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1.
J Orthod ; 47(2): 129-139, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32338124

RESUMO

OBJECTIVE: To explore the experiences of mentoring higher-grade trainees amongst senior orthodontic trainers at Bristol Dental School. DESIGN: Qualitative study using interpretive methodology. SETTING: University of Bristol Dental School. PARTICIPANTS: Six consultant orthodontists, five of whom also have district general hospital experience. METHODS: One-to-one semi-structured interviews were undertaken on a purposeful sample of orthodontic trainers. The interviews were audio recorded, transcribed verbatim and Thematic Analysis was used to analyse the data. RESULTS: Four main themes emerged from the data were. They were: How to Mentor; Mentor-Mentee Pairings; Resources and Success; and Pitfalls of Mentoring. CONCLUSION: The present study revealed that senior trainers have a good understanding of the qualities of a mentor and appreciate the roles which mentors need to perform. They are altruistic in their motives, but would benefit from more time, organisational support and training to help them perform their duties better.


Assuntos
Tutoria , Humanos , Mentores , Pesquisa Qualitativa , Faculdades de Odontologia
2.
Cleft Palate Craniofac J ; 57(1): 21-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31331191

RESUMO

OBJECTIVE: To determine whether a relationship exists between the aesthetic scores given to photographic records of the nasolabial region of patients with repaired unilateral cleft lip and palate (UCLP) and the 5-Year Olds' Index scores of study models for the same participants. DESIGN: Retrospective study. SETTING: University of Bristol Dental Hospital, United Kingdom. PARTICIPANTS: Patients with nonsyndromic UCLP previously enrolled in the Cleft Care UK (CCUK) Study. METHODS: The CCUK participants, who had both study models and photographs (frontal and worm's eye view), were identified and their records retrieved. These were rated by 2 consultants and 2 senior registrars in orthodontics. The 5-Year Olds' Index was used to score the study models, and at a separate sitting, a 5-point Likert scale was used to score the cropped frontal and worm's eye view photographs of the same children. The results were analyzed using intraclass correlation coefficients and Cohen κ. MAIN OUTCOME MEASURES: Correlation between the aesthetic scores of the photographic views and the concordant 5-Year Olds' Index scores of the study models. RESULTS: The intraclass correlation coefficient scores showed very poor agreement between the photographic views and their concordant study models. The level of inter- and intra-rater reliability was strongest when scoring the study models. CONCLUSIONS: There was no agreement between the scores given to various photographic views and their corresponding study models. Scoring the study models using the 5-Year Olds' Index was the most reliable outcome measure for this age-group.

3.
Br Dent J ; 227(8): 741-746, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31654014

RESUMO

Orthodontics, like all areas of dentistry, offers the option to pursue a career in academia. In addition to providing clinical care for patients, academic orthodontists have a role in educating dental students and the wider dental community. There is also the option to engage with and undertake research, which may advance treatment and improve patient care. There is currently a shortage of academic orthodontists in the UK, with institutions reporting difficulties in the recruitment to academic posts. This problem is not only confined to orthodontics but widespread among dentistry. As a result, there is concern regarding the long-term future of dental academia. This paper considers why this might be the case and aims to raise awareness of the shortage in dental academic staff. It will discuss some of the main reasons put forward to explain this shortage and offer information and guidance to those interested in pursuing a career as an orthodontic academic.


Assuntos
Odontólogos , Ortodontia , Escolha da Profissão , Assistência Odontológica , Humanos , Ortodontistas , Estudantes de Odontologia
4.
J Orthod ; 46(4): 287-296, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31595815

