Autotransplantation of premolars to replace maxillary incisors: a comparison with natural incisors.

The published literature contains no comprehensive studies that compare the outcome of premolar autotransplantation to the maxillary anterior region with natural incisors in the same patients. This article describes the gingival and periodontal conditions around premolars transplanted to the maxillary incisor region, subsequent to restoration. Forty-five premolars autotransplanted to the maxillary incisor region in 40 adolescent patients were evaluated after a mean observation period of 4.0 years. Mean age at surgery was 11.0 years. Established clinical criteria were used to assess tooth mobility, plaque and gingival indexes, probing pocket depth, and percussion. Recession and hyperplasia of interproximal gingival papillae were assessed according to a recently proposed index. Standardized radiography was used to evaluate presence of pathosis, pulp obliteration, root length, and crown-root ratios. Clinical variables for transplants did not differ from those of the natural incisors, except for increased mobility and more plaque in a few transplanted premolars. The interproximal gingival papillae adjacent to all transplanted teeth were normal or slightly hyperplastic. Radiographically, all transplants showed varying degrees of pulp obliteration, but no signs of pathosis. Crown-root ratios were similar for natural and transplanted teeth as were distances from cementoenamel junction to marginal bone. The overall status of the transplanted premolars and surrounding tissues indicated that this treatment modality may be recommended when maxillary incisors are missing in adolescents. In addition, tooth transplantation represents an inherent potential for bone induction and reestablishment of a normal alveolar process.

Outcome of a scheme for specialist orthodontic care.

With the purpose of examining the outcome of specialist orthodontic care on a population level (Halland, Sweden), a random sample of previously treated 19-year-olds (n=118) was clinically examined and interviewed. Thirty-three per cent of the cohort (n=1554) had received treatment, and mean treatment time was 19 months requiring 20 visits. Changes in occlusion were assessed using the PAR Index applied to dental study casts representing the pre- and post-treatment and follow-up (19 years) condition. The subjects' responses to questions addressing their past and present attitudes to dental appearance and orthodontic treatment were combined to represent "orthodontic concern", at the pre-treatment stage and at 19 years of age. A mean reduction in weighted PAR scores of 83% was observed from pre-treatment to post-treatment, whereas at follow-up, the net improvement was 69%. A significant shift in attitudes was observed, as 72% of the individuals expressed orthodontic concern pre-treatment compared to less than 10% at 19 years. The improvement obtained was similar to other studies on outcome of orthodontic treatment provided by specialist orthodontists. Compared to most PAR-studies providing information about orthodontic services, the present scheme appeared to be efficient on the assumption that duration of treatment and number of visits are expressions of costs.

Outcome of a scheme for orthodontic care: a comparison of untreated and treated 19-year-olds.

The organization of the orthodontic service within the Public Dental Health Service in the southern part of the county of Halland, Sweden is described, and data for the provision of treatment are presented. The aim of this study was to examine the outcome of this service by studying the prevalence of malocclusion and residual need, as well as attitudes to treatment in previously treated and untreated individuals. Three samples of 19-year-olds were established: patients treated by specialists (n=132), patients treated by general practitioners (GP) (n=132), and untreated individuals (n=492). All samples were examined clinically, and radiographs, photographs, and study casts were obtained from the two treated groups. Attitudes to own teeth and orthodontic treatment were recorded by use of questionnaires. Deviant occlusal traits were recorded, and all the individuals were categorised according to a treatment need index. Generally, good occlusal conditions were observed in all samples. More deviant traits were observed in individuals that had been treated by GPs, and significant differences were observed for overjet, overbite, and crowding compared to the other samples. The majority of individuals belonged to the little/no treatment need index categories. Of those treated by GPs, one third belonged to the moderate (22%) or urgent (11%) need categories. About 10% reported dissatisfaction with their dental appearance, but only 2% expressed a desire for (further) orthodontic treatment.

