[Targeting the smile: why don't we aim at the lips?] / Objectif sourire : et si l'on s'intéressait aux lèvres ?

INTRODUCTION: The smile is more than a question of well-aligned teeth. Harmonization of the dentition with the soft tissues is the key to a beautiful smile. This abundantly illustrated article looks more closely therefore at the lips and their movements. MATERIALS AND METHODS: The article begins by explicating the terminology relevant to the lips, then addresses the notions of volume, mobility and aging, and concludes by examining the orthodontic clinical dimension. DISCUSSION: Practitioners must be fully informed when assessing requests for treatment formulated by adult patients and a detailed analysis must be made of the lips at rest and during functioning. Harmony of both the teeth and the soft tissues is indispensable to a beautiful smile. A multidisciplinary approach is often necessary. CONCLUSION: Restoring the patient's smile therefore obliges the practitioner to think beyond mere problems of dental occlusion.

Systematic review for orthodontic and orthopedic treatments for anterior open bite in the mixed dentition.

BACKGROUND: The treatment options for the early treatment of anterior open bite are still controversial. The aim of this study was to evaluate the actual available evidence on treatments of anterior open bite in the mixed dentition in order to assess the effectiveness of the early treatment in reducing open bite, the most efficacious treatment strategy and the stability of the results. MATERIALS AND METHODS: A literature survey was done on November 15, 2015, by means of appropriate Medical Subject Headings (MeSH) using the following databases: PubMed, EMBASE, Cochrane Library, LILACS, VHL, and WEB OF SCIENCE. Randomized clinical trials and studies with a control group (treated or untreated) were then selected by two authors. Trials including patients with syndromes or in the permanent dentition and studies concerning treatment with extractions, full-fixed appliances, or surgery were not considered. Full articles were retrieved for abstracts or titles that met the initial inclusion criteria or lacked sufficient detail for immediate exclusion. RESULTS: Two thousand five hundred sixty-nine studies about open bite were available; the search strategy selected 240 of them. Twenty-four articles have been judged suitably for the final review, and their relevant data were analyzed. DISCUSSION: Although this review confirms the effectiveness of early treatment of open bite, particularly when no-compliance strategies are employed, meta-analysis was unfeasible due to lack of standardization, important methodological limitations, and shortcomings of the studies. CONCLUSIONS: A more robust approach to trial design in terms of methodology and error analysis is needed. Besides, more studies with longer periods of follow-up are required.

Long-term occlusal changes assessed by the American Board of Orthodontics' model grading system.

INTRODUCTION: The purpose of this study was to assess the long-term posttreatment changes in all criteria of the American Board of Orthodontics' (ABO) model grading system. METHODS: We used plaster models from patients' final and posttreatment records. Thirty patients treated by 1 orthodontist using 1 bracket prescription were selected. An initial discrepancy index for each subject was performed to determine the complexity of each case. The final models were then graded using the ABO's model grading system immediately at posttreatment and postretention. Statistical analysis was performed on the 8 criteria of the model grading system, including paired t tests and Pearson correlations. An alpha of 0.05 was considered statistically significant. RESULTS: The average length of time between the posttreatment and postretention records was 12.7 ± 4.4 years. It was shown that alignment and rotations worsened by postretention (P = 0.014), and a weak statistically significant correlation at posttreatment and postretention was found (0.44; P = 0.016). Both marginal ridges and occlusal contacts scored less well at posttreatment. These criteria showed a significant decrease in scores between posttreatment and postretention (P <0.001), but the correlations were not statistically significant. The average total score showed a significant decrease between posttreatment and postretention (P <0.001), partly because of the large decrease in the previous 2 criteria. CONCLUSIONS: Higher scores for occlusal contacts and marginal ridges were found at the end of treatment; however, those scores and the overall scores for the 30 subjects improved in the postretention phase.

