) reported a neutral to favorable experience with FFRD; 89.8% reported growing accustomed to the appliance within 4 weeks. The majority of those who had previously worn rubber bands found FFRD to be "easier." Cheek irritation was the most serious side effect (about 50%). Cheek irritation and other negative effects generally decreased over time. CONCLUSIONS: The FFRD is relatively well accepted by patients. Most patients experience some discomfort and functional limitations; however, the effect generally diminishes with time, and patients adapt to the appliance. Practitioners should be especially vigilant about problems with cheek irritation.