Residual need in orthodontically untreated 16-20-year-olds from areas with different treatment rates.

Knowledge concerning residual orthodontic need among individuals who have passed the age at which orthodontic treatment is normally provided, is important in the discussion of guidelines for the provision of care. The purpose of the present study was to examine and compare orthodontic need (objective and subjective) in cohorts of orthodontically untreated individuals from areas with various treatment rates. A total of 250 individuals, aged 16-20 years, comprised four samples representing cohorts from areas in Norway with low, medium, and high treatment rates. The occlusion was assessed according to a treatment need index (NOTI) from clinical and radiographic records, and dental cast measurements. Attitudes were assessed from questionnaires addressing satisfaction with dental arrangement, desire for treatment, and value placed upon well-aligned teeth. A significant decrease in occurrence of normative need (P < 0.001) and reported dissatisfaction (P < 0.05) was observed in samples representing increasing treatment rates. Dissatisfaction was completely eliminated among individuals from the high treatment rate area. Although a significant association between severity of malocclusion and desire for treatment existed within samples, this was not reflected in a corresponding trend for a decrease in desire across the samples. Well-aligned teeth seemed to be taken for granted among individuals from the area with a high treatment rate. From the present observations, a 'correct' level of treatment provision could not be identified.

The provision and outcome of orthodontic services in a Norwegian community: a longitudinal cohort study.

In a systematic child dental care system, professionals, consumers, and purchasers have a common interest in ensuring that provision and outcome of orthodontic care fulfill the goals of the service and the public's expectations. The purpose of this prospective study was to examine whether treatment was in fact provided to children with a normative treatment need, and also to assess the outcome of treatment. The baseline data were established for a sample of 83 11-year-olds before decisions about orthodontic treatment had been made, by recording the individuals' orthodontic concern as reported in questionnaires and their occlusal condition according to an index of orthodontic treatment need (NOTI). At re-examination at the age of 16 years, it was also recorded whether the individual had received orthodontic treatment. Most individuals (83%) with a normative need had been treated as well as some individuals without need but who had expressed orthodontic concern. Treatment had resulted in occlusal improvement ('health gain') in most patients, and generally this improvement paralleled a decrease in concern. The goals of the orthodontic service seem to have been fulfilled to the extent that residual treatment need was infrequent. The high treatment rate (63%) and standard may explain why all individuals, both treated and untreated, expressed satisfaction with their dental appearance at 16 years of age.

Patient-centered evaluation of orthodontic care: a longitudinal cohort study of children's and parents' attitudes.

As health services are adapted to meet consumers' needs, patient-centered evaluation of quality of care as well as informed consent to treatment decisions become increasingly important concepts in orthodontics. In an attempt to assess the orthodontic service in a region, this study focused on attitudes among children and their parents. The attitudes were recorded both before and after the period in which orthodontic treatment is usually carried out. Changes in children's and parents' attitudes were applied to measure outcome of care, and to evaluate the relevance of informed consent in decisions about treatment. Seventy-nine family units were interviewed with the use of questionnaires when the child was 11 years of age and again at 16 years. Both orthodontically treated and untreated subjects were included. Responses to questions about satisfaction with dental appearance and desire for treatment were transformed to a score for orthodontic concern. A significant decrease in the concern score was observed over the 5-year period among the treated subjects, and the care system apparently identified and provided treatment to the majority of those children concerned at 11 years. Intra-unit disagreement in concern was observed among 25% of the child/parent units at the 11-year stage, whereas at 16 years nearly all units agreed. Informed consent as a tool to ensure patients' autonomy when decisions about treatment are made did not appear to be negatively affected by conflicting attitudes between children and their parents.

Duration of orthodontic treatment involving orthognathic surgery.

