Self-perceived orthodontic treatment need and culturally related differences among adolescents in Sweden

The aim of this investigation was to compare Swedish and immigrant groups of 12- and 13-year-old boys and girls with respect to: (1) self-perceived need for and attitude to orthodontic treatment, (2) attitude to own teeth and general appearance, (3) behaviour pattern and psychosocial functioning, and (4) self-perceived need for orthodontic treatment in relation to psychosocial functioning. The subjects comprised 508 students, aged 12 and 13 years, living in Sweden, who were grouped according to nationality: (A) both parents born in Sweden (139 girls and 131 boys); at least one parent born in: (B) eastern Europe (27 girls and 34 boys); (C) Asia (66 girls and 61 boys) and (D) other countries (23 girls and 27 boys). Each student answered a questionnaire in the classroom. The questions concerned demographic data, self-perceived treatment need, attitude to orthodontic treatment, own teeth and general appearance, behaviour pattern and psychosocial functioning. The results showed that, on average, 20 per cent of the students had a self-perceived treatment need, more girls than boys, 24 per cent of Swedes (A), 12 per cent from eastern Europe (B), 18 per cent from Asia (C) and 14 per cent from other countries (D). Seventy-two per cent of the Swedish students were prepared to undergo fixed appliance therapy, compared with 58 per cent of immigrant students. Nine per cent of the Swedish students considered their general appearance to be less favourable compared with 7 per cent of their peers (not significant). While some differences in behaviour pattern were observed, these did not seem to influence the well-being of the subjects. The conclusion is that perceived orthodontic treatment need is lower in immigrant students than in Swedish students.

Evaluation of the aesthetic component of the Index of Orthodontic Treatment Need by Swedish orthodontists

The aim of the present study was to evaluate if the majority of orthodontists in Sweden agree with the ranking of the photographs in the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN), and its treatment need classification. Ten separate colour photographs (originals from the AC) and two questionnaires were sent to 272 orthodontists in Sweden. Eighty-one per cent (219) returned one or both questionnaires. One hundred and ninety-four orthodontists answered the AC 'grading of dental attractiveness' and 217 the AC 'need for orthodontic treatment' (nine of the integrated questions had to be excluded because more than one alternative had been chosen). The aesthetic ranking by the orthodontists was compared with the original AC and the deviation was estimated. The results showed that the grading of photographs 2-9 varied greatly among the orthodontists, but the agreement was almost complete for photographs 1 and 10. The establishment of treatment need for each photograph had good agreement with the original index for photographs 1, 2, and 8-10, while the majority of the orthodontists considered that photographs 5 and 7 should be treated and that photograph 6 showed a borderline case. The participating Swedish orthodontists' aesthetic ranking of the photographs was: 1, 2, 3, 4, 6, 5, 7, 9, 8, and 10. Regarding treatment need, no need for treatment was set for photographs 1-4, borderline for photograph 6 and a need for treatment for photographs 5, 7-10. Further studies are needed to evaluate if laymen in Sweden make the same judgements as Swedish orthodontists.

[Development of a questionnaire to evaluate the cooperation of adolescent orthodontic patients]

OBJECTIVE

To develop a questionnaire to evaluate the cooperation of adolescent orthodontic patients.

METHODS

182 orthodontic patients (9 - 15 years old, 78 boys and 104 girls) with fixed appliance were selected in Dalian. A questionnaire was developed according to the past research and 4 hypotheses.

RESULTS

The scale is made up of 25 items and 4 factors. The reliability of this scale was confirmed (the reliability coefficient > 0.9 and Cronbach alpha coefficient > 0.7).

CONCLUSION

The questionnaire may be used to evaluate the cooperation of orthodontic patients.

Expectations of treatment and satisfaction with facial appearance in Nigerian orthodontic patients

The aim of this study was to investigate correlation between satisfaction with facial appearance and expectations of orthodontic treatment. The effects of sex and age on these variables were also explored. A sample of 201 patients who presented for orthodontic treatment at two referral centers in Nigeria: the Orthodontic Unit, University College Hospital, Ibadan and Department of Child Dental Health, Lagos University Teaching Hospital, Lagos, completed a questionnaire on satisfaction with facial appearance and expectations of orthodontic treatment. They consisted of 89 (44.3%) males and 112 (55.7%) females with age range of 8 to 40 years (mean age, 13.60 +/- 8.03 SD). Correlation between patients' expectations, satisfaction with facial appearance, age and sex were examined. A multiple regression analysis was used to estimate the effect of the initial facial satisfaction on expectations of orthodontic treatment. No significant correlation was found between satisfaction with facial appearance and patients' expectations. The correlation was invariant over gender, but age was found a significant predictor of expectations of orthodontic treatment for patients up to 16 years of age (r = .210; p < 0.05). It was concluded that satisfaction with facial appearance is not a significant predictor of Nigerian orthodontic patients' expectations of treatment. However, age was found a significant predictor of orthodontic patients' expectations of treat-ment for the child orthodontic population sub-sample.

