Patients' perceptions of recovery after routine extraction of healthy premolars

Effect of aligners on patients' oral health-related quality of life and anxiety: a prospective pilot study

BACKGROUND

This prospective study explored the impact of aligners on the oral health-related quality of life and anxiety of patients during the first month of orthodontic treatment and the first month of the retention phase.

METHODS

A total of 23 male and female patients (median age 25 y) treated with clear aligners were included. The OHRQoL questionnaire was used at certain time points during treatment (T1: placement of the first aligner; T2: after one day of use; T3: after seven days; T4: after one month; and T5: after one month in the retention phase). The State-Trait Anxiety Inventory (STAI) was also self-administered to assess state and trait anxiety (Y1 and Y2 subscales, respectively) at the T1, T4 and T5 time points. A population average generalized estimating equations logistic regression model was fit to assess the effect of time on the responses, and the Wald test was used to examine the overall effect of time.

RESULTS

Overall time was a significant predictor for most of the questions. However, time was marginally significant for the OHRQoL questions evaluating oral symptoms such as bad taste/smell, sores, and food accumulation. Tooth discolouration did not differ between time points. The general activity disturbance was significantly lower in the retention phase. Higher depression and anxiety scores were reported at the initial appointment and decreased thereafter.

CONCLUSIONS

CAT has a negative impact on quality of life and psychological status during the initial days of treatment. These impairments ameliorate at later treatment stages.

Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management

Over the years, the pain has been defined numerous times in several ways. In oral and maxillofacial surgery, the occurrence of pain, especially postoperatively, is anticipated. Pain arises as a combination of various processes after tissue damage. Distinct pain experiences in oral surgery were depicted in several previous studies, adding knowledge to the field. The management of these encounters has been suggested over time, improving treatment approaches in the clinical setting. This review aims to understand the pain and its types and intervention in the field of oral and maxillofacial surgery.

Comparison of Short-Term Oral Impacts Experienced by Patients Treated with Invisalign or Conventional Fixed Orthodontic Appliances

OBJECTIVES

Our objective was to test the hypothesis that thermoplastic clear aligners (Invisalign®; Align Technology, Santa Clara, CA, USA) are more pleasant for patients than conventional fixed orthodontic appliances.

SUBJECTS AND METHODS

This was an observational retrospective study in which subjects were matched for age, treatment modality, and the treating orthodontist. A total of 60 adult patients (30 in the Invisalign group and 30 in the conventional buccal fixed appliance group) who met the inclusion criteria completed a validated self-reporting questionnaire, rating their experience after appliance activation in regard to oral impact experience and satisfaction of both treatment modalities. Categorical variables were compared using the χ2 test, Fisher's exact test, and the Z test. Continuous variables such as pain level and age were analyzed using the 2-sample t test.

RESULTS

Patients on clear aligner therapy reported significantly more difficulty in speech (p = 0.035) necessitating change in speech delivery (p = 0.003). In addition, they reported better chewing ability (p < 0.001), no restrictions on amounts or types of food (p = 0.02), and less mucosal ulcerations (p = 0.01). Effects on daily routine, use of analgesics, and overall treatment satisfaction were not significantly different between the 2 groups.

CONCLUSION

Clear aligner therapy is not necessarily more pleasant, but it is more tolerable as it satisfies patient needs over food consumption and absence of mucosal ulcerations. However, clear aligners affect pronunciation and speech delivery in the short term.

Canine retraction: A systematic review of different methods used

Canine retraction is a very important step in treatment of patients with crowding, or first premolar extraction cases. In severe crowding cases until, the canines have been distilized to relive the crowding, space to correctly align the incisors will not be available. Correct positioning of the canines after retraction is of great importance for the function, stability, and esthetics. The aim of this systematic review was to examine, in an evidence-based way, which kinds of canine retraction methods/techniques are most effective and which have the least side effects. A literature survey was performed by applying the Medline Database (Entrez PubMed) and Science Direct database covering the period from 1985 to 2014, to find out efficient ways to accomplish canine retraction. Randomized controlled trials (RCTs), prospective and retrospective controlled studies, and clinical trials were included. Two reviewers selected and extracted the data independently and assessed the quality of the retrieved studies. The search strategy resulted in 324 articles, of which 22 met the inclusion criteria. Due to the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate retraction efficiency during space closure. The data so far reviewed proved that elastomeric power chains, elastic threads, magnets, NiTi coil springs, corticotomies, distraction osteogenesis, and laser therapy, all are able to provide optimum rate of tooth movements. All the methods were nearly similar to each other for retraction of canines Most of the techniques lead to anchorage loss in various amounts depending on the methods used. Most of the studies had serious problems with small sample size, confounding factors, lack of method error analysis, and no blinding in measurements. To obtain reliable scientific evidence, controlled RCT's with sufficient sample sizes are needed to determine which method/technique is the most effective in the respective retraction situation. Further studies should also consider patient acceptance and cost analysis as well as implants and minor surgeries for canine retraction.

