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Cremonini F, Karami Shabankare A, Guiducci D, Lombardo L. Compliance with Headgear Evaluated by Force- and Temperature-Sensitive Monitoring Device: A Case-Control Study. Bioengineering (Basel) 2024; 11:789. [PMID: 39199747 PMCID: PMC11351614 DOI: 10.3390/bioengineering11080789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024] Open
Abstract
The aim was to objectively assess compliance in patients prescribed headgear and evaluate the impact of monitoring awareness, treatment duration, gender, and age on compliance levels. A total of 22 patients with Class II malocclusion wore the headgear integrated with the force and temperature sensitive Smartgear monitoring system (Smartgear, Swissorthodontics AG, Cham, Switzerland). Patients were instructed to wear the headgear for 13 h daily over a 3-month period. Randomly, 11 patients were informed that they monitored and 11 were not informed. Data were organized using Microsoft Excel and analyzed using R for statistical estimates, graphs, and hypothesis testing. Smartgear recorded an average daily compliance of 6.7 h. No statistically significant differences were found in cooperation between study group and control group over the 3 months of treatment, regardless of gender and age. However, there was slight greater cooperation in the first month than in the other months, and patients ≤10 years of age had almost 2 h more cooperation than their older counterparts. Moreover, the informed group exhibited an average of 1.1 more hours of cooperation per day than the uninformed group, which may carry clinical significance. This cooperation primarily occurred at night and was found to be statistically significant. Compliance among young patients typically remained lower than the prescribed level, regardless of their gender and psychological maturity. Although an awareness of monitoring does not seem to improve compliance, implementing such systems could still offer dentists a valuable means of obtaining objective information about their patients' adherence.
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Affiliation(s)
| | | | | | - Luca Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
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Atik E, Taner T, Aksu M. Is wear time of Hawley retainers measured with microsensors related to mandibular arch stability? J Orofac Orthop 2023:10.1007/s00056-023-00495-x. [PMID: 37731053 DOI: 10.1007/s00056-023-00495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/02/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The aim of this study was to show a possible correlation between the mean wear time of Hawley retainers and long-term mandibular arch stability as assessed via wear time analysis with microsensors. METHODS This longitudinal retrospective study comprised 47 subjects (mean age 16.30 ± 1.06 years) having been treated with a nonextraction protocol and presenting moderate crowding at pretreatment. For retention, all patients were instructed to use a mandibular Hawley retainer for 12 months, and wear time was documented every 3 months during a posttreatment period of 6 months using TheraMon software. These individuals were divided into two groups. Those who adhered to a wear time equal to or more than 12 h/day (group 1A; N = 17) and those who complied for less than 12 h/day (group 2A; N = 30) were compared with respect to changes of the mandibular arch during the first 6 months of retention. Furthermore, a subgroup of 28 patients who completed a 12-month follow-up period were again divided into two groups: the individuals in group 1B (N = 12) adhered to a wear time equal to or more than 8 h/day, while those in group 2B (N = 16) complied for less than 8 h/day. Little's Irregularity Index, intercanine and intermolar widths, arch length, overjet, and overbite were measured on mandibular models taken at pretreatment (T0) and posttreatment (T1), as well as 6 months (T2) and 12 months (T3) after debonding. Pearson correlation test, independent samples t‑test, and Mann-Whitney U test were used for statistical evaluation. RESULTS From T1 to T2, group 1A and group 2A showed a significant relapse in intermolar width with a difference in the median value of 0.38 mm (p = 0.019). At the complete 12-month follow-up, the increase in Little's irregularity score was significantly greater in group 2B (2.54 ± 1.29 mm) than in group 1B (1.32 ± 1.03 mm; p = 0.012). The established wear time measurements showed significant negative correlations with the Little's irregularity score and overjet changes between T1 and T3 (p < 0.05). CONCLUSIONS The results emphasized that the use of a retainer should not fall below a level of at least 8 h/day.
