[Motivation of our orthodopntic patients]

Eruption Guidance Appliance effects in the treatment of Class II, Division 1 malocclusions

The objective of this research was to cephalometrically evaluate the possible effects of the Eruption Guidance Appliance on the craniofacial complex in a sample of 30 patients, over a treatment period of 26 months. The experimental sample consisted of 30 patients (13 females and 17 males), 27 of which presented with a Class II, Division 1 malocclusion and 3 with a Class I malocclusion. The mean initial chronologic age was 9 years; the treatment period lasted 26 months. A control group was used for comparison and consisted of 30 subjects (13 females and 17 males) of similar ages and spanned a similar observation period. Twenty-six subjects of this control group had Class II, Division 1 malocclusions, and 4 had Class I malocclusions. Lateral cephalometric headplates were obtained for the experimental group initially and after 26 months of treatment. The subjects in the control group were randomly selected from a serial growth study sample from the Orthodontic Department at Bauru Dental School, University of São Paulo, for whom cephalometric headplates were obtained annually from 4 to 18 years of age. Comparative statistics were used to assess possible differences between the experimental and control groups during the 26-month period of observation. Results demonstrated statistically significant increases in mandibular growth, degree of mandibular protrusion, lower anterior and total anterior face height, mesial migration of the lower molars, and mandibular posterior dentoalveolar height. There was also lingual tipping and retrusion of the upper incisors, linear protrusion of the lower incisors, improvement in the maxillomandibular relationship and in molar relationship, as well as a significant decrease in the overjet and overbite and an inhibition of the vertical development of the upper incisors. The study demonstrated no significant changes in maxillary growth during the evaluation period. It was concluded from these results that the effects of the Eruption Guidance Appliance during this time period were mostly dentoalveolar, with a smaller, but significant, skeletal effect.

[A retrospective examination of the acceptance of removable appliances]

In order to study the subjective attitudes of patients and their parents to orthodontic treatment questionnaires were handed out to both groups. One hundred and forty five patient questionnaires and those answered by 114 parents formed the base of the study. The majority of the patients were only able to provide partial answers to precise questions about their treatment. Speech impairment, pressure, and salivation were given as being the most vexatious aspects of the treatment. The majority of the patients and the majority of parents favored removable appliances over fixed appliances. The patients' social environment did not negatively influence their attitude to orthodontic treatment.

Correlates of objective patient compliance with removable appliance wear

Patient compliance is considered a major problem in orthodontics. Yet, to date, few conclusive findings have been noted on determinants and consequences of failing adherence, probably because of method flaws and a lack of objective criteria. By following an outline of conceptual issues and selected research, we considered an investigation into correlates of patient compliance with removable appliance wear. We studied a sample of 77 university clinic patients ages 9 to 14 years over several months by means of psychologic inventories and electronic measurement of removable appliance wear. The actual compliance rate proved to be associated with many variables. Among those, characteristics of the patient and his family background, such as conformity and degree of consistent parental support and supervision are interpreted as determinants of satisfactory adherence, whereas treatment related and interactional correlates, such as duration of treatment, dominance of provider, and interpersonal perceptions, are conceived of in terms of mutually interdependent and/or consequent variables. The factors identified might be paralleled in the wearing of headgear and intraoral elastics that require a similar degree of active patient cooperation. After a critical discussion of our data in the light of previous findings, suggestions are provided for future research along with conclusions for clinical practice.

[The clinical and psychological indicators of behavior in wearing a removable appliance]

Compliance with wearing removable appliances cannot be determined directly from progress noted in the course of treatment. The orthodontist's judgement is influenced by many and varied observations and the evidence they yield is often unclear. We studied 104 orthodontic patients aged nine to 16 years using as data treatment records, provider and patient questionnaires, and oral hygiene indexes. In addition the Luescher psychological color test was administered to a subgroup and the duration of compliance wear was objectively measured. We found little consistency among different compliance indicators. Studying the patient's keeping of appointments, his oral hygiene habits, and appliance maintenance did not result in general conclusions pertaining to the patient's compliance with wearing the appliance. Only over a longer period it is possible to determine through clinical observation the patient's cooperation in his treatment. More promising on the other hand for better evaluating patient compliance behavior is the combination of information obtained clinically with the results obtained through psychological tests.

[The motivation and assessment of the success of adult patients undergoing orthodontic treatment--the interpretation of a questionnaire]

In order to analyze orthodontic treatment of adults concerning information, motives and retrospective evaluation 225 patients with fixed appliances were questioned. The dentist had a key position as a mediator of information. The decision to an orthodontic treatment was led by esthetic and functional motives. The extent of the respective motives depended from age, personal status, education and cooperation. Interest and understanding in functional improvements as they could be found above all by people with a higher education level were decisive for a durable regard of the treatment.