[Recommended times for wearing removable appliances--the results of a survey]

Orthodontic treatment of an adolescent with cerebral palsy - A case report

Cerebral palsy is a common cause of chronic motor neuron impairment. A constant prevalence of 2 to 3/1000 births in industrialized countries has been described. This case report describes the treatment of a 9 year old boy presenting this form of motor neuron impairment and class II malocclusion with an overjet of 14 mm, hyperdivergent growth pattern and various habits. Orthodontic treatment consisted mainly of a two-phase treatment. The first phase was treated with removable appliances and followed by a phase with fixed appliances. Treatment duration with removable appliances was 4 years and 5 months and for the fixed appliance phase, 1 year and 7 months. A class I occlusion could be achieved in this case by removable and fixed orthodontic appliances combined with adjunctive treatment for the hypotonic orofacial musculature.

Headgear compliance as assessed by a temperature-sensitive recording device: a prospective clinical study

Objective

To accurately describe compliance in headgear wearing time by using a temperature- and force-sensitive device over an 8 month period of use in a prospective clinical manner.

Materials and methods

Twenty children with Class II malocclusion aged 8–12 years were randomly selected for treatment with cervical headgear. The headgears were equipped with an electronic module, which measured temperature and force, and patients were instructed to wear the headgear 12 hours daily. The recorded values were analysed to determine the number of days the headgear was used, the number of hours per day it was worn, and the percentage of compliance (100 per cent corresponding to 12 hours daily).

Results

The average treatment period was 8.4 months with 5.8 months of effective use. When effectively used, headgear was worn 8.7 hours a day (compliance of 73 per cent). Including days where it was not worn, compliance was 6.4 hours (54 per cent). The appliance was used on average 0.5 hours during the day (8 am–8 pm) and 5.9 hours during the night (8 pm–8 am). Very low compliance was recorded during July and August.

Conclusion

The average compliance with cervical headgear use was 54 per cent of the 12 hour prescription. The headgear was effectively used only 5.8 months over the study period, with roughly 30 per cent of no use. Headgear was used almost exclusively during evening and night-time. During the summer period, compliance was particularly poor.

Quantifying patient adherence during active orthodontic treatment with removable appliances using microelectronic wear-time documentation

OBJECTIVES

The aim of this study was to quantify the wear times of removable appliances during active orthodontic treatment.

MATERIALS AND METHODS

The wear times of 141 orthodontic patients treated with active removable appliances in different locations were documented over a period of 3 months using an incorporated microsensor. Gender, age, treatment location, health insurance status, and type of device were evaluated with respect to wear time. Significant associations between wear times and patient factors were calculated using non-parametric tests.

RESULTS

The median daily wear time was 9.7 hours/day for the entire cohort, far less than the 15 hours/day prescribed. Younger patients wore their appliances for longer than older patients (7-9 years 12.1 hours/day, 10-12 years 9.8 hours/day, and 13-15 years 8.5 hours/day; P < 0.0001). The median wear time for females (10.6 hours/day) was 1.4 hours/day longer than males (9.3 hours/day; P = 0.017). Patients treated at different locations wore their devices with a difference of up to 5.0 hours/day. Privately insured patients had significantly longer median wear times than statutorily insured patients. No significant difference in wear time was noted according to device type.

CONCLUSIONS

The daily wear time of removable appliances during the active phase of orthodontic therapy can be routinely quantified using integrated microelectronic sensors. The relationship between orthodontist and patient seems to play a key role in patient adherence. Wear-time documentation provides the basis for more individualized wear-time recommendations for patients with removable appliances. This could result in a more efficient, shorter, and less painful orthodontic therapy.

Effects of wear time recording on the patient's compliance

OBJECTIVE

To assess the effect of wear-time recording on subjective and objective wear time.

MATERIALS AND METHODS

This study retrospectively examined a group of 18 patients and a control group of 14 patients at four appointments over 168 days. The patients were treated with removable appliances with embedded TheraMon-microsensors to be worn for 15 hours per day. The study group was not told about the microsensor until the first appointment after fitting of the appliance. At each appointment patients were asked about their subjective wear time and afterward were told about the objective wear time. The existence of the microsensor was revealed to the control group when the appliance was fitted. Objective wear time was also announced at every appointment.

RESULTS

Mean wear times did not significantly differ between groups at any appointment or regarding overall wear time. Highly significant differences between subjective and objective wear time were found when patients did not know that their wear time had been monitored.

CONCLUSION

Mean wear times assessed in this study concur with data of previous studies. Patients tend to overestimate their wear times but become more realistic once they know wear time is being monitored. Objective measurement of wear time allows a more realistic view of compliance by patient and orthodontist. Knowing that wear time is recorded does not necessarily increase the amount of time removable appliances are worn by the patient.

Effects of information-giving and communication during orthodontic consultation and treatment. Part 3: Optimized orthodontist-patient communication

Effective, orthodontist-patient communication must meet certain minimum requirements whose importance might vary, depending on the individual case and stage of treatment. In the course of treatment the following tasks are of primary importance: 1. Before the start of treatment, during preliminary consultation, information tailored in extent and quality to the individual patient has to be provided, a professional assessment of treatment needs made, and a relationship of mutual trust established. 2. In the initial phase of treatment, the individual shaping and optimisation of treatment needs is a matter of priority if initial acceptance of the appliance is to be assured. The patient should be advised how to meet the treatment needs in his individual situation. 3. In the further course of treatment, the fulfillment of the demands has to be repeatedly clarified. Feedback with regard to patient cooperation should be handled with caution. A tight recall schedule, a time-keeping record and involvement of the parents are obvious interventions in cases of inadequate cooperation. The treatment may also have to be reevaluated.

[The determinants of wear behavior in treatment with removable orthodontic appliances]

The interplay of significant determinants of patient appliance wear is discussed in terms of a conceptual model reflecting the current state of research in orthodontic compliance. Appliance wear is determined by treatment-related factors such as regimen and perceived comfort, as well as by external factors such as patient personality and parental attitudes. Patient attitudes are the critical link between these influences. In the focus of this article are the patient's experiences and perceptions of treatment and the way they are affected by appliance and prescribed wear. Furthermore, possible measures to enhance compliance are highlighted.