Quality of orthodontic care-A multicenter cohort study in Germany : Part 1: Evaluation of effectiveness of orthodontic treatments and predictive factors

Quality of occlusal outcome in adult Class II patients treated with completely customized lingual appliances and Class II elastics compared to adult Class I patients

OBJECTIVES

The aim of this investigation was to evaluate whether Class II malocclusion in adult patients can be successfully corrected using a completely customized lingual appliance (CCLA) in combination with Class II elastics.

METHODS

In order to detect differences in the final treatment outcome, two groups were matched for age and gender. Treatment results of 40 adult orthodontic patients with a Class I malocclusion (Group 1) were compared to 40 adults with a Class II malocclusion (Group 2). All patients had completed treatment with a CCLA (WIN, DW Lingual Systems, Bad Essen, Germany) without known centric occlusion-centric relation discrepancies, issues of compliance, or overcorrection in the individual treatment plan which was defined by a target set-up. In order to compare the treatment results of the two groups, 7 measurements using the American Board of Orthodontics Model Grading System (ABO MGS) and linear measurements for anterior-posterior (AP) and vertical dimensions were assessed at the start of lingual treatment (T1), after debonding (T2B) and compared to the individual target set-up (T2A).

RESULTS

A statistically significant AP correction was achieved in Group 2 which represented 95% of the planned amount. The planned overbite correction was fully achieved in the Class I and Class II group. In both groups, there was a statistically significant improvement in the ABO scores, with no significant difference between the two groups at T2. 100% of the patients in Group 2 and 92.5% in Group 1 would meet the ABO standards after CCLA treatment.

LIMITATIONS

The main limitation of this study is that only patients who were wearing the elastics as prescribed were retrospectively included. Therefore, the results of this study may have limited generalizability.

CONCLUSIONS

Completely customized lingual appliances in combination with Class II elastics can correct a Class II malocclusion successfully in adult patients. The final treatment outcome can be of a similar high quality in Class I and Class II patients.

Quality of occlusal outcome in adult class II patients after maxillary total arch distalization with interradicular mini-screws

BACKGROUND

The aim of the investigation was to evaluate if a Class II malocclusion in adult patients can be successfully corrected by maxillary total arch distalization with interradicular mini-screws in combination with completely customized lingual appliances (CCLA).

METHODS

Two patient groups were matched for age and gender to determine differences in the quality of final treatment outcome. The treatment results of 40 adult patients with a Class I malocclusion (Group 1) were compared with those of 40 adult patients with a moderate to severe Class II malocclusion (Group 2). All patients had completed treatment with a CCLA (WIN, DW Lingual Systems, Bad Essen, Germany) without overcorrection in the individual treatment plan defined by a target set-up. To compare the treatment results of the two groups, 7 measurements using the American Board of Orthodontics Model Grading System (ABO MGS) and linear measurements for anterior-posterior (AP) and vertical dimensions were assessed at the start of lingual treatment (T1), after debonding (T2B), and compared to the individual target set-up (T2A).

RESULTS

A statistically significant AP correction (mean 4.5 mm, min/max 2.1/8.6, SD 1.09) was achieved in Group 2, representing 99% of the planned amount. The planned overbite correction was fully achieved in both the Class I and Class II groups. There was a statistically significant improvement in the ABO scores in both groups (Group 1: 39.4 to 17.7, Group 2: 55.8 to 17.1), with no significant difference between the two groups at T2B. 95% of the adult patients in Group 1 and 95% in Group 2 would meet the ABO standards after maxillary total arch distalization with a CCLA and interradicular mini-screws.

CONCLUSIONS

CCLAs in combination with interradicular mini-screws for maxillary total arch distalization can successfully correct moderate to severe Class II malocclusions in adult patients. The quality of the final occlusal outcome is high and the amount of the sagittal correction can be predicted by the individual target set-up.

