Orthodontic apps: An assessment of content accuracy and validity.

OBJECTIVE: To assess the content accuracy of orthodontic treatment information in patient-focused apps. DESIGN: A cross-sectional review study. SETTING: Orthodontic apps available on the UK Android and Apple App Stores. METHODS: Apps identified in a previous research study and those identified via a questionnaire of specialist orthodontists were assessed for accuracy of content utilising an evidence-based checklist. The checklist covered five main orthodontically relevant themes and 32 codes with respective items. RESULTS: The accuracy of information content for 16 patient-focused apps was assessed. Eight apps provided information related to orthodontic treatment and handling emergencies. Five apps were reminder apps and a small number (n = 3) contained games and timers for toothbrushing and aligners. With regard to the accuracy of information content, only two apps contained information across all five themes of the evidence-based checklist. Only one app received a score of 'fair - excellent' under the oral hygiene theme; interestingly, this app was the most commonly used patient-focused app. Eight apps containing orthodontic treatment information scored poorly as they had inaccurate information on handling emergency situations. None of the apps were deemed excellent with regard to accuracy of information content. CONCLUSION: The orthodontic mobile apps assessed in this study mostly contained information of poor accuracy. Therefore, there is a need for high-quality apps with credible information supported by evidence to be developed.

The awareness and usage of orthodontic apps and social media by orthodontists in the UK: A questionnaire-based study.

OBJECTIVE: To assess the awareness and usage of mobile apps and social media among orthodontic clinicians to support patients with orthodontic treatment, support the professional development of orthodontists, and identify any relevant apps and social media platforms currently recommended to patients. DESIGN: Cross-sectional questionnaire-based study. SETTING: United Kingdom. METHODS: A questionnaire was developed and distributed to members of the British Orthodontic Society (BOS). To increase the response rate, the questionnaire was circulated at three time points between January and March 2020. RESULTS: A total of 149 orthodontists responded to the questionnaire (15% response rate) with 113 orthodontists completing all questions (11.4%). Of those who answered, 81% (n = 111) had been qualified for >10 years, 35% worked in practice (n = 48), 34% worked in a hospital (n = 47) and 26% worked in both hospital and practice (n = 36). The results indicated that 20% of clinicians (n = 22) used apps to support patients and 33% (n = 37) reported using apps for professional purposes. Brush DJ appeared to be the most popular patient focused app (39%, n = 18) whereas the IOTN (17%, n = 8), Invisalign (17%, n = 8) and Dental Monitoring apps (9%, n = 4) were the most popular clinician-focused apps. With regard to social media, 53% (n = 60) of respondents reported that they used social media to communicate generic orthodontic information and promote their practice to patients. The most commonly used social media platforms were Facebook and Instagram. Of respondents, 96% expressed a willingness to recommend an evidence-based mobile app to patients if available, and 88% were willing to recommend an evidence-based social media platform. CONCLUSIONS: Orthodontic clinicians are utilising mobile apps and social media to support both patients and their own professional development. There is a willingness to increase the use of evidence-based platforms and apps to support patients.

Social media and orthodontics: Are our patients scrolling?

OBJECTIVE: To assess patients' awareness of the availability of information related to orthodontics on social media, and to explore patients' willingness to engage with social media to aid with orthodontic treatment. DESIGN: Prospective cross-sectional survey. SETTING: This survey was conducted at Croydon University Hospital orthodontic department. PARTICIPANTS: A total of 125 orthodontic patients, both new and in treatment. There were no exclusion criteria. METHODS: All participants completed a questionnaire designed to explore their awareness, access to and utilisation of social media as well as their willingness to engage with social media to support orthodontic treatment. There were no age restrictions or exclusion criteria. RESULTS: Of the patients, 99% had access to social media. Of these patients, 64% were aware that social media platforms were available to help with orthodontic treatment, 30% had utilised social media related to orthodontics, with the most popular platforms being Instagram (n = 17) and Snapchat (n = 12). Of the patients, 73% stated that they would be willing to use social media in the future to support orthodontic treatment. CONCLUSION: Social media can be engaging, accessible and versatile, and has been shown to be effective at improving patients' knowledge regarding orthodontic treatment. As such, it may be used as a valuable tool for information provision to engage orthodontic patients. Awareness of the availability of orthodontics content on social media is increasing; however, only one-third of participants had previously used it to aid with orthodontic treatment. Given the availability of information on social media targeted at orthodontic patients there is a need to assess the quality of this information and if appropriate navigate patients towards high-quality, effective resources.

