Influence of second premolar extractions on the volume of the oral cavity proper: a control comparative cone-beam computed tomography volumetric analysis study.

OBJECTIVES: To compare the pre- and postorthodontic treatment volumetric changes of the oral cavity proper (OCP) in extraction and nonextraction patients and to identify influencing variables. MATERIALS AND METHODS: Pre- and posttreatment cone-beam computed tomography (CBCT) scans of patients undergoing orthodontic treatment with fixed labial appliances and who satisfied the inclusion criteria were individually landmarked. Linear, angular, and volumetric measurements were determined. Descriptive statistics, repeated measure analyses of variance, correlations, and stepwise regression statistical analyses were applied. RESULTS: The CBCT scans of 54 patients who underwent the extraction of second premolars and/or extraction of second primary molars associated with agenic second premolars, and 59 nonextraction patients matched for crowding, were assessed. The mean age for both groups was 15 years. There was a statistically significant increase in the volume of the OCP for both the extraction and nonextraction groups, with the nonextraction group demonstrating a larger increase in the volume of the OCP. Gender, age, changes in mandibular and maxillary arch length, and changes in mandibular and maxillary intermolar width all influenced the change in the OCP volume. CONCLUSIONS: The volume of the OCP increased in growing patients with and without the extraction of the second premolars and/or extraction of second primary molars associated with agenic second premolars. Patients who did not have extractions as part of their orthodontic treatment demonstrated a greater overall increase in OCP volume.

Tooth agenesis: An overview of diagnosis, aetiology and management.

Patients with one or more developmentally absent teeth are routinely encountered in dental practice. Tooth agenesis can be associated with significant functional, aesthetic and psycho-social problems. The present article provides an overview of the prevalence and aetiology of tooth agenesis, as well as the condition's clinical characteristics and management options with reference to the evidence base. A timely diagnosis can facilitate the appropriate planning and management which might not be straightforward, and patient care will likely require multi- and inter-disciplinary input. It is critical that dental care practitioners are aware of the clinical characteristics and management options for tooth agenesis.

Evaluation of the predicted vs. achieved occlusal outcomes with the Invisalign® appliance: A retrospective investigation of adult patients.

INTRODUCTION: The aim of this study was to investigate the relationship between occlusal contacts, overbite, transverse expansion, and the buccolingual inclination of the teeth with reference to the predicted treatment outcomes and achieved outcomes related to the use of the Invisalign® appliance in mild-to-moderate Class I malocclusions. MATERIAL AND METHODS: The occlusal contacts, overbite, the buccolingual inclination and transverse expansion of the maxillary arch of adult patients satisfying inclusion and exclusion criteria were measured at the initial (pre-treatment), predicted, and achieved treatment stages using metrology software. Pearson correlation coefficients and regression equations were calculated to determine the association between the initial, predicted and achieved changes in occlusal contact against the other variables. RESULTS: Thirty-three patients, who commenced treatment between 2013 and 2018 and satisfied inclusion/exclusion criteria were evaluated. An overall loss of posterior contact was recorded and highlighted by a significantly greater loss of contact from the maxillary buccal occlusal surfaces compared to the palatal occlusal surfaces. The mean [SD] achieved overbite outcome (2.94mm [1.17]) was greater than the predicted (1.74mm [0.87), P<0.001). The buccolingual inclination was significantly increased for the lateral incisors and first and second molars despite a predicted decrease (P≤0.007). Achieved transverse expansion showed significant variation from the predicted. The loss of posterior occlusal contact was correlated with the buccolingual inclination (r=0.70) and transverse expansion (r=0.74) of the posterior teeth. CONCLUSIONS: In mild-to-moderate Class I malocclusions, treatment using the Invisalign® appliance resulted in an overall loss of posterior contact. The loss of occlusal contact was correlated with deficiencies in achieved buccolingual inclination and transverse expansion of the posterior teeth. Planned bodily expansion was ineffective as most expansion occurred due to unplanned buccal tipping.

Occlusal contacts and treatment with the Invisalign appliance: a retrospective analysis of predicted vs achieved outcomes.

