Outcome and long-term stability of an early orthodontic treatment strategy in public health care

Quality assessment of available Internet information on early orthodontic treatment

BACKGROUND

This study aimed to evaluate the content, reliability, quality and readability of information on Internet websites about early orthodontic treatment.

METHODS

The "early orthodontic treatment" search term was individually entered into four web search engines. The content quality and reliability were reviewed with DISCERN, Journal of American Medical Association (JAMA), and Health on the Net code (HONcode) tools using the contents of websites meeting predetermined criteria. The readability of websites was evaluated with Flesch Reading Facilitate Score (FRES) and Flesch-Kincaid Grade Level (FKGL).

RESULTS

Eighty-six websites were suitable for inclusion and scoring of the 200 websites. 80.2% of websites belonged to orthodontists, 15.1% to multidisciplinary dental clinics and 4.7% to professional organizations. The mean DISCERN score of all websites (parts 1 and 2) was 27.98/75, ranging between 19 and 67. Professional organization websites had the highest scores for DISCERN criteria. Moreover, 45.3% of websites were compatible with JAMA's disclosure criterion, 7% with the currency criterion, 5.8% with the authorship criterion and 5.8% with the attribution criterion. Only three websites met all JAMA criteria, and these websites belonged to professional organizations. None of the websites had the HONcode logo. Mean FRES and FKGL were 47.6 and 11.6, respectively.

CONCLUSIONS

The quality of web-based information about early orthodontic treatment is poor, and readability is insufficient. More accurate and higher quality Internet sources are required on the web.

Long-term stability of mandibular incisor alignment in patients treated nonextraction with or without interproximal enamel reduction

INTRODUCTION

This study aimed to compare long-term mandibular incisor stability in nongrowing patients with moderate crowding treated nonextraction with and without interproximal enamel reduction (IPR).

METHODS

Forty-two nongrowing patients with Class I dental and skeletal malocclusion with moderate crowding were divided into 2 groups with an equal number of patients depending on whether IPR was used (IPR group) or not (non-IPR group) during treatment. All patients were treated by the same practitioner and used thermoplastic retainers full-time for 12 ± 1 months at the end of the active treatment. Changes in Peer Assessment Rating scores, Little's irregularity index (LII), intercanine width (ICW), and mandibular incisor inclination (IMPA and L1-NB°) were evaluated using pretreatment, posttreatment, and 8 ± 1 years postretention dental models and lateral cephalograms.

RESULTS

At the end of the treatment, Peer Assessment Rating scores and LII decreased, and ICW, IMPA, and L1-NB° increased significantly (P <0.001) in both groups. At the end of the postretention period, in both groups, LII increased, and ICW decreased significantly (P <0.001) compared with posttreatment values, whereas IMPA and L1-NB remained stable. When treatment changes were compared, increases in ICW, IMPA, and L1-NB were significantly (P <0.001) higher in the non-IPR group. When postretention changes were compared, the only significant difference between 2 groups was observed in ICW. The decrease in ICW was significantly higher in the non-IPR group.

CONCLUSIONS

Long-term stability of mandibular incisor alignment in Class I nongrowing patients with moderate crowding treated nonextraction with and without IPR was similar.

Knowledge and practice towards early orthodontic problems among general dentists and paediatric dentists

OBJECTIVES

To assess the knowledge, practice and challenges faced by general dental practitioners (GDPs), paediatric dentists (PDs) and postgraduate paediatric dentistry students (PGPDSs) in diagnosing and managing early orthodontic problems.

DESIGN

Cross-sectional study.

METHODS

A total of 159 dentists were enrolled in this study (121 GDPs, 21 PDs and 17 PGPDSs). Data were collected using a self-administered questionnaire involving two sections. Section A included questions regarding demographic features and orthodontic practice. Section B included photos of 12 orthodontic cases that needed early intervention. Knowledge and practice were assessed using six questions for each case that was then rated using predefined scores of poor (score <50%), average (score 50%-75%) and good (score >75%).

