Evaluation of objective structured clinical examination for advanced orthodontic education 12 years after introduction.

INTRODUCTION: Advanced education programs in orthodontics must ensure student competency in clinical skills. An objective structure clinical examination has been used in 1 program for over a decade. The results were analyzed cross-sectionally and longitudinally to provide insights regarding the achievement of competency, student growth, question difficulty, question discrimination, and question predictive ability. METHODS: In this study, we analyzed 218 (82 first-year, 68 second-year, and 68 third-year classes) scores of each station from 85 orthodontic students. The grades originated from 13 stations and were collected anonymously for 12 consecutive years during the first 2 decades of the 2000s. The stations tested knowledge and skills regarding dental relationships, analyzing a cephalometric tracing, performing a diagnostic skill, identifying cephalometric points, bracket placement, placing first-order and second-order bends, forming a loop, placing accentuated third-order bends, identifying problems and planning mixed dentition treatment, identifying problems and planning adolescent dentition treatment, identifying problems and planning nongrowing skeletal treatment, superimposing cephalometric tracings, and interpreting cephalometric superimpositions. Results were evaluated using multivariate analysis of variance, chi-square tests, and latent growth analysis. RESULTS: The multivariate analysis of variance showed that all stations except 3 (analyzing a cephalometric tracing, forming a loop, and identifying cephalometric points) had significantly lower mean scores for the first-year student class than the second- and third-year classes (P <0.028); scores between the second- and third-year student classes were not significantly different (P >0.108). The chi-square analysis of the distribution of the number of noncompetent item responses decreased from the first to the second years (P <0.0003), from the second to the third years (P <0.0042), and from the first to the third years (P <0.00003). The latent growth analysis showed a wide range of difficulty and discrimination between questions. It also showed continuous growth for some areas and the ability of 6 questions to predict competency at greater than the 80% level. CONCLUSIONS: Objective structure clinical examinations can provide a method of evaluating student performance and curriculum impact over time, but cross-sectional and longitudinal analyses of the results may not be complementary. Significant learning appears to occur during all years of a 3-year program. Valuable questions were both easy and difficult, discriminating and not discriminating, and came from all domains: diagnostic, technical, and evaluation/synthesis.

Overview of orthodontic care for children with cleft lip and palate, 1915-2015.

The purpose of this article is to review and discuss the advances in the management of children born with cleft lip and palate (CLP) as it has evolved over the past 100 years. This overview is based on articles published in the American Journal of Orthodontics, which frequently changed its name, over the past century. Additionally, other journals will be cited as craniofacial anomalies became recognized during the 20th century and the biologic basis became refined, with the new discipline of genetics replacing the term hereditary and its connotations of eugenics. The Human Genome Project, completed in 2003, has now provided an understanding of syndromic and nonsyndromic CLP that has led to advances in the diagnosis and treatment of CLP in the 21st century. These evolving concepts will be discussed in an overview of the types of procedures published from 1915 to 2015 and the major transition in the mid-20th century from multiple uncoordinated interventions from various specialists to a coordinated team approach in which the orthodontist has a specific role in the timing and sequencing of interdisciplinary treatment goals. Major technologic advancements in treatment modalities and the contemporary approach to the health-related quality of life of the patient and the caregiver have resulted in their participation in treatment options and decisions. The requirement of informed consent reflects the legal doctrine that now emphasizes the ethical imperative of greater respect for patient autonomy in the decision-making process. The orthodontist no longer makes decisions alone, but rather with the team and the patient or the caregiver.

Oral health-related quality of life in children with orofacial clefts.

Objectives : To determine the impact of orofacial clefts on the oral health-related quality of life of affected children and whether the oral health-related quality of life of children with orofacial clefts differs among different age groups. To assess whether the responses of children with orofacial clefts differ from the caregivers' perceptions of their child's oral health-related quality of life and compare with data from a control group. Design : Cross-sectional study. Patients/Setting : A total of 75 subjects with cleft lip and/or cleft palate (mean age, 13.0 years) from the Nationwide Children's Hospital Craniofacial Anomalies Clinic, as well as their caregivers, and 75 control subjects (mean age, 13.9 years). Main Outcome Measure : Self-reported oral health-related quality of life measured with the Child Oral Health Impact Profile, a reliable and valid questionnaire designed for use with children and teenagers. Results : Children with orofacial clefts had statistically significant lower quality of life scores than control subjects had for overall oral health-related quality of life, Functional Well-being, and Social Emotional Well-being. There was a statistically significant difference in the interaction of age group and Social-Emotional Well-being between children with orofacial clefts and control children. No statistically significant differences were found between the responses of children with orofacial clefts and their caregivers' reports. Conclusions : Presence of an orofacial cleft significantly decreases overall oral health-related quality of life, Functional Well-being, and Social-Emotional Well-being in children and adolescents. The negative impact of orofacial clefts on Social-Emotional Well-being is greater in 15- to 18-year-olds than in younger age groups. Children with orofacial clefts and their caregivers had very similar evaluations of the child's oral health-related quality of life.

