Appropriate orthodontic appliances during the COVID-19 pandemic: A scoping review

Effect of attachment flash on clear aligner force delivery: an in vitro study

BACKGROUND

The introduction of auxiliaries such as composite attachment has improved the force delivery of clear aligner (CA) therapy. However, the placement of the attachment may give rise to a flash, defined as excess resin around the attachment which may affect CA force delivery. This in vitro study aims to determine the differences in the force generated by the attachment in the presence or absence of flash in CA.

MATERIALS AND METHODS

Tristar Trubalance aligner sheets were used to fabricate the CAs. Thirty-four resin models were 3D printed and 17 each, were bonded with ellipsoidal or rectangular attachments on maxillary right central incisors. Fuji Prescale pressure film was used to measure the force generated by the attachment of CA. The images of colour density produced on the films were processed using a calibrated pressure mapping system utilising image processing techniques and topographical force mapping to quantify the force. The force measurement process was repeated after the flash was removed from the attachment using tungsten-carbide bur on a slow-speed handpiece.

RESULTS

The intraclass correlation coefficient showed excellent reliability (ICC = 0.96, 95% CI = 0.92-0.98). The average mean force exerted by ellipsoidal attachments with flash was 8.05 ± 0.16 N, while 8.11 ± 0.18 N was without flash. As for rectangular attachments, the average mean force with flash was 8.48 ± 0.27 N, while 8.53 ± 0.13 N was without flash. Paired t-test revealed no statistically significant difference in the mean force exerted by CA in the presence or absence of flash for both ellipsoidal (p = 0.07) and rectangular attachments (p = 0.41). Rectangular attachments generated statistically significantly (p < 0.001) higher mean force than ellipsoidal attachments for flash and without flash.

CONCLUSION

Although rectangular attachment generated a significantly higher force than ellipsoidal attachment, the force generated by both attachments in the presence or absence of flash is similar (p > 0.05).

Emergency appointments and psychological distress during COVID-19 lockdown among orthodontic patients in Spain

Background

COVID-19 created an unexpected situation for dental patients. However, the impact of the lockdown on orthodontic patients is still unknown. Hence, this study was conducted to analyse the number and type of emergencies, distress and fear of getting infected among brackets and aligners orthodontic patients during the COVID-19 lockdown.

Material and Methods

A total of 324 questionnaires about emergency appointments during the lockdown and Kessler Psychological Distress Scale-K10 were distributed between March and December 2022 among patients who were on active orthodontic treatment during lockdown at the Master of Orthodontics at the University Alfonso X el Sabio during February and December 2022. Chi-square was used to compare groups.

Results

Emergency appointment was needed by 37.78% of patients during lockdown: 73.5% among those with aligners and 45.9% with brackets (p<.01). Loose bracket was the most prevalent emergency for bracket patients and lack of aligners among invisible orthodontic patients. Of those, 36.95% in need of orthodontic emergency appointments didn´t attend the clinic for fear of being infected; 21% of patients had high or very high anxiety levels.

Conclusions

Orthodontic patients had moderate levels of anxiety and fear of being infected during lockdown. Of these, 31.78% needed an emergency appointment. Key words:Orthodontics, COVID-19, dental healthcare, dentistry, emergency.

Has the COVID-19 Pandemic Affected Orthodontists' Interest in Various Orthodontic Appliances?

Objective

To determine the changes in orthodontists' interest in various orthodontic appliances during the coronavirus disease-2019 (COVID-19) pandemic.

Methods

A questionnaire probing respondents' interest in orthodontic appliances and techniques, including standard buccal metal brackets, self-ligating brackets, standard ceramic brackets, lingual brackets, clear aligners, orthodontic facemasks, removable functional appliances, fixed functional appliances, orthognathic surgery, orthodontic miniscrews, and lingual retainers, was prepared using Google Forms and then sent to the Turkish Orthodontic Society to invite all members of the society to participate in the survey. Of the 1903 members invited, 230 (response rate, 12.08%) orthodontists completed the questionnaire.

Results

The respondents' interest in brackets did not change among 70% of the respondents (standard buccal metal bracket 80%, self-ligating bracket 72.2%, standard ceramic bracket 77%, and lingual bracket 76.5%). A significant difference was observed between the genders only about the interest in standard metal brackets and fixed functional appliances (p<0.05 for both). Interest in standard metal brackets decreased as respondents' work experience increased (p<0.05). The interest in self-ligating brackets was higher among respondents with 1-5 years of experience than among other respondents (p<0.05). Interest in self-ligating brackets increased more among lecturers and residents than among clinicians (p<0.05).

Conclusion

The interest of orthodontists in clear aligners showed the highest increase during the COVID-19 pandemic among all orthodontic appliances, whereas their interest in other appliances, particularly standard buccal metal brackets, did not change.

The Power of Customized Clear Aligners in Closing Molar Edentulous Spaces: Clinical and Medico-Legal Considerations in a Scoping Review and Case Report

Successful closure of edentulous spaces with clear aligners (CAs) is influenced by many factors. CAs are tailored orthodontic devices whose predictability may have relevant medico-legal implications. This study presents a scoping review about missing molar space closure (MMSC) with CAs and a clinical case. This study aims to highlight the feasibility of molar space closure by mesialization with CAs without hybrid supports. Following PRISMA Sc-review guidelines, English-written randomized/non-randomized/observational clinical studies on PubMed, Scopus, Cochrane and Lilacs were searched. An 18-year-old patient, with upper and lower edentulous spaces due to the loss of two first molars, was rehabilitated with CAs (Sorridi®, Sorridi srl, Latina, Italy) without hybrid supports and attachments. The therapy was carried out over 10 months. Currently, there are no studies documenting MMSC by mesialization with only CAs. Existing articles document the closure of premolar or incisor spaces. The upper and lower left second molars replaced the missing first molars, and erupting third molars replaced adjacent teeth. The biomechanical effects in space closure with CAs related to extraction cases appear as priorities of clinical/medico-legal interest. Our case turns attention to this movement of CAs without attachments/hybrid supports, indicating that even such a complex treatment can be comfortable for patients and safely predictable for specialists.