RESULTS

The knowledge scores regarding the identification of early orthodontic problems were average among the three groups with GDPs having the lowest score (P = 0.0001). The knowledge scores regarding the selection of optimal treatment time were average among the PDs and PGPDSs, and poor among GDPs. GDPs tended to refer most of their cases to an orthodontist except for cases of thumb sucking. PDs and PGPDSs were more confident in treating anterior crossbite, thumb sucking habits and delayed eruption of incisors. All participants scored 'poor' regarding the selection of an appropriate orthodontic appliance. There was no significant correlation between knowledge and practice (P > 0.05).

CONCLUSION

PDs and PGPDSs showed higher knowledge and practice scores when compared to GDPs. For all three groups included in this study, lack of clinical skills was the main reason for not treating early orthodontic problems.

YouTube as an information and education source for early orthodontic treatment

INTRODUCTION

This study aimed to evaluate the content, reliability, and quality of YouTube videos for early orthodontic treatment.

METHODS

YouTube video searches were carried out using the keyword "early orthodontic treatment," which was determined using Google Trends. After sorting according to relevance, the first 120 videos were observed, and 61 videos were analyzed accordingly. Further, the general characteristics, uploader source, reliability score (RS), global quality scale (GQS), video information quality index, audiovisual quality, viewers' interaction index, viewing rate, and total information content score (TCS) data belonging to these videos were analyzed. Based on their reliability scores, videos were divided into 2 main groups (low and medium/high information content) accordingly.

RESULTS

It was found that 25 (41%) of the videos had medium/high information content, and 36 (59%) had low information content, respectively. Videos with medium/high information content were found to have long video durations, increased comments, and high TCS, GQS, RS, and video information quality index scores (P <0.05). The videos uploaded by doctors had increased comments, long duration, and high TCS, GQS, and RS scores (P <0.05).

CONCLUSIONS

The quality of the information provided by YouTube videos on early orthodontic treatment was generally insufficient. In addition, the information quality was high for videos uploaded by doctors.

Epidemiology of orthodontic treatment need in southwestern Ethiopian children: a cross sectional study using the index of orthodontic treatment need

Background

The planning of orthodontic treatment within a public health system requires information on the orthodontic treatment needs of the population. It is important to have epidemiological data to estimate the total need for orthodontic care in any region. The present study aimed to determine the orthodontic treatment need in 12 years old Southwestern Ethiopian children.

Methods

The institution-based cross-sectional study was conducted which involved 347 twelve years old school children randomly selected from seven different public schools in Jimma Town, Southwestern Ethiopia. A structured interview and clinical examination were used to assess the subjects. One examiner used Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) to estimate the treatment need. Descriptive statistics and chi-square tests were used for data analysis with statistical significance set at P < 0.05.

Results

According to the DHC of IOTN, almost half of the subjects in the sample were in moderate to the great need for orthodontic treatment. About 15% of the children had a great need for orthodontic treatment based on IOTN-AC. The most prevalent occlusal traits for defining the DHC categorization include increased Overjet (30.8%) and Crowding (23.3%). There was no statistical difference in the distribution of DHC grades and AC scored based on gender.

Conclusion

This study revealed that the need for orthodontic treatment was high. The percentage of the need for orthodontic treatment is higher in comparison to most of the studies conducted in African regions. Therefore, publicly subsidized orthodontic treatment should be planned and provided to those who are in great need for orthodontic treatment. Besides, awareness about orthodontic treatment should also be considered.

Stability of orthodontic treatment outcome in relation to retention status: An 8-year follow-up

INTRODUCTION

Our aim was to evaluate the stability of orthodontic treatment outcome and retention status 7 or more years after active treatment in relation to posttreatment or postretention time, type of retention appliance, and duration of retainer use.

METHODS

The subjects were former patients who completed orthodontic treatment with fixed appliances from 2000 to 2007. The pretreatment eligibility criteria were anterior crowding of 4 mm or more in the maxilla or the mandible and Angle Class I or Class II sagittal molar relationship. Acceptable pretreatment and posttreatment dental casts were required. A total of 67 patients participated, 24 men and 43 women, with a mean age of 24.7 years (range, 20.0-50.0 years). All participants had a follow-up clinical examination, which included impressions for follow-up casts, and each completed a questionnaire. Data were obtained from pretreatment, posttreatment, and follow-up (T2) casts as well as from the patients' dental records. Treatment stability was evaluated with the peer assessment rating (PAR) index and Little's irregularity index.