RESUMO

OBJECTIVE: To carry out a UK national clinical audit of orthognathic acceptance criteria and information provided to orthognathic patients before treatment. DESIGN: National clinical audit. SETTING: Data collected using Bristol Online Surveys. PARTICIPANTS: Sixty-nine UK hospital orthodontic departments submitted data. METHODS: Data were collected at two time points using Bristol Online Surveys over a period of 12 months. These were before treatment at the first multidisciplinary clinic (MDT) and immediately after surgery. The data collected included: Index of Orthognathic Functional Treatment Need (IOFTN); Index of Orthodontic Treatment Need (IOTN); age; previous orthodontic treatment; attendance at an MDT; treatment times; and information provision. RESULTS: Eighty-five units agreed to take part in the audit with 69 submitting data, giving a response rate of 81%. The data from 3404 patients were uploaded, 2263 before treatment and 1141 immediately after surgery. Of patients, 91.07% had an IOFTN score of 4 or 5 and 88.73% had an IOTN score of 4 or 5. The mean age at the first MDT was 22 years in the first cohort and 21 years and 4 months in the second immediate post-surgery cohort. Of patients, 37.93% had undergone some form of previous orthodontic treatment, but only 0.28% had undergone previous orthognathic treatment; 96.93% had an MDT confirm that orthodontic treatment by itself was insufficient to adequately correct their functional symptoms. The average treatment time from bond up to surgery was 2 years and 6 months. With respect to information provision, patients received information from a number of sources, principally the British Orthodontic Society (BOS) patient information leaflets and the BOS website Your Jaw Surgery. CONCLUSIONS: In the UK, the majority of orthognathic cases fulfil the criteria for acceptance for NHS-funded orthognathic treatment, as outlined by the Chief Dental Officer's interim guidance on orthognathic treatment. This suggests any prior approval process would not be a good use of NHS resources in the commissioning of orthognathic treatment.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Sociedades Odontológicas , Adulto , Grupos Étnicos , Humanos , Índice de Necessidade de Tratamento Ortodôntico , Inquéritos e Questionários , Adulto Jovem
5.
Am J Orthod Dentofacial Orthop ; 155(6): 767-778, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31153497

RESUMO

INTRODUCTION: The aim of this laboratory and randomized clinical trial was to investigate particulate production at debonding and enamel clean-up following the use of flash-free ceramic brackets and to compare them with non-flash-free metal and ceramic brackets. METHODS: In the laboratory study, brackets were bonded to bovine teeth. After 24 hours of immersion in water, the brackets were debonded, the adhesive remnant scores noted, and the enamel cleaned with the use of rotary instruments. Four bracket-adhesive combinations and 2 different enamel pretreatment regimens were tested, including metal and ceramic brackets (conventional, adhesive precoat [APC], and APC flash-free) and conventional acid etch and self-etching primer. Quantitative (mg/m3) and qualitative analysis of particulate production was made in each case. In the clinical trial, 18 patients treated with the use of fixed appliances were recruited into this 3-arm parallel-design randomized controlled trial. They were randomly allocated to 1 of 3 groups: experimental flash-free ceramic bracket or non-flash-free ceramic or metal bracket group. Eligibility criteria included patients undergoing nonextraction maxillary and mandibular fixed appliance therapy. At completion of treatment, the brackets were debonded, and the primary outcome measure was particulate concentration (mg/m3). Randomization was by means of sealed envelopes. Data were analyzed with the use of quantile plots and linear mixed models. The effect of etch, bracket, and stage of debonding of clean-up on particle composition was analyzed with the use of mixed-effects regression. RESULTS: In the laboratory study, the APC brackets produced the highest particulate concentration. Although statistically significantly higher than the metal and conventional ceramic brackets, it was not significantly higher than the ceramic flash-free brackets. In the clinical study, there was no statistically significant effect of bracket type on particulate concentration (P = 0.29). This was despite 3 patients with APC flash-free and 1 patient with conventional Clarity (with 1 bracket) having 1 or more ceramic bracket fracture at debonding requiring removal. No adverse events reported. CONCLUSIONS: Particulates in the inhalable, thoracic, and respirable fractions were produced at enamel clean-up with all bracket types. Although APC and APC flash-free brackets produced the highest concentrations in the laboratory study, there was no difference between any of the brackets in the clinical trial. REGISTRATION: The trial was not registered. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Assuntos
Cerâmica/química , Cimentos Dentários/química , Descolagem Dentária/métodos , Aparelhos Ortodônticos Fixos , Braquetes Ortodônticos , Material Particulado/química , Animais , Bovinos , Humanos , Teste de Materiais , Microscopia Eletrônica de Varredura , Espectrometria por Raios X , Propriedades de Superfície
6.
Cleft Palate Craniofac J ; 56(2): 248-256, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29750571

RESUMO

OBJECTIVE: Can we reliably discriminate severity within the existing categories of the 5-Year-Olds' Index? DESIGN: Retrospective method comparison and development study. SETTING: School of Oral and Dental Science, University of Bristol. METHODS: Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds' Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds' Index was then applied to 198 study models of 5-year-olds with UCLP. RESULTS: The modified 5-Year-Olds' Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds' Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds' Index. Visual analogue Scale scores resulted in unacceptable variation between measurements. CONCLUSIONS: The new modified 5-Year-Olds' Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the "better" outcome categories than the original 5-Year-Olds' Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP.


