Immediate effect of clear aligners and fixed appliances on perioral soft tissues and speech.

OBJECTIVES: To compare the immediate three-dimensional (3D) perioral soft-tissue changes and impact on speech induced by clear aligners and fixed appliances. MATERIALS AND METHODS: In this repeated-measure experimental study, stereophotogrammetric 3D photographs of 40 participants were recorded before and immediately after the introduction of clear aligners and fixed appliances. The 3D surface meshes were registered to quantify changes in the direction and magnitude of nine soft tissue landmarks located on the upper and lower lips. Self-reported speech disturbance was evaluated using a questionnaire. Data were analysed using repeated-measures analysis of variance. RESULTS: In the vertical plane, the clear aligners induced inferior displacement (range 0.4-1.5 mm) for all nine landmarks (P < .01), whereas fixed appliances induced inferior displacement only of A-point (0.4 ± 0.9 mm), right crista philtri (0.5 ± 1.1 mm) and left crista philtri (0.7 ± 1.1 mm). The clear aligners induced greater vertical changes than fixed appliances for all landmarks (P < .05). In the sagittal plane, both clear aligners and fixed appliances slightly advanced all perioral landmarks, except subnasale. Fixed appliances caused greater changes than clear aligners for right cheilion (+0.8 mm), left cheilion (+0.8 mm) and labrale inferius (+0.9 mm) (P < .01). Both orthodontic appliances had a significant self-perceived effect on speech, with clear aligners affecting speech to a greater degree. CONCLUSION: Clear aligners and fixed appliances produced immediate effects on perioral soft tissues, which are most evident in the vertical plane for clear aligners, and in the sagittal plane for fixed appliances. Speech was affected by both appliances.

Oral health knowledge and practice among orthodontic clients in China and New Zealand.

Background: The oral hygiene habits of clients wearing fixed orthodontic appliances is poorly understood. Assessment of oral hygiene behavioural patterns is essential for understanding clients' oral health care needs. The aim of this study was to investigate orthodontic clients' oral hygiene behaviours, brushing techniques, and oral hygiene awareness. Methods: A total of 200 orthodontic clients wearing fixed orthodontic appliances were consecutively recruited from the Sichuan Provincial Hospital, Chengdu, China, and the Faculty of Dentistry, University of Otago, Dunedin, New Zealand. A 47-item questionnaire was used to survey study participants. Results: The survey had a 92% response rate, with 67.5% of respondents being female and 32.5% male. Most were non-smokers (94.2%) and the majority (80.0%) brushed their teeth twice daily. Most (80.4%) brushed their teeth for 1 to 2 minutes, and 68.7% positioned their toothbrush both horizontally and vertically, with horizontal being the preferred direction of motion. One-third (33.5%) did not use any auxiliary oral hygiene aids; most snacked between meals; only 31.4% received professional tooth cleaning during orthodontic treatment; and 56.8% experienced an increased level of halitosis after appliance placement. Most respondents (79.4%) thought their oral hygiene was good, but 51.0% reported bleeding gums during tooth brushing, 31.4% found they rarely bled, and only 17.6% reported no bleeding. Most respondents agreed that good oral health was very important for orthodontic treatment and that their own efforts were the most important factors. Conclusions: Client awareness of the importance of oral hygiene during orthodontic treatment requires improvement. Clinician reinforcement of oral hygiene should become a priority for orthodontic clients.

Contexte: Les habitudes d'hygiène buccodentaire des clients qui portent des appareils orthodontiques fixes sont mal comprises. L'évaluation des modèles de comportement en matière d'hygiène dentaire est essentielle pour comprendre les besoins en soins de santé buccodentaire des clients. L'objectif de cette étude était d'étudier les comportements d'hygiène buccodentaire des clients orthodontiques, leurs techniques de brossage, et leurs connaissances en matière d'hygiène buccodentaire. Méthodologie: Un total de 200 clients orthodontiques portant des appareils orthodontiques fixes ont été recrutés consécutivement à l'Hôpital Sichuan Provincial, à Chengdu en Chine et à la Faculté de dentisterie de l'Université d'Otago, à Dunedin en Nouvelle-Zélande. Un questionnaire de 47 éléments a été utilisé pour sonder les participants à l'étude. Résultats: Le sondage avait un taux de réponse de 92 %; 67,5 % des répondants étaient des femmes et 32,5 % étaient des hommes. La plupart parmi eux étaient des non-fumeurs (94,2 %) et la majorité (80,0 %) se brossait les dents 2 fois par jour. Pour la plupart (80,4 %), le brossage durait entre 1 et 2 minutes, et 68,7 % plaçaient leur brosse à dents horizontalement et verticalement; la position horizontale étant la direction de mouvement préférée. Un tiers (33,5 %) des répondants n'utilisaient pas d'aides-auxiliaires d'hygiène buccodentaire, la plupart mangeaient une collation entre les repas, seulement 31,4 % ont obtenu un nettoyage dentaire professionnel au cours de leur traitement orthodontique, et 56,8 % ont connu une augmentation du niveau d'halitose après la pose d'un appareil. La plupart des répondants (79,4 %) pensaient avoir une bonne hygiène buccodentaire, mais 51,0 % parmi eux ont déclaré avoir des saignements de gencives pendant le brossage des dents, 31,4 % ont trouvé qu'ils saignaient rarement, et seulement 17,6 % ont déclaré ne pas saigner. La plupart des répondants ont convenu qu'une bonne santé buccodentaire était très importante pour le traitement orthodontique et que leurs propres efforts étaient les facteurs les plus importants. Conclusion: La sensibilisation des clients à l'importance de l'hygiène buccodentaire pendant le traitement orthodontique exige une amélioration. Le renforcement de l'hygiène buccodentaire par les cliniciens devrait devenir une priorité pour les clients orthodontiques.

