The effect of digital diagnostic setups on orthodontic treatment planning.

INTRODUCTION: This study aimed to evaluate whether viewing digital treatment simulations influenced orthodontic treatment planning decisions or practitioners' confidence in their selected plans. METHODS: Records of 6 patients representing different case types (eg, missing teeth, crowding, sagittal discrepancies) were collected. A total of 22 orthodontists and 7 orthodontic residents viewed these records and formulated treatment plans for each case, indicating their most recommended plan and up to 2 alternative plans. After treatment planning each case, digital setups of each treatment plan indicated by the practitioner were shown. The practitioners were then asked if they still recommended their original plan, or if they would now recommend a different plan. Their confidence levels in the success of their plans were recorded before and after viewing the setups. RESULTS: After viewing the digital setups, there was a significant change in the treatment plan for 9.2% of the cases. These included modifications like changing the extraction pattern or proposing space closure rather than opening space for an implant. In an additional 14.4% of the cases, treatment plans underwent partial changes, like adding interproximal reduction or temporary anchorage devices. Practitioner confidence levels increased after viewing the setups. In cases where the treatment plan changed, the practitioner's confidence level in the plan increased the most, and the final confidence level was uniformly high among all practitioners. Practitioners reported the most helpful features of digital setups were the ability to superimpose the setup with the original model, determine the amount of tooth movement needed, check the final incisal relationship (overjet and overbite), and establish the amount of interproximal reduction required. CONCLUSIONS: Viewing digital setups resulted in changes to the treatment plans in about 24% of the cases. The use of digital setups was associated with higher levels of confidence in the selected plans.

Effect of supplemental vibration on orthodontic treatment with aligners: A randomized trial.

INTRODUCTION: Supplemental vibration has been reported to accelerate orthodontic tooth movement and reduce discomfort. Our purpose was to investigate the effects of AcceleDent on Invisalign treatment. This randomized clinical trial was carried out in 2 orthodontic private practices with a 1:1 allocation ratio. METHODS: Adult patients who were beginning their orthodontic treatment were randomly allocated to either an active (A) or a sham (B) AcceleDent Aura device (OrthoAccel Technologies, Inc. Houston, TX). All patients were placed on a 1-week aligner change regimen, and fit was evaluated every 3 weeks. The outcomes were the ability to complete the initial set of aligners and the incisor irregularity measurements for those who completed their regimen of aligners. In addition, aligner compliance, pain levels, and oral health-related quality of life data were gathered from questionnaires. The subjects, investigators, and assessors were all blinded to the treatment arms. RESULTS: Twenty-seven subjects were randomized into 2 groups (A and B), 1 subject discontinued treatment, and 13 subjects were analyzed in each group. The Fisher exact test showed no significant difference in completion rates between the 2 groups (group A, 77%; group B, 85%; P = 1). Independent-sample t tests showed no significant difference between the final irregularity index or change in irregularity index between the 2 groups. Compliance was similar in both groups. The Wilcoxon rank sum test showed minimal differences in pain levels. Quality of life responses were similar in both groups. No serious harm was observed. CONCLUSIONS: We found no evidence that the AcceleDent Aura device impacts the ability to complete a series of aligners with a 1-week change regimen or the final alignment achieved in adult patients. It also had no significant effect on the reduction of orthodontic pain or oral health-related quality of life parameters when used with Invisalign.

"Why do you want your child to have braces?" Investigating the motivations of Hispanic/Latino and white parents.

INTRODUCTION: Many psychological, social, and cultural factors influence parents' motivation to seek orthodontic care for their children. In this study, we used Q methodology to identify and categorize shared motives and determine whether cultural differences exist between Hispanic/Latino (H/L) and non-Hispanic/Latino, white (W) parents. METHODS: The fundamental question posed to the parents was "Why do you want your child to have braces?" Q methodology involves 3 stages. (1) Interviews of H/L (n = 5) and W (n = 5) parents generated 35 statements that represented different motives to seek orthodontic care. (2) In the Q sort, 70 new parents (22 H/L, 48 W) ranked statements in order of relative importance using a forced distribution grid. (3) Factor analysis was performed separately for the H/L and W groups to uncover cultural differences. RESULTS: Four motivational profiles were described for both the H/L and W parents based on the significant factors identified in each group. More H/L parents (18 of 22 parents) than W parents (22 of 48 parents) were characterized by 1 of their group's 4 profiles. Comparisons of the motivational profiles across the groups showed 4 global themes: well-timed treatment that prevents future dental problems, parental responsibility, perceived benefits, and perceived need instilled by the dentist. CONCLUSIONS: Four global themes captured the motives of most parents seeking orthodontic treatment for their children. Understanding these global themes can help clinicians frame their treatment discussions with parents.

Long-term mandibular skeletal and dental effects of standard edgewise treatment.