Application effect of behavioral cognition combined with psychological intervention on orthodontic patients: A prospective, randomized, controlled trial

To explore the application effect of behavioral cognition combined with psychological intervention in orthodontic patients, so as to provide new ideas for clinical nursing of orthodontic patients. The 70 patients with orthodontic treatment were divided into 2 groups: the control group and the nursing group. Control group received routine clinical intervention, was treated with the normal clinical intervention, while nursing group was treated with behavior cognition and psychology intervention. The orthodontic effects of the 2 groups were evaluated, and the mental state, health behavior, gum swelling and pain were compared between the 2 groups before and after care. The cure rate of orthodontic treatment in the nursing group was significantly higher than that in the control group (P < .05). At 12 months after intervention, the nursing group scored lower than the control group on the Hamilton Anxiety Scale and the Hamilton Depression Scale (P < .05), and the score of Health Promotion Lifestyle Profile-II was higher than that in the control group (P < .05). After intervention, the degree of gum swelling and pain in 2 group were notably relieved, and the alleviation degree of nursing group was better than that of control group (P < .05). Compared with normal clinical intervention, the behavioral cognition combined with psychological intervention have obvious improvement in mental state and health behavior of orthodontic patients, and can reduce the symptoms of gum swelling and pain, promote the recovery of gum, showing high clinical application value in improving the gingival health of patients.

Factors influencing treatment outcomes assessed by the American Board of Orthodontics Objective Grading System (ABO-OGS)

BACKGROUND

Treatment outcomes can be influenced by various factors. This study aimed to determine the association between predisposing patient- and treatment-related factors (demographic, cephalometric parameters, skeletal relationships, Discrepancy Index (DI), extractions, treatment type and duration) and treatment outcomes measures according to the American Board of Orthodontics Objective Grading System index (ABO-OGS).

METHODS

Completed cases (N = 100) were included in this cross-sectional study. One calibrated examiner assessed DI, pretreatment lateral cephalometric parameters and ABO-OGS. Patient data, including sex, age, types of malocclusion, extractions, treatment type, and duration, were also collected. Intraexaminer reliability for each measurement was evaluated using the intraclass correlation coefficients. Multiple linear regression analysis, using the backward elimination method with a significance level (α) of 0.05, was used to determine which factors significantly influenced the ABO-OGS score.

RESULTS

From the study, the overall mean ABO-OGS score was 11.36 points. Factors influencing the ABO-OGS score were pretreatment Wits values (p value = .000), L1-NB (°) (p value = .023) and treatment duration (p value = .019). Subjects with lower negative values of Wits and L1-NB (°) tended to have higher ABO-OGS scores. Additionally, the ABO-OGS score tended to be higher for subjects with longer treatment times.

CONCLUSIONS

The majority of treated subjects had satisfactory orthodontic treatment outcomes assessed by the ABO-OGS. The pretreatment severity of skeletal discrepancies determined by the Wits parameter, the degree of retroclined lower incisors and longer treatment duration negatively impacted the treatment outcomes.

Novel concept for posterior crossbite correction : Preliminary results

PURPOSE

The efficiency of dentoalveolar compensation involving both jaws for posterior crossbite correction using computer-aided design/computer-aided manufacturing (CAD/CAM) expansion and compression archwires was evaluated. Treatment outcome was tested against the null hypothesis that the transverse correction achieved would be significantly smaller than planned.

METHODS

This retrospective study included 64 patients (mean age 23.5 years, median 17.0, minimum/maximum: 9.0/63.0, standard deviation 13.7) with uni- or bilateral posterior crossbite. In all consecutively debonded patients, expansion and/or compression archwires were used for dentoalveolar correction involving both jaws. Plaster casts prior to (T1) and following treatment (T2) with completely customized lingual appliances (CCLA) were compared with the treatment plan represented by an individual target set-up. The statistical analysis was carried out using the Schuirmann TOST (two one-sided t‑tests) equivalence test on the basis of a one-sample t‑test with α = 0.025 to one side. The non-inferiority margin was set at δ = 0.5 mm.

RESULTS

All posterior crossbites could be corrected by dentoalveolar compensation involving both jaws. The mean total correction achieved was 6.9 mm (mean maxillary expansion: 4.3 mm/mean mandibular compression: 2.6 mm) with a maximum of 12.8 mm. The transverse corrections achieved in both arches at T2 were equivalent to the planned corrections in the set-up (p < 0.001).