Three-dimensional analysis of lip changes in response to simulated maxillary incisor advancement.

OBJECTIVE: To assess the immediate response of lips in three dimensions (3D) resulting from simulated maxillary incisor advancement. MATERIALS AND METHODS: Incremental maxillary incisor advancement was simulated by placing wax of increasing thickness (+2 mm, +4 mm, +6 mm) on the incisors of 20 participants, and the induced lip changes were recorded using 3D stereophotogrammetry. The induced displacement of lip landmarks was quantified using 3D image analysis software. Data were analyzed using a repeated-measures analysis of variance (ANOVA) after adjusting for age and sex of the study participants. RESULTS: A large interindividual variation in lip response to simulated incisor advancement was observed. A significant overall effect on 3D lip changes was found for increasing values of simulated incisor advancement (F = 13.2; P < .001) as well as significant differences between anatomical landmarks of the lip (F = 7.4; P < .01). Most points moved outward and anterosuperiorly, except the midpoint and corners of the lip. Greatest movement was observed in the sagittal plane, followed by the vertical and transverse planes. CONCLUSIONS: Maxillary incisor advancement significantly affects upper lip change in three planes of space: particularly the anteroposterior plane, in which the response to simulated advancement appears to be nonlinear.

Evaluation of objective and subjective treatment outcomes in orthodontic cases treated with extraction of a mandibular incisor.

OBJECTIVES: To analyze changes in occlusal characteristics following mandibular incisor extractions (MIE), to determine the usefulness of wax setups in treatment planning MIE cases and to compare the pre- and posttreatment dental attractiveness between MIE cases and nonextraction (NE) controls. MATERIALS AND METHODS: The Peer Assessment Rating (PAR) Index was used to score pre- and posttreatment dental casts of MIE cases (n = 14) and matched NE controls (n = 14). Occlusal characteristics were evaluated on diagnostic wax setups and posttreatment casts. Attractiveness of pre- and posttreatment cases judged on intraoral photographs of cases (n = 6) and controls (n = 6) were rated by 76 dental students and 10 laypeople using visual analogue scales (VAS). RESULTS: The difference in PAR score reduction (%) between the MIE and NE groups was not significant. Between the wax setup and posttreatment casts, there were moderate correlations in overjet, overbite, and right canine classification. There was no significant difference in pre- and posttreatment change in VAS scores (%) for attractiveness between the MIE (49.8 ± 4.3 [S.E.]) and control groups (40.8 ± 4.3 [S.E.]). However, there was a significant difference (P = .000) between the observer groups. CONCLUSIONS: There were no significant differences in the treatment outcomes of orthodontic cases treated with MIE or NE, indicating that MIE is a valid treatment option. A wax setup is moderately correlated with posttreatment results. Both laypeople and dental students rated posttreatment dental attractiveness higher than pretreatment in MIE and NE groups. Dental students tended to be more critical than laypeople in their ratings.

Survival analysis of orthodontic retainers.