OBJECTIVES: To quantify the predicted occlusal contact outcomes compared with the clinically achieved occlusal contacts following treatment using the Invisalign aligner appliance. MATERIALS AND METHODS: The occlusal contacts of 33 adult patients presenting with a Class I mild-to-moderate malocclusion (spacing <4 mm or crowding of <6 mm) and treated using the Invisalign appliance were measured at the initial, predicted, and achieved stages of treatment by the metrology software Geomagic Control X. Assessed measurements were related to individual teeth and anterior, posterior, and overall contacts. RESULTS: The mean (standard deviation) difference between the achieved occlusal contact was significantly less than that predicted for overall occlusal contact and posterior occlusal contact (P < .0025). The achieved posterior occlusal contact was also less than pretreatment initial posterior occlusal contact. There was no difference in anterior occlusal contact between the predicted and achieved outcomes (P > .05). The central and lateral incisors displayed no statistically significant difference between the predicted and achieved occlusal contact. The patients with prescribed overcorrection demonstrated a statistically significant difference in predicted occlusal contact compared with those with nonprescribed overcorrection (P ≤ .0025), but no statistically significant difference in achieved occlusal contact. CONCLUSIONS: Treatment by the Invisalign appliance in Class I mild-to-moderate malocclusion resulted in a decrease in posterior occlusal contact. Further research is required to account for the deficiencies between the predicted and achieved clinical outcome related to occlusal contact and to determine the corrective changes required in the treatment protocols.

The predictability of the mandibular curve of Wilson, buccolingual crown inclination, and transverse expansion expression with Invisalign treatment.

INTRODUCTION: This study aimed to provide an initial investigation into the mandibular curve of Wilson (COW) handling using the Invisalign appliance (Align Technology, Santa Clara, Calif). Individual buccolingual crown inclinations and transverse expansions were also investigated to detect any regions of ineffectiveness in the dental arch. METHODS: A retrospective sample of patients treated by an experienced Invisalign provider in private practice was used. All adult patients with Class I or II Angle malocclusions and mild to moderate crowding treated using a minimum of 14 Invisalign aligners without intermaxillary elastics, bite ramps, or auxiliaries and a nonextraction mandibular arch from 2013-2019 were selected. Dental models at the initial scan, the ClinCheck prediction, and the outcome after the initial series of aligners were analyzed with Geomagic Control X software (version 2017.0.3; 3D systems, Rock Hill, SC). The COW, buccolingual crown inclination relative to the occlusal plane and cusp tip expansion were compared between ClinCheck changes and achieved changes. RESULTS: Forty-two subjects met the selection criteria. 74% of subjects experienced a flatter COW than ClinCheck predictions, and the mean difference was 0.76 mm (P = 0.0149). The first molars encountered 0.52 mm (P <0.001) more buccal crown inclination than ClinCheck predictions. No other teeth experienced statistically significant buccolingual inclination differences to ClinCheck. The second molars were the only teeth to experience significantly more arch expansion than ClinCheck at 0.68 mm (P = 0.0046). CONCLUSIONS: The Invisalign appliance tended to over-flatten the mandibular COW compared with ClinCheck because of the lack of buccal root torque in the mandibular first molars during expansion. The mandibular second molars were the only teeth to experience more expansion than ClinCheck.

How readable are orthognathic surgery consent forms?

