Applications and effectiveness of teledentistry in orthodontic practice during the COVID-19 restrictions.

BACKGROUND: The aim of this study was to identify the areas of application for teledentistry and analyze its effectiveness in orthodontic practice during the COVID-19 pandemic. METHODS: A total of 233 patients (159 women, 74 men) receiving orthodontic treatment were included. During the COVID-19 restriction period, patients were given teledentistry appointments. During these video conferences, remote orthodontic checkups were performed by one orthodontist, who asked the patients for photos or videos. The applications carried out during the interviews were recorded, classified, and analyzed. In addition, clinical emergency patients were identified. After the teledentistry consultations, two different questionnaires were presented to the patients, depending on their attendance at teledentistry appointments, and the results were statistically evaluated. RESULTS: In all, 21.25% of the patients were identified as having clinical emergencies, including injury because of damage from brackets and wires; 10% of them reported bracket breakage; 17.5% were encouraged to use intermaxillary elastics; and 3.75% were in pain. However, 50% of them were found to be unproblematic. A total of 91% of the participants in the survey reported that online checkups were sufficient to understand and resolve their symptoms. However, 28% wanted to communicate with orthodontists by video call or with photos instead of meeting face to face (65.5%) when unexpected problems arose during the COVID-19 pandemic. CONCLUSIONS: Teledentistry can be an effective method for motivating patients who are undergoing orthodontic treatments that require cooperation. It is also an effective way of understanding the patients' symptoms and reducing the risk of cross-infection by identifying patients who will require face-to-face emergency treatment during pandemics.

The effect of COVID-19 on orthodontic treatment demand and its delivery in India.

Introduction: The ongoing pandemic has transformed the entire structural and functional framework of the world including the medical and dental healthcare services. The current study intends to examine the pattern of dynamically changing working conditions and orthodontic treatment delivery during the various phases of pandemic. Method: An online survey was conducted using Google form for orthodontic specialists practicing in India. Information regarding the impact of the pandemic on various aspects like patient turnover, treatment demand, clinical management, and new challenges faced were analysed through a self-designed close-ended questionnaire for two phases. Phase I (March 2020 to September 2020) corresponded to the onset of COVID 19 pandemic and lockdown, whereas the Phase II (October 2020 to March 2021) coincided with the time of Unlock and resumption of activities thereafter. Results: The parameters showing similar trend in Phases I and II included the willingness of ongoing orthodontic patients to report for appointments, choice of treatment modality, number and type of emergencies, cost of materials, guidelines for work, and duration of non-delivery of orthodontic procedures. The new patients reporting, complex orthodontic therapy, tele-consultation, and financial wellbeing showed an improvement while the usage of personal protective equipment kit, fear amongst orthodontists reduced in Phase II. Conclusions: Challenging situations warrant prudent measures to combat and continue the essential services, especially those related to the healthcare. A detailed analysis of the various phases of the ongoing pandemic will enable us to devise suitable measures to ensure uninterrupted orthodontic treatment even in such critical times.

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.

Relevance of teleorthodontic tools: a systematic review of the literature / Pertinence des outils de téléorthodontie : une revue systématique de la littérature

Introduction: The concept of teleorthodontics was recently born; the Covid-19 crise has participated to the emergence and the amplification of this phenomenon. Objective: The main aim of the present systematic review was to evaluate the teleorthodontics relevance. Method: An electronic and manual search was performed in four databases (PubMed, Scopus, Embase and Cochrane Library) up to December 2021 according to PRISMA guidelines. Both prospective and retrospective studies, as well as case reports, case series and satisfaction surveys published in English or in French without time restriction were included. Two independant reviewers were involved in the selection of the studies and a third reviewer was required in case of disagreement. A bias assessment was performed using the Mixed Methods Appraisal Tools. Results: Out of 1757 articles, 22 articles published mainly between 2019 and 2021 and with varying levels of evidence, were included. Considering the results obtained, different concepts were discussed (time management, quality of communication, reliability and use of tools, satisfaction, quality of human relations, emergency management, compliance). Conclusions: Teleorthodontics is an interesting and complementary tool that is, in no way, a systematic alternative to face-to-face orthodontic appointments in the office. However, many essential aspects of telemedicine in orthodontics, such as data protection, still need to be investigated in order to fully analyze this tool.