The purpose of this study was to analyze factors influencing the duration of treatment in a sample of patients treated by a combined orthodontic/orthognathic surgery approach. Presurgical and postsurgical treatment times were assessed for 315 patients processed through an orthognathic team over a 7-year period. The median total treatment duration for all patients was 21.9 months, the median presurgical duration was 15.4 months, and the median postsurgical duration was 5.9 months. Treatment involving extractions resulted in significantly increased presurgical and total treatment times. Treatments performed in the university clinic showed reduced presurgical duration and increased postsurgical duration compared to treatments carried out by specialists outside the university. Presurgical, postsurgical, and total treatment times were significantly reduced when the orthodontist had treated 10 or more patients during the period. An earlier regimen of orthodontic treatment did not appear to have a significant effect on treatment duration.

The need and demand for orthodontic treatment in 13- to 15-year-olds in Nairobi, Kenya.

The need for orthodontic treatment in Kenya was previously not been investigated. This study was undertaken to assess the need for orthodontic treatment in 13- to 15-year-old children in Nairobi. The objective need was assessed in 919 children by using the Norwegian treatment need index, and the subjective need was assessed in 739 children by using a structured questionnaire. Objective treatment need was recorded in 29% and subjective need in 33% of the children. Less than 1% were allocated the 'very great need' category. Relatively more girls than boys were dissatisfied with the appearance of their teeth, and a significantly higher number of girls (P < 0.001) said they would like to have their teeth straightened. The children's perceived need for treatment correlated significantly with the treatment need index. Fixed appliances were found necessary for correcting malocclusion in 23% of the children and removable appliances in 6%. Future studies in Kenya should be directed at determining the societal perception of malocclusion, upon which treatment standards may be based.

Lay attitudes to dental appearance and need for orthodontic treatment.

In provision of advice about aesthetic treatment need, visual stimuli as a tool in communication may have some advantages compared with verbal descriptions, in particular when children are addressed. The Aesthetic Component (AC) of the Index of Orthodontic Treatment Need is an illustrated scale for rating of dental attractiveness developed in the UK and based on lay adults' ratings of dental photographs. This scale has also been recommended for use in patient education. The purpose of the present study was to establish a sociocultural standard of reference for Norway related to the AC, in order to examine the applicability of the scale as a tool in patient information. Samples of 137 children, 126 of their parents and 98 young adults were shown the 10 photographs comprising the AC. The subjects were asked to assess the photographs for dental attractiveness and orthodontic treatment need on a four-category rating scale. The findings indicated that, in general, photographs with an increasing scale point were rated as increasingly more unattractive. The majority (80-100 per cent) of the parents and young adults rated the five photographs on the unattractive end of the scale to be in need of treatment. The children were significantly less critical in their aesthetic judgements. Photographs representing borderline need, identified for these groups to be scale points 5 and 6, have a potential in guiding patients and parents in making informed decisions about aesthetic treatment need.

A longitudinal study on subjective and objective orthodontic treatment need.

The purpose of the study was to analyse changes in professionally-defined need and self-perceived need between the ages of 12-20 years. In 1985, occlusion and perceived need for treatment were recorded in 306 12-year-olds (born 1973) living in five communes in Finnmark, the most northern part of Norway. In 1993-94, 271 of the individuals were traced through the Norwegian Central Person Register and invited in letters to attend a clinical examination and an interview. A total of 80 individuals responded, with a mean age of 20.7 years. Professionally-defined need was assessed according to the Need for Orthodontic Treatment Index (NOTI) which is used by the Norwegian Health Insurance System for reimbursement of treatment costs. Change in category of need between 12-20 years was used as a measurement of health gain. Perceived need was measured by the individuals' responses to a question about desire for treatment. Individuals who received treatment (n = 22) showed an improvement in occlusion (health gain) corresponding on average to one category of need. The occlusal status of the untreated individuals was unchanged. All the individuals that desired treatment at 12 years of age (n = 15) did not want treatment at 20, and they were satisfied with their dental arrangement. Most of these individuals had received treatment, but a few with minor malocclusions had at age 12 been informed about the small objective need and refrained from treatment. All the individuals that wanted treatment at 20 years of age, 29 per cent of the total sample, had not desired treatment at 12 years of age. The results underline the importance of information and education during orthodontic counselling of potential patients.