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Affiliation(s)
- Ezgi Atik
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
| | - Tulin Taner
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Gratsia S, Cocos A, Matsangas P, Shattuck N, Vastardis H. Cervical headgear therapy and sleep-related attributes. Am J Orthod Dentofacial Orthop 2023:S0889-5406(23)00104-X. [PMID: 37002113 DOI: 10.1016/j.ajodo.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The study aimed to assess (1) the effect of the treatment with cervical headgear on patients' sleep-related attributes and well-being and (2) whether these sleep-related parameters (ie, sleep quality and quantity) were associated with patients' compliance during the orthodontic treatment. METHODS The study protocol was based on a prospective longitudinal quasi-experimental design. Participants (n = 26; 9 males; mean age, 12.4 ± 1.68 years) were patients in the Postgraduate Orthodontic Clinic, National and Kapodistrian University of Athens. All patients received treatment with a cervical headgear having an embedded TheraMon microsensor. Sleep was assessed by wrist-worn actigraphy for 59 ± 19 days. The Epworth Sleepiness Scale was used to assess average daytime sleepiness, whereas we used the Athens Insomnia Scale for insomnia symptoms. Oral health-related quality of life (OHRQOL) was assessed by the Oral Health Impact Profile (OHIP-14). RESULTS Patients slept on average 7.35 ± 0.42 h/d. Compared with the lowest sleep duration recommended for their age group, patients had an average chronic sleep deficit of 1.40 ± 0.49 h/d. Patients wore the headgear 90.9% of the days for 10.40 ± 4.17 h/d. However, only 7 (28%) patients reached or exceeded the wear-time recommendation of 12 h/d. In contrast, 2 (8%) patients wore headgear <5 h/d, 11 (44%) 5-10 h/d, and 12 (48%) patients wore headgear >10 h/d. Aggregated by participants, the median Epworth Sleepiness Scale score during the study was 3.40 (interquartile range [IQR], 4.85; range, 0.2-13.6), the median Athens Insomnia Scale score was 3.00 (IQR, 4.25; range, 0-7), and the median Oral Health Impact Profile score was 1.40 (IQR, 4.17; range, 0.0-20.8). Compared with patients who wore the orthodontic appliance >7.8 h/d, patients who wore it <7.8 h/d had worse average daytime sleepiness (P = 0.050) and worse OHRQOL (P = 0.019). CONCLUSIONS Orthodontic treatment with cervical headgear has no substantive negative effect on sleep attributes (quantity and quality), average daytime sleepiness and OHRQOL. However, poor compliance with orthodontic treatment seems to be associated with higher levels of daytime sleepiness.
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Affiliation(s)
- Sofia Gratsia
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | | | | | | | - Heleni Vastardis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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de Almeida e Bueno L, Milnthorpe W, Bergmann JHM. Determining the performance of a temperature sensor embedded into a mouthguard. BDJ Open 2022; 8:23. [PMID: 35915087 PMCID: PMC9343656 DOI: 10.1038/s41405-022-00114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/09/2022] Open
Abstract
Objective This study aimed to determine the steady-state errors of oral-based temperature sensors, that are embedded in mouthguards, using a robust assessment process. Materials and methods Four electronic boards with temperature sensors were encapsulated in mouthguards made from ethylene-vinyl acetate (EVA). The error and time to reach steady-state temperature were determined using a thermostatic water bath during three different conditions (34, 38.5 and 43 °C). Subsequently, a case study of one volunteer wearing the instrumented mouthguard is presented. Results The water bath tests showed that a mean absolute error of 0.2 °C was reached after a maximum of 690 s across all test conditions. The case study yielded an absolute error was 0.2 °C after 1110 s. Conclusion These results show that an instrumented mouthguard with temperature sensing capabilities can yield a consistent steady-state error that is close to the clinical requirements across a range of temperatures. However, the time it takes to reach steady-state temperature needs to be considered for these systems to correctly interpret the outcomes.
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Nahajowski M, Lis J, Sarul M. Orthodontic Compliance Assessment: A Systematic Review. Int Dent J 2022; 72:597-606. [PMID: 35961844 PMCID: PMC9485511 DOI: 10.1016/j.identj.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this review was to determine whether the type of removable appliance, as well as the age and sex of the patient, may affect the extension or reduction of wear time by assessing the correlation between the mean actual and orthodontist-recommended wear times. METHODS Randomised case control trials, cohort studies, case series, observational studies, reviews, and retrospective analyses were identified. The quality of the studies was assessed using the Cochrane Collaboration Tool and modified Newcastle-Ottawa Scale. The electronic databases Embase, PubMed, Scopus, and Web of Science were reviewed, and 542 articles were obtained, of which 31 were qualified for qualitative synthesis. The data from 1674 participants were collected and a weighted average was determined for the mean wear time of each appliance. RESULTS Regardless of the type of extra- or intraoral appliances, mean wear time was shorter than recommended, although patients using intraoral appliances cooperated more. The best compliance was noted for Schwarz appliances (73.70%) and plate retainers (85%). There was no evidence of an influence of patients' age and sex on compliance during treatment. CONCLUSIONS The considerable inconsistency and imprecision of articles could affect the reliability of the results. Previous studies analysing the effectiveness of treatment with removable appliances based on an arbitrarily assumed average wear time need to be revised in order to verify the actual wear time with the use of microsensors.