Objetivos de tratamiento ortodóncico en el adulto / Objectives of orthodontic treatment in adults

Son objetivos del tratamiento ortodóncico en el adulto la estética facial, estética dental, oclusión funcional, salud periodontal y estabilidad prolongada. Los objetivos de este trabajo son definir y describir objetivos generales y adicionales en el tratamiento ortodóncico que se aplican en pacientes adultos los que requieren cuidadosa consideración en todo el transcurso del tratamiento de manera a lograr que los casos tratados tengan estabilidad con el paso de los años. Para ello se realizó una revisión bibliográfica de la literatura sobre: objetivos cambiantes del tratamiento ortodóncico, propósito y objetivos del tratamiento ortodóncico, objetivos del tratamiento ortodóncico interdisciplinario individualizado del adulto, y objetivos adicionales del tratamiento ortodóncico del adulto, con el propósito de proporcionar un material que oriente a colegas y alumnos sobre el tema, que finalmente signifique un beneficio para los pacientes que acuden a la consulta odontológica

Effectiveness of phase I orthodontic treatment in an undergraduate teaching clinic.

In this retrospective study, the Peer Assessment Rating (PAR) index was used to objectively evaluate the effectiveness of Phase I (early) orthodontic treatment provided in an undergraduate teaching clinic. Pre-treatment and post-treatment casts of ninety-three patients were analyzed. All patients selected for Phase I orthodontic treatment had Class I skeletal relationships and did not require complex orthodontic treatment such as growth modification or treatment of occlusions with missing or impacted teeth. The mean age of patients who received Phase I orthodontic treatment was 9.9 years. The mean initial PAR score for the sample was 29.70 +/-9.84. The mean reduction in PAR score was 14.9 points corresponding to a 50.2 percent decrease in the PAR score following Phase I orthodontic treatment. Seventy-three percent of the patients experienced at least a 30 percent reduction in their PAR score following Phase I (early) orthodontic treatment. The mean cost of $381.00 for the Phase I orthodontic treatment was found to be influenced by the length of treatment, type of Phase I treatment provided, age at start of treatment, and percentage reduction in PAR score. The greatest success rate for the Phase I orthodontic treatment occurred with either fixed or a combination of fixed and removable appliances. Over half of the patients recommended for Phase I orthodontic treatment in the undergraduate dental clinic were successfully treated and did not require Phase II treatment. For them, there was both a treatment and a financial benefit to the Phase I orthodontic treatment.

A treatment difficulty index for unerupted maxillary canines.

The aim of this study was to produce a treatment difficulty index (TDI) for unerupted maxillary canines. Thirty treated cases, each with an unerupted unilateral maxillary canine, were graded by 14 consultant orthodontists in terms of perceived alignment difficulty, and the four main factors which had contributed to each grade were listed in order of importance. The relationship between the grade and the contributory factors was then examined using regression analysis, and weightings were derived. These were applied to each factor, in order to derive a difficulty score total for each case. Linear regression analysis of difficulty scores against consultant grades produced an R2 value of 54.7 per cent using the original equation and an R2 of 52.3 per cent using values rounded to the nearest half. Both indicated a moderate level of agreement between allocated difficulty grade and calculated difficulty scores. The index provides a useful treatment planning aid for the management of impacted maxillary canines.

Measuring failure of orthodontic treatment: a comparison of outcome indicators.

OBJECTIVE: To compare treatment failure rates on a sample of completed and discontinued orthodontic treatment cases as measured by PAR, IOTN and ICON to determine whether the use of a sole index would suffice. SUBJECTS AND METHOD: All patients completing or discontinuing orthodontic treatment in the hospital orthodontic departments in the Northern Region during two calendar months were identified and pre and post-treatment models were analysed. PAR scores, IOTN (DHC and AC) and ICON were recorded. RESULTS: One-hundred-and-forty-five cases were identified and 15 had incomplete records on the day of analysis. The final sample was therefore 130. The overall treatment discontinuation rate of these 130 patients was 24.6%. The treatment failure rate with respect to occlusal improvement varied from 3.1% when measured by PAR and 10.0% using ICON. With respect to residual need it varied from 0.77 to 20.1% with respect to IOTN depending on the criteria examined. The residual treatment need with respect to ICON was 17.2%. CONCLUSIONS: Different occlusal indices give differing failure rates when used on the same patients with ICON being the most critical index. We felt that ICON was the most valid with respect to identifying treatment failure. Its use would enable international comparison of results.

