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1.
J Orthod ; 46(2): 118-125, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060463

RESUMO

OBJECTIVE: To investigate the impact of premature extraction of primary teeth (PEPT) on orthodontic treatment need in a cohort of children participating in the Born in Bradford (BiB) longitudinal birth cohort. DESIGN: Observational, cross-sectional cohort. PARTICIPANTS: We aim to recruit 1000 children aged 7-11 years: 500 with a history of PEPT and 500 matched non-PEPT controls. METHODS: After informed consent/assent, orthodontic records will be collected, including extra and intra-oral photographs and alginate impressions for study models. Participants will also complete a measure of oral health-related quality of life (COHIP-SF 19). The records will be used to quantify space loss, identify other occlusal anomalies and assess orthodontic treatment need using the Index of Orthodontic Treatment Need. For each outcome, summary statistics will be calculated and the data for children with and without PEPT compared. The records of the children identified to be in need of orthodontic treatment will be examined by an expert orthodontic panel to judge if this treatment should be undertaken at the time of the records or delayed until the early permanent dentition. Collecting robust records in the mixed dentition provides the clinical basis to link each stage of the causal chain and enable the impact of PEPT on orthodontic need to be characterised. This study is the first to provide the foundations for future longitudinal data collection allowing the long-term impact of PEPT to be studied.


Assuntos
Má Oclusão , Criança , Estudos Transversais , Humanos , Índice de Necessidade de Tratamento Ortodôntico , Ortodontia Corretiva , Qualidade de Vida , Dente Decíduo
2.
Dent Traumatol ; 35(4-5): 241-250, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31038825

RESUMO

BACKGROUND/AIM: There is a lack of research into orthodontic movement and management strategies of traumatized teeth. The aim of this survey was to assess the knowledge of UK-based orthodontists in the orthodontic management of traumatized teeth. MATERIALS/METHODS: A 24-item questionnaire survey was electronically distributed to all members of the British Orthodontic Society. RESULTS: A total of 213 respondents completed the survey with the majority of these being UK registered specialists in orthodontics. Three responses were excluded as one was not based within the UK and two were orthodontic trainees with <1 year of experience, leaving a total of 210 respondents. The majority had orthodontically treated up to three patients with a history of dental trauma in the preceding 3 months. Obtaining a trauma history was done by the majority of respondents. A wide variation in times waited by respondents before orthodontically treating teeth with different types of traumatic injuries was observed. Similarly, the preferred orthodontic management strategies of traumatized teeth differed substantially among respondents. Almost all respondents were interested in further training in the management of dental trauma. CONCLUSIONS: The study showed a wide variation in the orthodontic management of traumatized teeth among UK-based orthodontists. Further training and national guideline establishment are indicated for orthodontic management of traumatized teeth in the UK.


Assuntos
Ortodontia , Ortodontistas , Traumatismos Dentários/reabilitação , Humanos , Sociedades Odontológicas , Inquéritos e Questionários , Reino Unido
3.
Eur J Orthod ; 40(4): 387-398, 2018 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-29059289

RESUMO

Background: There is a shortage of evidence on the best type of retainer. Objectives: Evaluate upper and lower bonded retainers (BRs) versus upper and lower vacuum-formed retainers (VFRs) over 12 months, in terms of stability, retainer survival, and patient satisfaction. Trial design: Two-arm parallel group multi-centre randomized controlled clinical trial. Methods: Sixty consecutive patients completing fixed appliance therapy and requiring retainers were recruited from 3 hospital departments. They were randomly allocated to either upper and lower labial segment BRs (n = 30) or upper and lower full-arch VFRs (n = 30). Primary outcome was stability. Secondary outcomes were retainer survival and patient satisfaction. A random sequence of treatment allocation was computer-generated and implemented by sealing in sequentially numbered opaque sealed envelopes independently prepared in advance. Patients, operators and outcome could not be blinded due to the nature of the intervention. Results: Thirty patients received BRs (median [Mdn] age 16 years, inter-quartile range [IQR] = 2) and 30 received VFRs (Mdn age 17 years, IQR = 4). Baseline characteristics were similar between groups. At 12 months, there were no statistically significant inter-group differences in post-treatment change of maxillary labial segment alignment (BR = 1.1 mm, IQR = 1.56, VFR = 0.76 mm, IQR = 1.55, P = 0.61); however, there was greater post-treatment change in the mandibular VFR group (BR = 0.77 mm, IQR = 1.46, VFR = 1.69mm, IQR = 2.00, P = 0.008). The difference in maxillary retainer survival rates were statistically non-significant, P = 0.34 (BR = 63.6%, 239.3 days, 95% confidence interval [CI] = 191.1-287.5, VFR = 73.3%, 311.1 days, 95% CI = 278.3-344.29). The mandibular BR had a lower survival rate (P = 0.01) at 12 months (BR = 50%, 239.3 days 95% CI = 191.1-287.5, VFR = 80%, 324.9 days 95% CI = 295.4-354.4). More subjects with VFRs reported discomfort (P = 0.002) and speech difficulties (P = 0.004) but found them easier to clean than those with BRs (P = 0.001). Limitations: Results are after 1 year and we do not know how much the removable retainers were worn. Conclusions: After 1 year, there is no evidence of a significant difference in stability or retainer survival in the maxilla. In the mandible, BRs are more effective at maintaining mandibular labial segment alignment, but have a higher failure rate. In comparison with patients wearing VFRs, patients wearing BRs reported that they caused less interference with speech, required less compliance to wear them, and were more comfortable to wear than VFRs. Patients found the BRs harder to keep clean. Trial registration: The trail was not registered.