RESULTS

The participation rate was 64%. The average posttreatment time was 8.5 years (range, 7.0-11.0). All participants had received a retainer in the mandible, maxilla, or both after active treatment. At T2, the PAR score showed a mean relapse of 14%. The majority (78%) of participants still had a fixed retainer at T2 (retainer group), and 22% had been out of retention for at least 1 year (postretention group). The relapse according to the PAR did not differ significantly between participants with and without a retainer at T2. From posttreatment to T2, the irregularity of the mandibular incisors increased almost 3 times more in participants with no retainer in the mandible compared with those with an intact retainer at T2 (P = 0.001). In the maxilla, no corresponding difference was found.

CONCLUSIONS

Our results suggest that occlusal relapse can be expected after active orthodontic treatment irrespective of long-term use of fixed retainers. Fixed canine-to-canine retainers seem effective to maintain mandibular incisor alignment, whereas in the maxilla a fixed retainer may not make any difference in the long term.

Orthodontic treatment stability predictors: A retrospective longitudinal study

OBJECTIVE

To examine medium- to long-term orthodontic treatment stability and its possible association with certain variables.

MATERIALS AND METHODS

In a retrospective longitudinal study of 70 postretention patients, the Peer Assessment Rating (PAR) index was measured at the start (T1) and end (T2) of treatment and between 4 and 10 years afterwards (T3). The stability was considered absolute when the T2 and T3 values were identical and relative when the difference was within the ±5 range.

RESULTS

Among the 70 patients, 65.8% were female and 34.2% were male. Their mean age was 14.5 years. The mean treatment length was 2.4 years. The mean retention phase was 3.3 years. The mean pre- and posttreatment PAR scores were 29.8 (T1) and 6.3 (T2). The mean T1-T2 difference was 23.6. The mean T2-T3 difference was -0.39.

CONCLUSIONS

Within the study, 7.1% presented absolute stability and 68.6% presented relative stability. Lower anterior segment alignment and overbite were the most unstable occlusal features and tended to worsen. Fixed retainer (odds ratio [OR] 0.31; 95% confidence interval [CI] 0.10-0.98) as a protective factor and years without retention (OR 1.32; 95% CI 1.03-1.68) as a risk factor are predictor variables of instability in the case of lower anterior segment alignment. The PAR value at the end of treatment (OR 1.29; 95% CI 1.08-1.54) and extractions (OR 4.76; 95% CI 1.05-21.6) before treatment are predictors for midline instability.

Preventive and interceptive orthodontic needs among Syrian children

BACKGROUND

Preventing or intercepting a developing malocclusion in a public health program requires identifying or measuring the degree of malocclusion. The present study aimed to quantify the proportion of Syrian children in Damascus who would benefit from preventive and interceptive orthodontic treatment.

MATERIALS AND METHODS

In total, 1096 children (431 boys and 665 girls) of grade 1 up to grade 3 from 16 government elementary schools in Damascus city were evaluated using the index for preventive and interceptive orthodontic need (IPION). On the basis of IPION, the overall scores of children were distributed into three groups - no treatment need, moderate treatment need, and definite treatment need. According to dental development, children were divided into two groups - IPION-6 and IPION-9.

RESULTS

Of the enrolled children, 15.4% showed no treatment need, 26.7% showed moderate treatment need, and 57.9% showed definite treatment need. Comparison between male and female children indicated no significant effect on the overall treatment need distribution (P=0.439). The IPION groups had a significant effect on treatment distribution (6 vs. 9, P=0.038); the IPION-9 scores were significantly higher than the IPION-6 scores.

CONCLUSION AND RECOMMENDATIONS

The prevalence of preventive and interceptive orthodontic needs is unsatisfactorily high in Syrian children, which emphasizes the importance of including preventive and interceptive orthodontic treatment in the local dental healthcare program.

Implementation of post treatment critical evaluation improved the quality of orthodontic care in postgraduate orthodontic clinic: A 10 years comparative study

Objective:

The aim of the study was to evaluate the effect of post- treatment critical evaluation on the quality of orthodontic care in a postgraduate orthodontic clinic.