Evaluación del método de fotocopias de modelos para el estudio antropométrico de la arcada dental / Dental arch anthropometric survey by model photocopy method assessment

Los métodos para el estudio de la arcada dental son numerosos y diversos. El método de estudio sobre fotocopias de modelos conlleva ventajas, como la sencillez y la asequibilidad, la facilidad de registro y el almacenamiento para estudios a largo plazo o la posibilidad de digitalización y tratamiento de datos para su estudio y divulgación. En una muestra de 108 registros, tanto de modelos como de fotocopias de modelos, se han realizado diversas mediciones dentales y de arcada. Mediante los métodos estadísticos usuales se ha estudiado la fiabilidad del método de medición mediante fotocopias de modelos de estudio. Según nuestros resultados, las diferencias en las mediciones realizadas sobre modelos y sobre fotocopias de modelos son mínimas. El método de estudio de la arcada dental sobre fotocopias de modelos se puede considerar como un método válido para estudios anatómicos, antropológicos y ortodóncicos. Asimismo, la fotocopia de modelos de estudio puede facilitar la conservación de los datos sobre los tratamientos realizados, que la legislación actual exige. (AU)

Malocclusions and orthodontic treatment needs in a group of Spanish adolescents using the Dental Aesthetic Index.

OBJECTIVE: To evaluate the prevalence of malocclusion and orthodontic treatment need among Spanish adolescents and compare with other populations. METHODS: The study sample comprised 744 schoolchildren from urban and rural populations in Granada province (Southern Spain), aged from 14-20 years, who had received no orthodontic treatment. The measurement instrument was the Dental Aesthetic Index (DAI). RESULTS: The mean DAI score of the whole series was 25.6 (SD, 7.94). The distribution of the four DAI grades was: DAI 1, no anomaly or malocclusion, 58.6%; DAI 2, definite malocclusion, 20.3%; DAI 3, severe malocclusion, 11.2%; DAI 4, very severe or disabling malocclusion, 9.9%. There were no statistically significant differences in DAI score between genders or those in rural vs. urban residence, but a significant difference was found between social classes, with subjects of low social class presenting the worst scores (p<0.05). CONCLUSION: The distribution of DAI scores among Spanish adolescents is similar to that reported in other populations.

Dental treatment need among 20 to 25-year-old Swedes: discrepancy between subjective and objective need.

Our aim was to analyze variables from a questionnaire sent to 20 to 25-year-old Swedes to determine how they perceive their oral treatment need, and to determine which variables affect this perception. The questionnaire was sent to 650 individuals randomly selected from the database of the National Social Insurance Board of Sweden. The response rate was 78%. Another questionnaire was sent to the dentists of these young adults in order to collect clinical information. The response rate was 66%. The respondent's answer to the question 'How do you rate your dental treatment need today?' was dichotomized and used as a dependent variable in a multivariate logistic regression model. Each increase in number of decayed-filled teeth led to a 13% increased treatment need, bad oral hygiene a 2.24-fold increase, and no periodontal disease an 80% reduction in treatment need. A higher education beyond comprehensive school increased the perceived treatment need 7.16 times; a poorer dental health than one's contemporaries led to a 14.47-fold increase. When dentist and patient assessments were combined, variables related to the patients' self-assessments were the only significant contributors to the statistical model. A lack of concordance between patients' and dentists' assessments of treatment need was found which highlighted the differences between patients' and dentists' views on treatment need. This study shows the importance of communication between dentist and patient.