Patient compliance to wear orthodontic retainers during postretention may vary by age, gender, and time since braces were removed.

SUBJECTS: During January to July 2008 a questionnaire was mailed to 1085 subjects who had completed comprehensive orthodontic fixed-appliance treatment from 6 months to 6 years following active tooth movement. This yielded 280 responses (25.8% response rate) after 2 mailings, 3 months apart. The respondents ranged in age from 8 to 72 years. Respondents were from various socioeconomic groups and urban or rural environments. Identifiers allowed respondents to be classified into subgroups. KEY EXPOSURE/STUDY FACTOR: Predictors of compliance among patients/subjects who were provided with removable vacuum-formed retainers (VFRs) or Hawley retainers in the postretention phase of orthodontic treatment. MAIN OUTCOME MEASURE: The main outcome measure was self-reported compliance with different types of removable orthodontic retainers worn during the postretention phase of treatment. MAIN RESULTS: A logistic regression model identified probabilities of retainer wear, including a likelihood ratio to test the model parameters using chi-square statistics to identify significant variables. The model found age, gender, amount of time since braces were removed, type of retainer, and interpretation of compliance in retainer wear to be statistically significant variables. Time on retainer compliance revealed better compliance with VFR than Hawley retainers during the first 2 years after braces were removed, but then compliance increased with Hawley retainers and overall compliance was greater with Hawley retainers. CONCLUSIONS: Compliance with wearing removable retainers was initially better with VFRs but over time was greater with Hawley retainers, and esthetics was not a determinant. Several variables determined compliance, including age, gender, and type of retainer.

Patient compliance to wear orthodontic retainers during postretention may vary by age, gender, and time since braces were removed.

PURPOSE/QUESTION: To evaluate and quantify compliance of orthodontic retainer wear and predictors for noncompliance during the postretention phase. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Survey. LEVEL OF EVIDENCE: Level 3: Other evidence. STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Temporary anchorage device utilization: comparison of usage in orthodontic programs and private practice.

AIM: There is limited data on how temporary anchorage devices (TADs) are currently used in orthodontics. The aim of this study was to survey two groups of orthodontic providers-graduate orthodontic residencies and private practitioners-about their use. METHODS: A 15-question survey was prepared and administered to all 61 accredited orthodontic residencies and an equal number of private orthodontic practitioners (all in the United States). A second survey was also included and provided to the residency programs. RESULTS: The response rate was 63.9% for private practitioners and 70.4% for orthodontic residency programs. The majority of the residency programs (82.9%) and practitioners (69.2%) reported placing TADs in their practices. TADs were placed in 6.0% of the patients treated by private practitioner and in 5.3% of patients treated in residency programs. A combination of topical and local anesthesia was the anesthetic of choice for 59.0% of private practitioners and 65.0% of orthodontic residency programs. A large majority of the private practitioners (79.0%) and orthodontic residency programs (61.9%) reported that the TADs were loaded immediately. The most frequently cited use for TADs was anterior en masse retraction. In total, 27.9% of the residency programs used miniplates, compared to 17.9% of the practitioners. CONCLUSION: Since 2005, a large number of US programs have incorporated TADs into their didactic/research curriculum and residency programs. Both mini-implants and miniplates may have a far-reaching impact on the clinical practice of orthodontics for decades to come. This survey detailed the trends and differences between practitioners and residencies in the TAD utilization experience and provided important information that is otherwise not available in the literature.

Dental and skeletal outcomes for Class II surgical-orthodontic treatment: A comparison between novice and experienced clinicians.

