Effect of malocclusion on adults seeking orthodontic treatment

Quantifying health utilities of young adult orthodontic patients using the time trade-off method: a cross-sectional study

OBJECTIVE

To study the feasibility of time trade-off (TTO) method in quantifying health utility ratings in different types of malocclusion.

MATERIAL AND METHODS

In this cross-sectional study, 70 orthodontic patients aged 18 years or above, reporting for treatment/consultation, were included and interviewed. Malocclusion-related health utilities were assessed through the TTO method, and oral health-related quality of life was measured with the help of Orthognathic Quality of Life Questionnaire (OQLQ). Angle's classification of malocclusion was recorded. Bivariate analyses and multivariate Poisson's regression were done to find out an association between the oral health utility values, OQLQ and demographic and clinical characteristics.

RESULTS

Patients with skeletal Class III malocclusion had lower health utility values than those with Class I and Class II malocclusions (p=0.013). Poisson's regression showed that Angle's Class II division 1 (0.90, CI 0.84 to 0.97), Class III (0.68, CI 0.59 to 0.95) and Skeletal malocclusion (0.79, CI 0.71 to 0.87) and OQLQ scores (1.0, CI 1 to 1.003) were found to be significant predictors of TTO utility scores.

CONCLUSIONS

TTO utilities were found to be valid and well correlated with clinical findings. Health utilities could serve as useful and reliable markers of health-related quality of life (HRQL) among individuals or communities and help cost-effective preventive or intervention programs planning.

Benefits in Oral Health during Orthodontic Treatment of Patients Aged 17 to 21 Years

OBJECTIVES

 The aim of the present study was to evaluate the effects of orthodontic treatment on patients' oral health-related quality of life (OHRQoL) in a population aged 17 to 21 years. The influence of gender and malocclusion severity was also investigated.

MATERIALS AND METHODS

 In the present study, 108 patients were enrolled. Each patient completed a questionnaire about oral health impact profile (OHIP)-14 before treatment and after 12 months of treatment. The severity of the initial malocclusion was evaluated through the index for orthodontic treatment need (IOTN).

STATISTICAL ANALYSIS

 Statistical analysis was performed to assess the presence of difference in OHRQoL score before and after the treatment, and the influence of gender and IOTN score on the observed outcomes.

RESULTS

 We found no significant differences related to gender regarding their perception of how malocclusion affects the quality of life before orthodontic treatment. Moreover, no significant differences were found between males and females regarding their perception of how orthodontic treatment affects the quality of life 12 months after orthodontic treatment. Also, the analysis showed no statistically significant difference between males and females in the correlation IOTN-OHIP for Grades 2 and 3. A statistically significant difference between males and females was found only in Grade 4, both before (p=0.046) and after treatment (p=0.051).

CONCLUSION

 Finally, OHIP-14 can be a valuable instrument to assess the perceptions and the expectations of patients toward orthodontic treatment.

The implementation of PROMs/PREMs in the assessment of orthodontic treatment outcomes: A questionnaire survey

Objectives:

The aim of this study was to explore the impact of self-perceived treatment outcomes and experiences on psychological aspects, reflecting the importance of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in orthodontic practice.

Materials and Methods:

A questionnaire was constructed using the PROMs/PREMs concepts. It contained five parts: “Demographic data”, “Self-perceived esthetics”, “Self-perceived functional concern”, “Satisfaction of treatment procedures”, and “Psychological aspect”. The questionnaire was piloted in five experts and 50 orthodontic patients to ensure its quality, using content validity, test-retest reliability, and Cronbach’s alpha. The validated version was provided to patients who had a complete fixed appliance orthodontic treatment. These data were analyzed using descriptive statistics, Mann-Whitney U test, and Spearman correlation. In addition, a multiple linear regression was used to analyze whether there were any influential factors on a psychological aspect. Statistical significance was taken at P < 0.05.

Results:

A total of 271 respondents completed the questionnaire. They tended to have positive perceptions toward the outcomes of orthodontic treatment. There was a significant difference in self-perceived esthetics between the male and female groups. Self-perceived esthetic and functional concerns as well as satisfaction of treatment procedures were found to have significant correlations with the psychological aspect. Sex and self-perceived esthetics were also found to be significant predictors of the psychological aspect.

Conclusion:

PROMs/PREMs should be considered as an important tool to assess treatment outcomes in orthodontic practice. There appeared to be significant impact of self-perceived esthetics on psychological aspects. Consequently, PROMs and PREMs should be introduced in orthodontic postgraduate programs to enhance the concept of patient-centered care in orthodontic practice.