Assuntos
Fenda Labial , Fissura Palatina , Pré-Escolar , Arco Dental , Modelos Dentários , Humanos , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
7.
J Orthod ; 44(1): 3-7, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28248619

RESUMO

OBJECTIVES: Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia. METHODS: 1000 patients aged 11-17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief. Neither the clinicians nor patients were blinded to assignment. In addition to recording pain experience and analgesic use for 3 days following appliance placement and first archwire change, each patient recorded their level of anxiety immediately following the fitting of the appliance and the first archwire change. RESULTS: 419 chewing gum group (84%) and 407 ibuprofen group (83%) questionnaires were returned following appliance placement, and 343 chewing gum group (70%) and 341 ibuprofen group (71%) questionnaires were returned following the first archwire change. The mean anxiety scores following fitting of the appliance and first archwire change were 2.7 (SD 2.1) and 1.6 (SD 1.8), respectively. There were weak but significant positive associations between anxiety scores and pain scores. Multi-level modelling produced a coefficient for anxiety of 0.23 (95% CI 0.17-0.28) for appliance placement, suggesting a small rise (0.23) on the 11-point pain scale for a one-point increase on the corresponding anxiety scale. Following archwire change, the corresponding coefficient was 0.32 (0.24-0.39). For ibuprofen use, again simple analyses suggested a relationship with anxiety. Multi-level logistic modelling produced an odds ratio for ibuprofen use of 1.11 (95% CI 1.07-1.15) at appliance placement and 1.21 (1.10-1.33) at the first archwire change. There was a 10-20% increase in the odds of using ibuprofen for each one-point increase on the anxiety scale. No such relationship was found between anxiety and chewing gum use. There were no adverse effects or harms reported during the trial. Approvals were granted by the Research Ethics Committee (08/H0106/139), R&D and MHRA (Eudract 2008-005522-36) and the trial was registered on the ISRCTN (79884739) and NIHR (6631) portfolios. Support was provided by the British Orthodontic Society Foundation. CONCLUSIONS: There was a weak positive correlation between anxiety reported and pain experienced following both the initial fitting of the fixed appliances and at the subsequent archwire change. Patients that were more anxious tended to take more ibuprofen for their pain relief.


Assuntos
Goma de Mascar , Ibuprofeno , Adolescente , Ansiedade , Criança , Humanos , Dor , Sociedades Odontológicas
8.
Aust Orthod J ; Spec No: 65-72, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29709123

RESUMO

A number of arguments surround orthodontics and orthodontic treatment and this article aims to discuss the current thinking and evidence base associated with these controversies.


Assuntos
Ortodontia Corretiva/métodos , Estética Dentária , Humanos , Aparelhos Ortodônticos , Sorriso
9.
Am J Orthod Dentofacial Orthop ; 150(5): 831-838, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27871710

RESUMO

INTRODUCTION: The aims of this study were to describe bacterial load and diversity of the aerosol created during enamel cleanup after the removal of fixed orthodontic appliances and to assess the effect of a preprocedural mouth rinse. METHODS: The study involved the sampling of ambient air adjacent to the patient's mouth during adhesive removal using a slow-speed handpiece and a spiral fluted tungsten carbide bur without water irrigation. Sampling was carried out during enamel cleanup with or without a preprocedural mouth rinse of either sterile water or chlorhexidine. Airborne particles were collected using a viable inertial impactor simulating the human respiratory tree. The bacteria collected were analyzed using both culture and molecular techniques. RESULTS: Bacteria produced during debond and enamel cleanup can reach all levels of the respiratory tree. The use of a preprocedural mouth rinse, either sterile water or chlorhexidine, increased the numbers and diversity of the bacteria in the air. CONCLUSIONS: When using a slow-speed handpiece and a spiral fluted tungsten carbide bur for enamel cleanup after orthodontic treatment, the bacterial load and diversity of the aerosol produced are lower when a preprocedural mouth rinse is not used.


Assuntos
Descolagem Dentária/efeitos adversos , Aparelhos Ortodônticos/microbiologia , Aerossóis , Bactérias/isolamento & purificação , Clorexidina/uso terapêutico , Descolagem Dentária/instrumentação , Descolagem Dentária/métodos , Esmalte Dentário/microbiologia , Eletroforese/métodos , Humanos , Antissépticos Bucais/uso terapêutico
10.
Am J Orthod Dentofacial Orthop ; 150(2): 220-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27476354