A systematic review concerning early orthodontic treatment of unilateral posterior crossbite.

The aim of this study was to assess the orthodontic treatment effects on unilateral posterior crossbite in the primary and early mixed dentition by systematically reviewing the literature. A literature search was performed by applying the Medline database (Entrez PubMed) and covering the period from January 1966 to October 2002. The inclusion criteria were primary and early mixed dentition with unilateral posterior crossbite, randomized controlled trials (RCT), prospective and retrospective studies with concurrent untreated as well as normal controls, and clinical trials comparing at least two treatment strategies without any untreated or normal group involved. Two reviewers extracted the data independently and also assessed the quality of the studies. The search strategy resulted in 1001 articles, and 12 met the inclusion criteria. Two RCTs of early treatment of crossbite have been performed, and these two studies support grinding as treatment in the primary dentition. There is no scientific evidence available to show which of the treatment modalities, grinding, Quad-helix, expansion plates, or rapid maxillary expansion, is the most effective. Most of the studies have serious problems of lack of power because of small sample size, bias and confounding variables, lack of method error analysis, blinding in measurements, and deficient or lack of statistical methods. To obtain reliable scientific evidence, better-controlled RCTs with sufficient sample sizes are needed to determine which treatment is the most effective for early correction of unilateral posterior crossbite. Future studies should also include assessments of long-term stability as well as analysis of costs and side effects of the interventions.

[Efficacy of orthodontic treatment according to the Peer Assessment Rating index]. / Ocena skutecznosci leczenia ortodontycznego za pomoca wskaznika par (Peer Assessment Rating index).

The work deals with assessment of orthodontic treatment using the Peer Assessment Rating (PAR) index. The objective was to rate the results of orthodontic treatment in the following groups: 1. All patients seen at the Department of Orthodontics, Pomeranian Academy of Medicine; 2. Patients treated by individual dentists at the Department of Orthodontics, Pomeranian Academy of Medicine; 3. Patients with distocclusion; 4. Patients treated with fixed appliances. 1. Rating in patients treated at the Department of Orthodontics, Pomeranian Academy of Medicine Mean reduction in PAR for all patients treated at the Department of Orthodontics was 70%. On this basis, the efficiency of treatment in this group can be termed as high, with 18% of patients classified to "marked improvement", 73% of patients to "improvement" and 9% to "deterioration--no change" groups. This reduction in PAR index is a good result in comparison with published data. 2. Rating in patients treated by individual dentists at the Department of Orthodontics, Pomeranian Academy of Medicine Reduction in PAR ranged from 48% to 83%, depending on the dentist concerned. Orthodontist A achieved the highest reduction (83%), while orthodontists C and E achieved lowest reduction (64% and 48%, respectively). Analysis of patients treated by orthodontists A and C demonstrated that the median PAR for orthodontist A was higher by 5 points than for orthodontist C. 80 malocclusions treated by orthodontist A were difficult to manage. Besides, treatment by orthodontist A was approximately 4 months shorter than by orthodontist C. Patients of orthodontist A had approximately two visits less than patients of orthodontist C. Average costs of treatment for orthodontist A were approximately PLN 500 lower than costs for orthodontist C. In 25% of patients of orthodontist A "marked improvement" was achieved as opposed to only 17% of for orthodontist C. 3. Rating in patients with distocclusion The most significant improvement in this group was achieved with Lehman's appliance (84%). Significant improvement was also noted in patients treated with a two-arch fixed appliance (82%). The lowest reduction in PAR was observed in patients treated with one-arch fixed appliance (64%). High efficiency of treatment with Lehman's appliance or with two-arch fixed appliance in patients with distocclusion is comparable with published results. 4. Rating in patients treated with fixed appliances Patients treated with two-arch fixed appliance achieved higher reduction in PAR than patients treated with one-arch fixed appliance. The main criterion was overcrowding of lower incisors. Results show that treatment with two-arch fixed appliance, in spite of lack of overcrowding of lower incisors, improves the efficiency of treatment. Patients treated with two-arch fixed appliance achieved better qualitative and quantitative results than patients treated with one-arch fixed appliance. In effect, the former patients were managed more effectively. The following conclusions were drawn: 1. The efficiency of treatment at the Department of Orthodontics, Pomeranian Medical University, was high; 2. The efficiency of treatment by orthodontists at the Department of Orthodontics, Pomeranian Medical University, was high; 3. Treatment efficacy for patients with distocclusion was highest with Lehman's appliance and with two-arch fixed appliance; 4. Although costs of treatment were reduced with one-arch fixed appliance, efficiency was lower than for two-arch fixed appliance. Moreover, it is necessary to: 5. Treat abnormalities of occlusion affecting the esthetics of bite, but also abnormalities with importance for normal occlusion that the patient is not aware of, like abnormalities in buccal segments, compression of lower incisors, marked overbite and centerline shift; 6. Control right and left buccal occlusion to the same extent; 7. Treat both jaws using removable and fixed appliances.

