A systematic review of individual motivational factors in orthodontic treatment: facial attractiveness as the main motivational factor in orthodontic treatment

Study on decision-making for orthodontic treatment plans based on analytic hierarchy process

BACKGROUND

Orthodontics is a common treatment for malocclusion and is essential for improving the oral health and aesthetics of patients. Currently, patients often rely on the clinical expertise and professional knowledge of doctors to select orthodontic programs. However, they lack their own objective and systematic evaluation methods to quantitatively compare different programs. Therefore, there is a need for a more comprehensive and quantitative approach to selecting orthodontic treatment plans, aiming to enhance their scientific validity and effectiveness.

METHODS

In this study, a combination of the analytic hierarchy process (AHP) and semantic analysis was used to evaluate and compare different orthodontic treatment options. An AHP model and evaluation matrix were established through thorough research and semantic analysis of patient requirements. This model considered various treatment factors. Expert panels were invited to rate these factors using a 1-9 scale. The optimal solution was determined by ranking and comparing different orthodontic treatment plans using the geometric mean method to calculate the weights of each criterion.

RESULTS

The research indicates a higher preference for invisible correction compared to other orthodontic solutions, with a weight score that is 0.3923 higher. Factors such as comfort and difficulty of cleaning have been given significant attention.

CONCLUSION

The Analytic Hierarchy Process (AHP) method can be utilized to effectively develop orthodontic treatment plans, making the treatment process more objective, scientific, and personalized. The design of this study offers strong decision support for orthodontic treatment, potentially improving orthodontic treatment outcomes in clinical practice and ultimately enhancing oral health and patients' quality of life.

Effect of weight satisfaction on adolescent facial and dental satisfaction

PURPOSE

To investigate if facial and dental satisfaction is related to body fat percentage and body weight satisfaction.

METHODS

A self-administered questionnaire was applied to adolescents from a Private School in Southern Brazil containing sociodemographic (sex and age) and self-perception variables. Adolescents were asked about their perceptions concerning dental problems. Body fat percentage was collected using bioelectrical impedance analysis.

RESULTS

A total of 372 adolescents were examined. Most adolescents were satisfied with their dental (81.7%) and facial appearance (87.6%), while 39% of adolescents were satisfied with their body weight. Poisson regression model showed that adolescents who expressed satisfaction with their body weight (PR = 1.12, 95%CI 1.06-1.19) and were satisfied with their dental appearance (PR = 1.24, 95% CI 1.08-1.41) exhibited a positive association with facial satisfaction. Adolescents dissatisfied with dental color (PR = 0.88, 95%CI 0.80-0.97), those reporting dental pain (PR = 0.88, 95%CI 0.80-0.97), and individuals with obesity (PR = 0.91, 95%CI 0.83-0.99) demonstrated a decrease in facial satisfaction. Adolescents aged 16 to 19 years (PR = 1.08, 95% CI 1.01-1.15) and those satisfied with their facial appearance (PR = 1.20, 95%CI 1.01-1.43) exhibited a higher prevalence of dental satisfaction. Conversely, adolescents dissatisfied with dental color (PR = 0.74, 95% CI 0.66-0.82) and those with misaligned teeth (PR = 0.63, 95%CI 0.55-0.73) reported lower levels of dental satisfaction. Parametric g-formula analysis found that the association between body fat and facial satisfaction was mediated by body weight satisfaction (p = 0.001).

CONCLUSIONS

While dental satisfaction was not influenced by corporeal characteristics, facial satisfaction was influenced by dental and body weight satisfaction. Obese adolescents had low facial satisfaction.

Metal leakage from orthodontic appliances chemically alters enamel surface during experimental in vitro simulated treatment

Human enamel is composed mainly of apatite. This mineral of sorption properties is susceptible to chemical changes, which in turn affect its resistance to dissolution. This study aimed to investigate whether metal leakage from orthodontic appliances chemically alters the enamel surface during an in vitro simulated orthodontic treatment. Totally 107 human enamel samples were subjected to the simulation involving metal appliances and cyclic pH fluctuations over a period of 12 months in four complimentary experiments. The average concentrations and distribution of Fe, Cr, Ni, Ti and Cu within the enamel before and after the experiments were examined using ICP‒MS and LA‒ICP‒MS techniques. The samples exposed to the interaction with metal appliances exhibited a significant increase in average Fe, Cr and Ni (Kruskal-Wallis, p < 0.002) content in comparison to the control group. The outer layer, narrow fissures and points of contact with the metal components showed increased concentrations of Fe, Ti, Ni and Cr after simulated treatment, conversely to the enamel sealed with an adhesive system. It has been concluded that metal leakage from orthodontic appliances chemically alters enamel surface and microlesions during experimental in vitro simulated treatment.

Socio-economic and gender dynamics influence on the parental decision-making process for children's orthodontic care - A study in Madinah, Saudi Arabia

OBJECTIVES

To investigate the socio-economic and personal factors that impact parental decisions regarding orthodontic treatment for their children in Madinah, Saudi Arabia.

MATERIALS AND METHODS

A digital self-administered questionnaire was employed to collect data from 414 parents, focusing on their motivations and barriers that influence their decision-making process regarding orthodontic treatment.