Assuntos
Má Oclusão/terapia , Contenções Ortodônticas , Ortodontia Corretiva/instrumentação , Adolescente , Oclusão Dentária , Feminino , Humanos , Masculino , Mandíbula , Maxila , Desenho de Aparelho Ortodôntico , Aparelhos Ortodônticos Fixos , Cooperação do Paciente , Satisfação do Paciente , Vácuo , Adulto Jovem
4.
Eur J Orthod ; 40(4): 399-408, 2018 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-29059293

RESUMO

Background: Retainer have the potential to compromise periodontal health. Objectives: Evaluate the periodontal health implications of upper and lower bonded retainers (BRs) versus upper and lower vacuum-formed retainers (VFRs) over 12 months. Trial design: Two-arm parallel group multicentre randomized controlled clinical trial. Methods: Sixty consecutive patients completing upper and lower fixed appliance therapy and requiring retainers were recruited from three hospital orthodontic departments. They were randomly allocated to either upper and lower labial segment BRs (n = 30) or upper and lower full-arch VFRs (n = 30). Periodontal health was assessed using the plaque and gingival indices of Silness and Loe, and the calculus index of Greene and Vermillion. Data were collected at debond and placement of the retainers (T0), 3 months (T1), 6 months (T2), and 12 months (T3). A random sequence of treatment allocation was computer-generated and implemented by sealing in sequentially numbered opaque sealed envelopes independently prepared in advance. Patients, operators, and outcome could not be blinded due to the nature of the intervention. Results: Thirty patients received BRs (median age 16 years, interquartile range [IQR] = 2, 50% female, 50% male) and 30 received VFRs (median age 17 years, IQR = 4, 60% female, 40% male). Gingival inflammation decreased from baseline for both types of retainer. There was significantly less plaque and calculus accumulation and better gingival health with VFRs than BRs over the evaluated 12 months. No serious harm was observed. Limitations: It is not known how much the patients chose to wear their removable retainers. The results reported are after 1 year only. Conclusions: After 1 year, BRs were associated with greater accumulation of plaque and calculus than VFRs and minimally worse gingival inflammation than VFRs, but this did not appear to produce any clinically significant, adverse periodontal health problems. Trial registration: This trial was not registered. Funding: There was no funding.


Assuntos
Gengivite/etiologia , Contenções Ortodônticas/efeitos adversos , Ortodontia Corretiva/efeitos adversos , Adolescente , Cálculos Dentários/etiologia , Placa Dentária/etiologia , Feminino , Humanos , Masculino , Má Oclusão/terapia , Desenho de Aparelho Ortodôntico , Aparelhos Ortodônticos Fixos/efeitos adversos , Ortodontia Corretiva/instrumentação , Índice Periodontal , Vácuo , Adulto Jovem
5.
Orthod Fr ; 87(4): 457-465, 2016 Dec.
Artigo em Francês | MEDLINE | ID: mdl-27938657

RESUMO

INTRODUCTION: Retaining corrected skeletal anterior open bites is challenging. If it is possible to identify the aetiological factors causing an open bite, an appropriate choice of treatment and retention may reduce relapse. Extruding anterior teeth to close anterior open bites is known to be unstable, so treatment is typically aimed at controlling the vertical position of maxillary molars, in addition to removing causative factors, such as breaking habits and improving tongue posture. Relapse rates are high, with relapse estimated at about 20-30%, with slightly more stability for a surgical approach. MATERIALS AND METHODS: Various approaches with retainers are described that aim to restrict the eruption of posterior teeth, and improve the position of the tongue. RESULTS: These retainers often require excellent patient compliance and there is a lack of high quality evidence to support their use. Further research is required to confirm the effectiveness of these approaches.


Assuntos
Mordida Aberta/terapia , Humanos , Mordida Aberta/etiologia , Contenções Ortodônticas , Resultado do Tratamento
6.
J Orthod ; 43(3): 164-75, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27564126