BACKGROUND/OBJECTIVE: The valid consent process for medical intervention requires the disclosure of information in a format that is easily understandable by the patient. The aim of this investigation was to assess the readability of orthognathic surgery informed consent forms (OSICFs). METHODS: An online search methodology was conducted to identify OSICFs for analysis. The forms that satisfied inclusion/exclusion criteria were evaluated according to a standardised protocol. The readability of the content was assessed using three validated tools: the Simple Measure of Gobbledegook (SMOG) score, Flesch-Kincaid Grade-Level (FKGL) score and Flesch Reading Ease (FRE) score. RESULTS: Most of the 26 evaluated OSICFs were sourced from websites within the United States (69.2%) and from oral and maxillo-facial surgery practices (76.9%). Two of the assessed forms were template OSICFs available from oral and maxillo-facial professional societies to its members. The scores from the three tools found that the content of 84.6% to 92.3% of the forms were "difficult" to read. The mean (SD) SMOG score for all evaluated OSICFs was 12.31(2.22) [95% CI: 11.42 to 13.21]. The SMOG and FKGL scores were closely correlated (r=0.99, P < 0.0001; 95% CI: 0.9864 to 0.9973). There was no association between SMOG scores and the number of words contained within each consent form (r=-0.047;95% CI: -0.44 to 0.36). CONCLUSIONS: The OSICFs surveyed in this investigation failed to meet recommended readability levels. A significant number of patients are not likely to understand the information contained within the forms. Orthodontists are advised that poor literacy skills of their patients may preclude them from validly consenting to orthognathic surgery treatment procedures.

Analysis of the information contained within TikTok videos regarding orthodontic retention.

BACKGROUND: To analyze the content, reliability, and quality of relevant TikTok videos regarding orthodontic retention. METHODS: Six relevant terms were searched on the TikTok social media Web site. Uploaded videos satisfying inclusion/exclusion criteria were assessed for the presence of nine predetermined content domains and categorized as "high-content" (≥5) or "low-content" (<5). Reliability was determined using the DISCERN instrument and quality by the Global Quality Score (GQS). Layperson videos were evaluated for themes using discourse analysis. Intraclass coefficients for content, DISCERN scores, and GQS were calculated for intrarater reliability. Statistical analysis was via IBM SPSS Statistics (version 27.0.0.0; SPSS Inc. Chicago, IL). RESULTS: Orthodontists uploaded 37.8% and laypersons 34% of the 209 assessed videos. Just 22.1% of videos were considered to be 'high-content.' Quality of life issues related to retainer wear was the domain that was present least often in the videos provided by orthodontists (13.9%) and most often in those uploaded by laypersons (53.5%). High-content videos recorded greater mean GQS and DISCERN scores compared with low-content videos (P < 0.001). Strong positive associations existed between the number of domains present and DISCERN scores (rho = 0.808; P < 0.01) and between GQS and DISCERN scores (rho = 0.67; P < 0.01). Intraclass coefficient scores ranged between 0.92 and 0.98. Dissatisfaction with the need for long-term retainer wear was a prevalent negative theme in layperson videos. CONCLUSIONS: The content, reliability, and quality of TikTok videos regarding orthodontic retention were poor. The orthodontic profession must use TikTok effectively to ensure it delivers high-quality information relevant to laypersons' concerns.

Orthodontic clear aligners and TikTok videos: A content, reliability and quality analysis.

BACKGROUND AND OBJECTIVES: The social media platform, TikTok, has the potential to disseminate orthodontic information to an enormous global audience. The aim of this investigation was to assess the content, reliability and quality of videos regarding orthodontic clear aligners (OCAs) on the TikTok platform. METHODS: Three search terms were used to identify relevant videos. Characteristics such as video source and the number of views were documented. An 8-point information domain score was applied to categorise the videos as "not useful", "slightly useful", "moderately useful" and "very useful". The DISCERN tool and the Global Quality Score (GQS) were used to evaluate video reliability and quality. Intraclass coefficients (ICC) were computed for intrarater reliability. Statistical analyses were via IBM® SPSS®, version 27.0.0.0 (SPSS Inc. Chicago, IL, USA). RESULTS: Of the 117 videos that satisfied inclusion/exclusion criteria, most were uploaded by laypersons (44.4%) and orthodontists (35.9%). The assessed videos had over 300 million views. The overall mean (SD) number of information domains present in the videos was 1.85/8 (1.73). Most videos were deemed "slightly useful" (54.7%) or "not useful" (26.5%). The overall mean (SD) DISCERN score was 1.8/5 (1.28). The overall mean (SD) GQS was 2.48/5 (0.86). Higher DISCERN scores correlated with higher GQS (r=0.73; P<0.01). ICC scores (0.92-0.94) indicated excellent intrarater reliability. CONCLUSIONS: The content, reliability and quality of videos found on TikTok related to OCAs was poor. The orthodontic profession must direct patients to reliable and high-quality resources as well as uploading content onto TikTok to counteract the deficiencies highlighted in this study.