RESULTS

Income level was the most significant factor in orthodontic decisions. Parents with higher incomes were twice as likely to choose orthodontic treatment for esthetic reasons compared to parents with middle incomes. The main incentive for seeking treatment was getting advice from dental professionals, with 60% of participants rating it as the most important factor. 34.5% of respondents identified cost as the main barrier, with middle-income parents being 151% more inclined to perceive it as a significant barrier compared to high-income parents. Gender dynamics revealed that mothers exhibited 48.9% greater concern regarding treatment costs compared to fathers, whereas fathers placed 2.105 times more importance on the orthodontist's reputation than mothers.

CONCLUSION

Income levels, along with other socio-economic factors and gender dynamics, have a significant influence on parental decisions regarding orthodontic care. Personalized consultations that address these variations are crucial for improving communication between patients and practitioners and increasing the accessibility of treatment.

Gummy Smile Prevalence Among Ha'il City Female Young Adults and Its Impact on Quality of Life: A Cross-Sectional Study

BACKGROUND

Gummy smile (GS) has a direct effect on individuals, especially among young adults, because of its association with smile avoidance. The younger populations are sensitive about their smiles and prefer aesthetic, beautiful smiles, a lack of which can negatively impact their quality of life.

OBJECTIVES

This study aims to measure the GS prevalence among young adults aged 16 to 18 attending high schools in Ha'il City, Saudi Arabia, evaluating oral health related to quality of life (OHQoL) in those suffering GS by using the OHQoL questionnaire (OHIP-14).

METHODS

A cross-sectional study was conducted on 385 female high school students located in Ha'il. Students with GS took a survey on oral health using OHIP-14. For this, SPSS was used to analyze the data.

RESULTS

The study included 200 people with GS (52%). The mean age was 18±0.01. The prevalence of GS was analyzed, with a mean value of 4.68±1.2 mm, indicating most students had GS ranging between 4 and 5 mm. The most frequent value for all items in the OHIP-14 questionnaire was 1, indicating that students often had their quality of life affected. The non-parametric Kruskal-Wallis test indicated the results had a significant value (p < 0.05), showing a positive and significant association.

CONCLUSION

Based on the OHIP-14 questionnaire and respecting the methodology, it was concluded that the quality of life has been affected for all female students with GS. The high prevalence for ages 16-18 showed most students agreed their lives were being affected by GS and their condition needed to be treated. It was also confirmed by the significant association of GS with items of oral health and quality of life.

WEARING ORTHODONTIC APPLIANCES MAY NOT IMPACT THE ORAL HEALTH-RELATED QUALITY OF LIFE (OHRQOL) OF CHILDREN AND ADOLESCENTS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Impacts of using orthodontic appliances on the quality of life of children and adolescents: systematic review and meta-analysis. Vidigal MTC, Mesquita CM, de Oliveira MN, de Andrade Vieira W, Blumenberg C, Nascimento GG, Pithon MM, Paranhos LR. Eur J Orthod. 2022 Aug 16; 44(4):359-368.

SOURCE OF FUNDING

Government.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data.

Psychological impact and perceptions of orthodontic treatment of adult patients with different motivations

INTRODUCTION

Motivations, perceptions, and psychosocial states of adult patients with orthodontic disorders in China have not been widely studied. The study assessed the psychosocial states and perceptions of adult patients undergoing orthodontic treatments with different motivations.

METHODS

Two hundred forty-three adult patients (mean age, 30.2 ± 7.4 years; women, 79.0%) undergoing orthodontic treatment were recruited from a tertiary stomatology hospital. The patients answered a patient-centered questionnaire regarding motivations and perceptions of orthodontic treatment and the Psychosocial Impact of Dental Aesthetics Questionnaire. Data were analyzed using the chi-square test on the basis of multiple responses. Multiple linear regression analyses were performed to determine the association between motivation factors and the Psychosocial Impact of Dental Aesthetics Questionnaire subscale scores (P <0.05).

RESULTS

Patients with various motivations were as follows: occlusal function reason (70.4%), dental esthetic reason (54.7%), facial esthetic reason (24.3%), and following others' suggestions (18.5%). Patients with esthetic or occlusal motivations exhibited significantly greater need and interest for orthodontic treatment (P <0.001). Multiple linear regression analyses revealed that the scores of social impact, psychological impact, and esthetic concern subscales were significantly associated with both dental and facial esthetic motivations (P <0.001).

CONCLUSIONS

The primary motivations of Chinese patients were observed to be improved esthetics and occlusal function. Patients with esthetic or occlusal motivations exhibited significantly greater need and interest in treatment. Patients with facial or dental esthetic motivations experienced greater impacts of psychosocial states. Therefore, the patient motivations and impacts of esthetic-related psychosocial states on them should be considered during treatment.

Interdisciplinary Approach in Periodontal Management of Orthodontic Patient: Long-Term Follow-up

Orthodontic therapy is becoming a mainstay for the correction of esthetic and functional disturbances in both young and older adults. Orthodontic forces act on the periodontium and can have wide-ranging effects, from beneficial to harmful, from being a hindrance to oral hygiene maintenance to causing irreversible periodontal breakdown. In some patients, the presence of periodontal conditions like gingival recession, before start of orthodontic therapy, raises many questions. Much controversy and confusion exist regarding the need for periodontal therapy, its sequencing, especially in case of recession in a young patient who needs orthodontic therapy. An interactive, interdisciplinary approach is essential in such cases for success. This case report illustrates the interdisciplinary management of a young patient with gingival recession with an eight-year follow-up of the case.