RESUMO

OBJECTIVE: To evaluate whether patients who had received early class III protraction facemask treatment were less likely to need orthognathic surgery compared with untreated controls. This paper is a 6-year follow-up of a previous clinical trial. DESIGN: Multi-centre 2-arm parallel randomized controlled trial. SETTING: Eight United Kingdom hospital orthodontic departments. PARTICIPANTS: Seventy three 7- to 9-year-old children. METHOD: Patients were randomly allocated, stratified for gender, into an early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). The primary outcome, need for orthognathic surgery was assessed by panel consensus. Secondary outcomes were changed in skeletal pattern, overjet, Peer Assessment Rating (PAR), self-esteem and the oral aesthetic impact of malocclusion. The data were compared between baseline (DC1) and 6-year follow-up (DC4). A per-protocol analysis was carried out with n = 32 in the CG and n = 33 in the PFG. RESULTS: Thirty six percent of the PFG needed orthognathic surgery, compared with 66% of the CG (P = 0.027). The odds of needing surgery was 3.5 times more likely when protraction facemask treatment was not used (odds ratio = 3.34 95% CI 1.21-9.24). The PFG exhibited a clockwise rotation and the CG an anti-clockwise rotation in the maxilla (regression coefficient 8.24 (SE 0.75); 95% CI 6.73-9.75; P < 0.001) and the mandible (regression coefficient 6.72 (SE 0.73); 95% CI 5.27-8.18; P < 0.001). Sixty eight per cent of the PFG maintained a positive overjet at 6-year follow-up. There were no statistically significant differences between the PFG and CG for skeletal/occlusal improvement, self-esteem or oral aesthetic impact. CONCLUSIONS: Early class III protraction facemask treatment reduces the need for orthognathic surgery. However, this effect cannot be explained by the maintenance of skeletal cephalometric change.


Assuntos
Aparelhos de Tração Extrabucal , Má Oclusão de Angle Classe III , Cirurgia Ortognática , Cefalometria , Criança , Feminino , Humanos , Masculino , Maxila , Técnica de Expansão Palatina , Resultado do Tratamento , Reino Unido
7.
Cochrane Database Syst Rev ; (1): CD002283, 2016 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-26824885

RESUMO

BACKGROUND: Retention is the phase of orthodontic treatment that attempts to keep teeth in the corrected positions after treatment with orthodontic braces. Without a phase of retention, there is a tendency for teeth to return to their initial position (relapse). To prevent relapse, almost every person who has orthodontic treatment will require some type of retention. OBJECTIVES: To evaluate the effects of different retention strategies used to stabilise tooth position after orthodontic braces. SEARCH METHODS: We searched the following databases: the Cochrane Oral Health Group's Trials Register (to 26 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 12), MEDLINE via Ovid (1946 to 26 January 2016) and EMBASE via Ovid (1980 to 26 January 2016). We searched for ongoing trials in the US National Institutes of Health Trials Register (ClinicalTrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform. We applied no language or date restrictions in the searches of the electronic databases. We contacted authors of randomised controlled trials (RCTs) to help identify any unpublished trials. SELECTION CRITERIA: RCTs involving children and adults who had had retainers fitted or adjunctive procedures undertaken to prevent relapse following orthodontic treatment with braces. DATA COLLECTION AND ANALYSIS: Two review authors independently screened eligible studies, assessed the risk of bias in the trials and extracted data. The outcomes of interest were: how well the teeth were stabilised, failure of retainers, adverse effects on oral health and participant satisfaction. We calculated mean differences (MD) with 95% confidence intervals (CI) for continuous data and risk ratios (RR) with 95% CI for dichotomous outcomes. We conducted meta-analyses when studies with similar methodology reported the same outcome. We prioritised reporting of Little's Irregularity Index to measure relapse. MAIN RESULTS: We included 15 studies (1722 participants) in the review. There are also four ongoing studies and four studies await classification. The 15 included studies evaluated four comparisons: removable retainers versus fixed retainers (three studies); different types of fixed retainers (four studies); different types of removable retainers (eight studies); and one study compared a combination of upper thermoplastic and lower bonded versus upper thermoplastic with lower adjunctive procedures versus positioner. Four studies had a low risk of bias, four studies had an unclear risk of bias and seven studies had a high risk of bias. Removable versus fixed retainers Thermoplastic removable retainers provided slightly poorer stability in the lower arch than multistrand fixed retainers: MD (Little's Irregularity Index, 0 mm is stable) 0.6 mm (95% CI 0.17 to 1.03). This was based on one trial with 84 participants that was at high risk of bias; it was low quality evidence. Results on retainer failure were inconsistent. There was evidence of less gingival bleeding with removable retainers: RR 0.53 (95% CI 0.31 to 0.88; one trial, 84 participants, high risk of bias, low quality evidence), but participants found fixed retainers more acceptable to wear, with a mean difference on a visual analogue scale (VAS; 0 to 100; 100 being very satisfied) of -12.84 (95% CI -7.09 to -18.60). Fixed versus fixed retainersThe studies did not report stability, adverse effects or participant satisfaction. It was possible to pool the data on retention failure from three trials that compared polyethylene ribbon bonded retainer versus multistrand retainer in the lower arch with an RR of 1.10 (95% CI 0.77 to 1.57; moderate heterogeneity; three trials, 228 participants, low quality evidence). There was no evidence of a difference in failure rates. It was also possible to pool the data from two trials that compared the same types of upper fixed retainers, with a similar finding: RR 1.25 (95% CI 0.87 to 1.78; low heterogeneity; two trials, 174 participants, low quality evidence). Removable versus removable retainersOne study at low risk of bias comparing upper and lower part-time thermoplastic versus full-time thermoplastic retainer showed no evidence of a difference in relapse (graded moderate quality evidence). Another study, comparing part-time and full-time wear of lower Hawley retainers, found no evidence of any difference in relapse (low quality evidence). Two studies at high risk of bias suggested that stability was better in the lower arch for thermoplastic retainers versus Hawley, and for thermoplastic full-time versus Begg (full-time) (both low quality evidence).In one study, participants wearing Hawley retainers reported more embarrassment more often than participants wearing thermoplastic retainers: RR 2.42 (95% CI 1.30 to 4.49; one trial, 348 participants, high risk of bias, low quality evidence). They also found Hawley retainers harder to wear. There was conflicting evidence about survival rates of Hawley and thermoplastic retainers. Other retainer comparisonsAnother study with a low risk of bias looked at three different approaches to retention for people with crowding, but normal jaw relationships. The study found that there was no evidence of a difference in relapse between the combination of an upper thermoplastic and lower canine to canine bonded retainer and the combination of an upper thermoplastic retainer and lower interproximal stripping, without a lower retainer. Both these approaches are better than using a positioner as a retainer. AUTHORS' CONCLUSIONS: We did not find any evidence that wearing thermoplastic retainers full-time provides greater stability than wearing them part-time, but this was assessed in only a small number of participants.Overall, there is insufficient high quality evidence to make recommendations on retention procedures for stabilising tooth position after treatment with orthodontic braces. Further high quality RCTs are needed.