The relationship between patient, parent and clinician perceived need and normative orthodontic treatment need

The aim of the present study was to compare patient, parent and clinician perceived need for orthodontic treatment in relation to normative orthodontic treatment need as measured by the Index of Orthodontic Treatment Need (IOTN). A prospective cross-sectional study was designed to address this aim. The sample comprised 103 patients attending the 'new' patient clinic at the Jordan University Hospital. The patients' mean age was 15.3 years (standard deviation 3.8 years); 33 per cent were males and 67 per cent females. One clinician scored the patients' normative orthodontic treatment need using the IOTN, then determined perceived need using a 10 cm visual analogue scale (VAS). The subjects then assessed their own perceived need and aesthetic component (AC) score and the parents carried out similar assessments for their children. All scoring was carried out blind. The parents had the highest average perceived need scores, followed by patient and clinician scores (6.6, 6.1 and 5.4 cm, respectively). A significant difference was found between the parents and the clinician (P < 0.05). When the relationship between perceived need and clinician-measured normative orthodontic treatment need was investigated, significant differences were found with the dental health component (DHC) for all three groups (P < 0.05). Differences between AC and perceived need scores were also significant for the patients and parents, but not for the clinician (P > 0.05). The present study has shown that perceptions of orthodontic treatment need are multifactorial and influenced by elements other than health measures of normative orthodontic treatment need and perceptions of aesthetics.

Orthodontic treatment and its impact on oral health-related quality of life in Brazilian adolescents

OBJECTIVE

To assess whether Brazilian adolescents who had completed orthodontic treatment had lower levels of impacts on their oral health-related quality of life.

DESIGN

A cross-sectional study.

SETTING

The study was conducted in public and private secondary schools in Bauru-SP, Brazil.

PARTICIPANTS

1675 randomly selected adolescents aged between 15 and 16 years.

METHODS

Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess adolescents' oral health-related impacts. Multiple logistic regression was used in the data analysis.

RESULTS

A response rate of 100% was obtained. Adolescents who had completed orthodontic treatment had fewer oral health-related impacts compared to the other two groups. They were 1.85 times (95% CI 1.30 to 2.62) less likely to have an oral health impact on their daily life activities than adolescents currently under treatment or 1.43 (1.01 to 2.02) times than those who never had treatment.

CONCLUSIONS

Adolescents who had completed orthodontic treatment had a better oral health-related quality of life than those currently under treatment or those who never had treatment.

Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children

The aim of this study was to assess the opinions of Tanzanian children on dental attractiveness and their perceptions of orthodontic treatment need in relation to their own dental attractiveness as measured by the aesthetic component (AC) of the index of orthodontic treatment need (IOTN). In a random sample of 386 school children (48% boys, 52% girls), aged 9 to 18 years, the subjective need was assessed by using a prestructured questionnaire, and attractiveness was scored by using 18 intraoral frontal photographs. Orthodontic treatment need was measured with the IOTN, and 11% of the children definitely needed orthodontic treatment (grades 8-10 of the AC with 4-5 of the dental health component [DHC]). The AC indicated that 11% of the children needed orthodontic treatment, whereas the DHC indicated 22%. Although 38% of the children said they needed treatment, 33% and 31% were unhappy with the arrangement and the appearance of their teeth, respectively. Most children (85%) recognized well-aligned teeth as important for overall facial appearance. Photographs showing severe deviations including crowding were regarded as the most unattractive, with older children tending to dislike them the most (P <.0005). This suggests that, from the children's point of view, grades 8-10 of the AC and 4-5 of the DHC could be given the first priority when considering an orthodontic treatment policy in Tanzania.