Need and desire for orthodontic (re-)treatment in 35-year-old Norwegians.

Long-term outcome of orthodontic care systems may be studied by examining malocclusion and treatment need in groups of treated and untreated adults. The objective of the present work was to investigate the professionally defined need as well as the need perceived by the individuals in an attempt to study the outcome of orthodontic services. The material comprised data from 111 individuals collected from a random sample of 35-year-olds from Oslo, Norway. From a clinical examination and measurements on dental study casts, the subjects were classified into either of 4 levels of need according to the Need for Orthodontic Treatment Index (NOTI) used by the Norwegian Health Insurance System. Perceived need for treatment was analyzed from responses to questions about satisfaction with dental appearance and desire for orthodontic treatment presented in a questionnaire. Satisfaction with dental appearance was recorded in 85% and 92% of untreated and previously treated, respectively. Desire for treatment was expressed by 19% of the untreated and 3% of the treated individuals. Occlusal anomalies were present among both the treated and untreated subjects, and the clinical significance of the malocclusion traits observed is discussed.

Attitudes to malocclusion among 18- and 35-year-old Norwegians.

Knowledge about age-related changes in attitudes to dental appearance and orthodontic treatment may guide the orthodontist in educating and providing advice to potential patients and their parents. The purpose of the present study was to compare attitudes to malocclusion in groups of young and middle-aged adults from populations having been exposed to similar provision of care. The material comprised samples of orthodontically untreated 18-yr-olds (n = 50) and 35-yr-olds (n = 73) from Oslo, Norway. From a clinical examination, radiographs, and measurements on dental study casts, the subjects were classified according to the Need for Orthodontic Treatment Index (NOTI) used by the Norwegian Health Insurance System. Satisfaction with dental appearance and desire for orthodontic treatment were investigated using questionnaires. The 35-yr-olds exhibited significantly more malocclusion compared to the 18-yr-olds (P < 0.01). Among subjects classified to have obvious need for orthodontic treatment, 54% and 21% expressed dissatisfaction at ages 18 yr and 35 yr, respectively, indicating a lower level of concern for malocclusion in the older age group.

Concern for dental appearance among Norwegian young adults in region with low uptake of orthodontic treatment.

The purpose of the present study was to examine orthodontic concern among orthodontically untreated young adults living in an area where the relative number of children receiving treatment was only 15-20% and to compare orthodontic concern among these individuals with that of untreated persons from an area with a higher treatment frequency. All the subjects were clinically examined and impressions for dental study casts, radiographs and photographs were taken. The subject's occlusion was classified according to two methods: 1) allocation to one of four groups according to the national Need for Orthodontic Treatment Index (NOTI), and 2) allocation to one of three groups according to presence or absence of six Anterior Occlusal Traits (AOT). Frequencies of NOTI scores demonstrated that in the study group more individuals were in need of treatment relative to the comparison group. Reported concern was at the same level in both groups, and significantly related to NOTI and AOT scores. The individuals in the area with the low treatment frequency were generally less aware of their anterior traits compared to the individuals in the area with a higher treatment frequency. The results indicated that a long-term low uptake of orthodontic treatment among children in the particular area was not accompanied by a similar increase in concern about own dental appearance in early adulthood.

Orthodontic closure and transplantation in the treatment of missing anterior teeth. An overview.

Orthodontic closure and autotransplantation of teeth are valid treatment alternatives for young individuals with missing anterior teeth. These alternatives have, however, different indications and the choice should be based upon a comprehensive evaluation and diagnosis of the individual. Problems and limitations should be emphasized before treatment in order for the patient to have realistic expectations. The treatment plan will ultimately result from an evaluation of short- and long-term biologic and esthetic considerations. Indications, treatment principles and key factors in the treatment procedure are outlined in this overview. If transplantation is to be part of the treatment plan, the donor tooth which has the best prognosis should be selected.