Assuntos
Contenções Ortodônticas , Ortodontia Corretiva/métodos , Adulto , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Migração de Dente/prevenção & controle
8.
Angle Orthod ; 86(1): 149-56, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25811246

RESUMO

OBJECTIVE: To compare pain experience between self-ligating and conventional preadjusted edgewise appliance systems with a two-arm parallel trial. MATERIALS AND METHODS: A prospective multicenter randomized controlled clinical trial was conducted in three hospital orthodontic departments. Subjects were randomly allocated to receive treatment with either a self-ligating (3M SmartClip™) or conventional (3M Victory™) bracket system with stratification for operator and center. Standardized protocol was followed for bracket bonding procedure and archwire sequence. Subject pain was recorded using a Verbal Rating Scale to assess discomfort felt on the teeth and soft tissues at the time of the appointment and 1, 3, and 5 days after each archwire change up to the working archwire. Multilevel modeling was used to analyze the data by blinded assessors. RESULTS: One hundred thirty-eight subjects (mean age 14 years 11 months) were enrolled in the study, of which 135 subjects (97.8%) completed the study and 113 (82%) returned the required data regarding pain/discomfort. Perceived pain was statistically higher with the SmartClip™ system compared to the Victory™ system, but this difference was not deemed to be clinically significant. Discomfort was greatest after placement of the initial 0.014-inch nickel-titanium archwire, compared with subsequent wires, and was greatest on day 1, less on day 3, and much less on day 5 after each archwire change. Age and gender did not affect the level of discomfort experienced by subjects undergoing fixed appliance treatment. CONCLUSION: No clinically significant difference in pain experience was found between patients treated with a self-ligating bracket system compared to those treated with a conventional ligation system.


Assuntos
Desenho de Aparelho Ortodôntico , Braquetes Ortodônticos , Percepção da Dor , Adolescente , Humanos , Fios Ortodônticos , Estudos Prospectivos
9.
Angle Orthod ; 86(1): 142-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25853795

RESUMO

OBJECTIVE: To use a two-arm parallel trial to compare treatment efficiency between a self-ligating and a conventional preadjusted edgewise appliance system. MATERIALS AND METHODS: A prospective multi-center randomized controlled clinical trial was conducted in three hospital orthodontic departments. Subjects were randomly allocated to receive treatment with either a self-ligating (3M SmartClip) or conventional (3M Victory) preadjusted edgewise appliance bracket system using a computer-generated random sequence concealed in opaque envelopes, with stratification for operator and center. Two operators followed a standardized protocol regarding bracket bonding procedure and archwire sequence. Efficiency of each ligation system was assessed by comparing the duration of treatment (months), total number of appointments (scheduled and emergency visits), and number of bracket bond failures. RESULTS: One hundred thirty-eight subjects (mean age 14 years 11 months) were enrolled in the study, of which 135 subjects (97.8%) completed treatment. The mean treatment time and number of visits were 25.12 months and 19.97 visits in the SmartClip group and 25.80 months and 20.37 visits in the Victory group. The overall bond failure rate was 6.6% for the SmartClip and 7.2% for Victory, with a similar debond distribution between the two appliances. No significant differences were found between the bracket systems in any of the outcome measures. No serious harm was observed from either bracket system. CONCLUSIONS: There was no clinically significant difference in treatment efficiency between treatment with a self-ligating bracket system and a conventional ligation system.