A Novel Coating of Orthodontic Archwires with Chlorhexidine Hexametaphosphate Nanoparticles

Statement of the Problem. The use of orthodontic fixed appliances may adversely affect oral health leading to demineralizing lesions and the development of gingival problems. Aims of the Study. The study aimed to coat orthodontic archwires with chlorhexidine hexametaphosphate nanoparticles (CHX-HMP NPs) and to evaluate the elusion of CHX from CHX-HMP NPs. Materials and Methods. A solution of CHX-HMP nanoparticles with an overall concentration of 5 mM for both CHX and HMP was prepared, characterized (using atomic force microscope and Fourier transformation infrared spectroscopy), and used to coat orthodontic stainless steel (SSW) and NiTi archwires (NiTiW). The coated segments were characterized (using scanning electron microscopy SEM with energy dispersive X-ray spectrometry and field emission SEM) and subjected to the elusion assessment. Results. After having their composition validated, the average size of the CHX-HMP NPs was assessed to be 51.21 nm, and the analysis revealed that the particles had both chlorine and phosphorus. After 30 minutes in the coating solution, NPs deposited on the surface of the SSW and NiTiW. A continuous release of soluble CHX in artificial saliva was detected from both SSW and NiTiW as long as the experiment lasted for 28 days without reaching a plateau. However, the release from coated NiTiW was significantly more than coated SSW at 7, 14, and 28 days. While at day 21, the release from coated SSW was slightly greater than that from the coated NiTiW. Conclusion. Orthodontic stainless steel and NiTi archwires can be successfully coated with CHX-HMP NPs and give sustained release of CHX along the examined period.

The effect of orthodontic treatment on smile attractiveness: a systematic review

BACKGROUND

Smile attractiveness is a primary factor for patients to seek orthodontic treatment, however, there is yet no systematic evaluation of this topic in the literature.

OBJECTIVES

To assess the current evidence on the effect of orthodontic treatment on smile attractiveness.

SEARCH METHODS

Seven electronic databases (MEDLINE, Cochrane Library, Virtual Health Library, SCOPUS, Web of Science, Google Scholar and Embase) were searched on 14 September 2022.

SELECTION CRITERIA

Studies evaluating smile attractiveness before and after orthodontic treatment or only after completion of orthodontic treatment.

DATA COLLECTION AND ANALYSIS

Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomised studies. Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were planned a priori.

METHODS

After elimination of duplicate studies, data extraction and risk of bias assessment according to the Cochrane guidelines, an evaluation of the overall evidence was performed. The included studies were evaluated based on the characteristics of their study and control groups and based on their main research question. Also, all outcome measures were standardized into a common assessment scale (0-100), in order to obtain more easily interpretable results.

RESULTS

Ten studies were included in this review, nine of which were assessed as being at serious risk of bias and one at moderate risk of bias. The large heterogeneity between the included studies did not allow for a meta-analysis. Orthodontic treatment has a moderately positive effect on smile attractiveness. When compared to no treatment, orthodontic treatment with premolar extractions improves smile attractiveness by 22%. Also, surgical correction of Class III cases increases smile attractiveness by 7.5% more than camouflage treatment. No other significant differences were shown between different types of treatment.

CONCLUSION

Based on the available data, orthodontic treatment seems to moderately improve the attractiveness of the smile. There is significant bias in the current literature assessing the effect of orthodontics on smile attractiveness; therefore, the results cannot be accepted with certainty.

Applicability of the IOTN-AC index in a bimaxillary protrusion population

Objective

The objective of this study was to assess the validity of the IOTN-AC in the assessment of aesthetic impairment in bimaxillary protrusion patients.

Materials and methods

A cross-sectional study was conducted and involved 110 patients comprising 52 males (47.3%) and 58 females (52.7%) who were accepted for fixed appliance treatment at The University of the West Indies Dental Hospital and provided consent for the use of their records. The mean age was 13.45 years. Participants were asked to complete a questionnaire regarding their reasons for seeking orthodontic treatment and score their self-perceived IOTN-AC. An orthodontist also scored the malocclusion using the IOTN (AC and DHC).

Results

Spearman’s correlation between patient IOTN-AC and orthodontist IOTN-AC was r = 0.435, (p < 0.001). However, the patient IOTN-AC and the ‘normative’ need (p = 0.198), as well as the orthodontist IOTN-AC and the ‘normative’ need (p = 0.334), were not correlated (r = 0.124 and r = 0.094, respectively). Both patient and the orthodontist IOTN-AC scores were not in agreement with ‘normative’ need (IOTN-DHC). Cohen’s kappa test determined an agreement between the patient’s IOTN- AC and an orthodontist’s IOTN AC score, k = 0.395, p < 0.001. The questionnaire revealed aesthetics as the primary reason for seeking treatment but there was poor correlation between the questionnaire items and the patient or orthodontist IOTN-AC score, an AC score of 3 being the most common score for both.

Conclusion

The IOTN-AC is not a valid tool to determine patient perception of the need for treatment in a bimaxillary protrusion population when scored by either patients or orthodontists.

Comparative evaluation of facial attractiveness by laypersons in terms of facial proportions and equate it's deviation from divine proportions - A photographic study

Introduction

The human face is a unique structure and says a lot about an individual even more than what the body indicates about the overall attractiveness. Facial attractiveness is an important key to social interactions and individual behavior. The human body is made in such a way that it follows a specific mathematical proportion called the Golden Proportion. In order for any two parts to be aesthetically proportionate, the ratio between them should be 1.618. Studies have shown that aesthetically pleasing profiles have facial proportions and ratios that closely resemble the golden proportions.

