The influence of video imaging on patients' perceptions and expectations

Seventy-four patients, ranging in age from 15 to 50 and presenting with a moderate to severe dentofacial deformity requiring orthognathic surgery, were randomly assigned to a video imaging or a standard case presentation (CP) group. Motives for treatment did not differ significantly between the video image and standard CP groups. Two weeks after the case presentation, 60% of the standard CP group and 74% of the video image group ranked the anticipated change in facial appearance as an important factor in making a treatment decision. Seventy percent of the standard CP group and 83% of the video image group agreed with the statement that surgery would be necessary to correct their problem. In the standard CP group, 47% of the patients ranked dental casts as the most helpful physical record in making a treatment decision, and 46% said the acetate profile tracing was the most helpful tool for understanding what to expect from treatment. In the video imaging group, 42% of the patients said the video imaging presentation was the most helpful tool in making a treatment decision, and 39% of the patients said it was the most helpful tool for understanding treatment expectations. The proportion of patients in the video image case presentation group with elevated self-image expectations following treatment was significantly higher (P = .045) than in the standard case presentation group. The presentation of video images appears to be a valuable information source for conveying treatment options to patients, but caution may be needed to prevent elevated or possibly unrealistic treatment expectations.

Factors related to root resorption in edgewise practice

In a series of 200 consecutively debanded patients receiving comprehensive orthodontic treatment with the edgewise appliance, six (3%) showed severe resorption (greater than one-quarter of the root length) of both maxillary central incisors. For other teeth, resorption of this extent occurred in less than 1% of the patients. Using a case-control design, the characteristics of 21 patients with severe resorption were compared to randomly selected controls from the case series. There were significantly more Class III patients among the severe resorption cases than would have been expected. Risk indicators for resorption that were related to treatment procedures included approximation of the maxillary incisor roots against the lingual cortical plate (odds ratio 20), maxillary surgery (odds ratio 8), and root torque (odds ratio 4.5).

Skeletal jaw relationships: a quantitative assessment using elliptical Fourier functions

Elliptical Fourier functions (EFF) were generated for the boundary outlines of the hard tissue craniofacial complex including the maxilla, mandible, and cranial base in order to quantitatively describe adult patients (n = 98) who were initially classified into nine skeletal groups by a combination of conventional cephalometric measures and clinical judgement. The mean residual fit of the EFF-predicted points and the original digitized data for the individual subjects ranged from .42 mm to .61 mm with a mean of .52 mm suggesting an accurate fit. Visual inspection of the individual plots confirmed this. Predicted classifications from a step-wise discriminant analysis based on EFF amplitudes were compared with the original classifications. The discordance rates for A-P and vertical plane classification were 21% and 13% respectively with an overall discordance rate of 33%. In general, a cluster analysis using EFF amplitudes did not identify clusters very similar in membership to the original groups; however, it was marginally successful in identifying members of the more severe groups and, like discriminant analysis, appeared to be more sensitive to vertical morphological differences. The overall lack of agreement between classifications and clusters based on EFF amplitudes and the original classifications may indicate that traditional skeletal categories such as those used in this study do not actually represent discrete groups.

Stability of the palatal rugae as landmarks for analysis of dental casts

The aims of this study were to determine if the palatal rugae are stable during normal growth, and whether treatment with either headgear or functional appliances affects the position of the rugae. Initial and 15-month recall dental casts of 94 patients enrolled in a study of early Class II treatment were evaluated. The children had been randomly assigned to one of three groups: control (n = 34), headgear (n = 30), and functional appliance (n = 30). Landmarks on the palatal raphe and palatal rugae were recorded using the Reflex Metrograph. A median palatal plane was constructed using the digitized raphe points as reference. Offsets from this plane to the ruga points and transverse and anteroposterior linear distances between ruga points were obtained for all casts. Transverse offsets and linear distances between medial points of the first rugae and the anteroposterior distances between the medial points of the second and third rugae did not show statistically significant changes in all groups. Significant changes were observed for the lateral points of the rugae, particularly in the headgear group. The medial rugae appear to be suitable anatomic points for the construction of stable reference planes for longitudinal cast analysis.

Self-concept, Class II malocclusion, and early treatment

Increased overjet has been associated with teasing, negative stereotyping, and low self-concept. Early treatment for children with Class II malocclusion is often recommended under the assumption that an improved dental appearance may benefit a child by increasing his or her social acceptance and hence self-concept. The self-concept of 208 patients, age 7 to 15 years and with increased overjet, was measured before treatment using the Piers-Harris self-concept scale; a subset of 87 of these children were measured again after 15 months of early growth modification. The mean self-concept score for these children was above the population norm, and there was no association between the child's score and the magnitude of his or her overjet or age. Although some significant associations were found between Class II malocclusion features and self-concept scores, the explained variation in self-concept scores was low (R2 from 5% to 8%). There was no change in the mean self-concept score of these children during early treatment, nor was there any association between reduction of Class II malocclusion features and improved self-concept. These findings suggest that children with Class II malocclusion do not generally present for treatment with low self-concept and, on average, self-concept does not improve during the brief period of early orthodontic treatment.

Anterior tooth position and motivation for early treatment

During 1989-90, 473 parents of children being screened at an orthodontic graduate clinic completed a self-report form about the child's dental/facial appearance, reasons for seeking care and referral paths. Almost all (85%) of the 313 parents of children under the age of 16 years expressed concern about the appearance of the child's teeth, and 44% reported the child had been teased about this. Only 14% of the parents reported that it was the child who had first noticed the need for treatment. The rank order of reasons for seeking treatment were appearance of teeth (85%), advice of dentist (73%), and appearance of face (46%). Using logistic regression, overjet and malalignment were observed to be significant predictors of the parent-report of the child being teased (odds ratios, OR, 5.5 and 2.4, respectively). Overjet predicted citing facial appearance as the reason for seeking treatment (OR 2.9), while age predicted patient-referral (OR 2.2) and overjet predicted parental referral (OR 3.0). Increased overjet is an important focus for early treatment and might accordingly be expected to influence the value of early intervention.