Assuntos
Desenho de Aparelho Ortodôntico , Braquetes Ortodônticos , Ortodontia Corretiva , Adolescente , Agendamento de Consultas , Humanos , Estudos Prospectivos
10.
Eur J Orthod ; 37(2): 147-55, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25234405

RESUMO

OBJECTIVE: To evaluate the clinical performance of APC™II Victory Series™ (3M Unitek) brackets in direct orthodontic bonding with and without the use of primer. DESIGN: A single-operator, two-centre prospective, non-inferiority randomized controlled clinical trial. SETTING: The Orthodontic departments at the Leeds Dental Institute and St Luke's Hospital, Bradford, UK. ETHICAL APPROVAL: Ethical approval was granted by Leeds (East) Research Ethics Committee on 18th of December 2009 (Reference 09/H1306/102). PROTOCOL: The protocol was not published prior to trial commencement. SUBJECTS AND METHODS: Ninety-two patients requiring orthodontic treatment with fixed appliances were randomly allocated to the control (bonded with primer) or test groups (bonded without primer). Patients were randomly allocated to either the control or experimental group. This was performed by preparing opaque numbered sealed envelopes in advance using a random numbers table generated by a computer by an independent third party . Once the envelopes were opened, blinding of the operator and the patient was no longer possible due to the nature of the intervention. Patients were approached for inclusion in the trial if they qualified for NHS orthodontic treatment requiring fixed appliances and had no previous orthodontic treatment. MAIN OUTCOME MEASURES: Number of bracket failures, time to bond-up appliances, and the adhesive remnant index (ARI) when bracket failure occurred, over a 12-month period RESULTS: Failure rate with primer was 11.1 per cent and without primer was 15.8 per cent. Bonding without primer was shown statistically to be non-inferior to bonding with primer odds ratio 0.95-2.25 (P = 0.08). Mean difference in bond-up time per bracket was 0.068 minutes (4 seconds), which was not statistically significant (P = 0.402). There was a statistically significant difference in the Adhesive Remnant Index - ARI 0 with primer 49.4 per cent, no primer 76.5 per cent, (P < 0.0001). LIMITATIONS: As the study was only performed by one operator, the results can therefore only be truly be applied to their practice. Also this study was powered to ascertain if there was no difference between the 2 groups up to 5%, however orthodontists may consider a change in the bracket failure rate of 2% to be clinically significant. CONCLUSION: When bonding with APC™II Victory Series™ brackets without primer was shown statistically to be non-inferior to bonding with primer (P =0.08). There was no significant difference in bond-up times. Bond failure was more likely to happen at the composite-enamel interface when bonded without a primer. CONFLICT OF INTEREST: No conflict of interest for all authors. FUNDING: No funding sources were used. REGISTRATION: Study was not registered on external databases.


Assuntos
Colagem Dentária/métodos , Braquetes Ortodônticos , Cimentos de Resina/química , Adesivos/química , Adolescente , Falha de Equipamento , Feminino , Humanos , Masculino , Aparelhos Ortodônticos , Estudos Prospectivos , Fatores de Tempo
11.
Angle Orthod ; 84(4): 656-64, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24364752

RESUMO

OBJECTIVE: To investigate the resistance to wear of four different vacuum-formed retainer (VFR) materials: Essix C+, Essix ACE, Duran, and Tru-Tain. Essix C+ is a polypropylene polymer; the other materials are polyethylene co-polymers. MATERIALS AND METHODS: The study was undertaken at the Leeds Dental Institute, Leeds, UK, with 26 samples in each group. The specimens were vacuum-formed according to the manufacturers' guidelines, and a custom-made wear-simulation machine was used to conduct the test. Each specimen was subjected to 1000 cycles of the wear simulation, with steatite balls as the antagonist material. The resistance to wear of the VFR materials was evaluated by measuring the maximum wear depth using noncontact, three-dimensional surface profilometry. The wear depth was given in micrometers. RESULTS: The median wear depth was 63.20 µm for the Essix C+ group, 7.88 µm for the Essix ACE group, 9.75 µm for the Duran group, and 12.08 µm for the Tru-Tain group. The Kruskal-Wallis test to compare the four VFR materials detected a statistically significant difference between the groups (P < .001). Comparisons of the groups using the Mann-Whitney U-test demonstrated that the Essix C+ group had significantly greater wear than the other three groups (P < .001). There was no statistically significant difference in median wear depth between the two groups with the least amount of wear-the Essix ACE and Duran groups. CONCLUSIONS: Under the standardized conditions of this laboratory study, the three polyethylene co-polymer materials-Essix ACE, Duran, and Tru-Tain-exhibited significantly less wear than the polypropylene material, Essix C+.