Concern for dental appearance among young adults in a region with non-specialist orthodontic treatment.

With limited orthodontic manpower in an area, treatment resources may be allocated to deal with a restricted number of patients, e.g. those with the most severe malocclusions, or to treat a greater number of patients by letting the specialist supervised treatment delivered by non-specialists. The purpose of the present study was to examine orthodontic concern among young adults in a region where orthodontic treatment was mainly delivered by non-specialists. The material comprised 100 individuals born in 1971 and 1972 (mean age 18.0 years) who were consecutively examined and interviewed during their annual routine dental visits. Forty subjects (19 females, 21 males) had previous orthodontic treatment. In all but four individuals treatment was delivered by general dental practitioners. Impressions for dental study casts and standardized photographs (Polaroids) were taken. The individual's occlusion was classified according to two methods: the Need for Orthodontic Treatment Index (NOTI) and Anterior Occlusal Traits (AOT). Interviews concerning the subjects' perception of their occlusion were performed with the use of questionnaires. From the answers a composite measure representing orthodontic concern was constructed. Awareness of their own dental arrangement was assessed by comparing the respondents' reports with occlusal recordings from the study casts, and by a photo-identification test. Frequencies of NOTI and AOT scores demonstrated that more than 50 per cent of the treated individuals were still assessed to be in need of treatment and exhibited deviations in the anterior region. Furthermore, 30 per cent of the treated subjects expressed concern about their occlusal appearance, and dissatisfaction was generally based on a realistic perception of their own dental appearance.(ABSTRACT TRUNCATED AT 250 WORDS)

Perception of malocclusion in 11-year-old children: a comparison between personal and parental awareness.

In orthodontic counselling an understanding of how individuals perceive their occlusal features is important to ensure effective communication and for provision of adequate advice on treatment need. The purpose of the present study was to assess personal and parental awareness of malocclusion in children, and to examine whether agreement existed between children and their parents on assessments of malocclusion traits. Of 104 randomly selected fourth-grade children 99 presented themselves at a public dental clinic. Ninety-three accompanying parents attended. Awareness was assessed by comparing the opinion of parents and children on the presence or absence of anterior malocclusion with direct measurements on dental study casts. The subjects' abilities to identify a polaroid of the child's dentition in a panel of 17 alternative photographs were also used as a measure of awareness. The findings revealed a moderate level of awareness among both the children and their parents. About half of the children and the parents identified the child's photograph on the first attempt. About three-quarters of the traits recorded as marked/severe malocclusion and about half of the mild/moderate traits were recognized. A significant association existed between the number of correct reports on traits given by the children and the parents. However, agreement across professional, child, and parental assessments varied for the different traits. The results indicated that the individual's comprehension of professional terms may be unclear and that professionally defined cut-off points often do not coincide with norms existing within the actual family unit.

A new Norwegian index of orthodontic treatment need related to orthodontic concern among 11-year-olds and their parents.

A new index of orthodontic treatment need was introduced in Norway in 1990. On a morphologic and functional basis the four groups very great (A), great (B), obvious (C) and little/no (D) need were defined for social insurance refunding. The purpose of the present study was to investigate to what extent the new index corresponded with orthodontic concern among potential orthodontic patients and their parents. Of 104 randomly selected fourth grade children, 99 (48 girls, 51 boys, mean age 10.7 yr) presented themselves for clinical examination and interview. One parent was asked to accompany the child, and 93 parents attended. On the basis of clinical examination, morphologic measurements on study casts, and X-rays, the children were allocated to one of the four groups defined by the index. In separate questionnaires the children and the parents were asked to assess satisfaction with own/child's dental arrangement and desire for orthodontic treatment. The interview data were transformed into a composite measure representing orthodontic concern. The results indicated that orthodontic concern was significantly related to index group. For the individuals who expressed concern the new index seemed to be meaningful for allocation of public subsidies, as most individuals (85%) who expressed concern exhibited malocclusions fulfilling the criteria for receiving public subsidies of treatment costs. However, more than 50% of the individuals allocated to group B (great need) did not experience a need for treatment.