Ectopic and impacted maxillary canines: A quality evaluation of online information.

OBJECTIVE: To determine the quality of online information regarding ectopic and impacted maxillary canines (EIMCs). DESIGN: A cross-sectional survey on the Internet. MATERIAL AND METHODS: An online search using eight terms was carried out using four search engines. The relevant content of websites satisfying the inclusion and exclusion criteria were assessed for quality by applying three quality of information instruments and one readability tool. Statistical analyses were performed through GraphPad Prism 9.0. RESULTS: In total, 77 websites were evaluated. Most of the assessed content was associated with oral and maxillofacial surgery (49.35%) and orthodontic websites (31.18%). The overall mean DISCERN score was 38.05 ± 9.76/80 with 59.73% of websites recording a poor or very poor score. Three (3.9%) websites contained the HONCode seal. Twelve (15.58%) websites satisfied at least three out of a maximum four JAMA benchmarks and 11 (14.29%) satisfied none. The mean SMOG score was 9.81 ± 1.52 (95% confidence interval = 9.46-10.16; range = 6.7-15.1). CONCLUSION: The quality of online information related to EIMCs was poor and the content was difficult to read. Professional societies and clinicians should consider the use of quality of information and readability tools to enable the provision for reliable, high-quality and readable online information. This will assist EIMC treatment-related decision-making and management by patients and their families.

The predictability of the mandibular curve of Spee leveling with the Invisalign appliance.

INTRODUCTION: The purpose of this study is to provide an initial investigation into the predictability and characteristics of the mandibular curve of Spee (COS) leveling using the Invisalign appliance (Align Technology, Santa Clara, Calif) and any regions of ineffectiveness in the dental arch. METHODS: This study used a retrospective sample of patients treated by a single experienced Invisalign provider in private practice. All adult patients with Class I or II Angle malocclusions treated using a minimum of 14 Invisalign aligners without intermaxillary elastics, bite ramps, or auxiliaries and a nonextraction mandibular arch from 2013 to 2019 in the practice were selected. Dental models at the initial scan, the ClinCheck prediction, and the actual outcome were analyzed with Geomagic Control X software (version 2017.0.3; 3D systems, Rock Hill, SC). The COS and extrusion of posterior teeth relative to the occlusal plane were measured and compared. RESULTS: Forty-two subjects met the selection criteria. ClinCheck predicted 0.55 mm (P < 0.0001) more COS leveling than the actual outcome. The mean COS leveling accuracy using Invisalign was 35%, and ClinCheck overestimated the leveling in 86% of the patients. The first molars had the lowest accuracy and extrusion relative to the occlusal plane. CONCLUSIONS: To achieve desired clinical treatment goals, there should be a prescribed overcorrection of the mandibular COS leveling within the ClinCheck treatment plan, and the extrusion of mandibular first molars should be a region of focus. The clinician should consider using auxiliary appliances to improve mandibular COS leveling.

Validation of the Psychosocial Impact of Dental Aesthetics Questionnaire in the Australian population.