Adaptations in orthodontics for current and future coronavirus disease 2019 best practices

INTRODUCTION

This study aimed to determine adaptations orthodontists made during the coronavirus disease 2019 pandemic to maintain safety and determine which adaptations will remain after the pandemic.

METHODS

An original 34-question survey was sent by mail to a randomized selection of practicing orthodontic specialists (n = 1000). Questions included the changes made during the pandemic in 4 categories (infection control, social distancing, appliance type, and teleorthodontics) and whether those changes will remain postpandemic.

RESULTS

The use of personal protective equipment increased during the pandemic, with a significant decrease anticipated after the pandemic. The most common aerosol modification during the pandemic and predicted after the pandemic was using an assistant with high-volume suction (61% and 49%, respectively; P = 0.0013). Ninety-six percent of orthodontists changed their waiting room protocol during the pandemic, but only 23% plan to continue that practice (P <0.0001). Forty-two percent of orthodontists increased clear aligners during the pandemic in response to patient demand (91%). The use of teleorthodontics increased from 8% to 68% during the pandemic and is expected to decrease significantly postpandemic. Virtual appointments are anticipated to be used for screening and consultations of new patients and monitoring active patients in clear aligners but not fixed appliances.

CONCLUSIONS

The specialty recommended patient safety modifications during the coronavirus disease 2019 pandemic. Postpandemic, enhanced personal protective equipment is expected to decrease, and high-volume suction will likely be continued for aerosol-producing procedures. Teleorthodontics will likely remain in limited use.

Increased demand for orthodontic treatments during the COVID-19 pandemic: a commentary

Despite the impact of the COVID-19 pandemic upon healthcare sectors generally, and what this continues to mean in particular for the practice of dentistry, there is evidence of an unanticipated upsurge in the demand for orthodontic treatment. This was observed in the UK and internationally as a manifestation of the so-called 'Zoom boom', in which video conferencing from home on various platforms suddenly exponentiated. As a result, it seems people became more self-conscious when viewing their appearance on-screen. Among the precipitating factors for individuals taking the consequent step of seeking orthodontic treatment are: the unavailability of more invasive smile enhancement treatments due to the pandemic restrictions; a more favourable infection control probability in orthodontic therapy; and the extra disposable funds that would otherwise be spent on holidays and leisure activities. This article explores different possible social and commercial drivers behind this phenomenon and suggests that the circumstances of the pandemic have shifted the pursuit of the desirable smile somewhat towards orthodontics, and as a consequence, is beneficial both to the public and the profession of dentistry as a whole.

Patients' perceptions of orthodontic treatment experiences during COVID-19: a cross-sectional study

BACKGROUND

COVID-19 has impacted the care of patients undergoing orthodontic treatment. We aimed to provide an overall view of patients' perspectives, concerns, and expectations towards their treatment throughout the clinic lockdown during the pandemic; and to assess patients' levels of mental distress and its association with their confidence in resuming care.

METHODS

An anonymous, validated, in-person paper questionnaire was distributed to adult orthodontic patients' post-lockdown at an academic institution. The survey focused on the clinical aspects and patients' perspectives regarding orthodontic treatment during the pandemic. The Kessler Mental Distress Scale (K10) was used to evaluate their psychological status. Survey responses were descriptively summarized and confidence in resuming care was compared between normal patients and patients with mental distress using Mann-Whitney tests.

RESULTS

One hundred fifty-four patients were surveyed from July to October 2020. Mean age of the participants was 29.30 (SD = 12.01) years and 62% were females. Emergencies during the closure (21%, 32/154) involved primarily irritation with protruding wires. Patients were neutral regarding tele-dentistry and preferred their current fixed appliances over clear aligners. Upon resuming care, 80.51% were extremely pleased with the restrictive protocols and with high level of confidence in resuming treatment. The average level of anxiety was low, and a modest association was found between mental distress and reduced confidence in resuming treatment.

CONCLUSIONS

Few numbers of minor emergencies occurred during the clinic closure. Despite the rising interest in tele-dentistry, patients were neutral on considering this option to monitor treatment and were content with fixed appliances. Patients had high confidence levels to resume their care based on the protocols established upon reopening. The association of mental distress and confidence in resuming care is suggestive and needs further investigation.

Oral Mucosa, Saliva, and COVID-19 Infection in Oral Health Care

The SARS-CoV-2 virus has shaken the globe with an ongoing pandemic of COVID-19 and has set challenges to every corner of the modern health care setting. The oral mucosa and saliva are high risk sites for higher viral loads and dental health care professionals are considered a high risk group. COVID-19-induced oral lesions and loss of taste and smell are common clinical complaints in the dental health care setting. The SARS-CoV-2 virus has been found to cause a wide range of non-specific oral mucosal lesions, but the specific diagnosis of these mucocutaneous lesions as COVID-19 lesions will facilitate the prevention of SARS-CoV-2 in dental health care settings and aid in proper patient management. The reported loss of taste and smell needs further investigation at the receptor level as it will give new insights into SARS-CoV-2 pathogenicity. The high yield of virus in the salivary secretion is a common finding in this infection and ongoing research is focusing on developing saliva as a rapid diagnostic fluid in COVID-19. In this review, we discuss the significance of oral mucosa, saliva and the relevance of the COVID-19 pandemic in dentistry.