Materials and Methods:

Orthodontic treatment outcome of 109 consecutively treated cases was evaluated in Phase-I evaluation. Following Phase-I evaluation, PTCE of each case was made mandatory. After 6-years of implementation of compulsory PTCE for each case, orthodontic treatment outcome of all consecutively treated cases (n = 126) was evaluated (Phase-II). The treatment outcome was evaluated by American Board of Orthodontics Model Grading System (ABO MGS) and Subjective evaluation (Visual Analogue Scale, VAS).

Results:

Based on the ABO scores, the cases were divided into three grades, that is, Grade-I, Grade-II, and Grade-III. The mean total ABO score was improved significantly in Phase-II evaluation (P < 0.01). The total number of cases in ABO Grade-II were increased significantly (P < 0.01) whereas cases in ABO Grade-I remained comparable. The VAS score was improved from 5.66 ± 0.77 at Phase-I to 6.02 ± 0.99 at Phase-II evaluation (P < 0.01).

Conclusion:

The implementation of PTCE significantly improved the quality of orthodontic care in a postgraduate orthodontic clinic.

Clinical Significance:

Grading one's own treatment improves the quality of future treatment.

An analysis of residual orthodontic treatment need in municipal health centres

OBJECTIVE

The aim of this study was to analyse residual orthodontic treatment need in Finnish municipal health centres.

SUBJECTS AND METHODS

A random sample of two age groups, 16- and 18-year-olds (n = 2212), from seven municipalities was invited for a clinical examination, and 1041 adolescents participated. Two calibrated orthodontists blindly examined the participants for residual treatment need, applying the Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Self-perceived treatment need, satisfaction with occlusal function, and dental appearance were evaluated with a questionnaire. Differences between objective and self-perceived treatment need and between treated and untreated adolescents were analysed using the chi-square test.

RESULTS

A total of 18.8 per cent of all adolescents had DHC grade 4 or 5 and/or AC category 8-10, indicating a definite need for treatment. In the analysis between treated and untreated adolescents, orthodontic treatment history or gender had no statistically significant association with the objectively defined need (P > 0.05). Self-perceived treatment need was reported by 9.6 per cent of adolescents. This need was more common among treated (13.9 per cent) than untreated (4.6 per cent) adolescents (P < 0.001). Among all adolescents, satisfaction with occlusal function was high, 91.3 per cent; 78.9 per cent of adolescents were satisfied with their dental appearance. The main reasons for dissatisfaction and self-perceived need were visible contact point displacements.

CONCLUSIONS

The observed proportion of residual orthodontic treatment need is in line with earlier findings. The high satisfaction with occlusal function reflects the applied selection criteria; orthodontic treatment of displacements causing only aesthetic concern is not prioritized.

Prevalence of malocclusion and need for early orthodontic treatment in children

BACKGROUND

With the advent of functional appliances and orthopedic appliances the elimination and correction of skeletal and dental discrepancies has been much reduced. Most orthodontists agree that elimination of oral habits and orthopaedic treatment of class 3 malocclusion and posterior cross bites deserve treatment at an early age. Early treatment was proposed along the lines of "catch them in the young", and "you see it, you treat it" is the main ideology of Early Orthodonticc Treatment (EOT). Furthermore, the majority of children have habits driving the malocclusion. Mouth breathing, tongue thrusting and incorrect swallowing patterns are all known causes of malocclusion and poor facial growth.

AIMS

To evaluate the prevalence of dental feature that might result in malocclusion and need for early orthodontic treatment.

SETTINGS AND DESIGN

Groups of 532 school going children were selected and complete case history was taken and were categorized based on the type of malocclusions, dental features that can predetermine need for early orthodontic treatment. Statistical analysis used.

RESULTS

The results shows the increase in prevalence of malocclusion and the dental features that gives clues for an orthodontist to frame up his treatment modalities not just for corrective orthodontics but for also preventive and interceptive orthodontics.

CONCLUSION

Angle's Class I malocclusion is most commonly seen malocclusion followed by class II division 1 malocclusion followed by Angles class II division 2 malocclusion. In angle's class I malocclusion, incidence of crowding is more followed by proclination of anterior teeth. There is no significant difference between incidence of malocclusion in males and females. The children who needed immediate orthodontic care were more than the children who doesn't need an orthodontic treatment. Need for increase of awareness programs is required in order to educate the people about the early orthodontic treatment.