Introduction: Le concept de téléorthodontie a récemment vu le jour ; la crise de la Covid-19 a fortement participé à l'émergence et à l'amplification de ce phénomène. Objectif: L'objectif premier de cette revue systématique de la littérature était d'évaluer la pertinence de la téléorthodontie. Méthode: Une recherche électronique a été menée dans quatre bases de données (PubMed, Scopus, Embase et Cochrane Library), complétée par une recherche manuelle jusqu'à fin décembre 2021 conformément aux directives PRISMA. Tous types d'études cliniques, prospectives ou rétrospectives, y compris les rapports et les séries de cas ainsi que les enquêtes de satisfaction publiées en anglais ou en français sans restriction de temps, ont été inclus. Deux auteurs indépendants ont été impliqués dans la sélection des études et un troisième auteur a été sollicité en cas de désaccord. Une évaluation des biais a été réalisée à partir du Mixed Methods Appraisal Tools. Résultats: Sur les 1757 articles, 22 articles, publiés majoritairement entre 2019 et 2021 et de niveaux de preuve variables, ont été inclus. Tenant compte des résultats obtenus, différentes notions ont pu être discutées (gestion du temps, qualité de la communication, fiabilité des outils, facilité d'utilisation, satisfaction, qualité du rapport humain, gestion des urgences, observance). Conclusions: La téléorthodontie est un outil intéressant et complémentaire à une approche classique pour certaines indications. Cependant, elle ne constitue en aucun cas une alternative systématique aux rendez-vous orthodontiques en présentiel au cabinet. De nombreux aspects pourtant essentiels (protection des données, etc.) doivent être encore investigués pour analyser pleinement cet outil.

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.

A reflection on the role of women in Science, Dentistry and Brazilian Orthodontics.

INTRODUCTION: This paper reviews the history of women scientists in the 'Western world', whilst highlighting the persistent socio-structural issues that have led to the hiding and masking of the participation of women in Science. Further, a reflection is made of the situation of Dentistry, specifically in the field of Orthodontics in Brazil. The difference between genders is discussed, with the intention to map the progress of women in management and leadership positions, in both the academic and professional fields. DESCRIPTION: In Brazil, within Dentistry and Orthodontics, despite being in a numerical majority, women are still underrepresented in the area of professional leadership. This is true for Research Groups and Research Productivity; an example being the relatively low authorship of publications in a Brazilian journal of Orthodontics. They are also underrepresented as lead presenters at professional meetings, whilst there are also few female Presidents of professional organizations and associations. CONCLUSION: Despite being in a numerical majority, it is also important that women act in a more co-ordinated and consistent manner to achieve greater representation in these areas. The necessary changes in the structure in order to achieve this are not only of women and for women, but they must also involve the whole of society so that leadership, rights and duties are equally distributed between the genders.

The COVID-19 experience of orthodontists in the UK.

OBJECTIVE: To understand and compare the perceived impact and ongoing effects of the COVID-19 pandemic on orthodontic clinical services in the UK. DESIGN: Descriptive cross-sectional survey. SETTING: Online electronic questionnaire. PARTICIPANTS: Members of the British Orthodontic Society (BOS). METHODS: Electronic questionnaires were circulated between March and June 2021. The UK survey was distributed via emails from the BOS, Orthodontic Managed Clinical Networks and WhatsApp groups. RESULTS: A total of 560 unique responses were received. There were more respondents who were aged over 50 years (52%) then respondents who were aged below 50 years (48%) with the median age range being 50-54 years (20%). The main causes of disruption to clinical practice were felt to be national restrictions (85%), increased cross-infection measures (84%), social distancing (80%) and professional guidance (80%). Respondents felt more negatively in their opinions regarding dentistry's preparedness for the pandemic (5%) and how dentistry coped in the crisis (35%), when compared to orthodontic services specifically (8% and 58%, respectively). The respondents were not confident about the potential beneficial effects of a vaccination programme on orthodontic clinical service provision (21%). Telephone consultations (84%) and video consultations (61%) were the main adaptations used by the respondents during the pandemic. CONCLUSIONS: Respondents felt that COVID-19 will have long-term societal, clinical and professional implications. The majority of our respondents supported the vaccination and weekly testing of the orthodontic team. Respondents felt that during the pandemic there had been a deterioration in care provision and were not optimistic about a vaccination programme restoring services to pre-pandemic levels of activity. During the pandemic, patients in active orthodontic treatment have been prioritised but at the expense of new and review patients, and as services recover respondents were concerned about the difficulty of arranging dental extractions.