INTRODUCTION: The information that details dental changes accompanying presurgical and postsurgical orthodontic treatment during orthognathic surgery treatment is disappointing and results in less than ideal surgical change, but it is largely derived from university clinic samples with patients treated by residents (clinical novices). In this study, we examined similar treatments performed by experienced practitioners and compared them with the novices' results. METHODS: A sample of 72 Class II subjects treated by practitioners with a mean of 26.7 years of experience was selected. Inclusion criteria were consecutively treated surgical-orthodontic patients with mandibular advancement, rigid fixation, and good-quality lateral cephalograms. Pretreatment skeletal and dental variables were compared with those from a sample treated by novices in a previous study. Presurgical and final analyses were performed with analysis of covariance (ANCOVA), with pretreatment values as the covariate. An efficacy analyses for treatment phase and study comparisons was the final component. RESULTS: The novices treated patients with significantly more severe Class II skeletal problems. For both studies, there were significant positive changes in the position of the mandible. The ANCOVA analysis showed that the experienced practitioners managed the bodily position of the maxillary incisors more effectively. The efficacy analysis showed no statistically significant differences between novices and experienced practitioners. For both novices and experienced practitioners, according to the ANB changes, nonideal incisor decompensation led to less than ideal final mandibular positions. CONCLUSIONS: The dental and skeletal mean changes and efficacy analysis for both novices and experienced practitioners showed that presurgical orthodontic treatment often does not fully decompensate the incisors; this then limits the surgical outcome.

Prospective patients rate practice factors: development of a questionnaire.

INTRODUCTION: The importance that prospective patients place on practice characteristics when choosing an orthodontic practice has not been extensively reported. The objective of this research was to develop a valid and reliable questionnaire to address the relative importance of orthodontic office and doctor characteristics for prospective patients or parents of child patients during the initial orthodontic office consultation. METHODS: An initial questionnaire, based on published literature, was field-tested on 16 subjects to assess its validity. Based on the field test, the questionnaire was modified and tested for reliability by using a test-retest method. The questionnaire covered the following areas: doctor, office, staff, and finances. The reliability study included 2 groups of subjects: 12 consecutive prospective adult patients and 41 consecutive parents of prospective child patients. The questionnaires consisted of 43 and 50 questions for the adult patients and the parents of patients, respectively. The subjects rated the importance of practice characteristics in their selection of an orthodontic practice using a 100-mm visual analog scale anchored at "not important at all" and "most important." RESULTS: Reliability was analyzed by using the intraclass correlation coefficient (ICC). Summary scores of all 53 subjects showed excellent reliability (ICC, 0.88; range, 0.61-1.0). Summary scores of all 50 questions showed acceptable reliability (ICC, 0.70; range, 0.45-0.88). Twenty-one questions had excellent reliability (ICC, >.75), and 29 questions had fair-to-good reliability (ICC, 0.41-0.75). No questions showed poor reliability (ICC, <0.4). CONCLUSIONS: The pilot study data indicated that the overall reliability of the questionnaire is acceptable.

Root resorption associated with orthodontic tooth movement: a systematic review.

INTRODUCTION: This systematic review evaluated root resorption as an outcome for patients who had orthodontic tooth movement. The results could provide the best available evidence for clinical decisions to minimize the risks and severity of root resorption. METHODS: Electronic databases were searched, nonelectronic journals were hand searched, and experts in the field were consulted with no language restrictions. Study selection criteria included randomized clinical trials involving human subjects for orthodontic tooth movement, with fixed appliances, and root resorption recorded during or after treatment. Two authors independently reviewed and extracted data from the selected studies on a standardized form. RESULTS: The searches retrieved 921 unique citations. Titles and abstracts identified 144 full articles from which 13 remained after the inclusion criteria were applied. Differences in the methodologic approaches and reporting results made quantitative statistical comparisons impossible. Evidence suggests that comprehensive orthodontic treatment causes increased incidence and severity of root resorption, and heavy forces might be particularly harmful. Orthodontically induced inflammatory root resorption is unaffected by archwire sequencing, bracket prescription, and self-ligation. Previous trauma and tooth morphology are unlikely causative factors. There is some evidence that a 2 to 3 month pause in treatment decreases total root resorption. CONCLUSIONS: The results were inconclusive in the clinical management of root resorption, but there is evidence to support the use of light forces, especially with incisor intrusion.

Dental and skeletal changes associated with Class II surgical-orthodontic treatment.

