Quality of occlusal outcome in adult class II patients after maxillary total arch distalization with interradicular mini-screws.

BACKGROUND: The aim of the investigation was to evaluate if a Class II malocclusion in adult patients can be successfully corrected by maxillary total arch distalization with interradicular mini-screws in combination with completely customized lingual appliances (CCLA). METHODS: Two patient groups were matched for age and gender to determine differences in the quality of final treatment outcome. The treatment results of 40 adult patients with a Class I malocclusion (Group 1) were compared with those of 40 adult patients with a moderate to severe Class II malocclusion (Group 2). All patients had completed treatment with a CCLA (WIN, DW Lingual Systems, Bad Essen, Germany) without overcorrection in the individual treatment plan defined by a target set-up. To compare the treatment results of the two groups, 7 measurements using the American Board of Orthodontics Model Grading System (ABO MGS) and linear measurements for anterior-posterior (AP) and vertical dimensions were assessed at the start of lingual treatment (T1), after debonding (T2B), and compared to the individual target set-up (T2A). RESULTS: A statistically significant AP correction (mean 4.5 mm, min/max 2.1/8.6, SD 1.09) was achieved in Group 2, representing 99% of the planned amount. The planned overbite correction was fully achieved in both the Class I and Class II groups. There was a statistically significant improvement in the ABO scores in both groups (Group 1: 39.4 to 17.7, Group 2: 55.8 to 17.1), with no significant difference between the two groups at T2B. 95% of the adult patients in Group 1 and 95% in Group 2 would meet the ABO standards after maxillary total arch distalization with a CCLA and interradicular mini-screws. CONCLUSIONS: CCLAs in combination with interradicular mini-screws for maxillary total arch distalization can successfully correct moderate to severe Class II malocclusions in adult patients. The quality of the final occlusal outcome is high and the amount of the sagittal correction can be predicted by the individual target set-up.

2023-2024 American Board of Orthodontics practice analysis study: Part 1.

As a specialty board, the American Board of Orthodontics (ABO) serves to protect the public and the orthodontic specialty by certifying orthodontists. The demonstration of commitment to lifelong learning and self-improvement is critical to achieving the highest level of patient care. The ABO completed a practice analysis study in 2023 to ensure all examinations represent current assessments of proficiency in orthodontics at a level of quality that satisfies professional expectations. The practice analysis is essential to providing a demonstrable relationship between the examination content and orthodontic practice and provides a critical foundation for ABO's examination programs.

The effect of maxillary first and mandibular second premolar extractions on the posterior Bolton ratio.

INTRODUCTION: The anterior and overall Bolton ratios and their application in orthodontics are widely known. However, little has been reported about the posterior Bolton ratio, how it is affected by the extraction of posterior teeth, and its application in orthodontic treatment planning. This study aimed to investigate how extracting maxillary first and mandibular second premolars affects the posterior Bolton ratio. METHODS: The sample included 55 patients with Class I occlusion within 1 standard deviation of ideal anterior and overall Bolton ratios. The digitized models were subjected to virtual extraction of maxillary first premolars and mandibular second premolars and setup of posterior teeth in ideal occlusion. If space closure compromised occlusion, the teeth were moved to achieve ideal cusp-fossa or cusp-marginal ridge occlusion. The ideal setups were measured for residual interproximal spacing. Statistical analysis used R statistical software (version 2018; R Core Team, Vienna, Austria). RESULTS: The ideal nonextraction posterior Bolton ratio was determined from the sample to be 105.77 ± 1.99%. The ideal expected posterior Bolton ratio for maxillary first and mandibular second premolar extraction patients was 106.52 ± 2.52%. This significantly differed from the expected posterior Bolton ratio for the 4 first premolar extractions. Patients finished with an average of 1.28 mm net residual spacing between mandibular first premolars and first molars; 38.2% of patients finished with at least 1.5 mm of residual space, and 9.1% of patients finished with at least 2 mm of residual space. CONCLUSIONS: A patient with ideal anterior, posterior, and overall Bolton ratios treated with maxillary first and mandibular second premolar extractions to ideal occlusion will likely finish with some spacing in the mandibular dentition.

The effect of 4 first premolar extractions on the posterior Bolton ratio.