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Affiliation(s)
- Marek Nahajowski
- Department of Integrated Dentistry, Wroclaw Medical University, Wroclaw, Poland.
| | - Joanna Lis
- Department of Orthodontics and Dentofacial Orthopedics, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Sarul
- Department of Integrated Dentistry, Wroclaw Medical University, Wroclaw, Poland
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Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review aims to analyze the multiple factors affecting patients’ level of compliance (how much they wear removable devices/clear aligners) during orthodontic treatments and to investigate the available methods and devices to monitor the appliance wearing time and to improve it. A literature search was conducted on electronic databases (Pubmed, Scopus, and Google Scholar). The results of the present study suggest that compliance indicators may misestimate the intraoral wearing time. Compliance is affected by patient-related factors (age, personality traits, the importance of personal appearance, self-perception of malocclusion), appliance-related factors (visibility, pain/discomfort), and clinician-related factors (trust, clear and complete communication, motivation). The motivation of pre-pubertal patients is mostly external, while adolescents/young adults have intrinsic motivation for orthodontic treatment. Patients’ self-reports tend to overestimate the appliance wearing time. Even if there is a lack of evidence, teledentistry might improve patients’ awareness of being monitored, thus increasing the time for which orthodontic devices are worn. Compliance is a key factor for clear aligner treatments, but high-quality studies focusing on this aspect are missing. Further studies should focus on how to handle the lack of cooperation and how to increase compliance in order to maximize the treatment’s results.
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Sangalli L, Savoldi F, Dalessandri D, Visconti L, Massetti F, Bonetti S. Remote digital monitoring during the retention phase of orthodontic treatment: A prospective feasibility study. Korean J Orthod 2022; 52:123-130. [PMID: 35321951 PMCID: PMC8964474 DOI: 10.4041/kjod.2022.52.2.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/27/2021] [Accepted: 11/03/2021] [Indexed: 01/24/2023] Open
Abstract
Objective To evaluate if a remote digital monitoring system added at the end of orthodontic treatment could positively influence the retention phase by reducing the occurrence of misfit of removable appliances, number of emergency appointments (EA), and orthodontic relapse. Methods Twenty-seven patients who completed active orthodontic treatment were divided into the study and control groups. In addition to the standard chairside follow-up appointments at month 1 (T1), month 3 (T2), month 6 (T3), the study group patients were monitored using Dental Monitoring® with monthly intra-oral scans. Occurrence of misfit of removable retainers, number of EAs, and intercanine width change were recorded for both groups. Differences in EAs and retainer fit were assessed using the chi-square test. Intra-group and inter-group differences in the intercanine width were assessed with Friedman test and Mann-Whitney U test, respectively (α = 0.05). Results The study group showed a significantly lower occurrence of misfit of removable retainers (p = 0.027) compared to the control group. No significant inter- and intra-group difference was found in the EAs and intercanine width change at each time-point. Conclusions Integrating remote monitoring systems, such as Dental Monitoring®, to the retention phase of the orthodontic treatment may lower the occurrence of misfit of removable retainers. However, a small sample size and a short observation period limit the strength of this evidence. These preliminary results tentatively suggest that remote monitoring technologies may be beneficial, especially during the COVID-19 pandemic, when the regularity of in-office visits might be disrupted.