Development, implementation and feedback for an online speciality membership examination in orthodontics during the COVID-19 pandemic.

Introduction The Royal College of Surgeons of England (RCSEng) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG) offer the bi-collegiate Membership in Orthodontics (MOrth) examination, a summative assessment of specialist knowledge, skill and behaviour in orthodontics. The COVID-19 pandemic has had a profound global effect on almost every facet of normal life, including the conduct of face-to-face examinations. We highlight development, implementation and feedback for the bi-collegiate MOrth Part 2 examination delivered remotely to a cohort of candidates in September 2020 by RCSEng/RCPSG.Methods Two anonymised online surveys (Google Forms) were distributed via electronic mail following completion of the examination diet. Forty-two candidates were sent a survey covering four domains and comprising a total of 31 questions. The 20 examiners were sent a survey containing eight questions. In both surveys, free-text responses were also collected. A rating system was used to categorise responses. All survey responses were summarised in an online data collection sheet.Results The response rate was 78.5% (33/42) and 75% (15/20) for candidates and examiners, respectively. Overall, favourable responses in relation to all sections of the assessment were elicited from candidates with the majority (mean 79.8%; 75.8-81.9%) reporting that the online examination format worked well. Equally, favourable responses were reported by examiners. Notably, 80% of examiners felt that the online exam style did not affect the mark a candidate would receive, and 100% were confident that the marks the candidates received were a reflection of their ability and were not affected by the online delivery of the assessment.Conclusions The feedback from both candidates and examiners relating to an online remote assessment of the bi-collegiate MOrth Part 2 was generally positive. Based on the survey responses, this format of a high-stakes examination was acceptable to all stakeholders, and demonstrated a high level of perceived validity and reliability in terms of content.

Impact of COVID-19 pandemic on orthodontics in predoctoral and postdoctoral programs in the United States.

INTRODUCTION: The study aimed to characterize the impact of the coronavirus disease 2019 (COVID-19) pandemic on predoctoral and postdoctoral orthodontic education. METHODS: Electronic surveys were distributed via e-mail to predoctoral orthodontic directors at accredited dental schools (n = 66), postgraduate orthodontic program directors at orthodontic programs (n = 73), and craniofacial orthodontic fellowship directors (n = 5) in the United States and Canada. RESULTS: The predoctoral orthodontic survey received a response rate of 38%, of the which 62% indicated significant curriculum modifications. However, orthodontic curriculum hours were largely unchanged because of the COVID-19 pandemic. Of the responding predoctoral orthodontic programs with graduate orthodontic programs in which dental students can gain clinical experience (n = 14), all but 2 reported not allowing or limiting observation or assisting opportunities. The postdoctoral orthodontic survey received a response rate of 39% and was affected by clinic modifications, including financial limitations, severe acute respiratory syndrome coronavirus 2 testing, decreased clinical hours, among other modifications. CONCLUSIONS: COVID-19 pandemic has had a measurable impact on orthodontic clinical education for the predoctoral and postdoctoral orthodontic programs evaluated. Overall, less patient care was delivered, potentially resulting in delayed treatment for patients and fewer training opportunities for learners, particularly for predoctoral dental students, whose clinical observation and assisting hours were limited.

What has changed in orthodontic patient care between the two surges of the COVID-19 pandemic? A thematic analysis.