INTRODUCTION: The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception need for orthodontic treatment. The study aimed to determine the psychometric validity and reliability of PIDAQ in Australian adults. METHODS: Data were collected from the National Dental Telephone Interview Survey in 2013. The PIDAQ was used, comprising 4 conceptual domains: self-confidence, social impact, psychological impact, and esthetic concern. Psychometric sensitivity was estimated for each item. Confirmatory factor analysis was performed to determine factorial validity in which the ratio of chi-square by degrees of freedom, comparative fit, and root mean square error of approximation were used as indexes of the goodness of fit. Convergent validity was estimated from the average variance extracted and composite reliability, whereas internal consistency was estimated by Cronbach standardized alpha. RESULTS: The dataset comprised 2936 Australian adults aged ≥18 years and separated randomly into 2 subdata sets. The kurtosis and skewness values indicate an approximation to a normal distribution for each item, with acceptable thresholds for the goodness of fit and convergent validity (average variance extracted ≥0.50 and composite reliability ≥0.70), and discriminant validity was also demonstrated. Internal consistency was adequate in the 4 conceptual domains for PIDAQ for both subdata sets, with Cronbach standardized alpha being ≥0.70. CONCLUSIONS: The psychometric sensitivity, validity, and reliability of the PIDAQ instrument in a sample of the Australian adult population were found to be adequate. Both subdata sets drawn from the sample demonstrated acceptable goodness of fit and internal consistency.

Orthodontic treatment consent forms: A readability analysis.

OBJECTIVE: To evaluate the readability of orthodontic treatment informed consent forms (ICFs). DESIGN: A cross-sectional observational investigation. METHODS: An online search strategy was adopted to identify ICFs for orthodontic treatment. The text of each form that satisfied inclusion criteria was modified to a standardised protocol. The readability was evaluated using three validated instruments. GraphPad Software (GraphPad Software Inc., La Jolla, CA, USA) was used for statistical analyses. RESULTS: A total of 59 ICFs were evaluated. The majority were available on the websites of orthodontists (66.1%) and general dentists (27.1%). The scores recorded from the three instruments indicated that the content of 93.2%-98.3% of ICFs was difficult to read. A strong correlation was observed between the Simple Measure of Gobbledegook (SMOG) and the Flesch Kincaid Grade level (FKGL) instruments (r = 0.9782; P < 0.0001). The mean SMOG score for all assessed forms was 11.19 (95% confidence interval [CI] 10.85-11.54). The ICFs authored by the manufacturers of orthodontic appliances provided by clinicians recorded a mean Flesch Reading (FRE) score of 40.14 (95% CI 33.91-46.37) out of a maximum 100. An analysis of the SMOG scores indicated that the content of ICFs authored by national orthodontic societies was more difficult to read than those written by all other authors (P=0.01; 95% CI -1.6 to -0.2). CONCLUSION: The readability of the ICFs was too difficult for a significant number of the population. Many patients will be unable to validly consent to treatment based solely on reading of the content of the evaluated ICFs. A greater effort is required to improve the readability of ICFs to help ensure patient autonomy regarding orthodontic treatment decision-making and management.

Motivations of postgraduate dental students in Australia and New Zealand to pursue a dental specialty training program and their concerns.

OBJECTIVES: To determine the motivations of postgraduate dental students to pursue a specialist dental career and their concerns prior to and during the program. METHODS: A 3-part online survey comprising of participants' background, motivations and concerns and quality of life during the program, was distributed to students enrolled in the Doctor of Clinical Dentistry program in Australia and New Zealand from April to May 2018. Participation was voluntary and anonymous. Two separate reminders were provided two and four weeks after the initial survey was distributed. RESULTS: There was a 53.6% response rate (97/181 participants). The main factor for pursing a dental specialist degree was intellectual stimulation. Participants who were aged 40 years and above and those who were divorced/separated were most concerned about the amount of study required and finances during the program. Participants in their final year were most concerned about their personal relationships during the program. Orthodontic, oral medicine and paedodontic trainees reported concerns about the lack of exposure of their specialty during undergraduate training while periodontics and orthodontic trainees reported having the least exposure while working. CONCLUSION: This study showed that dental specialist trainees in Australia and New Zealand were primarily motivated to pursue a specialty for intellectual stimulation. Most students were concerned about the amount of study required, finances and having a work/life balance during the training program. Most students planned to work as associates in private practice upon graduation. Financial benefits may be required to stimulate an interest in academia. CLINICAL SIGNIFICANCE: An understanding of the motivations of postgraduate students is important to help dental programs mentor students in their future career pathway, improve the selection of candidates for the specialty programs and identify key areas to provide support, prior to, or during the program.

Accuracy of an automated method of 3D soft tissue landmark detection.