Malocclusion severity and its associations with oral health-related quality of life in an adult population

AIM

The aim of this study was to investigate malocclusion severity and its associations with oral health-related quality of life (OHRQoL) among middle-aged adults.

MATERIALS AND METHODS

The study material consisted of 1786 subjects from the Northern Finland Birth Cohort 1966 who attended dental and oral examination as part of the 46-year-old follow-up study. Malocclusion severity was assessed using the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) and the Peer Assessment Rating index (PAR) from digital 3D dental models. Participants also answered a questionnaire including the Oral Health Impact Profile (OHIP-14) and a question on their satisfaction with occlusal function. Differences between malocclusion severity groups were evaluated for both genders separately. For adjusted models, multivariate Poisson regression models were conducted.

RESULTS

In this study population, 31.3% had great or very great orthodontic treatment need according to DHC and the mean PAR total score was 22.05. The most severe malocclusions were associated with OHRQoL, especially the psychosocial and handicap dimensions, and satisfaction with occlusal function. There was a significant difference between genders, men having more severe malocclusion but women reporting more OHRQoL impacts.

CONCLUSION

One third of the study population were considered to have severe malocclusion. There was an association between malocclusion severity and OHRQoL in adult population, particularly in women.

Orthodontic retreatment: positive effects on the patient’s self-esteem and quality of life

Introduction:

An increasing percentage of the world’s population has had access to orthodontic treatment within the last few decades. Consequently, a larger number of patients seeking for correction of their malocclusions, nowadays, present with a history of previous orthodontic therapy. Orthodontists performing retreatments in their practice may have to face additional difficulties, and one of them is treating individuals that may be even more demanding for excellent results and efficient treatments.

Objectives:

This manuscript discusses the challenges faced when performing orthodontic retreatments. It illustrates a two-phase retreatment of a pre-adolescent and the ortho-surgical retreatment of a young adult with high demands for fast and exceptional results. Finally, this paper elaborates on the positive impacts that these retreatments had on the patients’ self-esteem and quality of life.

Oral health-related quality of life of adolescents assessed with the Malocclusion Impact and Child Perceptions questionnaires

INTRODUCTION

Our study objectives were to evaluate the impact of malocclusion on oral health-related quality of life (OHRQOL) of adolescents aged 11-14 years in Ile-Ife, Nigeria.

METHODS

Two hundred adolescents completed the Child Perceptions Questionnaire: Impact Short Form (CPQ_11-14-ISF:16) and the Malocclusion Impact Questionnaire (MIQ). The Aesthetic Component of the Index of Orthodontic Treatment Need scale was used to determine malocclusion severity. The effect of sex, age, and socioeconomic class on OHRQOL were determined with the Mann-Whitney U test, Kruskal-Wallis H test, correlation tests, and multiple regression analysis using SPSS (version 22.0; IBM, Armonk, NY). Statistical significance was set at P <0.05.

RESULTS

The CPQ_11-14-ISF:16 and MIQ identified the impact of malocclusion on OHRQOL with mean (standard deviation) scores of 12.85 (10.17) and 8.33 (7.50), respectively. Sex, socioeconomic class, and malocclusion severity had no significant effect on OHRQOL (P >0.05); however, OHRQOL differed significantly between the age groups (CPQ_11-14-ISF:16, P = 0.002; MIQ, P = 0.041). Multiple regression analysis showed that age was a significant predictor of OHRQOL determined with CPQ_11-14-ISF:16 (standardized coefficients B score = -0.242, P = 0.001). MIQ demonstrated good criterion validity with CPQ_11-14-ISF:16 (r = 0.59, P <0.001).

CONCLUSIONS

Both measures CPQ_11-14-ISF:16 and MIQ identified the impact of malocclusion on the OHRQOL of adolescents. Sex, socioeconomic class, and malocclusion severity did not affect OHRQOL; however, age was a significant predictor of OHRQOL. Further studies among orthodontic patient populations are desirable.

How is orthodontic treatment need associated with perceived esthetic impact of malocclusion in adolescents?

INTRODUCTION

The purpose of this research was to evaluate the esthetic impact of orthodontic treatment need in adolescents.

METHODS

This cross-sectional study was performed with 1172 adolescents aged 12 (n = 638) years and 15 (n = 534) years from Salvador, Bahia, Brazil. The esthetic impact was the following outcome variables: Aesthetic Component of the Index of Orthodontic Treatment Need and the Oral Aesthetic Subjective Impact Scale. The normative orthodontic treatment need was assessed by the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) and by the Dental Aesthetic Index (DAI). Logistic regression models were adjusted, estimating crude odds ratio with the respective 95% confidence intervals. The variables with P ≤0.20 in the individual analyses were tested in multiple logistic regression models, remaining the variables with P ≤0.05.