Objective: Retainers play a critical role in the long-term success of orthodontic treatment. The aims of this study were to evaluate the survival time of different retainers and to investigate the potential predictors of the retainer failures. Material and methods: A total of 591 retainers from 309 patients (between 2003 and 2014) were included in the study, including Hawley retainers (n = 199), vacuum-formed retainers (n = 34), lingual fixed retainers (n = 278), and the COMBO (a combination of two different retainers in the same arch; n = 80). Patient's demographics, retention procedures, time to failure (survival time), and reasons for failures were extracted from patient files. Failure of retainer was defined as any events after which the retainers needed to be replaced or repaired; loss of retainer was treated as a failure because the retainer could not fulfil its role. Survival analyses were performed to compare the survival time between different retainer groups. Results: The survival time was the longest for lingual fixed retainers (median 1604 days) and Hawley retainers (1529 days), followed by COMBO (258 days) and vacuum-formed retainers (105 days; overall P < 0.001). No statistical significance of survival time of lingual fixed retainers was found between maxilla (1497 days) and mandible (1604 days; P = 0.341), nor between different types of the COMBO (overall P = 0.078). These results were unchanged before and after adjusting for the age, gender, and socioeconomic status (SES) of the patients. The reasons for failures varied among different retainers: most failures of the Hawley retainers were 'lost' (52.0%), most failures of the lingual fixed retainers were debond (63.5%), and fracture was the most common cause of failure for both vacuum-formed retainers (43.5%) and the COMBO (41.9%). Conclusion: Lingual fixed retainers and Hawley retainers had the longest survival times, followed by the COMBO retainers and vacuum-formed retainers. The reasons of failure were mainly mechanical (debond and fracture) and patient-related (loss).

A qualitative study of orthodontic screening and referral practices among dental therapists in New Zealand.

BACKGROUND: Appropriate screening and referral is important in delivering effective and timely orthodontic treatment. In New Zealand, dental therapists are usually the initial contact for oral health care (including the assessment of malocclusion) in child and adolescent patients. OBJECTIVE: To investigate the orthodontic screening and referral practices of dental therapists in New Zealand. METHODS: Ten registered dental therapists from Auckland and Dunedin were interviewed using a semi-structured approach. Participants were selected based on years of work experience, where they practised, their educational background, and their sector of work (private/public). Resu/ts: Three main themes were identified: (I) the orthodontic screening and referral process; (2) the factors affecting orthodontic referral; and (3) their attitudes towards orthodontic treatment. Orthodontic screening and referrals were uniform among public dental therapists but varied for private dental therapists with regard to the type of malocclusions referred, the frequency of the referrals and to whom they referred. Factors that affected orthodontic referrals included participants' orthodontic educational background, work experience, Continuing Professional Development courses attended, and the opinions of orthodontists and/ or dentists. Dental therapists found that most patients were receptive to the idea of orthodontic treatment, but that cost was a major concern. Dental therapists were enthusiastic about the development and use of resources that could aid in the orthodontic screening and referral process. Conc/usions: This study has provided valuable insights into the current orthodontic referral process of New Zealand dental therapists. Variations among public and private therapists were identified. The implementation of an orthodontic referral guideline was viewed favourably by dental therapists.

Fingers in mouths: from cause to management.

Digit sucking is a habit that occurs in childhood and can lead to malocclusion if it persists for a long time. Understanding the cause and available management approaches for habit cessation can lead to more positive outcomes for clinicians, parents and children alike. Increasing clinicians' awareness of the causes and management of digit sucking behaviours can aid in their effective and systematic management, thereby reducing the risk of future malocclusion in some individuals.

Psychological aspects of orthodontics in clinical practice. Part two: general psychosocial wellbeing.

Orthodontists tend to treat/see their patients on a systematic, recurrent basis, often during crucial stages of psychological development. Therefore, they have a pivotal role in identifying a number of psychological as well as of psychiatric disorders. Effective communication is crucial and unfortunately, it is often underestimated in a busy clinical practice. Aim of part two of this article it to review the role clinical orthodontics and the orthodontist-patient relationship have on the patients' psychosocial wellbeing, including effects on self-esteem, bullying and harassment by peers, and even several psychiatric disorders, such as anorexia/bulimia nervosa, and attention deficit hyperactivity disorders. Due to the complexity and importance of these issues, the orthodontist may play a dynamic role, not only in the management of dental malocclusions, but at times, as "psychologist" and a counselor to the patient.

Psychological aspects of orthodontics in clinical practice. Part one: treatment-specific variables.

The orthodontist-patient relationship may have a significant impact on treatment outcome and patient satisfaction, thus improving the overall quality of care. Effective communication is crucial and unfortunately, it is often underestimated in a busy clinical practice. Aim of part one of this article is to review the psychological aspects that are relevant to a number of treatment variables in clinical orthodontics, including compliance with treatment, oral hygiene, management of orthodontic pain and discomfort, and oral habits. Due to the complex nature of the psychology of orthodontic treatment, it is difficult to determine the extent of the influence that the orthodontist-patient relationship may have on these variables, with effective communication and an awareness of the psychological issues playing an important role in enhancing the orthodontist-patient relationship.