INTRODUCTION: The purpose of this investigation was to examine the effect of Tweed edgewise treatment on the expression of mandibular growth in the horizontal direction through maintenance of vertical control. METHODS: We studied 36 patients who had 4 premolars extracted during treatment. Pretreatment, posttreatment, and postretention records of these patients were matched by age (± 6 months), sex, malocclusion, and treatment interval (± 6 months) to untreated controls from the Bolton-Brush Growth Study Center, Cleveland, Ohio. The cephalograms of the 2 samples were traced, digitized, and analyzed by descriptive cephalometric analysis and detailed regional superimposition. RESULTS: Tweed edgewise treatment can prevent clockwise rotation but was not observed to enhance the normal forward rotation of the mandible. The mandible did not rotate forward in the treated patients who underwent a greater chin advancement. CONCLUSIONS: The pattern of skeletal change was favorable both during treatment and in later years. A feature of this effect was an improved pattern of mandibular growth displacement, when mandibular change was compared with maxillary change.

Long-term dentoskeletal changes with the Bionator, Herbst, Twin Block, and MARA functional appliances.

OBJECTIVE: To determine if the long-term dentoskeletal changes in patients treated with tooth-borne functional appliances were comparable to each other and to matched controls. MATERIALS AND METHODS: The experimental sample consisted of 80 consecutively treated patients who were equally divided into Bionator, Herbst, Twin Block, and mandibular anterior repositioning appliance (MARA) groups. The control group comprised 21 children with untreated skeletal Class II malocclusions. Lateral cephalograms were taken for the treated group at T1 (initial records), T2 (completion of functional therapy), and T3 (completion of fixed appliance therapy). A repeated measure analysis of variance (ANOVA) was used to assess the differences between and within groups. If ANOVA results were significant, Tukey-Kramer tests were used to determine where the significant differences occurred. RESULTS: (1) Temporary restriction of maxillary growth was found in the MARA group (T2-T1). (2) SNB increased more with the Twin Block and Herbst groups when compared with the Bionator and MARA groups. (3) The occlusal plane significantly changed in the Herbst and Twin Block groups. (4) The Twin Block group expressed better control of the vertical dimension. (5) The overbite, overjet, and Wits appraisal decreased significantly with all of the appliances. (6) The Twin Block group had significant flaring of the lower incisors at the end of treatment. (7) Over the long-term, there were no significant soft tissue changes among treated and untreated subjects. CONCLUSIONS: No significant dentoskeletal differences were observed long-term, among the various treatment groups and matched controls.

Periodontal pathogen levels in adolescents before, during, and after fixed orthodontic appliance therapy.

INTRODUCTION: This purpose of this study was to document and investigate changes in periodontal pathogen levels before, during, and after orthodontic treatment in adolescents. METHODS: DNA gene probe analysis was used to quantify the levels of 8 periodontal pathogens before, during, and after treatment with fixed orthodontic appliances in 190 concurrently treated adolescent orthodontic patients. The 8 pathogens examined were Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis (PG), Prevotella intermedia (PI), Tannerella forsythia (TF), Eikenella corrodens (EC), Fusobacterium nucleatum (FN), Treponema denticola (TD), and Campylobacter rectus (CR). Chi-square tests were used to determine whether the percentages of subjects with high counts significantly changed over time. Logistic regression analyses were also performed to derive the relative risk of higher counts of pathogenic bacteria with fixed appliances at the various time intervals studied. RESULTS: For 6 (PI, TF, EC, FN, TD, CR) of the 8 pathogens, the percentages of subjects with high pathogen counts increased significantly after 6 months of fixed appliance treatment, but these returned to pretreatment levels by 12 months of orthodontic treatment. No pathogen level was significantly higher after 12 months of orthodontic treatment, and orthodontic treatment was found to be significantly protective for half of the pathogens (EC, FN, TD, CR) posttreatment. CONCLUSIONS: Orthodontic treatment with fixed appliances does not increase the risk of high levels of these periodontal pathogens.

Long-term stability of Class III treatment: rapid palatal expansion and protraction facemask vs LeFort I maxillary advancement osteotomy.

INTRODUCTION: The aim of this retrospective cephalometric study was 3-fold: (1) to compare the effects and long-term stability of protraction facemask treatment with untreated Class III controls, (2) to compare the long-term stability of early protraction facemask treatment with later surgical maxillary advancement with LeFort I osteotomy, and (3) to determine whether early intervention with protraction facemask is an effective treatment modality or whether surgical treatment after cessation of growth should be advocated. MATERIALS: The sample consisted of 34 consecutively treated white patients with Class III malocclusions characterized by maxillary deficiency. The protraction sample consisted of 17 children (8 boys, 9 girls). The surgical sample consisted of 17 adults (10 men, 7 women). The protraction group was also compared with a control group of white subjects with untreated Class III malocclusions. Lateral cephalograms were taken at T1 (initial records), T2 (end of functional appliance treatment or 2 weeks postsurgery), and T3 (7 years 6 months postprotraction or 1 year 5 months postsurgery). Means and standard deviations were calculated for descriptive cephalometric measurements. ANOVA was used to assess the differences between and within the protraction and surgery groups at T1, T2, and T3. The Tukey studentized range test was performed to determine the source of the difference. In addition, paired t tests were used to compare the differences between the protraction group and the matched controls as well as between the surgery group and the matched controls. RESULTS: In the protraction group, there was continued favorable growth of the maxilla, even after the removal of the protraction facemask. From T2 to T3, the maxilla continued to move anteriorly in the protraction patients more so than in the control groups, which had decreases in the intermaxillary measurements (ANB angle and Wits appraisal) over time. The surgical group remained stable from T2 to T3 in all measurements studied. CONCLUSIONS: The most striking findings of this study were the general similarity between the protraction and the surgical groups at T3 and the overall stability of both treatment modalities over time.