INTRODUCTION: Overall and anterior Bolton ratios have been well covered in the orthodontic literature; however, little has been reported on posterior Bolton ratios. Considering the frequency of premolar extractions in the specialty, it would be relevant to know how the posterior occlusion is affected by premolar extractions. This study aimed to investigate how the posterior Bolton ratio is affected by the extraction of the 4 first premolars. METHODS: Fifty-five patients with Class I occlusion within 1 standard deviation of ideal anterior and overall Bolton ratios models were selected and digitized. Tooth widths were measured. Virtual extractions of 4 first premolars were performed, and a digital setup of anterior and remaining posterior teeth observing ideal occlusion relationships was executed. When space closure compromised the occlusion, preference was given to the latter. Residual interproximal spacing was digitally measured on the setups. Analysis of variance and linear regression tests were used to identify factors contributing to interproximal spacing. RESULTS: An average of 1.1 mm of net residual spacing between mandibular second premolars and first molars was observed. In 27% of the sample, at least 1.5 mm of residual space was found. In addition, 16% showed at least 2 mm of residual space. The ratio of the maxillary second premolars to the mandibular second premolars and the width of the maxillary second premolars best explain residual space (r = 0.554; r2 = 0.307). A regression equation for predicting residual space is offered. CONCLUSIONS: Ideal anterior, posterior, and overall Bolton ratios treated with extraction of 4 first premolars and ideal occlusion will likely finish with some spacing in the mandible.

Class II malocclusion correction with Invisalign: Is it possible?

INTRODUCTION: This research aimed to determine whether Class II malocclusion can be treated with clear aligners after completing treatment with the initial set of aligners. METHODS: A sample of 80 adult patients were divided into Group 1 with Class I molar malocclusions (n = 40 [11 men and 29 women]; 38.70 ± 15.90 years) and Group 2 with Class II molar malocclusions (n = 40 [11 men and 29 women]; 35.25 ± 15.21 years). All patients had finished treatment with the initial set of Invisalign aligners (Align Technology, Santa Jose, Calif) without known centric occlusion-centric relation discrepancies, issues of compliance, or overcorrection. The 7 measurements using the American Board of Orthodontics (ABO) Model Grading System and millimetric measurements for anteroposterior (AP) and vertical dimensions were assessed and compared between the 2 groups at pretreatment, posttreatment ClinCheck (Align Technology) prediction, and posttreatment. RESULTS: No improvements were observed in the AP correction. The amount of AP correction in patients with Class II malocclusion was 6.8% of the predicted amount. The amount of overbite correction achieved was 28.8% and 38.9% of the predicted amounts in patients with Class I and Class II malocclusion, respectively. Significant improvements in alignment and interproximal contact scores were observed, with only slight improvements in total ABO scores. An increase in mean occlusal contacts score was observed after treatment. No patient with Class II malocclusions would meet the ABO standards after Invisalign treatment. CONCLUSIONS: The Invisalign system successfully achieves certain tooth movements but fails to achieve other movements predictably. No significant Class II correction or overjet reduction was observed with elastics for an average of 7-month duration in the adult population. Additional refinements may be necessary to address problems created during treatment, as evidenced by a posterior open bite incidence.

American Board of Orthodontics: Progress of the scenario-based clinical examination.

In 2017, the directors of the American Board of Orthodontics (ABO) decided to move forward with a new clinical examination format-a scenario-based examination. The first examination of this type was administered in February 2019, and 2 more exams have been given since then. Each examination consisted of at least 6 scenarios with 4-7 questions for each scenario. Questions came from 4 domains or categories-data gathering and diagnosis, treatment objectives and planning, treatment implementation and management, and critical analysis and outcomes assessment. As of today, 49% of members of the American Association of Orthodontists are ABO certified. For more information about the scenario-based examination and ABO certification or certification renewal processes, go to AmericanBoardOrtho.com.

American Board of Orthodontics: Update on the new scenario-based clinical examination.

The American Board of Orthodontics has updated its clinical examination process to remove barriers to the case-based examination, strengthen the specialty, and further distinguish board-certified orthodontists from other dental practitioners providing orthodontic care. The ABO adopted a scenario-based clinical examination and discontinued case requirements. The first new exam was administered in February 2019. It consisted of 6 scenarios with 4-7 questions for each scenario. The scenarios represent a variety of problems and patients, and the questions relate to data gathering and diagnosis, treatment objectives and planning, treatment implementation and management, and critical analysis and outcomes assessment. Feedback from the February 2019 exam was positive, and 4 more have been scheduled. For more information about the ABO certification process, go to AmericanBoardOrtho.com.

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.

Common errors observed at the American Board of Orthodontics clinical examination.

The American Board of Orthodontics has developed tools to help examinees select patients to be used for the Board examination. The Case Management Form can be used to evaluate aspects of a patient's treatment that cannot be measured by other tools. The Case Management Form is a structured treatment-neutral assessment of orthodontic objectives and outcomes associated with a patient's treatment. Despite the availability of this form, examiners continue to see problems, including lack of attention to finishing details, inappropriate treatment objectives, excessive proclination of mandibular incisors due to treatment mechanics, excessive expansion of mandibular intercanine width, closing skeletal open bite with extrusion of anterior teeth leading to excessive gingival display, and failure to recognize the importance of controlling the eruption or extrusion of molars during treatment. In addition, some examinees exhibit a lack of understanding of proper cephalometric tracing and superimposition techniques, which lead to improper interpretation of cephalometric data and treatment outcomes.