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Affiliation(s)
- Linda Sangalli
- Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Oral Health Science, Division of Orofacial Pain, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - Domenico Dalessandri
- Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luca Visconti
- Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesca Massetti
- Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Bonetti
- Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Moreno-Fernández A, Iranzo-Cortés JE, Paredes-Gallardo V, García-Sanz V, Tarazona-Álvarez B, Almerich-Silla JM, Bellot-Arcís C, Montiel-Company JM. Effectiveness of removable appliances with temperature sensors in orthodontic patients: a systematic review and meta-analysis. Eur J Orthod 2021; 44:134-145. [PMID: 34100070 DOI: 10.1093/ejo/cjab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVE Patient compliance during orthodontic treatment is one of the factors that most affects success in the final result. The use of removable appliances is frequent at an early age and the monitoring of its use is essential to assess the collaboration of the patient. The aim of this study was to establish the effectiveness of microsensors included in removable appliances during orthodontic treatment or in the retention phase to enable a reliable and individualized follow-up of the patient. SEARCH METHODS The article search was carried out in various electronic databases and journals without any language restrictions. SELECTION CRITERIA Studies using microsensors into removable appliances were selected with the key selection criterion of a minimum follow-up of 4 weeks. DATA COLLECTION AND ANALYSIS The quality of the studies included was evaluated using the Cochrane scale for the randomized controlled trials and the Newcastle Ottawa Scale for control-case, cohort, and transversal studies. The mean of the differences with a 95% confidence interval was expressed for the continuous data. RESULTS Twenty-nine full-text articles were analysed and included in the qualitative synthesis. In general, the mean daily wear time of removable appliances measured objectively was less than the time that the professional had predetermined. CONCLUSIONS The use of microsensors as an objective measurement method enhances communication and boosts confidence in the orthodontist-patient relationship. More random clinical studies with temperature sensors are needed to establish to what extent they influence the orthodontic outcome. REGISTRATION PROSPERO (CRD42019120525).
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Mohd Tahir N, Wan Hassan WN, Saub R. Comparing retainers constructed on conventional stone models and on 3D printed models: a randomized crossover clinical study. Eur J Orthod 2020; 41:370-380. [PMID: 30321319 DOI: 10.1093/ejo/cjy063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to compare vacuum-formed thermoplastic retainers (VFRs) constructed on stone models (VFR-CV) and those constructed on three-dimensional (3D) printed models (VFR-3D) based on patients' perspective and post-treatment stability. STUDY DESIGN The research was designed as a crossover, randomized control trial. MATERIALS AND METHODS Subjects comprised patients receiving fixed appliances at a teaching institution and indicated for VFRs. Post-treatment stone models were scanned with a structured-light scanner. A fused deposition modelling machine was used to construct acrylonitrile-butadiene-styrene (ABS)-based replicas from the 3D scanned images. VFRs were fabricated on the original stone and printed models. Analysis comprised independent t-tests and repeated measures analysis of variance. RANDOMIZATION Subjects were allocated to two groups using Latin squares methods and simple randomization. A week after debond, subjects received either VFR-CV first (group A) or VFR-3D first (group B) for 3 months, then the interventions were crossed over for another 3 months. BLINDING In this single-blinded study, subjects were assigned a blinding code for data entry; data were analysed by a third party. OUTCOME MEASURES The primary outcome measured was oral health-related quality of life (OHRQoL) based on Oral Health Impact Profile-14 (OHIP-14). Secondary outcome was post-treatment stability measured using Little's Irregularity Index (LII). RESULTS A total of 30 subjects (15 in each group) were recruited but 3 dropped out. Analysis included 13 subjects from group A and 14 subjects from group B. Group A showed an increase in LII (P < 0.05) after wearing VFR-CV and VFR-3D, whereas group B had no significant increase in LII after wearing both VFRs. Both groups reported significant improvement in OHRQoL after the first intervention but no significant differences after the second intervention. LII changes and OHIP-14 scores at T2 and T3 between groups, and overall between the retainers were not significantly different. No harm was reported during the study. CONCLUSION VFRs made on ABS-based 3D printed models showed no differences in terms of patients' OHRQoL and stability compared with conventionally made retainers. REGISTRATION NCT02866617 (ClinicalTrials.gov).