RESUMO

INTRODUCTION: The aim of this randomized trial was to investigate the effect of the use of a sugar-free chewing gum vs ibuprofen on reported pain in orthodontic patients. METHODS: This was a 2-arm parallel design randomized controlled trial in 9 sites in the southwest of England. Patients about to undergo orthodontic treatment with maxillary and mandibular fixed appliances were recruited and randomly allocated to an experimental chewing gum group or a control ibuprofen group. Eligibility criteria included patients undergoing fixed maxillary and mandibular appliance therapy, aged 11 to 17 years, and able to use ibuprofen and chewing gum. The primary outcome measure was pain experienced after appliance placement using a mean of 3 recordings on a scale of 0 to 10. Secondary outcome measures were pain experienced in the subsequent 3 days, pain after the first archwire change, ibuprofen use, and appliance breakages. Pain scores were recorded with a questionnaire and posted to a collection center by each patient. Randomization was by means of a central telephone service and comprised computer-generated random numbers used to generate a sequential allocation list, with permuted blocks of variable size (2 and 4) and stratified by center. Neither the clinicians nor the patients were blinded to the intervention. Patients in the control group were permitted to use ibuprofen only, and patients in the experimental group were allowed to use ibuprofen if they did not get sufficient analgesia from the chewing gum. Data were analyzed using the principle of intention to treat with multilevel modeling to reflect the structured nature of the data (scores within patient within site). RESULTS: One thousand patients were recruited and randomized in a ratio of 1:1 to the chewing gum and ibuprofen (control) groups. The male-to-female ratios were similar in the groups. The pain questionnaire response rates were good at approximately 84% and 83% after appliance placement (chewing gum group, 419; ibuprofen group, 407) and 70% and 71% after the first archwire change (chewing gum group, 343; ibuprofen group, 341). The primary outcomes were similar for the 2 groups: mean pain scores, 4.31 in the chewing gum group and 4.17 in the ibuprofen group; difference, 0.14 (95% CI, -0.13 to 0.41). There was a suggestion that the relative pain scores for the 2 groups changed over time, with the chewing gum group experiencing slightly more pain on the day of bond-up and less on the subsequent 3 days; however, the differences had no clinical importance. There were no significant differences for the period after archwire change. The reported use of ibuprofen was less in the chewing gum group than in the ibuprofen group; after appliance placement, the mean numbers of occasions that ibuprofen was used were 2.1 in the chewing gum group and 3.0 in the ibuprofen group (adjusted difference, -0.96 [95% CI, -0.75 to -1.17; P <0.001]); after archwire change, the figures were 0.8 and 1.5 occasions (difference, -0.65 [-0.44 to -0.86; P <0.001]). After appliance placement and the first archwire change, there was no clinically or statistically significant difference in appliance breakages between the chewing gum and ibuprofen groups after either bond-up (7% and 8.8%, respectively) or the first archwire change (4.2% and 5.5%, respectively). No adverse events were reported. CONCLUSIONS: The use of a sugar-free chewing gum may reduce the level of ibuprofen usage but has no clinically or statistically significant effect on bond failures. REGISTRATION: International Standard Randomised Controlled Trial Number (79884739) and National Institute of Health Research (6631) portfolios. FUNDING: This research was supported by an award by the British Orthodontic Society Foundation.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Goma de Mascar , Ibuprofeno/uso terapêutico , Braquetes Ortodônticos/efeitos adversos , Fios Ortodônticos/efeitos adversos , Manejo da Dor/métodos , Técnicas de Movimentação Dentária/instrumentação , Adolescente , Criança , Inglaterra , Falha de Equipamento , Feminino , Humanos , Masculino , Mastigação/fisiologia , Medição da Dor , Resultado do Tratamento
11.
Eur J Orthod ; 38(1): 66-70, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25788331

RESUMO

OBJECTIVES: To assess whether a true knowledge of crowding alters treatment decisions compared with estimates of crowding. MATERIALS AND METHODS: Thirty-six orthodontists were asked to estimate crowding using visualization on eight mandibular arch study models and to indicate possible extraction choices. For each model, the intermolar widths, intercanine widths, and clinical scenarios were identical, but the true crowding varied from 0.2 to 8.4mm as to a lesser extent did the curve of Spee. Eleven orthodontists repeated the visualization exercise after 2 weeks to assess reliability. All 36 of the orthodontists were asked to repeat the treatment planning exercise on the same models, but this time was provided with the true amount of crowding in each case. RESULTS: When the 36 orthodontists used direct visualization of the models to assess crowding, the range of their estimates of crowding increased as the crowding increased. As might be expected, they also tended to move towards extraction treatments as the crowding increased (P = 0.013, odds ratio = 3). Although the reliability of the repeat estimates of crowding were moderate, the mean estimates were greater than the true crowding for each model. When orthodontists were presented with the true amount of crowding, rather than their estimate of crowding, it had a significant effect on the decision to extract, with fewer orthodontists recommending extractions. LIMITATIONS: The principal limitation of this study is that it was a laboratory-based study and utilized just the mandibular arch model for estimation and treatment planning. CONCLUSIONS: Direct visualization may overestimate the amount of crowding present. When the true amount of crowding is known, it can lead to more consistent treatment planning, with the decision to extract fewer teeth in the borderline cases. A formal space analysis is likely to assist with treatment planning.