Periotome as an Aid to Atraumatic Extraction: A Comparative Double Blind Randomized Controlled Trial

AIM

The aim of this study was to evaluate the efficacy of periotomes in single rooted nonsurgical tooth extractions.

MATERIALS AND METHODS

A double blind, randomized controlled clinical trial of 100 patients requiring nonsurgical single rooted tooth extractions was performed. The subjects were randomized into the experimental group (underwent extractions with periotome and conventional extraction forceps) or into the control group (subjects underwent extractions using periosteal elevator and conventional extraction forceps). Pain was assessed using visual analogue scale all throughout 7 days postoperatively. Gingival laceration, duration of surgery, number and frequency of analgesics consumed and complications (if present) were also noted.

RESULTS

On inter-group comparison, all the parameters were statistically significant in control group (p < 0.05). Also on pre and post-operative inter-group comparison, statistically significant pain reduction was noted in experimental group (52.8 %) whereas pain increased in control group (65 %).

CONCLUSION

The results of this study suggest that use of periotome may be helpful in reducing post extraction discomfort.

The impact of personality on adult patients' adjustability to orthodontic appliances

OBJECTIVE

To evaluate the impact of psychological traits on patients' choice of orthodontic appliances and their adjustability to orthodontic treatment.

MATERIALS AND METHODS

The sample consisted of 68 adult patients divided into three groups (28 buccal, 19 lingual, and 21 clear aligners). Prior to treatment participants filled out the Brief Symptom Inventory to assess symptoms of mental distress and the Narcissistic Vulnerability Scale to assess narcissistic personality traits. During the first week after appliance delivery and on day 14, patients completed a Health-Related Quality of Life questionnaire to assess their perception of pain and four areas of dysfunction. The correlation between personality traits and patients' reaction to treatment was evaluated.

RESULTS

Somatization was the only trait that affected the choice of lingual and clear aligner appliance. Reduced self-esteem regulation was associated with increased pain in all patients, while exploitation was associated with pain in lingual patients. Narcissistic vulnerability slightly influenced patients' adaptability to orthodontic appliances. Although adjustability to lingual appliances was the most difficult, only two parameters were affected by personality features. In the buccal group, adjustability was affected by numerous parameters. Adaptation to the clear aligner appliance was relatively uneventful and least affected by psychological features.

CONCLUSION

Anxious individuals tend to prefer lingual and clear aligner appliances. The selection of lingual and clear aligner appliances governs the patient's response and recovery process, leaving little room for the effect of psychological features. On the other hand, the buccal appliance allows for greater impact of personality traits on adjustability.

Adult patients' adjustability to orthodontic appliances. Part I: a comparison between Labial, Lingual, and Invisalign™

This prospective study examined the adult patient's perception of recovery after insertion of three types of orthodontic appliances: Buccal, Lingual and Invisalign. The sample consisted of sixty-eight adult patients (45 females and 23 males) who comprised three groups: 28 Buccal, 19 Lingual, and 21 Invisalign patients. After appliance insertion, patients completed a Health-Related Quality of Life questionnaire daily for the first week and again on day 14, in order to assess patients' perception of pain and analgesic consumption. In addition, four areas of dysfunction were assessed: oral dysfunction, eating disturbances, general activity parameters, and oral symptoms. Lingual appliance was associated with more severe pain and analgesic consumption, the greatest oral and general dysfunction, and the most difficult and longest recovery. The Invisalign patients complained of relatively high levels of pain in the first days after insertion; however this group was characterized by the lowest level of oral symptoms and by a similar level of general activity disturbances and oral dysfunction compared to the Buccal appliance. Many Lingual and some Buccal patients did not reach a full recovery from their eating difficulties by the end of the study period. The present study provides information to adult patients and clinicians assisting them in choosing the most appropriate treatment modality in relation to Health-Related Quality of Life parameters.

The perception of pain following interdental microimplant treatment for skeletal anchorage: a retrospective study

During orthodontic therapy, patients frequently complain about pain and discomfort, especially during insertion of fixed appliances. Skeletal anchorage using an interdental microimplant is a new concept in orthodontic treatment. The purpose of this study was to investigate differences and changes in the level of pain among patients in relation to orthodontic microimplant treatments. Forty microimplants were applied to the maxilla as skeletal anchors in the orthodontic treatment. The visual analog scale (VAS) was used to evaluate the patients' perception of pain during this new modality treatment. The premolar extraction VAS core was used as a baseline for the complete orthodontic procedure. The mean VAS score was 35.8 mm at 24 h after premolar extraction. The mean VAS score for insertion and removal of the microimplant 24 h after the operation was 12.3 and 7.8 mm, respectively. Three months after removal of the skeletal anchors, the VAS score had decreased to 3.2 mm and was the same as with the traditional orthodontic treatment. By using the repeated-measure general linear model (GLM), we found that the score 1 day after microimplant placement was significantly less than that 1 day after first premolar extraction or that 1 day after fixed appliance insertion. This result indicates that interdental microimplant did not generate any greater pain than other orthodontic procedures. Therefore, patients were willing to adopt the new orthodontic treatment.