Assuntos
Materiais Dentários/química , Desenho de Aparelho Ortodôntico , Contenções Ortodônticas , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Teste de Materiais , Microscopia Confocal/métodos , Polietileno/química , Polipropilenos/química , Propriedades de Superfície , Vácuo
12.
J Orthod ; 39(3): 176-85, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22984102

RESUMO

OBJECTIVE: To investigate the effectiveness of early class III protraction facemask treatment in children under 10 years of age at 3-year follow-up. DESIGN: Multicentre randomized controlled trial. SUBJECTS AND METHODS: Seventy-three patients were randomly allocated, stratified for gender, into early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). OUTCOMES: Dentofacial changes were assessed from lateral cephalograms and occlusal changes using the peer assessment rating (PAR). Self-esteem was assessed using the Piers-Harris children's self-concept scale, and the psychosocial impact of malocclusion with oral aesthetic subjective impact score (OASIS) questionnaire. Temporomandibular joint (TMJ) signs and symptoms were also recorded. The time points for data collection were at registration (DC1), 15 months later (DC2) and 3 years post-registration (DC3). RESULTS: The following mean skeletal and occlusal changes occurred from the class III starting point to DC3 (3-year follow-up): SNA, PFG moved forwards +2·3° (CG forward +1·6°; P = 0·14); SNB, PFG moved forwards +0·8° (CG forward +1·5°, P = 0·26); ANB, PFG class III base improved +1·5° (CG stayed about the same at +0·1°; P = 0·001). This contributed to an overall difference in ANB between PFG and CG of +1·4° in favour of early protraction facemask treatment. The overjet was still improved by +3·6 mm in the PFG and changed a small amount +1·1 mm in the CG (P = 0·001). A 21% improvement in PAR was shown in the PFG and the CG worsened by 8·4% (P = 0·02). There was no increase in self-esteem (Piers-Harris score) for PFG compared with the CG (P = 0·56) and no statistically significant difference in the impact of malocclusion (OASIS) between groups in terms of the changes from DC1 to DC3 (P = 0·18). TMJ signs and symptoms were very low at DC1 and DC3. CONCLUSIONS: The favourable effect of early class III protraction facemask treatment undertaken in patients under 10 years of age, is maintained at 3-year follow-up in terms of ANB, overjet and % PAR improvement. The direct protraction treatment effect at SNA is still favourable although not statistically significantly better than the CG. Seventy per cent of patients in PFG had maintained a positive overjet which we have defined as ongoing treatment success. Early protraction facemask treatment does not seem to influence self-esteem or reduce the patient's personal impact of their malocclusion at 3-year follow-up.


Assuntos
Aparelhos de Tração Extrabucal , Má Oclusão de Angle Classe III/terapia , Ortodontia Interceptora/instrumentação , Cefalometria , Criança , Intervenção Médica Precoce , Estética Dentária , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Técnica de Expansão Palatina/instrumentação , Estudos Prospectivos , Qualidade de Vida , Autoimagem , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/diagnóstico , Resultado do Tratamento
13.
Am J Orthod Dentofacial Orthop ; 142(1): 52-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22748990

RESUMO

INTRODUCTION: The purpose of this study was to establish the influence of soft-tissue profile values on the decision of orthodontists to recommend orthognathic surgery for patients with Class II Division 1 malocclusion. METHODS: A questionnaire containing 40 profile photographs of adults with Class II Division 1 malocclusion was sent to all 256 consultant orthodontists in the United Kingdom asking for a "yes" or "no" response to the question: "Based on the profile view of this patient, would you treat this patient using an orthognathic surgical approach?" A soft-tissue analysis was carried out on each photograph, and multi-level logistic regression was used to investigate factors that affect the decision to recommend surgery. RESULTS: The response rate was high: 208 of 256 questionnaires (81.3%). Intraexaminer reliability of the photographic analysis method with a Bland-Altman plot showed good (95% CI) limits of agreement for each measurement. Consultants who carried out more orthognathic surgery treatment were more likely to recommend surgery. Secondary analysis with a logistic regression model indicated that 80% of the consultants would recommend surgery if B-point was more than or equal to -14.1 mm posterior to the true vertical through subnasale (95% CI, -29.9 to -10.9 mm), the facial profile angle was less than or equal to 148.9° (95% CI, 6.7° to 151.1°), pogonion to true vertical through subnasale was more than or equal to -12.0 mm (95% CI, -48.7 to -8.6 mm). CONCLUSIONS: The facial profile angle and the positions of soft-tissue pogonion and B-point are useful clinical guides for planning treatment for adults with Class II Division 1 malocclusion.


Assuntos
Atitude do Pessoal de Saúde , Odontólogos/psicologia , Má Oclusão de Angle Classe II/cirurgia , Determinação de Necessidades de Cuidados de Saúde , Ortodontia , Procedimentos Cirúrgicos Ortognáticos/psicologia , Adolescente , Adulto , Cefalometria/métodos , Queixo/patologia , Face , Feminino , Humanos , Lábio/patologia , Masculino , Mandíbula/patologia , Maxila/patologia , Planejamento de Assistência ao Paciente , Fotografação , Inquéritos e Questionários , Dimensão Vertical , Adulto Jovem
14.
Hematology ; 16(4): 213-20, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21756537