RESULTS

The results showed a statistically significant association for the esthetic impact (Aesthetic Component of the Index of Orthodontic Treatment Need and the Oral Aesthetic Subjective Impact Scale) when assessing the normative orthodontic treatment need by the DAI (P <0.05). However, there was no significant association between subjective esthetic impact and normative needs when using the IOTN-DHC (P >0.05).

CONCLUSIONS

DAI was more associated with the adolescents' esthetic concern than IOTN-DHC and should be the Index of Orthodontic Treatment Need to be selected to complement the patient's self-perception.

Relationship between Malocclusion and Periodontal Disease in Patients Seeking Orthodontic Treatment in Southwestern Saudi Arabia

Background:

Malocclusion is known to cause plaque accumulation and periodontal breakdown. However, no previous study from Saudi Arabia has assessed this relationship in patients seeking orthodontic treatment for esthetics.

Objective:

The objective of this study was to investigate the relationship between malocclusion and periodontal disease in terms of gingival inflammation, probing pocket depth (PPD) and recession in patients seeking orthodontic treatment for esthetic improvement.

Materials and Methods:

This prospective cross-sectional study was conducted at the Outpatient Division of Periodontics, College of Dentistry, King Khalid University, Saudi Arabia, among consecutive new patients seeking orthodontic treatment for esthetic improvement between June and August 2018. Angle’s class of malocclusion, various malalignments, plaque index (PI), gingival index (GI), adequacy of width of attached gingiva (WAG), response to fremitus test, PPD and gingival recession (GR) were recorded. P < 0.05 was considered statistically significant.

Results:

A total of 410 consecutive patients were included. Of these, 314 patients had Class I, 57 had Class II (division I), 25 had Class II (division II) and 14 had Class III malocclusions. In patients with all types of malocclusion, the majority had a PI and GI of score 2 (74.1% and 83.7%, respectively). Most of the patients (85.9%) had adequate WAG; similarly, 94.9% had a negative fremitus test, which shows the absence of trauma from occlusion. Mean PPD and GR in the maxillary and mandibular arches showed varying results.

Conclusion:

This study demonstrates a relationship between malocclusion and presence of periodontal disease in patients seeking orthodontic treatment for esthetic improvement in the southwestern region of Saudi Arabia. Therefore, in patients seeking orthodontic treatment, careful evaluation of gingival and oral hygiene along with adequacy of attached gingiva should be considered.

Open bite in adult patients

Anterior open bite (AOB) is characterized by the lack of overlap or contact between maxillary and mandibular incisors, while the posterior teeth are in occlusion. Correction of this malocclusion is challenging due to difficulties in determining and addressing the etiologic factors, and the high relapse rate. A multidisciplinary approach may be necessary, with participation of Orthodontics, Surgery and Speech Therapy, to achieve adequate esthetic and functional results for long term stability. The present paper discusses the treatment options for AOB, their advantages and implications.

Prosthetic Correction of Proclined Maxillary Incisors: A Biomechanical Analysis

In some cases of proclined maxillary incisors, the proclination can be corrected by a fixed prosthesis. The aim of this study was to investigate the magnitude and distribution of (i) principal stresses in the adjacent alveolar bone and (ii) direct and shear stresses that are normal and parallel, respectively, to the bone-tooth interface of a normal angulated maxillary incisor, a proclined one, and a proclined one corrected with an angled prosthetic crown. 2D finite-element models were constructed, and a static load of 200 N on the palatal surface of the maxillary incisor at different load angles was applied. Load angles (complementary angle to interincisal angle) ranging from 20° to 90° were applied. The results indicate that the load angle could have a more significant impact on the overall stress distributions in the surrounding alveolar bone and along the bone-tooth interface than the proclination of the maxillary incisor. Provided that the resulting interincisal angle is 150° or smaller, the stresses in the surrounding bone and at the bone-tooth interface are similar between a proclined maxillary incisor and the one with prosthodontic correction. Hence, such a correction, when deemed appropriate clinically, can be undertaken with confidence that there is little risk of incurring additional stresses over that already in existence, in the supporting bone and at the tooth-bone interface.