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Affiliation(s)
- Norhidayah Mohd Tahir
- Department of Paediatric Dentistry and Orthodontics, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Nurazreena Wan Hassan
- Department of Paediatric Dentistry and Orthodontics, University of Malaya, Kuala Lumpur, Malaysia.,Clinical Craniofacial Dentistry Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Roslan Saub
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Treatment compliance of adolescent orthodontic patients with headgear activator and twin-block appliance assessed prospectively using microelectronic wear-time documentation. Eur J Orthod 2020; 42:180-186. [DOI: 10.1093/ejo/cjaa001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Summary
Background
Success of orthodontic removable appliance treatment relies on patient compliance. The aim of this quantitative and qualitative study was to explore the compliance and self-reported experience of adolescents in orthodontic treatment with headgear activator (HGA) or twin-block (TB) appliance.
Materials/methods
The study group comprised 52 adolescents with a mean age of 12.6 (±1.3) years at the start of the treatment. The patients were treated at a free-of-charge public dental clinic. Participants were randomly allocated to two equal groups to be treated with either HGA or TB. Patient compliance was evaluated as appliance wear time and subjective experience. Appliance wear time was recorded with Theramon® microchip, and the self-reported subjective experience using a questionnaire.
Results
In total, 30 patients completed the treatment during the follow-up period. HGA was worn on average 7 hours per day and TB 9 hours per day by those patients, who successfully completed the treatment. During a mean observation period of 13 months (range 7–23 months), the mean actual wear time was 43 per cent less than the advised 12 or 18 hours per day in the whole patient group, and 55 per cent in those patients, who completed the treatment. Compliance level was unrelated to the appliance type.
Limitations
Study assessed a relatively small number of patients.
Conclusions/implications
Adolescent patients wear HGA and TB less than advised. Individual variation in treatment adherence is considerable. Thereby, microelectronic wear-time documentation can be a cost-effective mean of identifying non-compliance.
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Walsh LJ, Healey DL. Prevention and caries risk management in teenage and orthodontic patients. Aust Dent J 2020; 64 Suppl 1:S37-S45. [PMID: 31144319 DOI: 10.1111/adj.12671] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
As patients progress from childhood through to teenage years, they progress through periods of high caries risk as they undergo changes in lifestyle and oral microflora. Removable or fixed orthodontic treatment also alters the oral microflora and can dramatically increase caries risk. This paper outlines ways to identify the transition to higher caries risk, and practical ways to lower the risk of hard tissue loss from dental caries during orthodontic treatment across the teenage years, including tooth surface protection, optimised use of mechanical and chemical plaque control, and appropriate delivery of remineralising agents over time.
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Affiliation(s)
- L J Walsh
- The University of Queensland School of Dentistry, Herston, Brisbane, Australia
| | - D L Healey
- The University of Queensland School of Dentistry, Herston, Brisbane, Australia
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Vagdouti G, Karvouni E, Bitsanis E, Koletsi D. Objective evaluation of compliance after orthodontic treatment using Hawley or vacuum-formed retainers: A 2-center randomized controlled trial over a 3-month period. Am J Orthod Dentofacial Orthop 2019; 156:717-726.e2. [DOI: 10.1016/j.ajodo.2019.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 11/26/2022]
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Dieltjens M, Vanderveken OM. Oral Appliances in Obstructive Sleep Apnea. Healthcare (Basel) 2019; 7:healthcare7040141. [PMID: 31717429 PMCID: PMC6956298 DOI: 10.3390/healthcare7040141] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 12/25/2022] Open
Abstract
Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.