Assuntos
Competência Clínica , Tomada de Decisão Clínica/métodos , Má Oclusão/diagnóstico , Ortodontia Corretiva/normas , Arco Dental/patologia , Assistência Odontológica , Modelos Dentários , Inglaterra , Humanos , Má Oclusão/patologia , Má Oclusão/terapia , Ortodontia Corretiva/métodos , Planejamento de Assistência ao Paciente , Reprodutibilidade dos Testes , Extração Dentária
13.
Appl Environ Microbiol ; 80(20): 6480-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25107981

RESUMO

The diversity of bacterial species in the human oral cavity is well recognized, but a high proportion of them are presently uncultivable. Candidate division TM7 bacteria are almost always detected in metagenomic studies but have not yet been cultivated. In this paper, we identified candidate division TM7 bacterial phylotypes in mature plaque samples from around orthodontic bonds in subjects undergoing orthodontic treatment. Successive rounds of enrichment in laboratory media led to the isolation of a pure culture of one of these candidate division TM7 phylotypes. The bacteria formed filaments of 20 to 200 µm in length within agar plate colonies and in monospecies biofilms on salivary pellicle and exhibited some unusual morphological characteristics by transmission electron microscopy, including a trilaminated cell surface layer and dense cytoplasmic deposits. Proteomic analyses of cell wall protein extracts identified abundant polypeptides predicted from the TM7 partial genomic sequence. Pleiomorphic phenotypes were observed when the candidate division TM7 bacterium was grown in dual-species biofilms with representatives of six different oral bacterial genera. The TM7 bacterium formed long filaments in dual-species biofilm communities with Actinomyces oris or Fusobacterium nucleatum. However, the TM7 isolate grew as short rods or cocci in dual-species biofilms with Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra, or Streptococcus gordonii, forming notably robust biofilms with the latter two species. The ability to cultivate TM7 axenically should majorly advance understanding of the physiology, genetics, and virulence properties of this novel candidate division oral bacterium.


Assuntos
Cultura Axênica , Bactérias/citologia , Bactérias/genética , Boca/microbiologia , Actinomyces/crescimento & desenvolvimento , Actinomyces/fisiologia , Adolescente , Bactérias/classificação , Bactérias/isolamento & purificação , Biofilmes/crescimento & desenvolvimento , Criança , Eletroforese em Gel de Gradiente Desnaturante , Fusobacterium nucleatum/crescimento & desenvolvimento , Fusobacterium nucleatum/fisiologia , Humanos , Dados de Sequência Molecular , Aparelhos Ortodônticos/microbiologia , Filogenia , Porphyromonas gingivalis/crescimento & desenvolvimento , Porphyromonas gingivalis/fisiologia , Proteômica/métodos , RNA Ribossômico 16S , Streptococcus gordonii/crescimento & desenvolvimento , Streptococcus gordonii/fisiologia
14.
J Orthod ; 41(2): 77-83, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24951095

RESUMO

OBJECTIVE: To design a new index categorizing the functional need for orthognathic treatment. DESIGN: Laboratory-based study. SETTING: Records were obtained from two UK hospital-based orthodontic departments. PARTICIPANTS: A panel of four consultant orthodontists, experienced in providing orthognathic care, devised a new index of Orthognathic Functional Treatment Need (IOFTN) with the aid of the membership of the British Orthodontic Society Consultant Orthodontists Group (COG). Twenty-three consultants and post-CCST level specialists took part in the study as raters to test the validity and reliability of the new index. METHODS: A total of 163 start study models of patients who had previously undergone orthognathic treatment were assessed by the panel of four consultant orthodontists using the new index (IOFTN) and the agreed category was set as the 'gold standard'. Twenty-one consultants and post-CCST level specialists then scored the models on one occasion and two scored 50 sets of models twice to determine the test-re-test reliability. RESULTS: Kappa scores for inter-rater agreement with the expert panel for the major categories (1-5) demonstrated good to very good agreement (kappa: 0·64-0·89) for all raters. The percentage agreement ranged from 68·1 to 92% in all cases. Intra-rater agreement for the major categories was moderate to good (kappa: 0·53-0·80). CONCLUSIONS: A new index, the IOFTN, has been developed to help in the prioritization of severe malocclusions not amenable to orthodontic treatment alone. It demonstrates good content validity and good inter-rater and moderate to good intra-rater reliability. As a result of being an evolution of the IOTN, the familiar format should make it easy to determine functional treatment need within daily orthognathic practice.