Perception of personal dental appearance in young adults: relationship between occlusion, awareness, and satisfaction.

Information about the individual perception of a patient's own occlusion is considered of importance in orthodontics. One hundred thirty young adults (mean age, 18.1 years) were clinically examined and interviewed with the purpose of relating self-awareness and satisfaction to the actual occlusal status and determining whether dissatisfaction is based on realistically perceived anomalies. From study casts taken at the time of examination, six anterior traits were recorded as either malocclusion, minor deviation, or near-ideal occlusion according to two sets of criteria. Self-awareness was assessed by analyzing agreement between the subjects' reports on the presence of the six traits and the corresponding recordings. Satisfaction was evaluated from three questions with fixed alternative answers. The majority of the young adults (63%) were characterized as having near-ideal occlusion or only minor deviations. Only mild and moderate malocclusions were present in the sample since severe malocclusions are routinely treated during childhood. The subjects were generally aware of anterior traits. Almost all the subjects (98%) with near-ideal occlusion or minor deviations expressed satisfaction. Malocclusion was present in 14 of the 16 subjects who were dissatisfied, and dissatisfaction was based on realistically perceived anomalies. However, traits rated as malocclusion were present in 30% of the satisfied subjects, which may in part be explained by the mild degree of malocclusion in the sample. Awareness of occlusal traits varied among the satisfied subjects.

The efficacy of two-stage titanium implants as orthodontic anchorage in the preprosthodontic correction of third molars in adults--a report of three cases.

Orthodontic movement of teeth is often required to satisfactorily treat a variety of oral rehabilitation problems. Considerable limitations in the clinical application of orthodontic treatment may result from the lack of teeth suitable for anchorage. Three patients with edentulous posterior segments are presented illustrating how implants can be utilized for preprosthodontic correction of impacted third molars rendering them suitable as bridge abutments. The patients have been followed for 8-10 years. Two-stage titanium implants were used as orthodontic anchorage as no dental anchorage was available. Edgewise orthodontic mechanics were used to move the third molars mesially with forces up to 2.5 N (about 250 g). No movement of the implants occurred and they were radiologically and clinically intact at the end of the orthodontic loading and were, therefore, subsequently used as bridge abutments.

Orthodontically treated young adults: awareness of their own dental arrangement.

Orthodontic treatment goals are generally based upon professional ideals of function, aesthetics, and stability. In order to evaluate whether the professional treatment goals are meaningful to the patients, awareness of their own occlusion was studied in 80 orthodontically treated individuals (mean age 18.3 years). By comparing the treated patients to a control group of 50 untreated individuals (mean age 17.8 years) the effect of the treatment experience on the level of awareness was also examined. Awareness was assessed by comparing the subjects' answers to six questions about their own dental arrangement, to recordings on study casts according to two sets of criteria. These criteria defined malocclusion and minor deviations in tooth position. The validity of the method was tested by asking the subjects to identify their own teeth among 18 dental photographs. Almost two-thirds of the treated subjects described their teeth without making mistakes according to the malocclusion criteria. When the minor deviation criteria were applied, one third answered all the six questions correctly and two-thirds made not more than one mistake. Compared to the control group no significant differences existed as most untreated individuals also gave accurate descriptions. Eighty-two per cent of the tested subjects identified their own photo on the first attempt. Professional treatment goals seem to be justified by the high level of dental awareness in young adults, and the findings indicate that the treatment per se does not affect perceptual accuracy.