Aim

To evaluate the perception of esthetic facial photographs by laypersons and compare these with the accepted norms of divine proportions to find for any deviations from those norms.

Methodology

Forty subjects having normal soft tissue profile angle, as evaluated using Burstone's method, were selected to be photographed for the study. All the photographs were taken using DSLR Camera and under a standard photographic setup. All the photographs were edited and compiled into a PowerPoint presentation. The edited photographs on the PowerPoint presentation were displayed to 302 evaluators. These evaluators were asked to score each photograph according to a visual analogue scale with markings from 0 to 10 (with 0 being least attractive and 10 being most attractive) according to their attractiveness. All the scored photos were then grouped into three categories viz. Very attractive, Average attractive and Least attractive. Three horizontal proportions and three vertical proportions were assessed digitally in all the photographs and any deviations from the golden proportion were assessed.

Results

It was found that none of the three groups followed golden proportions accurately. However the Very Attractive group showed closest resemblance to the golden proportion as compared to the other two groups. Amongst all the horizontal and vertical proportions in the Very Attractive group, Interchelion to Interalar proportion (Ch:Ln) was the one that showed maximum deviation from the divine proportion (mean value 1.38 ± 0.15). Rest of the other horizontal and vertical proportions in the Very Attractive group were close enough to the divine proportion. However the difference between the proportions amongst the three groups was not statistically significant. Comparison between the three groups showed that Very Attractive faces showed the least deviations from the golden proportions whereas least attractive faces showed most deviations from the golden proportions.

Conclusion

The findings of this study state that the perception of aesthetically pleasing faces by laypersons do not accurately follow golden proportion but are close enough to it. The faces not showing golden proportions are perceived as less attractive.

The effect of orthodontic treatment on facial attractiveness: a systematic review and meta-analysis

BACKGROUND

Facial and smile attractiveness are significant motivating factor for patients to seek orthodontic treatment. Although there is a general belief that orthodontic treatment improves facial appearance, this has yet not been systematically evaluated.

OBJECTIVE

The objective of this study was to assess the current evidence on the effect of orthodontic treatment on facial attractiveness.

SEARCH METHODS

Systematic and unrestricted search of nine databases were performed up to January 2022.

SELECTION CRITERIA

Studies evaluating facial attractiveness before and after orthodontic treatment.

DATA COLLECTION AND ANALYSIS

Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality, and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomized studies and with RoB-2 for randomized controlled trials (RCTs). Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were performed.

RESULTS

Twenty studies were included in data synthesis; three randomized controlled clinical trials and 17 non-randomized clinical studies of retrospective or prospective design. One of the RCTs was found to have low risk of bias, one presented some concerns and the third showed a high risk of bias. All non-randomized studies showed either unclear or high risk of bias. Data syntheses showed that orthodontic treatment improved facial attractiveness ratings by 9% when compared with untreated controls (MD: 9.05/95% CI: 4.71; 13.39). A combination of orthodontics and orthognathic surgery also showed a positive effect of 5.5% (MD: 5.51/95% CI: 1.55; 9.47) when compared with orthodontic treatment alone. There was no difference in effect between extraction and non-extraction treatments (MD: -0.89/ 95% CI: -8.72; 6.94) or between different types of Class II correctors (MD: 2.21/95% CI: -16.51; 20.93).

LIMITATIONS

With the exception of two RCTs, included studies were of unclear or low quality.

CONCLUSIONS

Orthodontic treatment has a clinically weak effect on facial attractiveness when compared to no treatment. The same is true when a combined orthodontic/surgical treatment is compared to orthodontics alone.

REGISTRATION

PROSPERO #: CRD42020169904.

The Attitudes of Children Undergoing Orthodontic Treatment toward Face Mask Wearing during the COVID-19 Pandemic: A Cross Sectional Study

During the COVID-19 pandemic, the protective face mask has proven to be essential. The protective face masks cover the lower part of the face, including teeth and, for orthodontic patients, the orthodontic appliances. The aim of this study was to assess the impact that the restrictive measures that were imposed during the COVID-19 pandemic and, especially, wearing a protective face mask had on a sample of Romanian children, and to compare the results previously obtained on a sample of Romanian teenagers with the results obtained after investigating children under the age of 12 years. The cross-sectional survey was conducted in two orthodontic offices from the city of Oradea, Romania. The study sample included children with ages between 8 and 11.9 years that were undergoing an orthodontic treatment with removable or fixed orthodontic appliances. After obtaining the results, comparisons were made with the answers provided by a group of adolescents previously investigated. The questionnaires consisted of 9 items that investigated children’ attitudes toward protective face mask wearing and other aspects related to the COVID-19 pandemic. Two hundred fifty-six children were included in the study (53.1% female patients, 46.9% male patients). Most of the children were not worried that face masks would hide their orthodontic appliances (Item 1—Never, 40.2%; Rarely, 28.9%) and did not consider that the necessity of face mask wearing negatively impacted their desire to undergo an orthodontic treatment, despite the fact that it covered the appliances (Item 2—Never, 37.1%; Rarely, 31.6%). However, 44.5% of children were not happy because they had to wear a face mask during the orthodontic treatment, considering the fact that it covered the orthodontic appliance (Item 6), and most patients (49.2%) did not want the face mask to continue to be mandatory (Item 7). Although children were not happy that they had to wear a face mask that covered the orthodontic appliances, protective face masks were generally well tolerated by Romanian children.