Gender incongruence/dysphoria in children and adolescents: overview and implications for dentistry.

Introduction Over the past 10 to 15 years, there has been growing recognition that the traditional spectrum of gender-defined dichotomised roles does not necessarily, or accurately, fit within a certain subsection of the population. A condition associated with gender incongruity that dental practitioners must be aware of is gender dysphoria.Aims Our role as dental and oral healthcare professionals necessitates us to provide safe and effective dental healthcare to all members of the population; as such, it is essential for dental healthcare professionals to undertake appropriate professional development to increase their knowledge of gender dysphoria.Overview of gender dysphoria While gender incongruity is not considered a disorder on its own merit, when it is associated with significant distress or disability, the term 'gender dysphoria' is applied. The aetiological factors that underpin gender dysphoria are still yet to be fully understood; however, it is generally accepted that it arises from a combination of biological and psychosocial factors. In the UK, all paediatric and adolescent gender incongruence referrals are managed by specialist clinicians working within multidisciplinary clinics.Implications for dentistry Our focus in this paper is to highlight and aid the dental team in the management of patients with gender dysphoria alongside providing clinical tips in the clinical management of these patients by dental clinicians.Conclusion It is important that dental healthcare professionals familiarise themselves with the aetiology, diagnosis and treatment pathway of this important subset of the population.

Assessing the Effectiveness and Acceptability of a Personalized Mobile Phone App in Improving Adherence to Oral Hygiene Advice in Orthodontic Patients: Protocol for a Feasibility Study and a Randomized Controlled Trial.

BACKGROUND: Orthodontic treatment is a common health care intervention; treatment duration can be lengthy (2-3 years on average), and adherence to treatment advice is therefore essential for successful outcomes. It has been reported that up to 43% of patients fail to complete treatment, and there are currently no useful predictors of noncompletion. Given that the National Health Service England annual expenditure on primary-care orthodontic treatment is in excess of £200 million (US $267 million), noncompletion of treatment represents a significant inefficient use of public resources. Improving adherence to treatment is therefore essential. This necessitates behavior change, and interventions that improve adherence and are designed to elicit behavioral change must address an individual's capability, opportunity, and motivation. Mobile phones are potentially an invaluable tool in this regard, as they are readily available and can be used in a number of ways to address an individual's capability, opportunity, and motivation. OBJECTIVE: This study will assess the effectiveness and acceptability of a personalized mobile phone app in improving adherence to orthodontic treatment advice by way of a randomized controlled trial. METHODS: This study will be conducted in 2 phases at the Eastman Dental Hospital, University College London Hospitals Foundation Trust. Phase 1 is feasibility testing of the My Braces app. Participants will be asked to complete the user version of the Mobile Application Rating Scale. The app will be amended following analysis of the responses, if appropriate. Phase 2 is a randomized controlled trial to test the effectiveness and acceptability of the My Braces app. RESULTS: This study was approved by the London - Bloomsbury Research Ethics Committee on November 5, 2019 (reference 19/LO/1555). No patients have been recruited to date. The anticipated start date for recruitment to phase 1 is October 2020. CONCLUSIONS: Given the availability, affordability, and versatility of mobile phones, it is proposed that they will aid in improving adherence to treatment advice and hence improve treatment completion rates. If effective, the applicability of this methodology to developing behavior change/modification interventions and improving adherence to treatment across health care provides an exciting opportunity. TRIAL REGISTRATION: ClinicalTrials.gov NCT04184739; https://clinicaltrials.gov/ct2/show/NCT04184739. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/18021.

Maxillary sinus osteoma: A case report and literature review.

This case report describes a rare presentation of an osteoma in the maxillary sinus picked up from an incidental finding on an orthopantomogram that was obtained to inform orthodontic treatment. While orthodontists principally use this radiograph to assess the developing dentition, aid treatment planning and monitor treatment, several peripheral anatomical sites are evident on this radiograph. We review the literature in relation to osteomas presenting in the craniofacial area along with its management. We provide examples of common radiopaque lesions along with their radiographic features that dental healthcare clinicians may encounter.

