Orthodontic treatment protocol versus Peer Assessment Rating: Assessing the quality of orthodontic treatment.

OBJECTIVE: To apply the Peer Assessment Rating (PAR) to cases that have been assessed by the NHS Business Service Authority (NHSBSA) using the orthodontic treatment protocol (OTO), then compare the NHSBSA outcome assessment with weighted (W) and unweighted (U) PAR scores. DESIGN: Cross-sectional study. SETTING: UK. CASES: Anonymised orthodontic cases submitted to the NHSBSA. METHODS: A sample of 30 reports from 2021/2022 were randomly selected to include different standard of treatment grades. The records were de-identified and the pre- and post-treatment study models were PAR scored by a calibrated assessor. RESULTS: The mean percentage change in PAR was higher in cases from green reports (W: 78%; U: 79%) than amber (W: 68%; U: 67%) and red reports (W: 65%; U: 65%). Alignment and poor buccal segment interdigitation were the most reported concerns for cases included in the red and amber graded reports. A residual increased overjet was the most common occlusal feature leading to PAR scores not being more than 70% improved. Only slight agreement was shown between OTP and PAR using the kappa statistic, and the chi-square statistical test found that outcome measures are statistically significantly different. CONCLUSION: There are fundamental differences between OTP and PAR, and general agreement between them has not been demonstrated. The NHSBSA Report provides a more critical outcome assessment than PAR, identifying elements that are not assessed or measured by the PAR index.

UK dental students' ability and confidence in applying the Index of Orthodontic Treatment Need and determining appropriate orthodontic referral.

INTRODUCTION: The aim was to assess the ability and confidence of UK undergraduate dental students in applying the Index of Orthodontic Treatment Need (IOTN) and determining appropriate orthodontic referral. MATERIALS AND METHODS: This was a cross-sectional survey using a case-based online questionnaire. Fourth and fifth year undergraduate dental students were recruited from UK dental schools through their university and social media. Six cases were presented and participants were asked to provide an IOTN score and judgement about referral. Participants were asked about their confidence, experience and orthodontic teaching. RESULTS: Sixty-nine responses were returned. A quarter of participants reported having used IOTN before in a clinical setting. Clinical experience with IOTN influenced confidence. Familiarity with making orthodontic referrals was low and only one participant reported having made an orthodontic referral. Correct IOTN scores were given by 68% of participants for a large 14 mm overjet (5a) case, 43% of participants for an impacted canine (5i) case and 26% of participants for an impacted premolar (5i) case. Incorrect IOTN was most common in hypodontia cases with only 19% correctly identifying mild hypodontia (4h) and 28% identifying severe hypodontia (5h). For the majority of cases, incorrect answers about referral were due to confusion between specialist practitioner and orthodontic consultant pathways. CONCLUSIONS: Dental students' ability and confidence in correctly applying the IOTN Dental Health Component and selecting the appropriate referral pathway was inadequate. Responses suggest a lack of clinical experience in assessing patients, applying the IOTN and making referrals. The low response rate is disappointing and limits the scope for making recommendations.

CAD/CAM nitinol bonded retainer versus a chairside rectangular-chain bonded retainer: A multicentre randomised controlled trial.

BACKGROUND: Bonded retainers are widely used to maintain the positions of anterior teeth after orthodontic treatment. Various types of bonded retainer exist however, there is a lack of evidence to indicate which type is superior. AIM: To compare upper and lower CAD/CAM nitinol bonded retainers (Memotain®) with upper and lower chairside rectangular-chain bonded retainers (Ortho-FlexTech™), in terms of stability, retainer failures and patient satisfaction. TRIAL DESIGN: Multi-centre, two-arm, parallel-group, randomised controlled clinical trial with 1:1 allocation. SETTING: Three trial centres: University Teaching Hospital; District General Hospital; and Specialist Orthodontic Practice. All treatment was provided free as part of a state-funded healthcare system. MATERIALS AND METHODS: A total of 68 patients were randomly allocated to receive either upper and lower Memotain® bonded retainers or upper and lower Ortho-FlexTech™ bonded retainers. Ten trained operators placed and reviewed the bonded retainers. Measurements were carried out on study models taken at debond and after six months. Patient satisfaction questionnaires were completed at six months following debond. RESULTS: The trial was terminated due to the high number of failures (50%) of the upper Memotain® retainers within six months. Memotain® retainers were three times more likely to fail (unadjusted hazard ratio = 2.82, 95% confidence interval = 1.00-7.99) than Ortho-FlexTech™ retainers at six months in the upper arch. Patients were satisfied with both types of retainer. LIMITATIONS: Early termination of the trial means that the a priori sample size was not reached, so outcomes should be interpreted with caution. CONCLUSION: The trial was terminated early due to the high failure rate of upper Memotain® bonded retainers. They had a higher risk of failure in the maxillary arch when compared to upper Ortho-FlexTech™ bonded retainers after six months.