Comparison between the opinions of Tanzanian parents and their children on dental attractiveness

The objective was to investigate the opinion of Tanzanian parents on dental attractiveness and to compare their opinion with that of their children. A prestructured questionnaire with 18 intraoral frontal photographs was given to 286 parents and their children aged 9-18 years. The photographs represented various types of occlusion traits, with the first 10 intraoral photographs representing grade 1-10 of the aesthetic component (AC) of the index of orthodontic treatment need, and the remaining eight photographs were added to represent malocclusions that are often seen in Tanzania. Basic statistical techniques were used to analyze the data. Photographs showing severe deviations were perceived by both children and parents as the most unattractive. The opinion was significantly correlated with children's age (P = .02) and sex (P < .0005), with older girls tending to dislike photographs showing severe deviations the most. The mean of the opinion for the photographs showing some spacing with overbite < or = 2 mm or open bite and overbite > 2 mm fell in the middle of the scale, with a tendency toward unattractiveness. Photographs matching 8-10 on the AC scale were perceived as the most unattractive, indicating what could be a lay person's priority when considering an orthodontic treatment policy in Tanzania.

The views and attitudes of parents of children with a sensory impairment towards orthodontic care

A questionnaire was sent to the parents of 77 visually impaired (VI), 210 hearing impaired (HI) and 494 control children seeking their views on their child's dental appearance, orthodontic treatment need and issues that might influence the child undertaking treatment. The parents' views were compared with a dentist's assessment of treatment need using the Index of Orthodontic Treatment Need (IOTN). There was disagreement between the dentist's assessment and the parents' perceptions in all groups. However, the least disagreement was seen in the HI group. There was a statistically significant (P < 0.05) association between control and HI parents' views of their children's treatment needs and their opinion on their dental appearance. Most parents thought that orthodontic treatment was difficult to obtain and expensive and that their child would find difficulty coping with the treatment. Furthermore, parents of VI children considered that treatment was unlikely to be undertaken due to their child's reduced concern for their appearance. The study indicates that the awareness of treatment need for VI and HI children differs between their parents and dentists.

Longitudinal changes in gingival condition in crowded and noncrowded dentitions subjected to fixed orthodontic treatment

A previous study showed that initial crowding in the dentition was negatively correlated with gingival bleeding at the end of orthodontic treatment, whereas visible plaque on the labial surfaces had apparently no significant association with gingival health. The present study further examined the relationship between initial crowding and gingival health during fixed orthodontic treatment. A total of 220 patients were followed longitudinally during treatment. In this population, 2 groups, 1 consisting of 45 patients with severe crowding and 1 consisting of 52 patients with no crowding, were examined more closely. The gingival bleeding index (GBI) was recorded at bonding, at 12, 24, and 48 weeks after bonding, and at debonding. At bonding, the GBI was the same in the 2 groups. However, the GBI improved significantly from 12 weeks after bonding to debonding in the patients with crowded dentitions, whereas the patients with noncrowded dentitions showed no changes. Possible reasons for this difference were identified: to have the same GBI at bonding, despite the severe crowding, the patients in this group probably had better oral hygiene. Those with crowded dentitions had received more oral hygiene instruction within 2 years before bonding than those with noncrowded dentitions, according to the general practitioners' records. When the crowding was eliminated after approximately 3 months, the conditions for cleaning the teeth were improved, and, accordingly, the patients' improved oral hygiene resulted in lowered GBI scores. One could also speculate that correcting the crowding during the first few months of treatment had a positive psychological effect, motivating the patients to use the skills in oral hygiene that they had adopted before treatment.

Age dependence of compliance with orthodontic treatment in children with large overjet. An interview study

Large overjet has been associated with an increased risk of trauma of the permanent maxillary incisors, especially before 10 years of age. The prevalence of an overjet of more than 6 mm in 10-year-old Swedish children is about 15%. To prevent trauma by reducing the overjet, this treatment be set in early in life. However, compliance with orthodontic treatment is a significant and well known problem and may be associated with the age of the patient. This study concerns children treated with an open activator with built in headgear (HG activator). The aim of treatment was to reduce the trauma risk in these patients as early as possible, and an objective of the study was to gain better knowledge of young children's (6-13 years of age) motivation for and response to correction of large overjet. In-depth interviews focusing on motivation were held with 18 children. Interviews were transcribed verbatim and analysed according to Grounded Theory, a qualitative method. The results indicate the importance of parental involvement for younger children's compliance. Older children seem to have a higher degree of internal motivation for treatment and less need for parental support for compliance with treatment. If treatment compliance can not be ensured through parents' wholehearted involvement and control it seems to be better to delay treatment until the child is older.