Adult patient preference for an orthodontic care provider in Canada

INTRODUCTION

This study evaluated the factors influencing potential orthodontic patients' choice between an orthodontist, general dentist (GD), and direct-to-consumer (DTC) aligners for their treatment and their choice of orthodontic appliance type and explored their motivating factors for seeking orthodontic treatment and preference for appliance type.

METHODS

An electronic survey was administered to 330 Canadian adults to determine demographic background, choice of the orthodontic treatment provider, the preferred mode of treatment, orthodontic issues they wished to address, and motivation for treatment.

RESULTS

When participants were asked their preference in provider type, 49.4% of participants selected an orthodontist, 19.2% would follow the recommendation of their GD, 18.9% selected a GD, and 12.5% selected DTC aligners. Younger adult participants (P = 0.037) and those living in metropolitan areas (P = 0.0005) were significantly more likely to select an orthodontist than GD or DTC aligners. When asked about their preference in the mode of orthodontic treatment, 45.4% selected clear braces, 34.1% selected clear aligners, 14.3% selected metal braces, and 6.1% indicated they currently have no interest in orthodontic treatment. Older participants (P = 0.0005) and those in moderate-sized population centers (P = 0.001) were significantly more likely to select clear braces or aligners.

CONCLUSIONS

Adults in Canada have a high preference for orthodontic treatment performed by orthodontists, especially among younger participants and those in metropolitan areas. Although all ages preferred clear braces, younger adult participants tended to be more open to metal braces, whereas older participants' preference for clear braces was the strongest. Preference for clear aligners is positively correlated to increased community size.

The antibacterial effect of silver, zinc-oxide and combination of silver/ zinc oxide nanoparticles coating of orthodontic brackets (an in vitro study)

Background

Preventive measures are essential during the length of orthodontic treatment to reduce the risk of decalcification and white spot lesions formation. With the evolution of procedures that enable coating of the orthodontic brackets using nanoparticles known for their good antibacterial activity, coating the brackets with nanoparticles of silver, zinc oxide and combination of silver and zinc oxide to evaluate their antibacterial effect in comparison to a control group without coating was carried out in this study.

Methods

Four groups of 12 brackets each were included in the study. The coating procedure was carried out using physical vapor deposition. The antibacterial activity was tested on Streptococcus mutans and Lactobacillus Acidophilus using colony forming count. The antibacterial activity was evaluated immediately after coating and later after 3 months.

Results

Brackets coated with combination of silver and zinc oxide nanoparticles had the highest ability on reduction of both Streptococcus mutans and Lactobacillus Acidophilus count followed by silver nanoparticles and then zinc oxide nanoparticles. No significant difference was found between the first and second antibacterial tests.

Conclusion

The silver/zinc oxide nanoparticles coated brackets had the highest antibacterial effect in comparison to silver nanoparticles and zinc oxide nanoparticles individually coated brackets on Streptococcus mutans and Lactobacillus acidophilus, and all types of coatings showed enhanced antibacterial effect in comparison to the uncoated bracket. Coating of orthodontic brackets could be further assessed in clinical application to prevent decalcification.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02263-6.

Adolescents' perception of malocclusion, their motivations, and expectations concerning the orthodontic treatment. Is it all about attractiveness? A qualitative study

INTRODUCTION

In addition to essential clinical parameters, orthodontic treatment outcomes should also consider patients' opinions and perceptions, which could be comprehensively clarified with a qualitative scientific approach. Considering that the information on younger patients' views is scarce, the objective of this study was to investigate how adolescent orthodontic patients perceive malocclusion, and their motivations and expectations concerning orthodontic corrective treatment.

METHODS

In this descriptive qualitative study, 12 adolescents aged 12 to 14 years and of both genders, covering a heterogeneous collection of malocclusions, were recruited from the waiting list of an Orthodontics Graduate Course. They were individually interviewed before the appliance insertion by an experienced researcher using an interview guide and photographic records to stimulate patients' self-perception of their oral condition. The interviews proceeded simultaneously with transcription analyses until saturation. After the transcription evaluation, the framework analysis technique was performed.

RESULTS

Data derived from the transcription analyses were grouped into 3 major themes: perceptions concerning the concepts of normality and abnormality regarding oral health; self-perceptions regarding malocclusion and other discrepancies; and motivations for seeking orthodontic treatment and expectations related to the results.

CONCLUSIONS

Attractiveness was exceptionally relevant among adolescent patients. Most interviewees seemed to focus their attention on esthetically upsetting dentofacial traits, which they expected to be corrected by orthodontic treatment. In addition to self-oriented appearance-driven motivations, parents, other health professionals, friends, and peers also influenced adolescents' perception of their need for treatment. The achievement of a normal dentofacial status seems to be closely attached to social and individual aspirations.

Quantitating the art and science of esthetic clinical success

BACKGROUND

Beginning with the biobehavioral bases of esthetic experiences, this article presents a quantitative analytic review of the motives and methods of providers and consumers of orthodontic treatment.

METHOD

A primary focus is determining the anthropometric bases of self and others' perceived preference and satisfaction with changes in facial appearance. These quantitative analyses have been based on determining the frequency and magnitude of reliability and validity measures of diagnosis, treatment, and satisfaction outcome. Socioeconomic considerations are also quantitated regarding the discrepancy between objective need for treatment as determined for example by the Index of Orthodontic Treatment Need and the subjective demand for treatment.