CONCLUSION

The results of this study indicate that CAD/CAM expansion and compression archwires can be an efficient tool to achieve the desired correction in patients with a posterior crossbite even in more severe cases.

Orthodontic treatment quality evaluated by partially automated digital IOTN and PAR index determination: a retrospective multicentre study

Background

Orthodontic therapy aims to treat misaligned teeth and jaws to improve dental occlusion as well as the function and aesthetics of the masticatory system. Continuous data collection to check treatment quality is of great importance for the constant optimization of orthodontic care.

Objective

The aim of this retrospective multicentre cohort study was to systematically determine the outcome and quality of orthodontic treatment by applying the internationally established Index of Orthodontic Treatment Need (IOTN) and Peer Assessment Rating (PAR) index in multiple clinical settings for a representative number of patient cases.

Materials and methods

A total of 1509 consecutive orthodontic patient cases (treatment completion between January 2018 and December 2020) from three representative orthodontic centres (University clinic, city office, small town office) were analysed in a multicentre study. The pre- and post-treatment casts were scanned, digitally measured, and partially automatically evaluated using the IOTN and PAR indices.

Results

A statistically significant improvement in occlusion was observed for medically necessary treatment of IOTN grades 4 and 5 in 97.30 per cent of the analysed cases and for treatment-requiring grades 2 and 3 in 94.08 per cent of the analysed cases. The average percentage PAR improvement was 76.51 per cent. 72.50 per cent of cases showed improvement of more than 70 per cent. The mean PAR index score was reduced from 28.19 ± 9.49 to 6.22 ± 5.41 points.

Conclusion

The present data demonstrate that orthodontic treatment is efficient in inducing significant improvement of malocclusions in general and has a high success rate with severe dysgnathia.

[Health relevance of malocclusions and their treatment]

Zahn- und Kieferfehlstellungen gehören zu den häufigsten Mundgesundheitsbeeinträchtigungen beim Menschen. Der vorliegende Beitrag gibt eine Übersicht zu deren Ursachen, Häufigkeit und Folgen. Er zeigt die präventiven und kurativen Möglichkeiten kieferorthopädischer Behandlungen auf und gibt Informationen zu deren rechtlichen Rahmenbedingungen in Deutschland. Inanspruchnahme und Qualität der kieferorthopädischen Versorgung werden im internationalen Vergleich dargestellt.

Bei den Ursachen für Zahn- und Kieferfehlstellungen spielen genetische, epigenetische, funktionelle und umweltbedingte Faktoren eine Rolle, die individuell meist nicht eindeutig feststellbar sind. Bisher zeigen nur kleinere Querschnittsstudien, dass bis zu 80 % der Kinder in Deutschland betroffen sind. Essen, Trinken, Kauen, Sprechen und Atmen können beeinträchtigt sein, die Neigung zu Parodontalerkrankungen sowie Überlastungsschäden von Kiefergelenk und Kaumuskulatur sind erhöht. Bei einer Proklination der oberen Schneidezähne steigt die Gefahr von Frontzahntraumata. Fehlstellungen können zudem negative psychosoziale Folgen oder Einschränkungen der Lebensqualität zur Folge haben. Kieferorthopädische Behandlungen leisten in Kooperation mit anderen (zahn-)medizinischen Fachdisziplinen einen wichtigen präventiven bzw. kurativen Beitrag zur Verbesserung der Mundgesundheit, der Allgemeingesundheit und der Lebensqualität.

Die Kieferorthopädie bietet ein erhebliches Potenzial für die Stärkung der zahnärztlichen Prävention im Gesundheitswesen, zumal die gesetzliche Krankenversicherung (GKV) eine breitflächige Versorgung der Bevölkerung mit kieferorthopädischen Leistungen auf international anerkanntem, hohem Niveau ermöglicht. Um die Prävention weiter zu verbessern, wird die Einführung eines kieferorthopädischen Screenings im 7.–8. Lebensjahr als systematische Vorsorge empfohlen.