Patient and parent understanding of informed consent in orthodontics

In both medical and dental settings, researchers have found that patients do not adequately comprehend the information given during informed consent discussions, especially the less educated, low-income patients. Because of the importance of patient compliance with orthodontic treatment regimens, this study examined patient and parent understanding of the child's Phase I orthodontic treatment in a public dental clinic with ethnically diverse, low-income patients. Interviews were conducted with 29 children (ages 6-12) and their parents or guardians at the orthodontic case presentation appointment. The orthodontist explained the reasons for treatment, the orthodontic procedures to be used, the risks, the alternatives, and patient and parent responsibilities during treatment; the session was audiotaped. Interviews were conducted immediately after this discussion and the results compared with the orthodontists' presentations. In general, both children and parents recalled significantly fewer reasons for treatment (1.10, 1.66, and 2.34 items, respectively), procedures (1.55, 1.59, and 2.45, respectively), risks associated with treatment (0.66, 1.48, and 4.66, respectively), and responsibilities of the child during treatment (2.21, 2.07, and 3.38, respectively) than what the orthodontist had told them. They were also less likely to recall the reasons, procedures, and risks that were most frequently cited by the orthodontist. These findings raise concerns about the effectiveness of current informed consent techniques with public health populations, especially the low recall rates within 30 minutes of the case presentations. Low recall of risks by children and their parents, particularly for critical risks such as relapse, caries, and periodontal problems, raises concerns about treatment compliance, success, and more importantly, the effectiveness of the informed consent process itself. Future research should focus on methods to improve the informed consent process among children undergoing orthodontic treatment in a low-income population.

Perceived information needs in respect of orthodontics amongst 11-12-year-old girls: a study through health visitor sessions in schools

AIM

The aims of this study were: to explore: (i) the knowledge and views regarding orthodontics of a group of 11-12-year-old girls attending a school in Southeast London and (ii) the terms that they used to obtain the information.

METHODS AND SUBJECTS

The study used Dental Health Education sessions to investigate the aims of the study. Eight DHE sessions at a secondary school for girls were tape recorded. In order to raise the issue of orthodontics and trigger the formation of questions during health education session, a worksheet containing true/false questions, a crossword puzzle regarding orthodontics and some open ended questions was designed and sent to students. They were required to read and complete the worksheet before each session. They were not required to return the completed worksheets to the investigators but did return them to their teachers. The sessions were tape recorded and supplemented by notes taken at the sessions by the investigator. A total of eight DHE sessions, attended by 14 girls each, were tape-recorded. Each tape recording was immediately transcribed verbatim. The next stage was to organize the data and to single out the orthodontic questions and discussions and categorize them.

RESULTS

A total of 117 girls aged 11-12-year-old comprised the study group: 77% were white and 23% black children. After reading the transcripts several times, certain themes on orthodontics emerged. The results showed that children questioned different aspects of orthodontics. Nine themes emerged from their questions and discussions. They wanted to know why orthodontic treatment was carried out and when was the right time to start treatment. They were very keen to find out the differences between different orthodontic appliances. The psychosocial impacts of wearing an orthodontic appliance, i.e., experience of pain as well as the need for extraction of some permanent teeth as part of the treatment were of concern. They asked some questions on the need for repair, adjustment and taking care of appliances. The aetiology of malocclusion was another theme that emerged. The students tended to ask questions and describe problems in their own lay terms.

CONCLUSION

The methodology used in this study provided an opportunity to assess the information needs with regards to orthodontics of a group of children attending a school in Southwark, London, UK. It was successful in discovering the views and concerns, and to some extent, their knowledge regarding orthodontics and the terms pupils used in asking questions and making comments.

The uninformed orthodontic patient and parent: treatment outcomes

In both medical and dental settings, researchers have found that patients do not always adequately comprehend the information given during informed consent discussions. The objective of this study was to evaluate patient and parent understanding of the child's orthodontic treatment in a dental school population, compare this with information in patients' charts, and assess the effects of vocabulary and educational level on patients' and parents' comprehension. Interviews were conducted with 21 children, ages 7 to 12 years, undergoing early orthodontic treatment at a dental school and 1 parent or guardian per child. Open-ended questions were asked regarding reasons for treatment, risks, and patient and parent responsibilities. Children had been in treatment for 1 to 24 months (mean = 7.84 +/- 9.42). Patient and parent responses were compared with information in the children's charts. On average, parents recalled only 2.1 reasons for treatment and children recalled only 1.24; the charts listed an average of 4.1 diagnoses. Children could recall only 0.67 risks and parents 0.60 risks, yet many patients had already experienced problems with their treatment on average. The vocabulary levels of the children and their parents were low; parents' vocabulary and educational levels were correlated with their comprehension of this material. Further research should be aimed at improving methods of preparing child patients and their parents for major dental procedures, especially in a publicly funded clinic.