RESULTS

The major contribution of this article is the quantitation of the components of esthetic experience from sensation of perception using psycho physical methods, such as Perceptometrics, for determining the morphological basis of perceived facial attractiveness adjusted for ethnocultural differences updated by 3-dimensional and artificial intelligence technology. Recent quantitation of smile components has also added to the measures of esthetically successful treatment. Further contribution of orthodontists to mental and physical health is demonstrated by the differences between perceived personality attributes in profile and full-frontal views of symmetric and asymmetric faces. Such information can facilitate the clinician's ability to determine the ideational representation of the patients' perceived pre- and post-treatment outcome.

CONCLUSION

The quantitative analysis of the motives and methods involved in the orthodontic treatment process has been combined with the neurophysiological correlates of producing and observing/evaluation of the esthetic experiences of both patients and orthodontists/dentists.

Short-term variation in the subgingival microbiota in two groups of patients treated with clear aligners and vestibular fixed appliances: A longitudinal study

OBJECTIVE

To evaluate the subgingival microbiological changes during the first six months of therapy with clear aligners (CAs) and fixed appliances (FAs). The null hypothesis was that there would be no microbiological differences between the two.

SETTING/SAMPLE

Two groups of patients to be treated, respectively, with CAs (14 patients; 9 females and 5 males; mean age 21 years ± 0.25) and FAs (13 patients; 8 females and 5 males; mean 14 years ± 0.75) were consecutively recruited.

MATERIALS AND METHODS

Subgingival microbiological samples were obtained at the right upper central incisor and right first molar at four different time points: before appliance fitting (T0), and at 1 month (T1), 3 months (T3) and 6 months (T6) thereafter. Total bacterial load (TBL) and counts of the bacteria Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum, Campylobacter rectus, Treponema denticola and Tannerella forsythia were determined using real-time PCR.

RESULTS

Total bacterial load did not vary in the CA group, while a significant increase was detected after 3 and 6 months of treatment in the FA group. Unlike red complex species, C rectus and F nucleatum were often detected: levels remained stable in the CA group but increased progressively in the FA group.

CONCLUSION

The type of orthodontic appliance influences the subgingival microbiota. TBL increased in the FA group but not in the CA group, although the levels of the individual periodontal pathogenic bacteria species did not significantly increase during the observation period.

The perceptions of preclinical and clinical dental students to altered smile aesthetics

Introduction

This prospective cohort study was designed to identify which components of a smile make it more or less aesthetically acceptable to dental students.

Aim

To investigate whether students at different stages of their undergraduate dental education held similar views on smile aesthetics. Additionally, to see whether students from the same ethnicity were more likely to have similar perceptions of smile aesthetics than students from different backgrounds.

Methodology

Dental students in either Year 1 (preclinical) or Year 5 (clinical) of their studies at the University of Bristol were asked to complete a questionnaire. Students were asked to rank 12 photographic images in order from most aesthetically pleasing (1) to least pleasing (12). The 12 images included one ‘ideal’ smile and 11 digitally altered images of the same “ideal” smile.

Results

A total of 123 questionnaires were completed. Clinical students were more likely to rank the ‘ideal smile’ as more aesthetically pleasing and identify it as the “best” smile from the set of images. Preclinical students considered retroclined incisors to be significantly less pleasing than clinical year students, whilst clinical year students found a midline diastema significantly less pleasing than preclinical students.

Conclusions

Dental students at different stages of their undergraduate dental education have different perceptions of smile aesthetics. There was no evidence that the perception of dental attractiveness was affected by students’ ethnicities or location of upbringing.

Combined effect of Er,Cr:YSGG laser and casein phosphopeptide amorphous calcium phosphate on the prevention of enamel demineralization

OBJECTIVES

To compare the effect of use of laser, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and their combination on prevention of enamel demineralization using polarized light microscopy to assess lesion depth.

MATERIALS AND METHODS

Eighty premolars were randomly allocated to four equal groups (n = 20): Group I: Control group, no preventive measures. Group II: CPP-ACP. Group III: Er,Cr:YSGG laser. Group IV: Er,Cr:YSGG laser followed by CPP-ACP. Specimens were subjected to thermocycling and brushing protocols equivalent to 1 year intraorally. Then, all teeth were subjected to acid challenge. Teeth were then sectioned longitudinally and examined under a polarized light microscope and lesion depth was measured.

RESULTS

Group IV resulted in the least lesion depth with a significant difference between it and all other groups. CPP-ACP alone and laser alone also showed a significant difference in white spot lesion (WSL) depth compared to the control group; however, no significant difference was found between them.

CONCLUSIONS

The combined use of laser and CPP-ACP showed the best prevention against WSL development. The use of CPP-ACP or laser alone also resulted in a significant reduction in lesion depth but was significantly less than their combined use, with no significant difference between them.

Evaluation of the airway space changes after extraction of four second premolars and orthodontic space closure in adult female patients with bimaxillary protrusion - A retrospective study

Background & objectives

Previous studies have found that first premolar extractions during orthodontic treatment may alter the upper airway dimensions. The objective of this study is to investigate the effects of second premolar extraction during orthodontic treatment on the dimensions of the upper airway in a sample of female adults.

