Orthodontists' perceptions of the impact of phase 1 treatment for Class II malocclusion on phase 2 needs

Successful 2 phase treatment of growing skeletal Class III malocclusion based upon cephalometric prognostic factor: A case report

Early treatment of Class III malocclusion provides an improvement in facial appearance and corrects the reverse bite. Orthopedic protraction of maxilla is considered best approach in growing Class III patients with maxillary deficiency. Present case report describes the management of a growing 10-year-old boy with skeletal Class III malocclusion using facemask therapy (Phase 1) followed by fixed orthodontic treatment (Phase 2) based upon cephalometric prognostic findings of growth treatment response vector (GTRV). With the successful orthopedic phase of maxillary protraction with facemask therapy for 7 months of period, a significant improvement in profile had been achieved along with the correction in reverse overjet. This was followed by retention with chin cup therapy for a period of 20 months. After a period of 20 months retention, a fixed orthodontic treatment was started with the objective to achieve stable functional occlusion. After 11 months of treatment with fixed appliance therapy a stable functional occlusion was achieved. The patient was placed on Hawleys retainer in maxillary arch and bonded fixed spiral wire (FSW) retainer in mandibular arch. Successful management of growing Class III patient was done using facemask and fixed orthodontic therapy based upon cephalometric prognostic findings of growth treatment response vector (GTRV).

Patient compliance and orthodontic treatment efficacy of Planas functional appliances with TheraMon microsensors

OBJECTIVES

To assess patient compliance and treatment efficacy of preventive expansion treatment with removable Planas functional appliances using an integrated microsensor.

MATERIALS AND METHODS

Wear time (WT) and behavior of 69 patients undergoing treatment with Planas functional appliances were assessed and analysed using TheraMon microsensors (Gschladt, Hargelsberg, Austria). Patients were followed up for a period of 9 months, and visits were made every 3 months to download WT data from the microsensor and to assess wearing behavior. From individual WT graphs,10 parameters were derived to characterize compliance for each patient. Treatment efficacy was measured by eight parameters determining the level of expansion after 9 months of treatment.

RESULTS

Patients wore their device on average 15.8 ± 5.2 h/d. WT was unrelated to age and gender, but it was positively influenced by patient habits when keeping appliances during eating, sports, care and handling. Treatment efficacy in terms of intercanine and intermolar expansion was 4.4 ± 1.9 mm and 4.6 ± 2.0 mm for the maxilla, and 5.3 ± 2.0 mm and 4.7 ± 2.3 mm for the mandible, respectively. Efficacy was negatively affected by poor compliance (WT < 9 h/d) and by high variability of within-subject WT recordings.

CONCLUSIONS

Perfect compliance is not necessary to achieve treatment success, but patients should exhibit sufficient wear time to allow maxillary expansion to occur. The TheraMon microsensor offers a new perspective and aid to individualize treatment prescriptions.

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

Our aim was to evaluate the long-term treatment outcome of a systematically applied orthodontic screening and early treatment strategy in a public dental health care system, with special reference to occlusal stability at least 5 years post-retention. The subjects (N = 68) belonged to one age cohort born in a Finnish rural municipality (N = 85), and they were regularly followed from 8 to 20 years. Persons with malocclusions were screened and treated according to pre-planned protocol. Treatment need was assessed according to the Dental Health Component of the Index of Orthodontic Treatment Need, and treatment outcome using the peer assessment rating (PAR) Index and Little's Index of Irregularity. Eighty-two per cent of the treated participants were out of retention (mean 6.9 years post-retention) at age 20. Definite treatment need in the study population decreased from 37% to 3 %. In the treated group, the mean PAR improvement decreased from 65 % to 63% from age 15 to 20 years. The mean irregularity score for the mandibular incisors was 4.0 [standard deviation (SD) 2.4] and for maxillary incisors 3.7 (SD 2.1) with no significant difference between treated and not treated subjects. The results suggest that definite need for orthodontic treatment may be predominantly eliminated from the target population with a systematically implemented treatment strategy focusing on early treatment with simple appliances. Emphasis on early timing of treatments may have contributed to the good long-term stability of treatment results.

Two-phase treatment of skeletal class II malocclusion with the combination of the twin-block appliance and high-pull headgear

The patient was a boy with a Class II skeletal and dental relationship, a large overjet, an impinging overbite, and a steep mandibular plane angle. Treatment started with the Twin-block appliance combined with high-pull headgear to promote growth of the mandible, restrain the maxilla in the anteroposterior and vertical planes, and improve his profile. This was followed by extraction of the maxillary second premolars and the mandibular first premolars. Then fixed appliances were used to align and level the dentition. Pretreatment and posttreatment records are shown, and the treatment results are stable 2 years after debonding.

The seven-year outcome of an early orthodontic treatment strategy

The benefits of early orthodontic treatment are continuously discussed, but studies are few. We examined whether definite need for orthodontic treatment could be eliminated in public health care by systematically focusing on early intervention. One age cohort living in a rural Finnish municipality (N = 85) was regularly followed from ages 8 to 15 years, and persons with malocclusions were treated according to a pre-planned protocol. Treatment need was assessed according to the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need, and treatment outcome by the Peer Assessment Rating Index (PAR). Fifty-two percent of the cohort received treatment, and definite treatment need decreased from 33% to 9%. In the treated group, the mean PAR score reduction was 63%, and 51% showed more than 70% improvement. The results suggest that an early treatment strategy may considerably reduce the need for orthodontic treatment in public health care with limited specialist resources.

Effect of early treatment on stability of occlusion in patients with Class II malocclusion

INTRODUCTION

The purpose of this study was to evaluate the effect of early treatment on the stability of occlusion in patients with Class II malocclusions. The peer assessment rating (PAR) index was used to evaluate changes in occlusion after treatment of subjects treated in 1 phase or 2 phases. This study was a prospective, randomized, controlled clinical trial.