Relationship of malocclusion severity and treatment fee to consumer's expectation of treatment outcome

Understanding consumer expectations is important if orthodontists are to be successful in marketing their elective services. The purpose of this study was to examine the relationship between consumer outcome expectations and treatment variables, including cost of treatment and malocclusion severity. The subjects were parents of patients recruited from 9 private orthodontic practices in southwestern Pennsylvania who were entering a single comprehensive phase of orthodontic treatment, characterized by a full fee and complete fixed appliances. The parents completed a questionnaire regarding outcome expectations for their child's orthodontic treatment. Pretreatment orthodontic study models of each child were evaluated with the peer assessment rating. The results of this study suggest that orthodontic consumers have very high outcome expectations. Also, the parents of patients with severe overall malocclusions, overjet, or midline deviations have expectations that exceed probable treatment outcomes. Orthodontists should consider that consumers seeking their services have increased expectations not related to the treatment outcomes.

Expectations of treatment and satisfaction with dentofacial appearance in orthodontic patients

The aim of this study was to investigate correlations between satisfaction with dental and facial appearance and expectations of orthodontic treatment. The effects of sex and age on these variables were also explored. A sample of 154 patients who applied for orthodontic treatment at the Academic Centre of Dentistry Amsterdam, The Netherlands, completed 2 questionnaires, containing 16 items on satisfaction with facial appearance and 23 items on expectations of orthodontic treatment. First, the structure of the questionnaires was analyzed. Next, correlations between patients' expectations, satisfaction with facial appearance, age, and sex were examined. A multiple regression analysis was used to estimate the effect of the initial facial satisfaction on expectations of orthodontic treatment. Principal components analysis of the questionnaire about expectations showed 4 factors with an Eigenvalue greater than 1, accounting for 72% of the total variance. These were defined as "general well-being," "self-image/appearance," "future dental health," and "oral function." We found that "satisfaction with facial appearance" could be divided into 2 factors, each with an Eigenvalue greater than 1, accounting for 64% of the total variance. These were interpreted as "general facial appearance" and "dental appearance." Significant correlations were found between satisfaction with dental appearance and patients' expectations. These correlations were invariant over gender, but not over age. It was concluded that satisfaction with dental appearance is a significant predictor of orthodontic patients' expectations of treatment.

Attitudes and satisfaction with dental appearance in young adults with and without malocclusion

The aim of the study was to assess the quality of a Public Dental Service (PDS) system in Sweden with regard to the orthodontic care and to investigate the selection made for the consultation by the general practitioners (GPs) and by orthodontists of those patients with malocclusion. In the individuals leaving the PDS system, the residual need and demand for treatment due to malocclusions and satisfaction with and opinion of their teeth was assessed in orthodontically treated and untreated 19-year-olds. Altogether 121 19-year-olds were clinically investigated with respect to six defined malocclusion traits and given a questionnaire. The following results were found: Ten per cent of the 19-year-olds that had not had an orthodontic consultation showed a residual treatment need. One third of the individuals judged by the orthodontist not to need treatment and one third that had been treated by the GP showed a marked orthodontic treatment need at the age of 19 years. Twenty-two per cent of all 19-year-olds left the PDS with an orthodontic treatment need. Ninety-four per cent were satisfied with their teeth irrespective of malocclusion or not. Every second individual considered their teeth important for their self-esteem. It was concluded that 19-year-olds in general were satisfied with their dental appearance. Half of the registered residual need and demand for orthodontic treatment was not related to measurable malocclusions.

Perception of orthodontic treatment need: opinion comparisons of orthodontists, pediatric dentists, and general practitioners

AIM

To determine the relationship between treatment need assessment scores of orthodontists, general practitioners, and pediatric dentists.

STUDY DESIGN

Observational.

SAMPLE

Ten general dental practitioners, 18 orthodontists and 15 pediatric dentists reviewed 137 dental casts and recorded their opinion on whether orthodontic treatment was needed.

RESULTS

We found a high level of agreement between pediatric dentists, orthodontists and general practitioners (Kappa range 0.86-0.95). Between the groups, the amount of agreement was lower.

CONCLUSIONS

Orthodontists, general dental practitioners, and pediatric dentists in this sample exhibit high levels of agreement on orthodontic treatment need.