Assuntos
Índice de Necessidade de Tratamento Ortodôntico , Determinação de Necessidades de Cuidados de Saúde , Procedimentos Cirúrgicos Ortognáticos , Fenda Labial/classificação , Fissura Palatina/classificação , Modelos Dentários , Assimetria Facial/classificação , Humanos , Má Oclusão/classificação , Variações Dependentes do Observador , Mordida Aberta/classificação , Ortodontia , Sobremordida/classificação , Planejamento de Assistência ao Paciente , Reprodutibilidade dos Testes , Reino Unido
15.
Am J Orthod Dentofacial Orthop ; 145(5): 569-78, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24785921

RESUMO

INTRODUCTION: The aim of this study was to compare the time to initial alignment and extraction space closure using conventional brackets and active and passive self-ligating brackets. METHODS: One hundred adolescent patients 11 to 18 years of age undergoing maxillary and mandibular fixed appliance therapy after the extraction of 4 premolars were randomized with stratification of 2 age ranges (11-14 and 15-18 years) and 3 maxillomandibular plane angles (high, medium, and low) with an allocation ratio of 1:2:2. Restrictions were applied using a block size of 10. Allocation was to 1 of 3 treatment groups: conventional brackets, active self-ligating, or passive self-ligating brackets. All subjects were treated with the same archwire sequence and space-closing mechanics in a district general hospital setting. The trial was a 3-arm parallel design. Labial-segment alignment and space closure were measured on study models taken every 12 weeks throughout treatment. All measurements were made by 1 operator who was blinded to bracket type. The patients and other operators were not blinded to bracket type during treatment. RESULTS: Ninety-eight patients were followed to completion of treatment (conventional, n = 20; active self-ligating brackets, n = 37; passive self-ligating brackets, n = 41). The data were analyzed using linear mixed models and demonstrated a significant effect of bracket type on the time to initial alignment (P = 0.001), which was shorter with the conventional brackets than either of the self-ligating brackets. Sidak's adjustment showed no significant difference in effect size (the difference in average response in millimeters) between the active and passive self-ligating brackets (the results are presented as effect size, 95% confidence intervals, probabilities, and intraclass correlation coefficients) (-0.42 [-1.32, 0.48], 0.600, 0.15), but the conventional bracket was significantly different from both of these (-1.98 [-3.19, -0.76], 0.001, 0.15; and -1.56 [-2.79, -0.32], 0.001, 0.15). There was no statistically significant difference between any of the 3 bracket types with respect to space closure. Space-closure times were shorter in the mandible, except for the Damon 3MX bracket (Ormco, Orange, Calif), where active and total space-closure times were shorter in the maxilla. No adverse events were recorded in the trial. CONCLUSIONS: Time to initial alignment was significantly shorter for the conventional bracket than for either the active or passive self-ligating brackets. There was no statistically significant difference in passive, active, or total space-closure times among the 3 brackets under investigation.


Assuntos
Desenho de Aparelho Ortodôntico , Braquetes Ortodônticos , Fechamento de Espaço Ortodôntico/instrumentação , Técnicas de Movimentação Dentária/instrumentação , Adolescente , Dente Pré-Molar/cirurgia , Cefalometria/métodos , Criança , Cobre/química , Ligas Dentárias/química , Elastômeros , Feminino , Seguimentos , Humanos , Masculino , Mandíbula/patologia , Maxila/patologia , Níquel/química , Fios Ortodônticos , Aço Inoxidável/química , Fatores de Tempo , Titânio/química , Extração Dentária
16.
Eur J Orthod ; 36(4): 465-70, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24243622