Maurice Berman prize for clinical excellence 2018.

This paper describes the orthodontic treatment of the three cases awarded the 2018 Maurice Berman Prize. The award is made on the basis of case complexity, case-mix variety, quality of treatment provided and results obtained, and the quality and format of the three case reports submitted through to post-treatment records.

The orthodontic-restorative interface: 1. Patient assessment.

UNLABELLED: The first article in this series of two aims to outline the assessment of patients for whom a combined orthodontic-restorative approach would be beneficial. In particular, it will concentrate on the assessment of patients who have hypodontia and tooth size discrepancies. The importance of the aesthetic assessment for these cases will be highlighted. Variations in tooth number and tooth size discrepancy often require a combined treatment planning approach from the orthodontist and restorative dentist. The referring general dental practitioner has a key role in recognizing that this approach may be required and highlighting this in the initial patient referral. It is likely in the more straightforward cases that the GDP will be providing the restorative treatment and so an increased understanding of these cases would be beneficial. In the second paper, treatment options will be presented. CLINICAL RELEVANCE: For patients who require a combined orthodontic/restorative approach, it is important that orthodontic and restorative disciplines liaise closely in the assessment and treatment planning process so that optimal care may be planned.

The orthodontic-restorative interface: 2. Compensating for variations in tooth number and shape.

UNLABELLED: The aim of this second article in this series of two is to outline a variety of methods which may be used to compensate for variations in tooth shape and number using a combination of orthodontic and restorative approaches. It will also provide an overview of other areas of patient care which necessitate a multi-disciplinary orthodontic/restorative approach. The article will highlight the importance of combined planning from the outset and the close relationship between the different specialties, which must be maintained throughout treatment. The methods of compensating for variations in tooth number and shape will often require contributions from both orthodontist and restorative dentist. It is important that both disciplines are involved in the assessment and treatment planning process so that they know what will be expected of them during the patient's care. Treatment planning in isolation may lead to care being delivered which is below the optimum standard which can be achieved. The orthodontist and restorative dentist are likely to liaise with the patient's general dental practitioner so that he/she can provide the restorative treatment in some cases. CLINICAL RELEVANCE: Great improvements in aesthetics and function may be obtained using an interdisciplinary approach for patients who have variations in tooth number and shape.

Is social media the way to empower patients to share their experiences of dental care?

BACKGROUND: Social media present opportunities to understand patient experience and information needs. In this study, the authors use hypodontia as an example to explore social media use by dental patients and how this provides for understanding patient experience. METHODS: The cross-sectional survey design involved systematic search of 6 social media online environments with hypodontia-related terms. The authors categorized records by using a coding system for user, type and theme of post, and target audience. The authors used a thematic framework approach to analyze qualitatively the word content of posts from people affected by hypodontia (nondentists). RESULTS: The authors searched and identified 571 records and included 467 of them in their study. The authors analyzed the content of records from people affected by hypodontia (n = 176). Themes emerged about the experience of untreated hypodontia, treatment experience and outcomes, and decision making. Content analysis provided evidence about peer-to-peer communication, areas of information need, and desire for peer support. CONCLUSIONS: Social media communities have responded to the need for information exchange and peer support by the public. Analysis of communications helped identify a need for dissemination of understandable information to patients and improved dentist awareness of patient needs. PRACTICAL IMPLICATIONS: Clinicians should reassess understanding and information needs actively throughout treatment and identify support needs. Clinicians should refer patients to quality information sources and peer support groups.