BACKGROUND AND AIM: The coronavirus disease 2019 (COVID-19) has brought new challenges to every specialty and orthodontics is no exception. Currently, there seems no way other than to mitigate the risk and proceed with routine orthodontic treatment. The aim of the present study was to conduct a qualitative inquiry into the coping strategies, perceptions and anticipations of orthodontic patients and the challenges faced by orthodontists. METHODS: An in-depth telephone interview of 30 patients and/or their parents and orthodontists belonging to an Academic-based Residency Program and Private Practice was conducted regarding the challenges, opportunities and futuristic ways of coping with COVID-19. Inputs were recorded, transcripts were prepared and anonymised, and a thematic analysis was performed. RESULTS: Six themes and several sub-themes emerged from the detailed interviews and their transcripts. The initial fearful situation due to COVID-19 has gradually transformed into a certain 'new normal' in the lives of patients and caregivers, explaining why patients started seeking orthodontic treatment as usual or even preferring to begin treatment during this period. Orthodontists in the midst of uncertainty are delivering quality care and expecting future innovations and changes to combat such pandemics. CONCLUSION: Humans can adapt to any crisis that runs over a period of time. The new insights obtained will help to plan treatment and set up practice to cope with pandemics and crises that can affect orthodontic treatment in the future.

Effects of the COVID-19 pandemic on new patient visits for orthodontic treatment: A comparison of 2020 and the previous 3 years.

BACKGROUND: Coronavirus disease (COVID-19) has led to unprecedented challenges in the arts, sports, education, finance, and healthcare. The aim of this study was to compare demographic characteristics of new-patient visits for orthodontic treatment in the pandemic year (2020) versus previous years. METHODS: The retrospective study included patients who sought care at a tertiary orthodontic referral center between January 1, 2016 and December 31, 2020. Clinical and demographic characteristics, including age, age group (child, young adult, adult), gender, and numbers of monthly and annual new-patient visits were compared between the pre-pandemic (2017-2020) and post-pandemic (2020) periods. The daily average numbers of appointments were compared for 2019 versus 2020. RESULTS: The average number of monthly new-patient visits was 240.69 ± 81.48 in the pre-pandemic period, as opposed to 113.75 ± 88.89 in the year 2020 (P < 0.001). The average number of monthly new-patient visits decreased by 48.3% in 2020 compared to 2019, while the average number of daily new-patient visits in 2020 decreased significantly in all months (P < 0.05), except for January (P = 0.613) compared to the monthly numbers from the previous year. No significant difference was found between the pre-pandemic period and 2020 with regard to gender (P = 0.410). In all years, the numbers of new-patient visits were higher for women, compared with men, and for children, compared with adults. CONCLUSIONS: The results indicated a sharp decrease in the number of new-patient visits for orthodontic treatment in the pandemic year (2020) compared to previous years.

Robotic Applications in Orthodontics: Changing the Face of Contemporary Clinical Care.

The last decade (2010-2021) has witnessed the evolution of robotic applications in orthodontics. This review scopes and analyzes published orthodontic literature in eight different domains: (1) robotic dental assistants; (2) robotics in diagnosis and simulation of orthodontic problems; (3) robotics in orthodontic patient education, teaching, and training; (4) wire bending and customized appliance robotics; (5) nanorobots/microrobots for acceleration of tooth movement and for remote monitoring; (6) robotics in maxillofacial surgeries and implant placement; (7) automated aligner production robotics; and (8) TMD rehabilitative robotics. A total of 1,150 records were searched, of which 124 potentially relevant articles were retrieved in full. 87 studies met the selection criteria following screening and were included in the scoping review. The review found that studies pertaining to arch wire bending and customized appliance robots, simulative robots for diagnosis, and surgical robots have been important areas of research in the last decade (32%, 22%, and 16%). Rehabilitative robots and nanorobots are quite promising and have been considerably reported in the orthodontic literature (13%, 9%). On the other hand, assistive robots, automated aligner production robots, and patient robots need more scientific data to be gathered in the future (1%, 1%, and 6%). Technological readiness of different robotic applications in orthodontics was further assessed. The presented eight domains of robotic technologies were assigned to an estimated technological readiness level according to the information given in the publications. Wire bending robots, TMD robots, nanorobots, and aligner production robots have reached the highest levels of technological readiness: 9; diagnostic robots and patient robots reached level 7, whereas surgical robots and assistive robots reached lower levels of readiness: 4 and 3, respectively.