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Affiliation(s)
- Marijke Dieltjens
- Department of Translational neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium;
- Special Dentistry Care, Antwerp University Hospital, 2650 Edegem, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Olivier M. Vanderveken
- Department of Translational neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium;
- ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium
- Correspondence:
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Castle E, Chung P, Behfar MH, Chen M, Gao J, Chiu N, Nelson G, Roy S, Oberoi S. Compliance monitoring via a Bluetooth‐enabled retainer: A prospective clinical pilot study. Orthod Craniofac Res 2019; 22 Suppl 1:149-153. [DOI: 10.1111/ocr.12263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Eric Castle
- Private Practice Orthodontist at Castle Orthodontics Santa Maria California
| | - Philip Chung
- School of MedicineUniversity of California, San Francisco San Francisco California
| | | | - Matthew Chen
- University of CaliforniaBerkeley Berkeley California
| | - Jonathan Gao
- School of DentistryUniversity of California, San Francisco San Francisco California
| | - Nicholas Chiu
- School of DentistryUniversity of California, San Francisco San Francisco California
| | - Gerald Nelson
- Division of OrthodonticsUniversity of California, San Francisco San Francisco California
| | - Shuvo Roy
- Department of Bioengineering & Therapeutic SciencesUniversity of California, San Francisco San Francisco California
| | - Snehlata Oberoi
- Division of OrthodonticsUniversity of California, San Francisco San Francisco California
- Division of Craniofacial AnomaliesDepartment of Orofacial SciencesUniversity of California San Francisco San Francisco California
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Brierley CA, Benson PE, Sandler J. How accurate are TheraMon® microsensors at measuring intraoral wear-time? Recorded vs. actual wear times in five volunteers. J Orthod 2017; 44:241-248. [DOI: 10.1080/14653125.2017.1365220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Catherine A Brierley
- Academic Unit of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
- Orthodontic Department, Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK
| | - Philip E Benson
- Academic Unit of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jonathan Sandler
- Orthodontic Department, Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK
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Arreghini A, Trigila S, Lombardo L, Siciliani G. Objective assessment of compliance with intra- and extraoral removable appliances. Angle Orthod 2016; 87:88-95. [PMID: 27508935 DOI: 10.2319/020616-104.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To conduct an objective assessment of the level of compliance in young patients prescribed various types of removable appliances and to determine the influence of device type, treatment duration, and patient age, gender, psychological maturity, and awareness of monitoring on compliance. MATERIALS AND METHODS A total of 30 patients were fitted with either a class 2 (Frankel or bionator) or a class 3 (face mask) removable appliance, each bearing a compliance indicator chip, and they were instructed to wear them for 13 hours per day. Compliance was monitored by means of the sensor for an average of 8 months. Of the patients, 14 were informed that their appliance was fitted with a monitoring sensor, and 16 were not. The psychological maturity of all patients was assessed on the Nowicki-Strickland Locus of Control Scale, and the effect on compliance of this score as well as the patient- and treatment-related variables considered were determined via statistical analysis Results: The mean compliance recorded by the chips was 8.6 ± 2.9 hours, far lower than the 13 hours prescribed, and younger patients showed significantly greater compliance than adolescents (P < .01). However, no significant differences in compliance were found between intra- and extraoral appliances, and neither gender, psychological scores, treatment duration, nor awareness of being monitored had any significant effect. CONCLUSIONS Compliance is generally very poor in young patients, regardless of their gender and psychological maturity. Although awareness of monitoring does not appear to boost compliance, such systems may be a valuable means of providing a dentist with objective information regarding their patients' compliance.
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Kaklamanos EG, Kourakou M, Kloukos D, Doulis I, Kavvadia S. Performance of clear vacuum-formed thermoplastic retainers depending on retention protocol: a systematic review. Odontology 2016; 105:237-247. [PMID: 27270920 DOI: 10.1007/s10266-016-0254-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
We aimed at comparing the performance of vacuum-formed thermoplastic retainers (VFR) worn either full-time or part-time, in maintaining orthodontic treatment results in terms of tooth alignment, arch form and occlusion. We reviewed randomized and prospective controlled clinical trials comparing VFR wearing protocols and searched databases, without restrictions, for published and unpublished literature. The risk of bias was assessed using the Cochrane Risk of Bias tool and the overall level of certainty in the evidence following ADA methodology. 184 studies were initially identified and reduced to the 3 randomized controlled trials included in the systematic review by means of specific criteria. One study followed patients 1 year into retention, and the other two for 6 months. Little's Irregularity Index, intermolar and intercanine width, arch length, overjet and PAR score did not differ significantly between the patients wearing their retainers part time or full time. We observed a slight increase in the overbite in the part-time group in only one trial. With a moderate level of certainty, we found that during the observation period, full-time VFR wear is not superior to part-time, bearing in mind the potential implications for health burden, retainer longevity and cost-effectiveness, as well as patient satisfaction and compliance.