METHODS

Dental casts were obtained from the participants, who were randomized into 3 phase-1 early treatment groups: bionator, headgear/bite plane, or observation. Phase 2 consisted of continued treatment of the bionator and the headgear/biteplane subjects and comprehensive treatment of the observation subjects. PAR scores were obtained for 208 subjects at end of treatment; 173 (83%) had at least 1 follow-up visit, with a median follow-up time of 5.0 years. PAR scores were calculated for each subject at key treatment and posttreatment time points. Linear mixed-effect models were used to evaluate the impact of phase-1 treatment group, years posttreatment, end of treatment PAR score, and other covariates that could affect stability on the posttreatment PAR score.

RESULTS

Factors significantly affecting posttreatment PAR scores were PAR score at end of treatment (P <.0001), years posttreatment (P =.0064), and PAR score at the start of phase 2. Although phase-1 treatment was not statistically significant, those with early treatment had lower PAR scores at the start of phase 2 than the observation subjects (means [SD]: bionator 17.5 [7.4], headgear/biteplane 15.3 [7.0], observation 22.2 [8.6], P <.0001). Thus, early treatment had an indirect effect.

CONCLUSIONS

Factors that affect posttreatment PAR score stability include PAR score at the end of treatment, years posttreatment, and PAR score at the start of phase-2 treatment. The early treatment modalities have limited positive impact on posttreatment stability PAR scores in Class II malocclusion patients due to their effect on PAR scores at the start of phase-2 treatment.

Early orthodontic treatment as a means to increase access for children enrolled in Medicaid in Washington state

BACKGROUND

The authors assessed the likelihood that interceptive orthodontic Medicaid programs would increase access to care for Washington children.

METHODS

The authors surveyed 210 Washington state orthodontists, including questions on demographics, attitudes toward early treatment, use of innovations and perceptions of Medicaid. Respondents were either Medicaid participants or nonparticipants.

RESULTS

Fifty of 159 respondents were Medicaid participants. Most respondents perceived early orthodontic treatment as beneficial. Medicaid participants were more willing to participate in Medicaid early-treatment programs, had slightly fewer patients in the "other insurance" category, provided more discounted fees, received more Medicaid inquiries, practiced in rural areas with lower household incomes, reported feeling overworked and experienced fewer Medicaid problems. The principal problem reported with the Medicaid system was low fee reimbursement.

CONCLUSIONS

Programs offering early orthodontic treatment could increase access. Important barriers would be low fees and unfamiliarity with Medicaid.

PRACTICE IMPLICATIONS

Medicaid should design programs aimed at early treatment with reasonable reimbursement and an educational component.

Rationale for referring class II patients for early orthodontic treatment

The tendency of indicating early treatment (before growth spurt) when dealing with Angle Class II cases has been noticed, although there is no definite scientific evidence to justify such decision. The aim of this study was to identify the advantages and disadvantages to this approach and which appliances are used for this purpose. For that purpose, a questionnaire containing full records of a Class II patient was sent to two professors of each Orthodontic graduate program in Brazil (n=96, total 192), from which 107 were properly answered. Results demonstrated that the most used appliances were the headgear (80.4%), maxillary splint (50%) and Bionator (44.4%). The benefits most often quoted were increase of patient self-esteem (78.5%) and reduction in the incidence of incisors trauma (63.6%), while the main disadvantage was saturation of patient compliance (73.8%). Considering early Class II treatment, there is still no unanimity as to treating in one or two stages or in selection of appliances. However, the orthodontists should consider the physical situation of the patient, severity of cases and susceptibility of trauma to the maxillary incisors. It is crucial that updated information is given to parents, in order to justify this approach.

Facial growth and management of orthodontic problems

This article enables pediatricians to identify and understand the implications of common facial growth problems in children and adolescents. Problems with facial growth can result in aesthetic and functional concerns. Using a simple method of clinical evaluation, pediatricians can identify facial growth problems in the anteroposterior, vertical, and transverse dimensions. These problems can then be referred for evaluation and treatment by various means. Because facial growth is the result of the interaction of genetic and environmental factors (some of which are functional), growth modification may be a possibility. Some problems may be camouflaged or treated by combined surgical and orthodontic means. Continued growth in early adulthood may enhance or detract from treatment results obtained in childhood or adolescence. These dynamic properties of the face make management of facial growth challenging but generally rewarding and successful because of substantial aesthetic and functional improvements.

Early orthodontic treatment: what are the imperatives?

BACKGROUND

Then authors provide a critical review of the issues involved in determining the appropriate timing of orthodontic treatment. Both single- and two-phase treatments are discussed and guidelines are offered to assist in formulating treatment plans.

OVERVIEW

In providing orthodontic care for pediatric patients, clinicians often question whether to begin treatment early--during the primary or early-transitional dentition--or wait until all or most of the permanent teeth are present. The authors review the most current literature (from 1991 to 1999), including several recently completed and ongoing randomized clinical trials, to critically evaluate the effectiveness of each approach.

PRACTICAL IMPLICATIONS

The controversy surrounding early vs. late orthodontic treatment is often confusing to the dental community. This article reviews both sides of the issue for orthodontic treatment of Class II and III malocclusions, as well as for the management of Class I crowding and problems in the transverse dimension. Early orthodontic treatment is effective and desirable in specific situations. However, the evidence is equally compelling that such an approach is not indicated in many cases for which later, single-phase treatment is more effective. Therefore, clinicians must decide, on a case-by-case basis, when to provide orthodontic treatment. For many patients, delaying treatment until later in their dental and skeletal development may be advisable.