The availability and characteristics of patient-focused YouTube videos related to oral hygiene instruction.

Introduction YouTube is a popular social media platform that is being increasingly used for the distribution of healthcare-related information. To date, there appear to be no published studies assessing the quality of oral hygiene instruction provided by YouTube videos.Objective To assess the availability, quality and accuracy of patient-focused YouTube videos aiming to provide oral hygiene instruction.Method YouTube videos meeting the inclusion criteria were evaluated for quality and information accuracy using an eight-item, evidence-based checklist relating to important aspects in the prevention of caries and periodontal disease.Results Fifty-two relevant videos were included; 20 videos (38.5%) were produced by lay people (social media influencers and bloggers) who had no professional qualifications. None of the included videos contained accurate information relating to all eight items of the evidence-based checklist. Seven videos contained none of the information from the checklist. Numerous videos contained health advice which was not scientifically sound.Conclusion The results of this study highlight that currently available YouTube videos may not contain evidence-based information relating to oral hygiene instruction. There are also concerns regarding the lack of regulation and quality assurance processes in the development of healthcare-related YouTube videos. Currently, clinicians should be cautious when advising patients to utilise YouTube as a source of information regarding oral health.

A theory-based intervention delivered by an online social media platform to promote oral health among Iranian adolescents: a cluster randomized controlled trial.

Objective: Based on the Health Action Process Approach, we tested the efficacy of a theory-based program using an online social media platform (Telegram) to promote good oral hygiene behaviour among Iranian adolescents.Design: A three-arm randomized-controlled trial design was used, consisting of an adolescent only intervention group (A group; n = 253), an adolescent and mother intervention group (A + M group; n = 260), and a control group (n = 278).Main outcome measures: Psychosocial variables, toothbrushing behaviour, Visual Plaque Index, and Community Periodontal Index.Results: Increases in adolescent toothbrushing at the one- and six-month follow-ups in both intervention groups compared to the control group were observed. Adolescents in the A + M group showed significant greater improvements in their toothbrushing behaviour, Visual Plaque Index, and Community Periodontal Index scores than adolescents in the A group. Improvements to toothbrushing social cognitions were also observed.Conclusions: Current results support the use of the theory-based program delivered by Telegram in improving good oral hygiene behaviour and oral health outcomes among Iranian adolescents. Involving mothers in an intervention can confer additional benefits for adolescent oral health.

Patient focused oral hygiene apps: an assessment of quality (using MARS) and knowledge content.

Introduction Smartphone apps can be a valuable means for education and prevention to improve the health of children, adolescents and adults. A recent review of apps has revealed that there are over 1,000 patient-focused oral hygiene apps available on the Apple App Store and Google Play (Android) store.Objective The purpose of this research is to objectively assess the quality of 20 commercially available, patient-focused oral hygiene apps using the Mobile App Rating Scale (MARS). Furthermore, the accuracy of oral hygiene-related information contained within the apps will be assessed.Methods Apps meeting inclusion criteria were evaluated for: 1) quality using the MARS tool; and 2) information accuracy using an eight-item, evidence-based checklist relating to important aspects in the prevention of caries and periodontal disease.Results The mean app quality score was 3.4/5 (2.3-4.9). On average, of the four MARS subscales assessed, 'functionality' had the highest mean score (4) and 'information' had the lowest (2.9). With regard to the accuracy of information contained within these apps, only two were found to contain accurate information for all eight items of the checklist. The majority (60%) of the apps (n = 13) did not contain information relating to at least 50% or more of the items present.Conclusions Currently available apps appear to be functional, however, there is a need to improve engagement, aesthetics and most importantly information content of apps.

A systematic review to assess interventions delivered by mobile phones in improving adherence to oral hygiene advice for children and adolescents.