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Affiliation(s)
- Eleftherios G Kaklamanos
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, P.O. Box 505055, Dubai, United Arab Emirates.
| | - Maria Kourakou
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force V.A. General Hospital, Athens, Greece
| | - Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force V.A. General Hospital, Athens, Greece.,Department of Orthodontics and Dentofacial Orthopedics, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Ioannis Doulis
- Department of Orthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Smaragda Kavvadia
- Department of Orthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bock N, Klewitz H, Hudel H, Ruf S. Removable plate treatment of anterior forced crossbite. J Orofac Orthop 2015; 76:283-93. [DOI: 10.1007/s00056-015-0291-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schäfer K, Ludwig B, Meyer-Gutknecht H, Schott TC. Quantifying patient adherence during active orthodontic treatment with removable appliances using microelectronic wear-time documentation. Eur J Orthod 2014; 37:73-80. [PMID: 24993614 DOI: 10.1093/ejo/cju012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Katharina Schäfer
- *Department of Orthodontics and Orofacial Orthopedics, University Hospital of Dentistry, Eberhard Karls University Tübingen
| | - Björn Ludwig
- **Department of Orthodontics, University of Homburg/Saar, and Private Practice, Traben-Trarbach
| | | | - Timm Cornelius Schott
- *Department of Orthodontics and Orofacial Orthopedics, University Hospital of Dentistry, Eberhard Karls University Tübingen,
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Hyun P, Preston CB, Al-Jewair TS, Park-Hyun E, Tabbaa S. Patient compliance with Hawley retainers fitted with the SMART(®) sensor: a prospective clinical pilot study. Angle Orthod 2014; 85:263-9. [PMID: 24869901 DOI: 10.2319/030814-163.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the compliance of patients while wearing maxillary Hawley retainers embedded with SMART microsensors. METHODS The sample population consisted of 22 patients who were divided into an experimental (group A) and a control group (group B). Group A was informed that they would be monitored through the use of SMART microsensors, while group B was not informed that they would be monitored. After the delivery of the retainers (T0), the patients were evaluated at T1 and T2, represented by 6- and 12-week follow-up visits, respectively. At T1, group B was informed of our ability to monitor their compliance. Both groups continued wearing their retainers during T1 to T2. RESULTS During T0-T1, Group A wore their retainers for an average of 16.3 hours (SD 4.39), while group B wore their appliances for an average of 10.6 hours (SD 5.36, t = 2.426, P = .027). Although group B increased their retainer wear by 0.5 hours/day from T1 to T2, this increase was not statistically significant. CONCLUSIONS Despite significant differences being noted between the two groups at T1, group B did not show significant mean changes in their wear time before and after becoming aware of the use of the SMART microsensor.
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Affiliation(s)
- Paul Hyun
- a Postgraduate Orthodontic Resident, State University of New York at Buffalo, Buffalo, NY
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SELECTIONS FROM THE CURRENT LITERATURE. J Am Dent Assoc 2014. [DOI: 10.14219/jada.2013.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Januschowski K, Bechtold TE, Schott TC, Huelber-Januschowski MS, Blumenstock G, Bartz-Schmidt KU, Besch D, Schramm C. Measuring wearing times of glasses and ocular patches using a thermosensor device from orthodontics. Acta Ophthalmol 2013; 91:e635-40. [PMID: 23759025 DOI: 10.1111/aos.12171] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Amblyopia is one of the most common visual disorders in children. The risk of severe visual impairment on the healthy eye is doubled in patients with amblyopia. If detected early enough, the chances of visual rehabilitation are good. Treatment consists of refractive correction and occlusion of the dominant eye. Patient compliance is an important factor and can be monitored using thermosensors. It was the goal of our study to give proof of the principle that the wearing times of glasses and patches can be measured using a comparatively small and commercially available microsensor. METHODS Agreement between wearing times protocols of ocular patching/refractive correction and temperature measurements of thermosensors attached to the patches or glasses of three individuals were analysed using the Bland-Altman method. It was also analysed whether blinded persons could distinguish between temperature curves of patches and glasses, or temperature curves of an incubator or while worn in a pocket. RESULTS The temperatures picked up by the microsensors indicate the beginning and the end wearing times of either glasses or ocular patches through steep temperature difference and a distinct temperature curve during measurements. Although blinded test persons were able to cleary distinguish between temperature profiles from incubator/pocket measurements compared to glasses/patching, glasses and patching curves could be discriminated correctly in only 50%. Differences between wearing time protocols and temperature measurements were within the limits of agreement as stated by the Bland-Altman plots. CONCLUSION The TheraMon(®) microsensor can reliably measure wearing times of glasses and ocular patches without making the wearer uncomfortable, although the data are not unquestionable, especially in higher surrounding temperatures. Further studies on a larger number of individuals with different wearing profiles are needed.