RESUMO

Viral haemorrhagic cystitis (HC) is a significant complication after haematopoietic stem cell transplantation (HSCT), with a potential for major morbidity. The aim of this 7-year analysis of 1160 HSCT patients was to evaluate risk factors for the incidence, severity, toxicity of therapy, clinical course, and outcome of this condition. The overall incidence of HC was 5·8%, with most cases occurring after allogeneic HSCT. Unrelated donors (P = 0·001), non-peripheral blood stem cell source (P = 0·005), myeloablative conditioning (P<0·001), use of alemtuzumab in conditioning (P = 0·001), and severe acute graft versus host disease (P<0·001) were independent risk factors for an increased incidence of HC post-allogeneic transplant on multivariate analysis. Severe forms of HC were associated with grades II-IV acute graft versus host disease and a longer duration of haematuria. Contrary to previous studies which were carried out on smaller patient populations, busulphan, cyclophosphamide, anti-thymocyte globulin, and total body irradiation were not found to independently increase the risk of viral HC, unless used in a myeloablative combination. Neither duration of viriuria nor peak viral load in urine influenced the severity of HC on multivariate analysis. Severe HC contributed to the deaths of two patients. Overall survival was not statistically different between patient subgroups with non-severe and severe HC.


Assuntos
Cistite/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hemorragia/etiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Cistite/terapia , Coleta de Dados , Feminino , Hemorragia/terapia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
15.
J Orthod ; 37(3): 149-61, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20805344

RESUMO

OBJECTIVE: To investigate the effectiveness of early class III protraction facemask treatment in children under 10 years of age. DESIGN: Multicentre, randomized controlled trial. SETTING: Eight UK hospital orthodontic units. SUBJECTS AND METHODS: Seventy-three patients were randomly allocated, stratified for gender, into an early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). OUTCOMES: Dentofacial changes from lateral cephalograms and occlusal changes using the peer assessment rating (PAR). Self-esteem was assessed using the Piers-Harris children's self-concept scale, and the psychosocial impact of malocclusion with an oral aesthetic subjective impact scores (OASIS) questionnaire. Temporomandibular joint (TMJ) signs and symptoms were also recorded. The time points for data collection were at registration (DC1) and 15 months later (DC2). RESULTS: The following mean skeletal and occlusal changes occurred from the class III starting point: SNA, PFG moved forwards 1.4 degrees (CG forward 0.3 degrees; P = 0.018); SNB, PFG moved backwards -0.7 degrees (CG forward 0.8 degrees; P<0.001); ANB, PFG class III base improved +2.1 degrees (CG worsened by -0.5 degrees; P<0.001). This contributed to an overall difference in ANB between PFG and CG of 2.6 degrees in favour of early protraction facemask treatment. The overjet improved +4.4 mm in the PFG and marginally changed +0.3 mm in the CG (P<0.001). A 32.2% improvement in PAR was shown in the PFG and the CG worsened by 8.6%. There was no increased self-esteem (Piers-Harris score) for treated children compared with controls (P = 0.22). However, there was a reduced impact of malocclusion (OASIS score) for the PFG compared with the CG (P = 0.003), suggesting treatment resulted in slightly less concern about the tooth appearance. TMJ signs and symptoms were very low at DC1 and DC2 and none were reported during active facemask treatment. CONCLUSIONS: Early class III orthopaedic treatment, with protraction facemask, in patients under 10 years of age, is skeletally and dentally effective in the short term and does not result in TMJ dysfunction. Seventy per cent of patients had successful treatment, defined as achieving a positive overjet. However, early treatment does not seem to confer a clinically significant psychosocial benefit.


Assuntos
Estética Dentária , Aparelhos de Tração Extrabucal , Má Oclusão de Angle Classe III/terapia , Ortodontia Corretiva/instrumentação , Cefalometria , Distribuição de Qui-Quadrado , Criança , Feminino , Humanos , Modelos Lineares , Masculino , Técnica de Expansão Palatina , Revisão dos Cuidados de Saúde por Pares , Estudos Prospectivos , Autoimagem , Método Simples-Cego , Desejabilidade Social , Resultado do Tratamento
17.
Am J Orthod Dentofacial Orthop ; 135(6): 709-14, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19524829

RESUMO

INTRODUCTION: The aim of this study was to evaluate the effectiveness of orthodontic/orthognathic surgical care provided in the North West region of England. It was an observational, prospective cohort study at 13 maxillofacial clinics in the United Kingdom. METHODS: The 131 patients comprised 47 males (35.9%) and 84 females (64.1%), with an average age of 22.6 years. They received orthodontic/orthognathic treatment according to the normal protocols of the operators. They were then followed until all orthodontic treatment was completed. Final skeletal pattern, final peer assessment rating score, number of attendances, and duration of treatment were recorded. RESULTS: At the end of the 5-year study, 94 patients had completed treatment, and 71 had complete data. Data analysis showed that, overall, the treatments provided were effective in terms of skeletal and dental occlusal outcomes; the final mean peer assessment rating score was 10.58. However, treatment duration was longer than commonly expected, with a mean length of 32.8 months (SD,11.3). The outcome of treatment was influenced by only pretreatment skeletal discrepancy. CONCLUSIONS: This prospective investigation showed that orthodontic/orthognathic surgical care was effective. The outcome of treatment was influenced only by the severity of the pretreatment skeletal discrepancy.