Subjective need and orthodontic treatment experience in a Middle East country providing free orthodontic services: a questionnaire survey

The aims of this study were to explore orthodontic treatment experience, subjective need for treatment, and perceptions of teeth and dental appearance in relation to background factors such as funding system, area of living, age, gender, ethnicity, and socioeconomic status. The subjects were 1076 randomly selected second-year high school students from a rural (Jahra) and an urban (Capital) area of Kuwait, with a mean age of 15.1 years. Kuwaiti citizens constituted 79% of the sample, and the rest were of other Arab origins. The data were collected using a questionnaire. Orthodontic treatment rate was significantly higher for Kuwaitis (10%) than for non-Kuwaitis (2%). Among Kuwaiti subjects, urban area of living and female gender increased the odds of receiving orthodontic treatment. Subjective treatment need was 36%, with no difference between Kuwaiti and non-Kuwaiti subjects, but Kuwaitis in the rural area expressed subjective treatment need less often than those in the urban area. The results suggest that access to free-of-cost orthodontic treatment was likely to affect treatment rate, whereas it did not seem to influence the self-perceived need for treatment. Gender and area of living may be significant for the distribution of free-of-cost orthodontic treatment.

[Treatment with or without cooperation]

The first condition required for carrying out a successful orthodontic treatment involves patient cooperation. Yet, for a long time, orthodontic research has minimized the importance of nontechnical factors: until a recent period practitioners had to content themselves with mere impressions, feelings and other beliefs, rather than a qualitative control of knowledge and behaviors. Thanks to data processing, testing one's choices, decisions and therapeutic strategies has been made possible to obtain a better cooperation. At the beginning of this third millennium, this new concept of the orthodontist's role is moreover in keeping with a general trend in medical and dental therapeutics: any biotechnological innovation is nowadays presented with a concern for the patient's information, education and relation, taking into account his/her social and cultural background.

[Reactive anxiety in patients during orthodontic treatment with crowns]

Reactive anxiety of patients was evaluated at clinical stages of orthodontic treatment with polymeric crowns. Antistress therapy essentially decreased the number of patients with high reactive anxiety. Measures to control fear are obligatory before tooth preparation and impression making. At the rest stages it is hardly necessary to focus the dentist's and patient's attention at these measures.

A qualitative study of teenagers' decisions to undergo orthodontic treatment with fixed appliance

OBJECTIVE

The aim of this study was to describe thoughts and values influencing young people's choices to undergo orthodontic treatment.

SUBJECTS AND METHODS

Twenty-eight patients (11 boys), aged 13-19 years, at an orthodontic clinic in the western part of Sweden participated. Open, taped interviews, lasting about 1 hour, were conducted with each subject and analysed by the grounded theory method. Five descriptive categories, each related to several subcategories, were generated in the analysis and labelled: 'being like everyone else', 'being diagnosed', 'focusing on the mouth', 'obeying social norms' and 'forced decision-making'.

OUTCOME

Category forced decision-making was identified as a core category, describing the power in the social process, resulting in the decision to undergo orthodontic treatment.

CONCLUSIONS

Motivation for the decision to undergo orthodontic treatment seemed to be social norms, and the beauty culture in their reference group and in society in general. The teenagers were not fully conscious of these external influences. Their opinion, as a group, was that they had made an independent decision to undergo orthodontic treatment.

Esthetic aspects of orthodontic-surgical treatment of sagittal-vertical anomalies: the example of the short face syndrome

BACKGROUND

Psycho-esthetic aspects play an important role in motivating patients to undergo combined orthodontic-surgical treatment as well as in the subjective appraisal of treatment outcome. The facial soft tissues are the crucial interlink between the underlying skeletal and dental structures and their perception by the patient and his social environment. TREATMENT OF SHORT FACE SYNDROME: In the therapy of Class II malocclusions with skeletal deep bite and short lower face (short face syndrome), the soft tissues and the psycho-esthetic treatment expectations of the patient are taken systematically and appropriately into account during treatment planning and evaluation.

PATIENTS AND METHOD

The respective elements of the treatment concept are outlined and explained in this article. Based on the empirical evaluation of 15 patients treated according to this concept, the soft tissue changes in patients with short face syndrome and the changes in esthetic and psychosocial self-perception are reported.

RESULTS

The results demonstrate the efficiency of the treatment concept in improving facial soft tissues, especially in the vertical dimension, and the resulting psycho-esthetic benefit to the patient.