INTRODUCTION: Due to technological advances, the quantification of facial form can now be done via three-dimensional (3D) photographic systems such as stereophotogrammetry. To enable comparison with traditional cephalometry, soft-tissue anatomical landmark definitions have been modified to incorporate the third dimension. Annotating these landmarks manually, however, is still a time-consuming and arduous process. OBJECTIVE: To develop an automated algorithm to accurately identify anatomical landmarks on three-dimensional soft tissue images. METHODS: Thirty 3dMD images were selected from a private orthodontic practice consisting of 15 males and 15 females between 9 and 17 years of age. The soft-tissue 3D images were aligned along a reference plane to setup a Cartesian coordinate system. Screened by 2 observers, 21 landmarks were manually annotated and their coordinates defined. An automated landmark identification algorithm, based on their anatomical definitions, was developed to compare the landmark validity against the manually identified counterpart. RESULTS: Twenty-one landmarks were analysed in detail. Inter-observer and intra-observer reliability using ICC was >0.9. The average difference and standard deviation between manual and automated methods for all landmarks was 3.2 and 1.64 mm, respectively. Sixteen out of twenty-one landmarks had a mean difference less than 4 mm. The landmarks of greatest agreement (≤2 mm) were mainly in the midline: pronasale, subnasale, subspinale, labiale superius, stomion, with the exception of chelion right. Five linear facial measurements were found to have moderate to good agreement between the manual and automated identification methods. CONCLUSIONS: The developed algorithm was determined to be clinically relevant in the detection of midsagittal landmarks and associated measurements within the studied sample of adolescent Caucasian subjects.

What's in a hashtag: A content evaluation of Instagram posts related to orthodontic retention and retainers.

OBJECTIVE: To evaluate and compare the content of posts placed on Instagram by orthodontic treatment providers (OTP) and patients regarding orthodontic retention and retainers. MATERIALS AND METHODS: Six "hashtag" terms related to orthodontic retention were searched on the social media Web site, Instagram. Relevant uploaded posts were evaluated for the presence of nine retainer and retention-related domains. Patient posts were also qualitatively evaluated for themes via discourse analysis. Descriptive and univariate statistical analyses were carried out. Cohen's kappa intrarater reliability testing was performed. RESULTS: Most of the 144 posts that satisfied inclusion criteria were uploaded by OTPs (81.9%). Text and image(s) comprised 86.8% of posts. The most frequently included domain posted by OTPs related to "what is a retainer" and "the importance of wearing a retainer" (49.2%). Posts by OTPs referred to a greater number of domains (P = 0.028), whereas posts by patients recorded comparatively more "quality-of-life"-related content (P = 0.027). Most patient posts were positive (53.8%). The main negative theme within patient posts related to retainer discomfort and the unhappiness associated with the requirement for indefinite retainer wear. The intrarater score was 0.89 for the presence of domains. CONCLUSIONS: OTPs appear to use Instagram for posting orthodontic retention-related information more often than patients. The content of Instagram posts differed between OTPs and patients. OTPs must ensure that the content of their Instagram posts is relevant to the concerns articulated in posts uploaded by patients.

Modelling risk factors for high/low Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) in the Australian adults.