RESUMO

OBJECTIVES: To assess the estimation of crowding by orthodontists and their subsequent extraction choices. MATERIALS AND METHODS: Sixty-two orthodontists were asked to quantify crowding on eight lower arch study models using their preferred method and also to indicate possible extraction choices. For each model, the intermolar widths, intercanine widths, and clinical scenarios were identical, but the true crowding varied from 0.1 to 7.5mm across the eight models as to a lesser extent did the curve of Spee. Eleven orthodontists repeated the exercise after 9 months to assess reliability. RESULTS: The preferred method of space estimation by all of the orthodontists was direct visualization. However, the estimates of crowding were very variable. For the most crowded lower model with 7.5mm of crowding, the estimates ranged from 5 to 20mm. Extraction choices were less variable than estimates of crowding and shifted from second to first premolars as crowding increased. Estimates of crowding and treatment decisions changed with time in 28 of 33 repeat measures. Estimates of crowding were unrelated to clinical experience. LIMITATIONS: The principal limitation of this study is that it was a laboratory-based study and utilized just the lower arch model for estimation and treatment planning. CONCLUSIONS: Extraction decisions and estimates of crowding tended to vary both initially and over time but were less varied in the case of the extraction decisions. Although this may have been a reflection of the limited treatment options, perhaps reassuringly, as the degree of crowding increased, so did the likelihood of prescribing extractions and the decisions generally shifted from second to first premolars. How orthodontists estimate crowding and make subsequent extraction choices is important and has potential medico-legal implications.


Assuntos
Tomada de Decisões , Má Oclusão/diagnóstico , Planejamento de Assistência ao Paciente , Dente Pré-Molar/cirurgia , Cefalometria/métodos , Dente Canino/patologia , Arco Dental/patologia , Modelos Dentários , Humanos , Má Oclusão/patologia , Mandíbula/patologia , Dente Molar/patologia , Odontometria/métodos , Reprodutibilidade dos Testes , Extração Dentária
17.
Dent Mater ; 29(6): e85-90, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23618555

RESUMO

OBJECTIVES: Light cured materials are increasingly used in orthodontic clinical practice and concurrent with developments in materials have been developments in light curing unit technology. In recent years the irradiances of these units have increased. The aim of this study was to determine the safe exposure times to both direct and reflected light. METHODS: The weighted irradiance and safe exposure times of 11 dental curing lights (1 plasma arc, 2 halogen and 8 LED lights) were determined at 6 distances (2-60 cm) from the light guide tip using a spectroradiometer. In addition, using the single most powerful light, the same two parameters were determined for reflected light. This was done at a distance of 10 cm from the reflected light, but during simulated bonding of 8 different orthodontic brackets of three material types, namely stainless steel, ceramic and composite. RESULTS: The results indicate that the LED Fusion lamp had the highest weighted irradiance and the shortest safe exposure time. With this light the maximum safe exposure time without additional eye protection for the patient (at 10 cm), the operator (at 30 cm) and the assistant (at 60 cm) ranged from 2.5 min, 22.1 min and 88.8 min respectively. This indicates a relatively low short term risk during normal operation of dental curing lights. For reflected light at a distance of 10 cm the risk was even lower, but was affected by the material and shape of the orthodontic bracket under test. SIGNIFICANCE: The short term risks associated with the use of dental curing lights, halogen, LED or plasma, appear to be low, particularly if as is the case adequate safety precautions are employed. The same is true for reflected light from orthodontic brackets during bonding. What is still unclear is the potential long term ocular effects of prolonged exposure to the blue light generated from dental curing lights.


Assuntos
Luzes de Cura Dentária/normas , Cura Luminosa de Adesivos Dentários/instrumentação , Ortodontia , Cerâmica/química , Resinas Compostas/química , Luzes de Cura Dentária/classificação , Ligas Dentárias/química , Materiais Dentários/química , Dispositivos de Proteção dos Olhos , Humanos , Concentração Máxima Permitida , Braquetes Ortodônticos , Doses de Radiação , Proteção Radiológica/instrumentação , Radiometria/métodos , Fatores de Risco , Segurança , Aço Inoxidável/química , Fatores de Tempo
18.
Am J Orthod Dentofacial Orthop ; 143(3): 317-23, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23452965