Background Mobile phones are potentially an invaluable tool in addressing the global challenge associated with dental caries as they may elicit behaviour change by incorporating numerous behaviour change techniques (BCTs) to address an individual's capability, opportunity and motivation.Methods The methodology for this review is published on the PROSPERO database (CRD42017078414).Results Two randomised controlled trials were included, both were undertaken with orthodontic patients and both reported significantly reduced plaque scores in the intervention group compared with the control at final follow-up. One study also reported statistically significantly lower gingival bleeding scores and caries in the intervention group at final follow-up. The risk of bias was 'unclear' for both studies and neither study intervention appeared to be based on specific theories of behaviour change. Of 93 BCTs available, only six were utilised across the two trials. The overall strength of evidence for the effectiveness of mobile phones in reducing plaque score was rated as moderate using GRADE, while the effectiveness in reducing bleeding scores was considered to be high.Conclusion There is some evidence that mobile phones are effective in improving adherence to oral hygiene advice in orthodontic patients. The generalisability of this review is limited due to the small number of trials and the unclear risk of bias of included studies.

Availability of orthodontic smartphone apps.

OBJECTIVE: To identify and profile the available orthodontic smartphone apps published on the UK Apple App Store and Google Play Store. DESIGN: A review of available smartphone apps. SETTING: London, UK. METHODS: The Apple App Store and Google Play Store were accessed in October 2018; all orthodontic apps with a title and description available in English were included. Each app was classified according to the following criteria: name; target audience (patient or clinician); focus; platform (Apple App Store and/or Google Play Store); cost; rating and number of ratings; size; creation date; country of development and developer. RESULTS: A total of 305 orthodontic related apps were identified for inclusion. The majority of apps were aimed at patients (n = 241) and the most of these were focussed on gaming (n = 136), many apps were also found to be developed by specialist practices (n = 63) and to provide knowledge for patients (n = 56). Two hundred and ninety-five apps were free, with some of these including the option of paying for in-app purchases. Most apps were developed in the USA (n = 84). CONCLUSIONS: There has been an increase in the availability of orthodontic apps in recent years. The majority of available apps are patient-focused, most commonly games. A number of apps aim to elicit a behaviour change in our patients; therefore, there is a need to assess the quality and educational content of these.

Patient awareness of orthodontic mobile phone apps.

INTRODUCTION: Mobile phone applications (apps) can be engaging, accessible, versatile and have the potential to improve patient care. In 2017, 354 orthodontic apps were reported to be available, many of them targeted at patients; however, the awareness and usage of apps among orthodontic patients was unreported. AIM: The primary aim of this study was to assess patients' current awareness of orthodontic apps. METHODS: One hundred orthodontic patients (50 new and 50 in treatment) completed a questionnaire designed to explore their awareness, access to and utilisation of orthodontic apps and social media to support orthodontic treatment. Furthermore, their willingness to engage with and use an app to aid with orthodontic treatment was explored. There were no age restrictions or exclusion criteria. RESULTS: Ninety percent of patients had access to a smartphone, of which 73% belonged to them (rather than a parent/relative). Apple was the most popular platform (56%) followed by Android (26%). Only 7% of patients were aware that apps were available to help with orthodontic treatment and no patients had previously used an app related to orthodontics. However, 87% of patients stated that they would be willing to use an app to support treatment. Twenty-one percent of patients had previously looked up information on social media, with YouTube being the most popular platform. CONCLUSION: Current awareness of the availability of apps is poor, despite the finding that 87% of patients reported they would be willing to use an app to aid with orthodontic treatment. Given the availability of apps targeted at orthodontic patients, there is a need to assess the quality of these apps and, if appropriate, navigate patients towards high-quality, effective apps.

The availability and characteristics of patient-focused oral hygiene apps.

Introduction The use of apps has increased in recent years, especially in healthcare. Due to apps being largely unregulated, the quality and accuracy of the information provided can be variable.Aim To assess the availability of patient-focused oral hygiene apps and profile the characteristics of the most popular apps on Apple's 'App Store' and, on Android, 'Google Play'.Method Oral hygiene-related search terms were used to identify apps on these platforms. Detailed information for the 20 most popular apps for each search term was recorded.Results In total, 1,075 apps were identified with fewer apps available on the App Store than on Google Play. The 20 most popular apps for each search term focused on providing oral hygiene information, were free of charge and were developed after 2015. No apps contained information regarding whether they were approved by official organisations and if effectiveness or acceptability testing had been conducted. App ratings were variable and unrelated to the quality and accuracy of the information.Conclusion Due to a lack of professional regulation, there is a risk that patients may access inaccurate information via apps. Therefore, evaluation, validation, and quality assessment of healthcare apps is needed before recommending these to patients.

