Iatrogenic retroposition of the lips sequel after bicuspid extraction-a retrospective study.

AIM: This study aims to explore the prevalence of Iatrogenic retroposition of the lips sequel (IRLS) after bicuspid extraction, associated dentofacial characteristics and the effectiveness of surgical treatment. MATERIAL: and methods: Patients with bicuspid extraction as part of an orthodontic treatment plan were retrospectively included. IRLS was identified by clinical evaluation and cephalometric Legan and Burstone analysis. Association of demographic and cephalometric variables were assessed. The effectiveness of combined orthodontic-orthognathic correction of the retroposition of the lips was evaluated. RESULTS: Out of 144 patients with extracted bicuspids, eight Class I patients, nine Class II patients and five Class III patients were seeking treatment because their lips had retruded as a consequence of compensating orthodontic treatment. Lower jaw bicuspid extraction and a decreased vertical facial height in Class II patients correlated significantly more with IRLS development. Postoperative cephalometric analysis of orthodontic-orthognathic treated patients reported improvement in lip projection and naso-labial angle. Only two Class I patients reported postoperative normalization of the lip position according to Legan and Burstone. CONCLUSION: The consequence of bicuspid extractions on soft tissue profile differs according to skeletal jaw relation. The impact of orthognathic surgery on IRLS is beneficial, although insufficient to completely correct the facial profile when judged on cephalometric standards.

The promise of self-determination theory to study the therapist-client relationship in speech-language treatment.

This study aims at examining the therapist-client relationship in speech-language treatment and its relationships with clients' motivation from the perspective of Self-Determination Theory (SDT). It adds to the current literature by relying on observations as well as client perceptions of the therapists' interaction style and by studying three different age groups of adults (>18 years old), adolescents (12-18 years old) as well as children (<12 years). Two convenience samples: 1) 42 Speech Language Therapists (SLPs; 95.2 % female) and 72 individuals with communication disorders (ICDs) (72.2 % female;>12 years old), and 2) 21 SLPs (100 % female) and 44 ICDs (50 % girls; <12 years) were recruited for this cross-sectional study. After engaging in a treatment session, ICDs responded to a set of validated questionnaires measuring the SLPs' motivating style, their need-based experiences and motivation towards the treatment. Moreover, each treatment session was observed. Both client-reported as well as observational measures show that SLPs more strongly evince an autonomy-supportive (i.e. motivating) when compared to a controlling (i.e. demotivating) style to the benefit of their clients' motivation. The display of empathy was the most frequently observed strategy. SLPs regularly provided rationales, choices, and opportunities for clients to experiment. However, these behaviors were more frequent in younger compared to older clients. With the younger clients, SLPs frequently used effort-contingent rewards, which is considered a controlling strategy in SDT. Results showed that motivational benefits may be expected if SLPs rely on an autonomy-supportive rather than a controlling style. This study provides a valuable starting point for an SDT-driven examination of the therapist-client relationship and ICD's motivation in the context of speech-language pathology.