Assuntos
Má Oclusão/cirurgia , Procedimentos Cirúrgicos Bucais/estatística & dados numéricos , Ortodontia Corretiva/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Cefalometria , Estudos de Coortes , Inglaterra , Feminino , Seguimentos , Humanos , Masculino , Má Oclusão/classificação , Má Oclusão/terapia , Mandíbula/patologia , Maxila/patologia , Pessoa de Meia-Idade , Osteotomia/métodos , Cooperação do Paciente , Revisão dos Cuidados de Saúde por Pares , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Reino Unido , Adulto Jovem
18.
Am J Orthod Dentofacial Orthop ; 135(5): 573-9, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19409339

RESUMO

INTRODUCTION: The aim of this study was to evaluate the effectiveness of early orthodontic treatment with the Twin-block appliance for the treatment of Class II Division 1 malocclusion. This was a multi-center, randomized, controlled trial with subjects from 14 orthodontic clinics in the United Kingdom. METHODS: The study included 174 children aged 8 to 10 years with Class II Division 1 malocclusion; they were randomly allocated to receive treatment with a Twin-block appliance or to an initially untreated control group. The subjects were then followed until all orthodontic treatment was completed. Final skeletal pattern, number of attendances, duration of orthodontic treatment, extraction rate, cost of treatment, and the child's self-concept were considered. RESULTS: At the end of the 10-year study, 141 patients either completed treatment or accepted their occlusion. Data analysis showed that there was no differences between those who received early Twin-block treatment and those who had 1 course of treatment in adolescence with respect to skeletal pattern, extraction rate, and self-esteem. Those who had early treatment had more attendances, received treatment for longer times, and incurred more costs than the adolescent treatment group. They also had significantly poorer final dental occlusion. CONCLUSIONS: Twin-block treatment when a child is 8 to 9 years old has no advantages over treatment started at an average age of 12.4 years. However, the cost of early treatment to the patient in terms of attendances and length of appliance wear is increased.


Assuntos
Má Oclusão de Angle Classe II/terapia , Aparelhos Ortodônticos Funcionais , Ortodontia Interceptora/instrumentação , Adolescente , Fatores Etários , Cefalometria , Criança , Análise Custo-Benefício , Dentição Mista , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Ortodontia Interceptora/economia , Autoimagem , Resultado do Tratamento , Reino Unido
19.
Am J Orthod Dentofacial Orthop ; 135(5): 580-5, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19409340

RESUMO

INTRODUCTION: The aims of this study were to assess whether early Twin-block appliance treatment improves the attractiveness of Class II profiles and to determine the orofacial features of a profile that most influence the perception of attractiveness. METHODS: Silhouetted profiles of 20 treated patients and 20 untreated controls randomly selected from 174 subjects (ages, 8-10 years) of a randomized, controlled trial into the effectiveness of early Class II treatment were assessed by 30 children (ages, 10-11 years) and 24 teaching staff using a 5-point Likert scale. Independent samples t tests were used to compare attractiveness ratings between the treated and untreated groups. Linear regression was used to determine the features defining attractiveness. RESULTS: Early orthodontic treatment resulted in improved perceptions of facial profile attractiveness. Profiles were likely to be rated as attractive if the overjet was smaller (P = 0.001) and no teeth showed (P <0.05). CONCLUSIONS: Profile silhouettes of children who had received early orthodontic treatment for Class II malocclusion were perceived to be more attractive by peers than those of children who did not receive treatment.


Assuntos
Estética Dentária , Face/anatomia & histologia , Má Oclusão de Angle Classe II/terapia , Aparelhos Ortodônticos Funcionais , Ortodontia Interceptora , Criança , Dentição Mista , Feminino , Humanos , Modelos Lineares , Masculino , Ortodontia Interceptora/instrumentação , Grupo Associado , Autoimagem , Resultado do Tratamento
20.
Dent Update ; 36(2): 102-4, 107-10, 113, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19388391

RESUMO

UNLABELLED: Autotransplantation is the surgical repositioning of a tooth within the same patient. It can be thought of as a controlled avulsion and re-implantation of a tooth in a new, surgically prepared socket. The indications for its use are discussed, as too are factors affecting the success and the clinical procedures. The preservation and regeneration of the periodontal ligament is the key to success of this treatment. A case involving the transplantation of a premolar tooth into the central incisor location in a child is presented to show the different stages of the process. CLINICAL RELEVANCE: Autotransplantation is an underutilized technique which, when used within a multidisciplinary team, can offer an ideal treatment option for child or adolescent patients with missing or failing anterior teeth.


Assuntos
Anodontia/cirurgia , Ortodontia Corretiva/métodos , Ligamento Periodontal/cirurgia , Perda de Dente/cirurgia , Dente/transplante , Adolescente , Criança , Humanos , Arcada Parcialmente Edêntula/cirurgia , Regeneração , Alvéolo Dental/cirurgia , Transplante Autólogo/métodos
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