INTRODUCTION: Few published reports detail the dental changes produced by orthodontic treatment in conjunction with orthognathic surgery. METHODS: Thirty-four Class II subjects who underwent surgical-orthodontic treatment with mandibular advancement and rigid fixation were selected, and their lateral cephalograms were digitized. Mean skeletal and dental values were calculated for pretreatment, presurgical, and final treatment times. Treatment efficacy as a percentage of an ideal goal achieved also was calculated. RESULTS: All data showed significant positive changes in the position of the mandible. The mean changes showed that the maxillary incisors were overretracted presurgically and then returned to a normal position postsurgically, whereas the mandibular incisors were proclined and protruded presurgically and remained so at posttreatment. The efficacy data showed that the incisors were not ideally decompensated in many patients. CONCLUSIONS: The efficacy data show that presurgical orthodontic treatment often does not fully decompensate the incisors; this then limits the surgical outcome.

Objective structured clinical examination use in advanced orthodontic dental education.

INTRODUCTION: Continuous evaluation of residents and the advanced education curriculum is required to maintain the quality of a program and ensure appropriate accreditation status. The purpose of this project was to describe the process of introducing the objective structured clinical examination (OSCE) into an advanced orthodontic education program and to evaluate its impact on the curriculum. METHODS: To determine the content of the examination, 60 orthodontic practitioners were consulted to identify the most important clinical skills that an entry-level practitioner must be able to perform proficiently. From 18 critical clinical skills, 13 were evaluated by the OSCE in the areas of diagnosis, clinical evaluation and synthesis, and orthodontic technique. The OSCE was given to 3 classes of residents each year for 3 years (n = 46). RESULTS: The classes were tracked longitudinally, and the students' levels were evaluated cross-sectionally. Curriculum changes were evaluated for impact in areas of deficiency. There were no significant correlations between student confidence and performance or faculty prediction of proficiency and performance beyond the first year. Great gains in performance were observed between the first and second years of the 3-year program. All skills did not reach proficiency levels, and peak performance did not always occur during the third year. Some curriculum changes were fruitful, and others were not sustained by improved performance. CONCLUSIONS: An OSCE can provide important information regarding students and the curriculum in a clinically meaningful way that might be otherwise unattainable.

Differential scanning calorimetry (DSC) and temperature-modulated DSC study of three mouthguard materials.

OBJECTIVES: Employ differential scanning calorimetry (DSC) and temperature-modulated DSC (TMDSC) to investigate thermal transformations in three mouthguard materials and provide insight into their previously investigated energy absorption. METHODS: Samples (13-21mg) were obtained from (a) conventional ethylene vinyl acetate (EVA), (b) Pro-form, another EVA polymer, and (c) PolyShok, an EVA polymer containing polyurethane. Conventional DSC (n=5) was first performed from -80 to 150 degrees C at a heating rate of 10 degrees C/min to determine the temperature range for structural transformations. Subsequently, TMDSC (n=5) was performed from -20 to 150 degrees C at a heating rate of 1 degrees C/min. Onset and peak temperatures were compared using ANOVA and the Tukey-Kramer HSD test. Other samples were coated with a gold-palladium film and examined with an SEM. RESULTS: DSC and TMDSC curves were similar for both conventional EVA and Pro-form, showing two endothermic peaks suggestive of melting processes, with crystallization after the higher-temperature peak. Evidence for crystallization and the second endothermic peak were much less prominent for PolyShok, which had no peaks associated with the polyurethane constituent. The onset of the lower-temperature endothermic transformation is near body temperature. No glass transitions were observed in the materials. SEM examination revealed different surface morphology and possible cushioning effect for PolyShok, compared to Pro-form and EVA. SIGNIFICANCE: The difference in thermal behavior for PolyShok is tentatively attributed to disruption of EVA crystal formation, which may contribute to its superior impact resistance. The lower-temperature endothermic peak suggests that impact testing of these materials should be performed at 37 degrees C.

Development of cephalometric norms using a unified facial and dental approach.

OBJECTIVE: To develop a cephalometric determination of anteroposterior skeletal occlusion on the basis of a clinically rational "gold standard" and objectively determined cut points. MATERIALS AND METHODS: Pretreatment cephalograms from 10- to 18-year-old Caucasian patients with a normal vertical face dimension were digitized. Facial profile line drawings were judged by orthodontist raters as Class I, II, or III. Subjects who met all inclusion criteria were divided into Class I, Class II, and Class III on the basis of the matched skeletal (facial) and dental occlusion and comprised our gold standard for anteroposterior skeletal occlusions. Cephalometric variables included ANB angle, McNamara analysis, Harvold unit differential, anteroposterior dysplasia index (APDI), and Wits analysis. Half the sample was used to derive skeletal classification norms using receiver operator characteristic (ROC) curves, and half the sample was used to test for diagnostic ability and to compare the diagnoses based on traditional cephalometric norms with the new norms. RESULTS: Results of the study showed that ANB and McNamara analysis performed well with traditional and ROC-derived norms, whereas Wits, Harvold unit differential, and APDI showed fewer errors in diagnosis with ROC norms compared with traditional norms. CONCLUSIONS: The use of a single set of diagnostic norms for each analysis to distinguish between the skeletal classifications for the 10- to 18-year-age group proved to be highly successful for each of the analyses and performed as well or better than when using traditional norms based on age and sex.