A systematic review of outcome measures used in clinical trials of treatment interventions following traumatic dental injuries.

BACKGROUND: Traumatic dental injuries (TDI) are common, and appropriate treatment will maximize the chances of maintaining teeth in function while safeguarding their longevity and aesthetics. Subjectively, it appears that outcome measures used in studies investigating TDI are numerous and diverse. OBJECTIVES: To undertake a systematic review of the outcomes used in clinical trials of treatment interventions following TDI. DATA SOURCES: The MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and EMBASE databases were searched up to June 2014. Reference lists of eligible studies were cross-checked to identify additional studies and strategies to identify grey literature and ongoing trials were employed. STUDY SELECTION: Two authors independently assessed studies for inclusion and undertook data extraction. The study designs included were as follows: systematic reviews with/without meta-analyses, randomized and pseudo-randomized controlled trials and controlled clinical trials. There were no language restrictions. RESULTS: Ten studies confined to two types of TDI were included: avulsion (5) and non-vital immature permanent incisor teeth (5). The outcomes reported predominantly concentrated on injury activity and the physical consequence of injury. There was little consistency between studies for the length of follow up, the time points at which outcomes were evaluated or the methods used to measure them. CONCLUSIONS: There is significant heterogeneity in outcomes reported for TDI in the literature. These findings preclude meaningful meta-analysis between studies. Future clinical studies need to consider collecting a more consistent and wider range of outcomes, which should include one or more from each of the following domains: health resources utilisation, adverse effects and quality of life and family outcome. There is a clear need for the development of a Core Outcome Set for TDI using robust and established methodology, thus optimizing the value of future research.

Lingual Orthodontics: The future?

The increase in demand for adult orthodontics has been mirrored by an increased availability and demand of cosmetic appliances. This article focuses on one type of cosmetic appliance--the lingual appliance. Factors to consider in case selection as well as the advantages and disadvantages of lingual appliances are discussed. This paper also outlines the sequence of treatment using these appliances by way of two treated cases.

MOMENT--Management of Otitis Media with Effusion in Cleft Palate: protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey.

BACKGROUND: Cleft palate (CP) has an incidence of approximately 1 in 700. Children with CP are also susceptible to otitis media with effusion (OME), with approximately 90% experiencing nontrivial OME. There are several approaches to the management of OME in children with CP. The Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) study is a feasibility study that includes the development of a core outcome set for use in future trials of the management of OME in children with CP. METHODS/DESIGN: The MOMENT study will include a systematic review of the literature to identify a list of outcomes that have previously been reported. This list of outcomes will be used in a Delphi study with cleft clinicians. The Delphi study is anticipated to include three rounds. The first round will ask clinicians to score the outcome list and to add any outcomes they think are relevant. The second round involves presentation of scores according to stakeholder group and the opportunity for participants to rescore outcomes. To ensure that the opinion of parents and children are sought, qualitative interviews will be completed with a purposive sample in parallel. In the final round of the Delphi process, participants will be shown the distribution of scores, for each outcome, for all stakeholder groups separately as well as a summary of the results concerning outcomes from the qualitative interviews with parents. A final consensus meeting will be held with all stakeholders, including parents and children, to review outcomes. DISCUSSION: A core outcome set represents the minimum that should be measured in a clinical trial for a particular condition. The MOMENT study will aim to identify a core outcome set that can be used in future trials of the management of OME, improving the consistency of research in this clinical area.

The perspectives of children and young people living with cleft lip and palate: a review of qualitative literature.