OBJECTIVE: Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception needed for orthodontic treatment (OT). The study aimed to (1) evaluate the psychosocial impact of dental aesthetics and the potential role of OT and (2) determine associations between PIDAQ with self-rated general and oral health, oral health-related quality of life (OHRQOL), and receipt of OT among Australian adults. METHODS: Data were obtained from the 2013 Australian National Dental Telephone Interview Survey (NDTIS). The PIDAQ was utilized as main outcome, comprising items from four conceptual domains: self-confidence, social impact, psychological impact, and aesthetic concern. Participants reported their socio-demographic, behavioural, self-rated general and oral health as well as the poor OHRQOL using the Oral Impact on Daily Performance (OIDP) instrument and OT. The mean of PIDAQ and four subscales score and their 95% confidence intervals (CI) were estimated. Generalized liner regression was used to estimate association between PIDAQ and covariates by calculating the mean ratio (MR) and their 95% CI. RESULTS: There were 2936 Australian adults who completed the PIDAQ items. The mean PIDAQ score was 28.8 (95% CI: 28.0-29.6). Higher PIDAQ scores were identified among those who reported non-Australian birth, lower incomes, infrequent dental visits, less than 21 teeth and brushing teeth less than twice a day, fair/poor self-rated general and oral health, and poor OHRQOL. In multivariable modelling, the mean PIDAQ score was 1.91 (95% CI: 1.82-2.00) times higher among those with OIDP score >3 and 1.06 (95% CI:1.01-1.10) times higher in those who had OT, comparing with their counterparts. Also, higher PIDAQ scores were identified among females, last visiting a dentist more than 2 years ago, fair or poor self-rated oral and general health. CONCLUSIONS: Higher PIDAQ scores that have a greater impact on OHRQOL were associated with poorer self-rated general and oral health. This may be explained by unfavourable dental attendance and oral health habits. The positive correlation with OIDP scores verifies the validity of the PIDAQ. Those who had received OT had lower PIDAQ and OIDP scores.

Orthodontic temporary anchorage devices: A qualitative evaluation of Internet information available to the general public.

INTRODUCTION: The evaluation of online information regarding orthodontic temporary anchorage devices (TADs) is lacking despite the increase in their use by orthodontists. This cross-sectional study aimed to investigate the quality of information regarding TADs available on the Internet to the general public. METHODS: Two search terms ("orthodontic temporary anchorage device" and "orthodontic miniscrew") were entered separately into a total of 5 search engines. The DISCERN instrument, Journal of the American Medical Association (JAMA) benchmarks, and Health on the Net Foundation Code of Conduct were used to evaluate the quality of information contained within Web sites that satisfied the inclusion and/or exclusion criteria. Web site readability was assessed via the Simple Measure of Gobbledygook and Flesch Reading Ease Score tools. Descriptive statistical analyses and Cohen's kappa intrarater reliability tests were performed. RESULTS: Thirty-one Web sites were evaluated. Most were authored by orthodontists (77.4%) and originated from the U.S. (38.7%). The mean (standard deviation [SD]) DISCERN score was 41.87 (8.45) out of 80, with a range of 27-57. Intrarater reliability testing for DISCERN scores was excellent (0.84). Four Web sites achieved all 4 JAMA benchmarks, and 2 achieved none. Referencing of content sources throughout the Web sites scored least via DISCERN (mean 1.49 out of 5 per Web site [SD, 0.77]) and JAMA (19.35% of Web sites). One Web site contained the Health on the Net Foundation Code of Conduct seal. The mean (SD) Simple Measure of Gobbledygook score was 8.75 (1.25), with a range of 6.5-11.3. The mean (SD) Flesch Reading Ease Score was 59.81 (7.17), with a range of 47.6-73.8. CONCLUSIONS: The quality of information related to TADs on the Internet is moderate. The usefulness of the information may be further reduced because it was beyond the readability of the average member of the general public. Web site authors should consider the use of additional expertise, quality of information tools, and readability formulas to ensure high-quality and easily readable content.

Orthodontic retention and retainers: Quality of information provided by dental professionals on YouTube.