Influence of clinicians' experience and gender on extraction decision in orthodontics.

OBJECTIVE: To determine whether, in Class I borderline cases, experienced orthodontists choose nonextraction treatment more frequently than do orthodontists with less experience. A secondary aim was to evaluate whether clinicians' gender and place of education play a role in extraction decision making. MATERIALS AND METHODS: An online survey was developed using three Class I borderline patient cases. The survey included questions about clinicians' demographics as well as questions about the selected cases. The survey was distributed to approximately 2000 clinicians through the American Association of Orthodontics. RESULTS: Of the 253 responses collected, a trend was observed wherein clinicians with more than 15 years of experience preferred an extraction treatment option more frequently than did clinicians with less than 5 years of experience. There was no association between gender and place of education and the decision to extract in the selected borderline cases. Crowding, patient's profile, and mandibular incisor inclination were among the top three reasons chosen by clinicians for both the extraction and nonextraction treatment decisions. CONCLUSIONS: A trend was observed in which clinicians with more experience chose an extraction treatment option more frequently in borderline cases than did those with less experience. Clinicians' gender did not play a role in extraction decision making.

Treatment effects of the mandibular anterior repositioning appliance in patients with Class II skeletal malocclusions.

OBJECTIVE: To examine the changes produced by the mandibular anterior repositioning appliance (MARA) appliance and compare the treatment effects to an untreated Class II control group. MATERIALS AND METHODS: Thirty consecutively treated patients were matched with an untreated control group. Lateral cephalograms were taken at T1, 5 months pre-MARA (CVMS 2.7); T2, immediately after MARA removal and prior to placement of full fixed edgewise appliances (CVMS 4.2); and T3, at least 2 years after MARA removal and completion of edgewise treatment (CVMS 5.4). The mean age of the MARA patients was 11.9 years for boys and 10.8 years for girls. Repeated-measures analysis of variance (ANOVA) was used to assess if the samples were morphologically comparable at the outset and to test if there were significant differences between the groups for the various increments of change. Given a significant ANOVA, the source of the difference was explored via Tukey-Kramer tests. RESULTS: Restriction of maxillary growth and no significant mandibular growth were observed with the MARA appliance. The Class II correction was obtained mainly by slight maxillary molar distalization and intrusion, in addition to mesial migration of the lower molars and flaring of the lower incisors. No vertical effect was observed with this appliance. CONCLUSION: The MARA appliance was effective in the treatment of Class II malocclusions. Restriction of maxillary growth and dentoalveolar changes in the maxillary and mandibular arches were responsible for the correction of the Class II malocclusion. Significant mandibular growth did not contribute to this correction.

Dentoskeletal effects of functional appliances vs bimaxillary surgery in hyperdivergent Class II patients.

OBJECTIVE: To compare treatment outcomes of growing and nongrowing Class II patients characterized by mandibular retrusion and increased vertical dimension. MATERIALS AND METHODS: Seventeen patients (mean age 9 years 5 months) were treated with a Bionator fabricated with posterior bite block and high-pull headgear, while 15 patients (mean age 23 years 6 months) received Le Fort I osteotomy for maxillary impaction and mandibular advancement. These groups were compared with 17 nontreated control subjects from the Bolton and Michigan growth studies. Lateral cephalograms taken for the functional group at T1 (initial records), T2 (completion of functional appliance treatment), and T3 (completion of comprehensive treatment) were compared with radiographs taken at T1 (initial records), T2 (immediate post surgery), and T3 (1 year post surgery) for the surgical patients. A null hypothesis of no difference in treatment outcomes between the functional and surgical groups was proposed. A mixed-design analysis of variance was used to compare changes within and between groups. Significance was set at P ≤ .002. RESULTS: In the functional appliance group, the mandible showed a more favorable growth direction and rotation. Both groups had stable results over time and finished treatment with similar cephalometric measurements. CONCLUSION: Both the functional appliances and orthognathic surgery resulted in similar dentoskeletal treatment changes. The control groups did not self correct either in the anteroposterior or vertical dimensions.