Three-year stability of open-bite correction by 1-piece maxillary osteotomy.

INTRODUCTION: The purpose of this retrospective cephalometric study was to evaluate the long-term vertical stability of anterior open-bite correction by 1-piece Le Fort I osteotomy and rigid fixation. METHODS: The sample comprised 40 consecutively treated patients from the files of the Department of Orthodontics, University of Oslo, Norway. All subjects had received a 1-piece Le Fort I osteotomy as the only surgical procedure from 1990 through 1998 and were followed for 3 years according to a protocol for data collection. Lateral cephalograms were obtained before surgery and at 5 occasions after surgery. RESULTS: The mean open bite before surgery was 2.6 mm; at the 3-year follow-up, 35 patients had a positive overbite, and the remaining 5 patients had an open bite between 0.2 and 0.9 mm. Impaction of the posterior maxilla >or=2 mm relapsed on average by 31%, and inferior repositioning of the anterior maxilla >or=2 mm relapsed by 62%. Maxillary vertical skeletal changes during the postsurgery period were compensated for by orthodontic dentoalveolar adaptation. Most of the skeletal relapse occurred during the first 6 months after surgery and always in the direction opposite to the surgical movement. The relative contribution of mandibular and maxillary changes in anterior open-bite closure was approximately 3:1. CONCLUSIONS: Surgical correction of anterior open bite was generally stable over a 3-year period, and skeletal relapse was counteracted by dentoalveolar compensation.

LeFort I maxillary advancement: 3-year stability and risk factors for relapse.

INTRODUCTION: The objectives of this retrospective cephalometric study were to assess the amount, direction, and timing of postoperative changes after LeFort I maxillary advancement, and to identify risk factors for skeletal relapse. METHODS: The material was selected from the files at the Department of Orthodontics, University of Oslo, and comprised 43 patients who underwent 1-piece LeFort I advancement as the only surgical procedure from 1990 to 1998. All patients were followed for 3 years by using a strict data collection protocol. Lateral cephalograms were obtained before surgery and at 5 times after surgery. RESULTS: A mean relapse of 18% of the surgical advancement occurred. In 14% of the patients, clinically significant skeletal relapse (> or = 2 mm) was observed. Most (89%) postoperative change occurred during the first 6 months after surgery. Skeletal relapse increased significantly with degree of surgical advancement (P = .001) and degree of inferior repositioning of the anterior maxilla (P = .004) (linear regression analysis). At the end of follow-up, overjet and overbite were within clinically acceptable ranges for all patients. CONCLUSIONS: Maxillary advancement with a 1-piece LeFort I osteotomy is a relatively stable procedure. Identified risk factors for horizontal relapse were degree of surgical advancement and degree of inferior repositioning of anterior maxilla.

Towards higher standards in dental and stomatological education in Europe.

In the creation of the European Union, attention was given to portability of licensure for professionals. Considerable differences exist among countries in culture, economic conditions, and educational resources and practices. In dentistry, these differences in professional training have been addressed through a peer consultative process rather than through political and legal means. The process of visits to dental schools throughout Europe and the organizational structure (DentEd) used to conduct the visits and summarize findings are described.

European convergence towards higher standards in dental education: the DentEd Thematic Network Project.

INTRODUCTION: This paper describes a Thematic Network Project (TNP) funded by the European Union's Directorate for Education and Culture. It focused on convergence towards higher standards in dental education in the European Union and included those 'Associate Countries' seeking membership of an expanding EU. The DentEd Project sought to use peer influence in promoting convergence towards higher standards in European dental education and training. There is evidence of serious differences in standards despite the European Union's Dental Directives and the series of guidelines and recommendations of their Advisory Committee on the Training of Dental Practitioners. METHODS: The DentEd TNP sought to improve communication, better understanding of different systems and to pool intellectual resources. A central objective of the network was to promote outcome analysis and the implementation of evidence-based treatments. DentEd sought to identify and disseminate innovations and best practices in European dental schools and stomatological institutions. This was achieved by instigating 30 self-assessments of dental schools throughout Europe. Self-assessment was followed by a visit from a team of international peers. Each assessment comprised 19 sections and was placed on the DentEd web site (www.dented.org) after it was jointly approved by the visitors and host school. The 30 self-assessment reports together with the visitors comments and recommendations were then divided into their component sections and analysed. Responsibility for each section was allocated to one of 19 different international working groups of between 8 and 12 people. Preliminary analyses from these working groups were presented and debated on the DentEd interactive web site. They finalised their findings in the DentEd Report at a Plenary meeting in the Nobel Forum in the Karolinska Institute in Stockholm. The meeting was organised in such a way that each working group finalised their report. This was followed by the rotation of the working groups to listen and respond to the presentation of another group on the basis of a series interactive meetings. At the end of the meeting the original groups reassembled and revised their analysis on the basis of the additional input from the other 200 individuals involved and then finalised their group's report on the web site. These reports are available on the web site and were also published in hard copy.1 The three-year DentEd Project achieved its stated objectives. CONCLUSION: The DentEd Thematic Network Project employed a process of schools visits, plenary meetings and the use of an interactive web site to help reach consensus on innovations, best practices and significant divergence in standards in dental education in Europe. This process has proven an effective method of improving communication and of increasing the understanding of diversity in a wide range of educational methods. It also emphasised the importance of continuing quality improvement and outcome analysis of the clinical competence of graduates from European dental schools. It is important to emphasise that schools visited are likely to reflect those with an open and flexible attitude to educational reform and development and perhaps they were not representative of those schools that would benefit most from a self-assessment followed by peer review. On completion of the DentEd Thematic Network Project (TNP) the European Union's Directorate for Education and Culture approved a new three-year DentEdEvolves TNP and the consortium has recently submitted a major proposal in the EU's eLearning initiative on the basis of the success of this collaboration. This has extended to include 75% of dental schools from North America and plans for extension to South-east Asia will bring a major meeting to Singapore in April 2002.