Periodontal and root changes after orthodontic treatment in middle-aged adults are similar to those in young adults

INTRODUCTION

The goal of this study was to compare the outcomes and amount of change in periodontal health of anterior teeth in young versus middle-aged adults, who were treated to improve anterior alignment and occlusion.

METHODS

Pre- and posttreatment records including orthodontic casts, cephalograms, and standardized periapical radiographs were retrospectively collected from young adults (aged 19-30 years; n = 12) and middle-aged adults (aged ≥40 years; n = 27). Following the American Board of Orthodontics criteria, discrepancy index (DI), cast-radiograph evaluation (CRE), treatment duration (TD), marginal bone loss (MBL), and tooth length (TL) were measured, and with the use of periapical radiographs, changes in the level of marginal bone (MBC) and the amount of root resorption (RR) after orthodontic treatment were calculated.

RESULTS

DI, MBL, and TD were significantly higher in the middle-aged adults than in the young adults (P < 0.05). However, CRE and MBC after treatment were similar between the 2 groups (P > 0.05). The mean amount of RR following treatment was -0.6 ± 0.44 mm and -1.0 ± 0.61 mm in young and middle-aged adults, respectively. The degree of RR after compensating for treatment complexity and TD was similar between the 2 groups (P > 0.05).

CONCLUSIONS

Although the initial malocclusion and periodontal conditions were unfavorable for the middle-aged adults, the overall treatment and periodontal outcomes after orthodontic treatment of the anterior teeth were similar to those for young adults. It appears that older adults tolerate orthodontics to improve the appearance of the anterior teeth as well as younger adults, with no additional burden because of their increased age.

Agreement and association between normative and subjective orthodontic treatment need using the Index of Orthodontic Treatment Need

AIMS:

To determine the association and level of agreement between young adults’ perception of orthodontic treatment need (subjective need) and the orthodontists’ assessment of treatment need (normative objective need).

METHODOLOGY:

For this study, 670 students [280 males and 390 females; mean age (standard deviation) of 15.32 (1.81) years] were selected from public and private schools from different demographic areas of Jeddah city, Saudi Arabia, and divided into two age groups (12–15 years) and (16–19 years). All the participants were examined, and the Index of Orthodontic Treatment Need (IOTN) components [dental health component (DHC) and aesthetic component (AC)] were recorded.

RESULTS:

Kappa statistics showed a statistically significant but fair agreement between clinician AC (CAC) and student AC (SAC) assessments in both age groups (k = 0.343 and 0.334, respectively; P < 0.001), whereas Spearman's correlation coefficient showed a statistically significant but moderate association (r = 0.487 and 0.517, respectively; P < 0.001). The degrees of agreement were 76.4% and 76.7% at the no-need and mild-need levels of treatment, respectively. There was a statistically significant but weak association between the subjective and normative needs (SAC and IOTN-DHC) in both age groups (r = 0.336 and 0.360, respectively; P < 0.001). However, the degrees of agreement were 58.9% and 61.5% at the no-need and mild-need levels of treatment, respectively.

CONCLUSION:

Significant but weak positive association was found between the normative and subjective orthodontic treatment needs, indicating a lack of understanding of the nature of malocclusion and its consequences. Thus, promoting further knowledge and awareness of malocclusion are indicated.

Prevalence of gingival recession after orthodontic treatment of infraversion and open bite

Purpose

Aim of the present study was to investigate the prevalence of gingival recession and related factors in teeth with low occlusal function (open bite and infraversion) after orthodontic treatment.

Methods

From January 2014 to December 2017, 403 patients received orthodontic treatment. Their gingival recession and related factors before and after treatment were retrospectively analyzed.

Results

The prevalence of gingival recession in patients with infraversion and open bite after orthodontic treatment were 80.6 and 75.0%, respectively; these values were 43.4 and 47.5% before treatment, respectively. Notably, the Miller index of gingival recession increased after orthodontic treatment (P < 0.05). The risk of gingival recession in patients with infraversion or open bite after orthodontic treatment was remarkably higher than the risk in other patients (odds ratio [OR] = 16.712 and 5.073, respectively); the gingival recession rate was related to treatment with tooth extraction (OR = 2.043), as well as gingival biotype (OR = 0.341) and gingival index (GI) before orthodontic treatment (OR = 97.404; P < 0.05).

Conclusions

Patients with these two types of low occlusal function are more likely to exhibit gingival recession after orthodontic treatment. Moreover, the prevalence of gingival recession after orthodontic treatment is higher among patients who have undergone tooth extraction during orthodontic treatment, and among those who exhibit thin gingival biotype and high gingival index before orthodontic treatment.