Tratamiento precoz en dismorfosis dentofacial / Early treatment in dentofacial dysmorphosis

Para decidir un tratamiento ortodoncico-quirúrgico precoz, se debe evaluar el perfil psicológico del paciente. Debe tenerse presente que la posibilidad de realizar camuflaje en pacientes afectados psicológicamentye no es viable, ya que esperan cambios mucho más profundos y evidentes. Como la inserción social y su asutoestima están afectados por su aspecto, algunas veces se hace necesario tomar decisiones de tratamiento en forma precoz, antes de la culminación del crecimiento y desarrollo(AU)

A comparison of the index of complexity outcome and need (ICON) with the peer assessment rating (PAR) and the index of orthodontic treatment need (IOTN).

AIM: To evaluate any relationship between ICON, IOTN and PAR. To establish whether or not ICON could replace these indices as a measure of orthodontic treatment complexity, outcome and need. METHOD: The study models of 55 consecutively treated cases were examined and PAR, IOTN and ICON recorded. RESULTS: The study showed significant correlations between IOTN and ICON with respect to need and PAR and ICON with respect to outcome. CONCLUSION: It appears that ICON does reflect UK opinion and the current study provides some evidence that ICON may effectively replace PAR and IOTN as a means of determining need and outcome.

The relationship between odontogenic bacteraemia and orthodontic treatment procedures.

The purpose of this research was to estimate the prevalence and intensity of bacteraemia associated with orthodontic treatment procedures. The four procedures investigated were: an upper alginate impression, separator placement, band placement, and adjustment of an archwire on a fixed appliance. Eighty-one children undergoing general anaesthesia (GA) for dento-alveolar surgery related to their orthodontic treatment were randomly allocated to the impression or separator group. A further 61 children, receiving treatment in the Outpatient Department, were included and randomly allocated to the banding or archwire adjustment groups. A cannula was inserted into either the left or right antecubital fossa using an aseptic technique. A baseline 6 ml sample of blood was taken before treatment and a second 6 ml sample was taken 30 seconds after the procedure. There was no significant difference in the number of positive blood cultures between baseline (nine, 23 per cent), and following an upper alginate impression (twelve, 31 per cent); between baseline (twelve, 27 per cent), and placement of a separator (fifteen, 36 per cent); between baseline (nine, 36 per cent), and fitting or placement of a band (eleven, 44 per cent); or between baseline (twelve, 33 per cent), and archwire adjustment (seven, 19.4 per cent). For the separator group only the mean total number of aerobic and anaerobic bacteria combined, isolated from the blood samples (cfu of bacteria per ml of blood), was significantly greater following the placement of a separator (2.2, SD 9.1), compared with baseline (0.9, SD 0.2; P < 0.02). This investigation demonstrates that the only orthodontic treatment procedure that causes a significant bacteraemia is the placement of a separator.