A comparison of providers' and consumers' perceptions of facial-profile attractiveness.

INTRODUCTION: The purpose of this study was to evaluate the perception of facial attractiveness in profile digital photographs that were incrementally altered to produce different combinations of mandibular anteroposterior positions and lower anterior facial heights. The specific aims were to determine whether there is concordance between providers and consumers in their perceptions of facial attractiveness, and to evaluate whether interactions of the anteroposterior and vertical dimensions and the magnitude of these interactions influence perception of facial attractiveness. METHODS: Profile digital photographs and cephalograms of 3 men and 3 women were used. The position of the jaw was altered incrementally with Dolphin imaging equipment (Dolphin Imaging and Management, Chatsworth, Calif), and booklets were created. One hundred raters (50 laypersons, 25 oral surgeons, 25 orthodontists) scored the profiles on a visual analog scale. All images were duplicated to test intrarater reliability. Factorial ANOVA with repeated measures and the Tukey-Kramer post-hoc test for multiple comparisons were used to test for differences in facial attractiveness. The level of significance was set at .05 (P = .05) for all analyses. RESULTS: Intrarater reliability was good (ICC = 0.71), and general concordance was found between providers and consumers in their perceptions of facial attractiveness. Interactions of the anteroposterior and vertical dimensions and the magnitude of change in each dimension influence the perception of facial attractiveness. CONCLUSIONS: The results suggest that preferences of facial attractiveness by laypersons, orthodontists, and oral surgeons in central Ohio are generally in agreement. This information might assist clinicians in treatment planning and making recommendations.

Comparison of peer assessment rating (PAR) index scores of plaster and computer-based digital models.

INTRODUCTION: The peer assessment rating (PAR) index is a valid and reliable tool for measuring malocclusion on plaster models, but it has not been shown to be valid and reliable when used to score computer-based digital models. The purpose of this study was to determine whether the PAR index is a valid and reliable measure on digital models. METHODS: The study sample consisted of 48 pairs of plaster and digital pretreatment models. One examiner, calibrated in the PAR index, scored the digital and plaster models. The overall PAR scores were examined for reliability and validity by using analysis of variance and the intraclass correlation coefficient (ICC). Reliability of the components of the PAR score was compared with values originally presented by Richmond et al (1992). RESULTS: No significant differences were found between overall PAR scores of plaster and digital models (P = .82), and scores were highly correlated (ICC = 0.95; lower confidence boundary (LCB) = 0.92; upper confidence boundary (UCB) = 0.97). Intraexaminer reliability was excellent for both plaster models (ICC = 0.98; LCB = 0.97; UCB = 0.99) and digital models (ICC = 0.96; LCB = 0.94; UCB = 0.98). Reliability of all components of the PAR score generated on digital models except for buccal occlusion was similar to those of Richmond et al. CONCLUSION: PAR scores derived from digital models are valid and reliable measures of occlusion.

The influence of a structured telephone call on orthodontic pain and anxiety.

INTRODUCTION: This purpose of this study was to examine the effects of a structured telephone call after orthodontic appliance placement on self-reported pain and anxiety. METHODS: One hundred-fifty orthodontic patients were randomly assigned to 1 of 3 groups and matched for age, sex, and ethnicity. The subjects completed baseline questionnaires to assess their levels of pain (on a 100-mm visual analog scale) and anxiety (Spielberger's State-Trait Anxiety Inventory) before orthodontic treatment. After the initial archwires were placed, all subjects completed the pain questionnaire and state-anxiety inventory at the same time daily for 1 week. One group also received a structured telephone call demonstrating care and reassurance; the second group received an attention-only telephone call, thanking them for participating in the study; the third group served as a control. RESULTS: Although both telephone groups reported significantly less pain (P = .005) and state-anxiety (P = .033) than the control group, there was no difference between the 2 telephone groups (P > .12 for pain; P > .81 for state-anxiety). CONCLUSIONS: A telephone call from a health-care provider reduced patients' self-reported pain and anxiety; the content of the telephone call was not important.