Methods

Twenty-nine female adult patients with ages between 18 and 30 years old and incisor bimaxillary protrusion were included in this study. They were treated with comprehensive orthodontic treatment which included the extraction of four second premolars. Pre and post cephalometric radiographs were analyzed using Dolphin imaging software for changes in tongue length and height, soft palate thickness and length, the superior, middle, and inferior airway space, and vertical airway length. Descriptive statistics were used to characterize measurements. Student’s paired t-test was preformed to compare the pre- and post-test mean values of the dimensions.

Results

A significant increase in the vertical airway length was observed after the extraction of the second premolars (p = 0.02). The soft palate length showed a tendency towards an increase that did not reach statistical significance (p = 0.053). No other significant changes in the airway soft tissue measurements were observed. The proclination and protrusion of the upper and lower incisors were significantly decreased compared to pre-treatment measurements.

Interpretation & conclusions.

Orthodontic treatment involving the extraction of all four second premolars in females with bimaxillary protrusion increases the vertical airway length, which is the amount of distance between base of the tongue and posterior nasal spine. No other significant alterations in the upper airway measurements were observed.

Prevalence of temporomandibular disorders in patients seeking orthodontic treatment: A systematic review

The objective of this systematic review was (a) to establish the prevalence of temporomandibular disorders (TMDs) in patients seeking orthodontic treatment and (b) to determine the association between the presence of TMD and sex, age and malocclusion. A systematic literature search was performed according to PRISMA guidelines from 1969 to 2019 using the PubMed and LIVIVO databases. Eight study articles met the inclusion and exclusion criteria. An additional three contributions were identified through manual searching of the reference lists of retrieved articles. The methodological quality of the 11 articles was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for prevalence studies. TMD prevalence ranged from 21.1% to 73.3%. The frequency of painful TMD signs/symptoms varied from 3.4% to 65.7%, while non-painful signs/symptoms ranged from 3.1% to 40.8%. The percentage of males and females presenting with TMD varied from 10.6% to 68.1% and 21.2 to 72.4%, respectively. In all studies, TMD prevalence was higher among females. The majority of articles reported more TMD signs/symptoms in individuals older than 18 years as compared to younger ones (≤18 years). While in four studies no association between TMD and malocclusion was found, another three investigations indicated that TMD may be related to certain occlusal traits. The TMD prevalence in patients seeking orthodontic treatment was high, with many individuals presenting painful TMD signs/symptoms. Female and older patients appear to have a greater occurrence of TMD. Although no strong association between TMD and malocclusion was established, several occlusal traits were implicated.

Orthodontic treatment motivation and cooperation: A cross-sectional analysis of adolescent patients' and parents' responses

INTRODUCTION:

Motivation for orthodontic treatment among adolescents has been linked with patients’ response during treatment. Parents have also been seen to be influencing factors in patient motivation. This study investigates the motivation for orthodontic treatment among patients and their parents/guardians.

MATERIALS AND METHODS:

Data were obtained from 100 orthodontic children (41 boys, 59 girls), with a mean age of 11.9 years, in the age range of 7–17 years, and with parents/guardians from three public hospitals. Recruitment focused on patients and their parents at their initial screening appointment and those scheduled for regular orthodontic treatment. Data were collected by the use of survey forms for both patients and parents. Data were analyzed using Epi info™ version 3.5.1.

RESULTS:

Children were more motivated to have orthodontic treatment than their parents before treatment, however parents showed greater motivation for their children to have orthodontic treatment than did the children during treatment. Children on treatment were less motivated than those who have not started treatment. Using braces was more important to children than their parents. Parents of children on treatment were more motivated for their children to have orthodontic treatment than parents of children who were not yet on treatment. Children undergoing orthodontic treatment were not willing to have extractions as part of their treatment, while parents did not have much objections (P = 0.001). Parents were willing to comply with dietary instructions imposed on their children. (P = 0.45). Pretreatment, children were more willing to brush after meals than the ones undergoing treatment (0.010).

CONCLUSION:

Parents of children on treatment were more motivated for their children to have orthodontic treatment than parents of children who were not yet on treatment. Children on treatment were less motivated during treatment.

Parental influence is the most important predictor of child's orthodontic treatment demand in a preadolescent age

The aim was to explore the predictive value of objective treatment need, impaired quality of life, and parental influence on orthodontic treatment demand in preadolescents and adolescents. A secondary goal was to validate 16-item Child Perceptions Questionnaire for the 11-14 year age group (CPQ11-14): item-impact and stepwise-regression short-forms. A convenience sample of 287 participants (55% female) was used for validation. Internal consistency, test-retest reliability, and convergent validity were evaluated. Predictors of treatment demand were explored in 197 orthodontic patients: 93 preadolescents (51% females), 104 adolescents (55% females). Hierarchical linear regression and multilevel logistic regression models were used to explore the predictive power of age, gender, objective treatment need, impaired quality of life and parental influence on treatment demand. CPQ11-14 regression short-form had acceptable psychometric properties. Significant linear predictors of treatment demand were impaired emotional well-being (EW) (β = 0.335, p = 0.002), parental influence (β = 0.221, p = 0.002), and malocclusion severity (β = 0.152, p = 0.025). In logistic regression, parental influence was revealed as the most important predictor of treatment demand in preadolescents, OR = 7.7 (95% confidence interval CI 2.4-25.1; p = 0.001); objective treatment need in adolescents, OR = 4.5 (95% CI 1.5-12.9; p = 0.006). The increase of impairment in EW by one scalar point increased treatment demand by 1.4 (95% CI 1.1-1.9; p = 0.017) in preadolescents; 1.3 (95% CI 1.0-1.7; p = 0.021) in adolescents. Greater parental agreement and motivation for treatment could result in higher preadolescents' cooperation. Orthodontic treatment in adolescents might be more effective with the patient-oriented approach.