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Affiliation(s)
- Kai Januschowski
- Department of Ophthalmology, Eberhard-Karls University of Tuebingen, Tuebingen, GermanyDepartment of Orthodontics, Eberhard-Karls University of Tuebingen, Tuebingen, GermanyDepartment of Pediatric and Operative Dentistry, Periodontology and Endodontology, Eberhard-Karls University of Tuebingen, Tuebingen, GermanyDepartment of Eberhard-Karls Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls University of Tuebingen, Tuebingen, Germany
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Pauls A, Nienkemper M, Panayotidis A, Wilmes B, Drescher D. Effects of wear time recording on the patient's compliance. Angle Orthod 2013; 83:1002-1008. [PMID: 23611166 PMCID: PMC8722835 DOI: 10.2319/010913-25.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 03/01/2013] [Indexed: 08/24/2023] Open
Abstract
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.
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Affiliation(s)
- Alexander Pauls
- Researcher, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Manuel Nienkemper
- Instructor, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Agamemnon Panayotidis
- Researcher, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Benedict Wilmes
- Associate Professor, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Dieter Drescher
- Professor and Department Chair, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
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Schott TC, Schlipf C, Glasl B, Schwarzer CL, Weber J, Ludwig B. Quantification of patient compliance with Hawley retainers and removable functional appliances during the retention phase. Am J Orthod Dentofacial Orthop 2013; 144:533-40. [DOI: 10.1016/j.ajodo.2013.04.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 10/26/2022]
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Tsomos G, Ludwig B, Grossen J, Pazera P, Gkantidis N. Objective assessment of patient compliance with removable orthodontic appliances: a cross-sectional cohort study. Angle Orthod 2013; 84:56-61. [PMID: 23834273 DOI: 10.2319/042313-315.1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess objectively patient compliance with removable orthodontic appliances and the effect of possible influential factors. MATERIALS AND METHODS Wearing times of 45 White patients were recorded with the aid of the TheraMon microsensor. Patient compliance was assessed relative to wear prescription and other parameters, such as age and sex. RESULTS There was high individual variation in most measured variables and in all groups/subgroups. During a median observation period of 186 days (range, 55-318 days) the actual wear time was 9.0 h/d (range, 0.0-16.0 h/d) and did not differ between distinct prescriptions (P = .49). Eight patients wore their appliances less than 2 h/d, and six of them did not wear their appliances at all. Overall, the median wear per day relative to prescription was 62.5% (range, 0.0-89.3%) for the 14 h/d and 112.5% (range, 0.0-200.0%) for the 8 h/d prescription wear (P = .01) groups. There was a strong negative correlation of age (median: 12.5 years) with the daily percentage of actual wear time per day relative to wear prescription (14 h/d prescription: n = 21, rho = -0.61, P = .00; 8 h/d prescription: n = 24, rho = -0.73, P = .00), while sex did not exert a significant influence on compliance (P = .58). CONCLUSIONS Despite the fact that patients and parents were informed about wear time recording, compliance was insufficient with regard to functional treatment (14 h/d prescription), while it was sufficient for retention purposes (8 h/d prescription). Objective measures are necessary to assess compliance with removable orthodontic appliances since patient compliance is a highly variable issue.
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Affiliation(s)
- George Tsomos
- a Doctoral Candidate, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
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Questionnaire study of electronic wear-time tracking as experienced by patients and parents during treatment with removable orthodontic appliances. J Orofac Orthop 2013; 74:217-25. [DOI: 10.1007/s00056-013-0143-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 11/27/2012] [Indexed: 10/26/2022]
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Applicative Characteristics of New Microelectronic Sensors Smart Retainer® and TheraMon® for Mea suring Wear Time. J Orofac Orthop 2010; 71:339-47. [DOI: 10.1007/s00056-010-1019-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 08/23/2010] [Indexed: 11/25/2022]
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Young Patients’ Attitudes toward Removable Appliance Wear Times, Wear-time Instructions and Electronic Wear-time Measurements – Results of a Questionnaire Study. J Orofac Orthop 2010; 71:108-16. [DOI: 10.1007/s00056-010-9925-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 01/12/2010] [Indexed: 11/26/2022]
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