Orthodontic treatment in times of Covid-19.

During the first two months of the Coronavirus Disease 2019 (Covid-19) pandemic, Romania was in lockdown, and all dental practices were closed, so orthodontic patients had to postpone their check-ups for at least eight weeks. This led not only to a delayed end of treatment but also to accidents and complications. The present study tried to evaluate the orthodontic situation both from the patient's and orthodontist's point of view, so the patients were given a few questions to answer, and the orthodontist analyzed each treatment before and after the two-month lockdown and decided if it was mildly or severely affected by the absence of check-ups. The study group consisted of 105 patients evaluated by three orthodontists in the same private practice. Patients that have gotten worse after the lockdown or who had problems were included in the study. Also, all the patients were given a 7-question form in order to find out their opinion. After two months without check-ups, our orthodontists found that 9.52% got worse because of the lack of intermaxillary elastics, broken brackets, broken removable orthodontic appliances, and others. Most of the patients believe that their treatment was delayed by the Covid-19 pandemic, but none of the patients felt unsafe when visiting the clinic. The Covid-19 pandemic had severe effects on orthodontic treatments. Orthodontists noticed a delay for about one-third of their patients. However, from the patient's point of view, half believe that their treatment was negatively affected by the Covid-19 pandemic in different degrees.

Education Technology in Orthodontics and Paediatric Dentistry during the COVID-19 Pandemic: A Systematic Review.

Over the last decade, medical education changed from traditional teaching methods to telematic and networking scholar and e-learning approach. The objective of the present systematic review was to evaluate the effectiveness and teachers/student's acceptability of e-learning applied to the field of orthodontics and paediatric dentistry. A database search of the literature was conducted on PubMed and Embase databases from January 2005 to May 2021. A total of 172 articles were identified by the electronic search, while a total of 32 papers were selected for qualitative analysis. Overall, 19 articles investigated the effectiveness of e-learning, and no difference of acceptability was reported between e-learning and traditional methods for a wide part of the articles selected. A total of 25 papers provided a satisfaction questionnaire for learners and all were positive in their attitude towards e-learning. The results showed that e-learning is an effective method of instruction, complementing the traditional teaching methods, and learners had a positive attitude and perception. The evidence of the present study reported a high level of acceptability and knowledge level of e-learning techniques, compared to frontal lecture methods, in the fields of orthodontics and paediatric dentistry.

Aerosol generating procedural risks and concomitant mitigation strategies in orthodontics amid COVID-19 pandemic - An updated evidence-based review.

IMPORTANCE: The ongoing COVID-19 pandemic has posed unique challenges to orthodontic profession by adversely impacting provision of in-office orthodontic care due to prevailing uncertainty around risks pertaining to splatter and 'aerosol-generating procedures' (AGPs). This review aims to provide an insight into the prevailing and emerging evidence informing potential risks related to splatter and AGPs, and risk mitigation strategies employed for reducing the potential risk of SARS-CoV-2 transmission from dental bioaerosols. METHODS: PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, LILACS, WHO COVID-19 databases and preprint databases were searched for eligible English language publications. Citation chasing was undertaken up until the review date of 4 January 2021. Study selection, data extraction and risk of bias assessment was undertaken independently in duplicate, or else by consultation with a third author. RESULTS: Following filter application and duplicates removed, a total of 13 articles assessing procedural mitigation measures were included. Seven included studies revealed overall low-risk of bias. The overall risk varied from unclear to high for rest of the studies, with the most concerning domains being blinding of the participants and the personnel and blinding of the outcome assessors. Accumulated consensual evidence points towards the use of dental suction devices with wide bore aspirating tips as effective procedural mitigation strategies. Variations in the literature can be observed concerning aerosol transmission associated with water spray use during debonding. Emerging direct evidence consistently supports adjunctive use of pre-procedural povidone-iodine mouthrinse to mitigate direct transmission risk in the orthodontic practice. CONCLUSIONS: A thorough risk assessment concerning AGPs and implementation of consistent and evidence-based procedural mitigation strategies may play an indispensable role in navigating optimal orthodontic practice through unforeseen similar pandemic threats. High-quality robust research focussing on more biologically relevant models of dental bioaerosols in orthodontic settings is warranted.