Objective : To explore the experiences of children and young people with cleft lip and/or palate (CL/P) in relation to being treated for and living with this condition. Design : A systematic review of qualitative research. Electronic databases and hand-searching were employed to identify relevant studies. The review centered on studies examining the views or experiences of young patients first-hand. Any study using a qualitative/mixed method design was eligible for inclusion. Results : From 184 potential references, 38 papers were read in full, from which only two studies of young people met all the review's inclusion criteria. Common reasons for exclusion were not being a qualitative study, not focusing on CL/P, or data coming from parents only. A further two papers provided a retrospective account of childhood with CL/P from interviews with adults. Their suitability for the review's aims was limited, but they were discussed. Conclusions : This review demonstrates that there is a paucity of evidence about the experiences of young people living with CL/P. No studies of children and only two studies of young people met all inclusion criteria. Identified papers implied that more attention is needed within families and services to help young people manage everyday difficulties such as bullying and self-consciousness due to facial difference.

An AMSTAR assessment of the methodological quality of systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS).

BACKGROUND: Systematic reviews are not an assembly of anecdotes but a distillation of current best available evidence on a particular topic and as such have an important role to play in evidence-based healthcare. A substantial proportion of these systematic reviews focus on interventions, and are able to provide clinicians with the opportunity to understand and translate the best available evidence on the effects of these healthcare interventions into clinical practice. The importance of systematic reviews in summarising and identifying the gaps in evidence which might inform new research initiatives is also widely acknowledged. Their potential impact on practice and research makes their methodological quality especially important as it may directly influence their utility for clinicians, patients and policy makers. The objectives of this study were to identify systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS) and to evaluate their methodological quality using the evaluation tool, AMSTAR. METHODS: Potentially eligible systematic reviews in JAOS were identified through an electronic search of the Scientific Electronic Library Online (SciELO). Details of the relevant aspects of methodology as reported in these systematic reviews were extracted from the full text publications. Methodological quality was assessed independently by two reviewers using the AMSTAR questionnaire. RESULTS: Five systematic reviews were identified, one of which was subsequently excluded as it was a review of a diagnostic test. Summary AMSTAR scores for the four included reviews were: 1, 5, 2 and 4 out of a maximum score of 11 (range 1-5, mean 3) with only one of the reviews scoring 5. CONCLUSION: AMSTAR evaluation of the methodological quality of the relatively small number of systematic reviews published in JAOS illustrated that there was room for improvement. Pre-publication and editorial appraisal of future systematic reviews might benefit from the application of tools such as AMSTAR and is to be recommended.

An AMSTAR assessment of the methodological quality of systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS)

BACKGROUND: Systematic reviews are not an assembly of anecdotes but a distillation of current best available evidence on a particular topic and as such have an important role to play in evidence-based healthcare. A substantial proportion of these systematic reviews focus on interventions, and are able to provide clinicians with the opportunity to understand and translate the best available evidence on the effects of these healthcare interventions into clinical practice. The importance of systematic reviews in summarising and identifying the gaps in evidence which might inform new research initiatives is also widely acknowledged. Their potential impact on practice and research makes their methodological quality especially important as it may directly infuence their utility for clinicians, patients and policy makers. The objectives of this study were to identify systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS) and to evaluate their methodological quality using the evaluation tool, AMSTAR. METHODS: Potentially eligible systematic reviews in JAOS were identifed through an electronic search of the Scientific Electronic Library Online (SciELO). Details of the relevant aspects of methodology as reported in these systematic reviews were extracted from the full text publications. Methodological quality was assessed independently by two reviewers using the AMSTAR questionnaire. RESULTS: Five systematic reviews were identifed, one of which was subsequently excluded as it was a review of a diagnostic test. Summary AMSTAR scores for the four included reviews were: 1, 5, 2 and 4 out of a maximum score of 11 (range 1-5, mean 3) with only one of the reviews scoring 5. CONCLUSION: AMSTAR evaluation of the methodological quality of the relatively small number of systematic reviews published in JAOS illustrated that there was room for improvement. Pre-publication and editorial appraisal of future systematic reviews might beneft from the application of tools such as AMSTAR and is to be recommended.

Suturing: an update for the general dental practitioner.

UNLABELLED: Sutures are routinely used to achieve haemostasis and to approximate soft tissues after extractions, periodontal procedures, implant surgery and soft tissue biopsies. This paper provides the general dental practitioner with the knowledge and understanding of sutures to select the most appropriate for use. Common suturing techniques are also discussed. CLINICAL RELEVANCE: Suturing is an important aspect of dental practice, the selection of an appropriate suture and technique is integral to obtaining an optimal outcome.