RESUMO

INTRODUCTION: Our objective was to determine whether components of fixed orthodontic appliances as received from the manufacturers and after exposure to the clinical environment are free from microbial contamination before clinical use. A pilot molecular microbiologic laboratory study was undertaken at a dental hospital in the United Kingdom. METHODS: A range of orthodontic materials "as received" from the manufacturers and materials "exposed" to the clinical environment were studied for bacterial contamination. After growth on blood-rich media, cultured bacteria were identified by 16S rDNA polymerase chain reaction amplification and sequence phylogeny. RESULTS: Bacteria were isolated from "as received" bands, archwires, and impression trays, but the level of contamination was low (0.5 × 10(1) to 1.825 × 10(2) CFU/mL(-1)). Various bacterial species were isolated from "clinic exposed" bands, archwires, impression trays, coil springs, and elastomeric modules, but the level of contamination was low (0.5 × 10(1) to 8.0 × 10(1) CFU/mL(-1)). The most commonly identified bacterial species was Staphylococcus epidermidis, followed by Kocuria, Moraxella, and Micrococcus species. CONCLUSIONS: New materials "as received" from the manufacturers and those exposed to the clinical environment are not free from bacterial contamination before use in patients, but this contamination is low considering the potential for aerosol and operator contamination and could be considered insignificant. Further studies would be required to determine the level of risk that this poses.


Assuntos
Aparelhos Ortodônticos/microbiologia , Contagem de Colônia Microbiana , Exposição Ambiental , Contaminação de Equipamentos , Humanos , Micrococcaceae/isolamento & purificação , Micrococcus/isolamento & purificação , Moraxella/isolamento & purificação , Projetos Piloto , Embalagem de Produtos , Staphylococcus epidermidis/isolamento & purificação , Reino Unido
19.
Am J Orthod Dentofacial Orthop ; 142(3): 355-63, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22920702

RESUMO

INTRODUCTION: Light curing has become increasingly popular for orthodontic bonding, partly as a result of improvements in light-curing unit technology and higher light intensities. The aim of this study was to determine orthodontists' knowledge of dental light-curing units, their safety aspects, and the possible effects on color perception. METHODS: Questionnaires were administered to 120 specialists or trainees to assess their knowledge of light curing and safety issues. In addition, 15 orthodontists and 15 nonorthodontists were asked to complete the Farnsworth Munsell 100 hue test to assess color perception. RESULTS: One hundred four questionnaires were returned, giving a response rate of 86.6%. Light-emitting diode lights were the most popular (73.4%), followed by quartz-halogen (9.2%) and plasma lights (5.5%); 11.9% were unsure of the type of light used, 84% did not know the intensity, and 67% did not know the wavelength of the lights. Although most used safety equipment-eg, paddles-7% used no safety measures. Seventy-six percent were either unsure or took no precautions during light curing for staff or patients who had previous cataract surgery, and up to 99% were either unsure or took no precautions during light curing for staff or patients taking photosensitizing medications. With the Farnsworth Munsell test, 28 participants had average color discrimination, with 2 demonstrating superior discrimination. There were no differences between the orthodontists and the controls, or between men and women. CONCLUSIONS: Orthodontists' knowledge of dental light-curing units and hazards is poor. Although potential risks are associated with the long-term use of these light-curing units, no effect on color discrimination was detected.


Assuntos
Percepção de Cores/efeitos da radiação , Luzes de Cura Dentária/efeitos adversos , Cura Luminosa de Adesivos Dentários/efeitos adversos , Ortodontia , Adulto , Atitude do Pessoal de Saúde , Estudos de Casos e Controles , Testes de Percepção de Cores , Traumatismos Oculares/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
20.
Int J Dent ; 2012: 768126, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22919389

RESUMO

An increasing interest in dental erosion as a clinical and scientific phenomenon has led to concerted efforts to identify agents which might protect against erosion. In this study, nanoindentation was used to investigate inhibition of erosive enamel demineralisation over time scales with direct clinical relevance. Nanohardness of polished human enamel specimens (n = 8 per group) was measured at baseline (B), after demineralisation (D1: citric acid, 0.3% w/v, pH3.20, 20s), after treatment (T), and after a second demineralisation (D2: as above). Data were analysed using repeated measures ANOVA. All specimens exhibited a similar reduction in nanohardness B-D1 in the range 35.2-39.5%. The positive control solution (saturated hydroxyapatite solution) and 4500 mg/L fluoride as NaF significantly increased nanohardness D1-T by 19.9% and 24.1%, respectively, whereas 1400 mg/L fluoride as NaF, casein phosphopeptide-amorphous calcium phosphate mousse and negative control (deionised water) had no significant effect. Nanohardness at D2 was indistinguishable for all groups, with total reduction in nanohardness B-D2 of 31.6% (4500 mg/L fluoride), 35.2% (positive control), 39.9% (1400 mg/L fluoride), 42.4% (negative control), and 43.7% (CPP-ACP product). In summary, 4500 mg/L fluoride significantly increased the nanohardness of previously demineralised enamel and resulted in the smallest total reduction in nanohardness but there were few statistically significant differences among the groups.

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