Teledentistry Platforms for Orthodontics.

Technology has transformed almost every aspect of our lives. Smartphones enable patients to request, receive, and transmit information irrespective of the time and place. The global pandemic has forced healthcare providers to employ technology to aid in 'flattening the curve. The Novel Coronavirus, which is responsible for COVID-19, is transmitted primarily through person-to-person contact but may also be spread through aerosol generating procedures, so many clinics have severely limited interpersonal interactions. The purpose of this article is to provide helpful information for those orthodontists considering some form of remote practice. Various HIPAA-compliant telecommunication or teledentistry systems that can be used for orthodontic treatment are introduced and discussed. Detailed information about each platform that can potentially be used for orthodontics is provided in Figure 1. The authors do not endorse any of the products listed and the included software is not all inclusive but instead is a glimpse into the options available.

When convenience trumps quality of care: A population-based survey on direct to consumer orthodontics.

INTRODUCTION: Since the introduction of direct to consumer orthodontic (DTCO) products in the last decade, these products have been increasing in popularity among orthodontic patients. The purpose of the current article was to assess the populations' perception of DTCOs and to examine various factors that may influence their decision in choosing treatment with DTCO products. METHODS: A cross-sectional population-based survey was conducted in the United States. The 35-question survey was disseminated through Amazon Mechanical Turk (Amazon.com, Inc, Seattle, Wash), and participants were asked questions about their demographics, their perceptions of DTCOs, orthodontists, and factors that may influence their decision should they decide to pursue orthodontic treatment. Pearson's correlations were conducted to assess the association between various factors and the participants' likelihood to choose DTCO products. RESULTS: A total of 1441 subjects participated in the study. More than 83% of the participants have considered pursuing orthodontic treatment to some extent. Twenty-three percent reported that they would highly likely choose DTCO products. The majority of participants reported convenience to be the greatest benefit of DTCOs, followed by cost. The majority of responses seemed to favor DTCOs. Forty-seven percent reported that the coronavirus disease 2019 pandemic did not affect their preference, whereas 26.6% reported to be more likely to pursue DTCOs because of the pandemic. CONCLUSIONS: The majority of participants seemed to perceive DTCOs as a viable alternative for seeking orthodontic care. Although participants had concerns about the coronavirus disease 2019 pandemic, results showed that the pandemic might not significantly affect the preferences. Orthodontists and their constituent organizations may consider more robust awareness and advocacy campaigns to educate the population about orthodontic treatment and the benefits of pursuing treatment with a trained orthodontist.

Implementation of teledentistry for orthodontic practices.

Recent advances in technology, growing patient demand, and the need for social distancing due to Coronavirus Disease 2019 has expedited adoption of teledentistry in orthodontics as a means of consulting and monitoring a patient without an in-office visit. However, a lack of computer literacy and knowledge of software choices, and concerns regarding patient safety and potential infringement of regulations can make venturing into this new technology intimidating. In this article, various types of teledentistry systems for orthodontic practices, implementation guidelines, and important regulatory considerations on the use of teledentistry for orthodontic purposes are discussed. A thorough evaluation of the intended use of the software should precede commitment to a service. Selected service should be Health Insurance Portability and Accountability Act compliant at minimum and a Business Associate Agreement should be in place for protection of privacy. Ensuring the compatibility of the designated clinic computer with the system's requirements and installation of all safeguards must follow. Appointments should be documented in the same manner as in-office visits and teledentistry patients must be located within the clinician's statutory license boundary. Informed consent forms should include teledentistry or a supplemental teledentistry consent form should be used. Malpractice insurance covers everything usual and customary under the provider's license but the need for cyber liability insurance increases with teledentistry.