INTRODUCTION: The evaluation of the quality of information (QOI) contained within oral health-related videos on the video-streaming Web site YouTube has been limited. This study aimed to determine the QOI regarding orthodontic retention and retainers contained within videos uploaded by dental professionals (DPs) to YouTube. METHODS: YouTube was systematically searched using 4 terms. The top 50 videos per search term by "number of times viewed" were stored in a specially created account. Following the application of inclusion/exclusion criteria, the videos were assessed for viewing characteristics, and a 4-point scoring system (0-3) was applied to evaluate QOI in 10 predetermined domains. Descriptive statistical analyses, intrarater, and interrater reliability tests were performed. RESULTS: Strong intrarater and interrater reliability scores were observed. Sixty-two videos from the top 50 most-viewed DPs were viewed a total of 1,367,810 times (range 77- 529,543). Most DPs originated from the United States (68%), and orthodontists (88%) uploaded most videos. The mean number (standard deviation [SD]) of reported domains was 5.5 out of 10 (SD, 2.2). The mean overall QOI score per domain was 1.14 out of 3 (SD, 0.64). The "importance of retention" domain scored highest (2.18; SD, 1.2). "The need for retention reviews" domain scored the lowest (0.3; SD, 0.65). The mean overall QOI score per DP was 11.72 out of 30.00 (SD, 5.85). CONCLUSIONS: The QOI related to orthodontic retention and retainers contained within videos provided by DPs through the YouTube Web site is deficient, particularly the need for retainer review. Orthodontists should be aware of the importance of YouTube as an information resource and ensure that videos related to orthodontic retention and retainers contain relevant, high-quality, and evidence-based information.

Differences in dentofacial morphology in children with sleep disordered breathing are detected with routine orthodontic records.

BACKGROUND: Residual snoring in children with obstructive sleep disordered breathing (SDB) may continue post-adenotonsillectomy. This study aims to identify baseline dentofacial differences in children with SDB using routine orthodontic records that might aid effective early intervention for the upper airway to prevent continued obstruction. METHODS: Children (6-16 years) with clinically diagnosed SDB from a paediatric Otolaryngology Clinic who required adenotonsillectomy were participants (n = 10). The control group (n = 9) comprised healthy non-snoring children from the community. Baseline overnight polysomnography (PSG), standardised frontal and right profile photographs and alginate impressions were taken of all children. Facial width, length, depth, convexity and mandibular position were measured from the photographs. The occlusion, arch width, arch depth, maxillary arch form, palatal height and volume were recorded from digitised dental models. Inter-group differences were compared. RESULTS: SDB patients had a significantly increased lower face height, maxillo-mandibular angle (1.73°; 95% CI 0.45-3.0) and a narrower maxillary arch in the upper posterior region. There was a trend towards a decreased palatal volume, increased posterior crossbite and Class II molar relationship. CONCLUSION: Dentofacial phenotypic differences between children with SDB and controls can be detected using facial photographs and dental models. Increased awareness of these features may help to identify children who to continue to snore post adenotonsillectomy.

The influence of miniscrew insertion torque.

Objective: The aim of this in vitro study was to evaluate the progressive development of surface microdamage produced following the insertion of orthodontic miniscrews (OMs) into 1.5 mm thick porcine tibia bone using maximum insertion torque values of 12 Ncm, 18 Ncm, and 24 Ncm. Methods: Aarhus OMs (diameter 1.5 mm; length 6 mm) were inserted into 1.5 mm porcine bone using a torque limiting hand screwdriver set at 12 Ncm, 18 Ncm, and 24 Ncm. A custom rig equipped with a compression load cell was used to record the compression force exerted during manual insertion. A sequential staining technique was used to identify microdamage viewed under laser confocal microscopy. Virtual slices were created and stitched together to form a compressed two-dimensional composition of the microdamage. Histomorphometric parameters, including total damage area, diffuse damage area, maximum crack length, maximum damage radius, and maximum diffuse damage radius, were measured. Kruskal-Wallis Tests and Wilcoxon Rank-Sum Tests were used to analyse the generated data. Results: All OMs inserted using 12 Ncm failed to insert completely, while partial insertion was observed for two OMs inserted at 18 Ncm. Complete insertion was achieved for all OMs inserted at 24 Ncm. Histomorphometrically, OMs inserted using 24 Ncm produced a significantly larger diffuse damage area (P < 0.05; P < 0.05) and maximum diffuse damage radius (P < 0.05; P < 0.05), for both the entry and exit surfaces, respectively, compared with the 12 Ncm and 18 Ncm groups. Conclusions: Insertion torque can influence the degree of OM insertion and, subsequently, the amount of microdamage formed following insertion into 1.5 mm thick porcine tibia bone. An increase in insertion torque corresponds with greater insertion depth and larger amounts of microdamage.