The impact of labial fixed appliance orthodontic treatment on patient expectation, experience, and satisfaction: an overview of systematic reviews

Background

Patient perception with fixed appliance orthodontic treatment is important to improve oral health-related quality of life.

Objective

The main objective of this study was to evaluate the impact of labial fixed appliance orthodontic care on patient perception before, during, and after the treatment.

Search methods

Relevant systematic reviews investigating patient perception with fixed appliance orthodontic treatment were identified by searching electronic databases: MEDLINE via OVID (1946 to 31 December 2018), EMBASE (1974 to 31 December 2018), AMED (Allied and Complementary Medicine Database; 1985 to November 2018), PubMed (inception to 31 December 2018), Web of Science (1900 to 2018), and PsychINFO (1806 to 31 December 2018). Ongoing systematic reviews were searched using Prospero and a grey literature search was undertaken using Google Scholar and OpenGrey (www.opengrey.eu/). No language restriction was applied.

Selection criteria

Only studies investigating patient perception of fixed appliance orthodontic treatment were included.

Data collection and analysis

Screening, quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)], and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings.

Results

A total of 163 articles investigating patient expectation, experience, and satisfaction with conventional ligation labial fixed orthodontic appliances were obtained. Of these, 152 observational or interventional studies were excluded, resulting in 11 eligible systematic reviews. Two were excluded as earlier reports of a Cochrane review. The quality of the reviews was variable (critically low, low, and moderate). The findings were as follows: aesthetics represents a primary motive for orthodontic treatment; a temporary deterioration in the quality of life occurs during the initial phases of treatment; gender and ethnicity factors do not have an impact on patient perception of treatment; and a positive relationship between orthodontist–patient–parent is important to achieve patient compliance and satisfaction.

Conclusions

There is a lack of high-quality studies in terms of systematic reviews and meta-analyses for assessing patient perception with fixed appliance orthodontic treatment. The aesthetic impact of malocclusion is the main motive for seeking orthodontic treatment. Quality of life reduces during the initial stages of orthodontic treatment but improves in the later stages of treatment. Assessment before, during, and after orthodontic treatment is necessary to comprehensively assess patient perception at all stages of care.

Trial registration

CRD42019122653.

Conflict of Interest

None to declare.

Orthodontic treatment need among young Saudis attending public versus private dental practices in Riyadh

Objective

To assess and compare the severity of malocclusion and orthodontic treatment need among young Saudis receiving free treatment at public dental practices versus those paying for treatment at private practices.

Materials and methods

This retrospective study evaluated the records of 300 patients (179 females, 121 males; age 13–21 years) treated at orthodontic clinics from 2013 through 2015. The public sample was selected from orthodontic clinics at the College of Dentistry, King Saud University (KSU); the private sample was selected from five private orthodontic clinics in Riyadh, Saudi Arabia. The records were examined for the severity of malocclusion and for orthodontic treatment need using the Dental Health Component of the Index of Orthodontic Treatment Need. The prevalence of each occlusal discrepancy and the Dental Health Component grade were recorded. The severity of malocclusion and orthodontic treatment need were compared between practice types, age groups, and sexes with the chi-square test.

Results

Displacement, increased overjet, and Class II and III malocclusion were the most common orthodontic problems in this study. Patients attending public clinics at KSU generally had more severe malocclusion than the patients attending private clinics. Seventy-seven percent of orthodontically treated patients at KSU clinics were in great need of treatment, compared with 58.5% of patients treated at private clinics (P=0.003). Among the patients with great treatment need, approximately 62% of male patients and 70% of patients ≤16 years of age were treated at KSU clinics, compared with 38% and 48%, respectively, treated at private clinics (P<0.0001).

Conclusion

Young Saudis receiving free orthodontic treatment at public clinics at KSU had more severe malocclusion with greater need of orthodontic treatment than the patients paying for treatment at private clinics.

Prevalence of caries and malocclusion in an indigenous population in Chiapas, Mexico

OBJECTIVES

To assess the prevalence of caries and malocclusion in Mayan Mexican adolescents, 14-20 years of age, living in Chiapas, Mexico.

METHODS

This was a cross-sectional, population-based, quantitative, epidemiological study. Sites were chosen to capture subjects representative of the state's Mayan population. A total of 354 subjects were recruited. Caries experience was quantified, via visual inspection, using the Decayed, Missing and Filled Surface (DMFS) index. Malocclusion was quantified using the Index of Complexity, Outcome and Need (ICON).

RESULTS

Our data showed that 99% of the population had caries experience, with a median DMFS score of 8. Of the 99% with caries experience, over half had caries affecting more than five tooth surfaces. Thirty-seven per cent of the students had unmet orthodontic treatment need, and 46.46% presented a Class II, and 39.09% a Class III, anterior-posterior relationship.

CONCLUSIONS

Less than 1% of the population had any exposure to orthodontics, demonstrating the lack of access to care. Likewise, only 1% of the population was found to have no caries experience, exhibiting a large unmet treatment need. The median DMFS score of 8 was also high in comparison with the median DMFS in the USA of 6. Our data suggest a correlation between the lack of access to care and high prevalence of caries and malocclusion in Mexican Mayans who inhabit Chiapas, Mexico.