Postgraduate orthodontic education: An international perspective on content and satisfaction levels.

BACKGROUND: There is significant international variation in the postgraduate orthodontic training. The aim of this study was to obtain information relating to the design, content, and delivery of formal postgraduate orthodontic training internationally. Moreover, we aimed to evaluate the perception of orthodontists towards their training as well as identifying factors associated with an improved level of satisfaction. METHODS: A 42-question survey was sent to orthodontists worldwide via SurveyMonkey. The survey was circulated on orthodontic Facebook groups and through other digital channels including Instagram. RESULTS: A total of 168 respondents completed all sections of the questionnaire. The vast majority believed programme length was appropriate (n = 150; 89%). Most respondents were confident with their research skills and in their ability to diagnose and treatment plan. Social media was frequently accessed by the respondents for the purposes of orthodontic education (n = 83; 49%). A high proportion (n = 70; 42%) did not treat any clear aligner cases during postgraduate training with many having experience using InvisalignTM only. The majority of respondents across the regions had training in buccal miniscrew insertions. Exposure to three-dimensional printing during residency was limited. CONCLUSIONS: The study offers an overview of the structure, content, and modes of delivery in orthodontic postgraduate training internationally. While satisfaction levels are good, there is a disparity in terms of exposure to certain techniques internationally. Further training in the modern diagnostic approaches and mechanics may improve satisfaction with postgraduate training.

Clear Aligner Orthodontics: What is the Evidence for their Efficacy?

Orthodontic treatment with the Invisalign® appliance (and other clear aligners) may be more aesthetically appealing to most adult patients when compared with conventional fixed appliances. When the first clear aligner systems were introduced into the market some 20 years ago, they were very basic in their mode of force delivery. In the last ten years, the Invisalign® system has undergone some remarkable changes and refinements in order to deliver more predictable treatment outcomes and allow for the treatment of more complex malocclusions. However, there remains an issue in terms of differences between the predicted and achieved tooth movements. Some tooth movements are more difficult to achieve than others. This article aims to examine the evidence of effectiveness and predictability of Invisalign® appliances for the correction of different tooth movements.

An analysis of dental articles in predatory journals and associated online engagement.

OBJECTIVE: We aimed to assess the extent of social media sharing of presumed predatory (PP) dental journals and to compare level of engagement, type of accounts and characteristics of the articles published in presumed legitimate (PL) and PP journals. METHODS: Six hashtags were searched across three social media platforms (Instagram, Facebook and Twitter). Data extraction was performed and journals were classified into PP or PL in a multistep approach using MEDLINE, Beall's list and Directory of Open Access Journals (DOAJ). A checklist was created and used for studies not found in the aforementioned recognized databases. RESULTS: A total of 1742 posts were identified, with the majority (94%) found on Instagram. Of the identified journals, 15.6% were PP. Over one-third of articles from PP journals (35.42%) were indexed on PubMed. The majority of presumed legitimate publications were published in dental specialty only journals (56.44%), compared to 24% in the PP group. The majority of accounts were those of healthcare professionals with most publications related to prosthodontics and implantology (26.3%) and restorative and esthetic dentistry (14.4%), in PL and PP groups, respectively. Similar median number of followers/friends and comments were found among the PL and PP groups. CONCLUSION: Our findings highlight that presumed predatory publications have comparable reach to PL journals on social media risking the sharing of unreliable and misleading information. CLINICAL SIGNIFICANCE: Researchers, students and social media users should be capable of identifying presumed predatory dental publications. Means of moderating the influence of these publications should be explored.

The effectiveness of adjuncts or alternatives to the use of orthodontic retainers in preserving posttreatment outcomes: A systematic review.

INTRODUCTION: The objective of this study was to systematically evaluate the efficacy of adjuncts or alternatives to mechanical retention in preserving postorthodontic treatment outcomes. METHODS: Electronic databases, unpublished literature, and ongoing trials were searched until July 22, 2022 (PROSPERO CRD42021291165). Randomized and nonrandomized controlled trials investigating the efficacy of adjuncts and alternatives to conventional orthodontic retainers were included. Stability, periodontal effects, cost-effectiveness, and patient-reported outcomes were to be evaluated. The Cochrane Risk of Bias Tool and Risk of Bias In Nonrandomized Studies of Interventions (ROBINS-I) were used for risk of bias assessment. The certainty of the evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation system. Exploratory sensitivity analysis was undertaken to calculate the weighted treatment effects of the intervention. RESULTS: A total of 5128 records were screened. Seven trials fulfilled the inclusion criteria, of which 5 were randomized controlled trials. Five trials were judged to be at high risk of bias, with 2 studies of unclear risk of bias. Heterogeneity between the limited number of included studies precluded the conduct of meta-analysis. Circumferential supracrestal fibrotomy resulted in less increase in the mandibular Little's Irregularity Index (mean difference, -2.30 mm; 95% confidence interval, -2.86 to -1.74). The overall level of evidence was of very low quality. CONCLUSIONS: Adjuncts and alternatives to mechanical retention have promise, but based on the existing evidence, the reliance on mechanical retention cannot be reduced. There is weak evidence supporting circumferential supracrestal fibrotomy to improve stability outcomes. Further high-quality prospective research focusing on the predictability and acceptability of these approaches is needed.

Blanket or tailored prescription of retainers in orthodontics: a questionnaire-based study.

OBJECTIVE: To explore retainer protocols and how they are influenced by orthodontic presentation and the nature of occlusal correction. MATERIALS AND METHODS: A prepiloted 45-item online questionnaire targeting orthodontists was developed. The questionnaire covered clinical preferences in terms of retainer type, fabrication, and follow-up during retention; the clinical indications for adjunctive surgical procedures; and the use of active designs to mitigate relapse in specific malocclusions. RESULTS: A total of 206 responses were obtained. The majority of the respondents prescribed maxillary removable and mandibular fixed retainers, with almost half (49.1%) reviewing patients for more than 1 year primarily in person (95.1%). The majority prescribed vacuum-formed (69.6%) 1-mm-thick (44.3%) retainers. Only 37.3% were aware of the type of material used, with polyethylene terephthalate glycol copolymer, followed by polypropylene, being the most common. Hawley retainers were preferred following nonsurgical maxillary expansion and with suboptimal interdigitation. A preference for clear retainers and/or fixed retainers was found in open-bite cases and deep-bite cases. Supracrestal fiberotomy was prescribed commonly (61.1%) for rotations greater than 90°. No retainer was rarely prescribed except after the correction of an anterior crossbite. CONCLUSIONS: Blanket prescription of orthodontic retention is common, with limited awareness of clear plastic retainer materials. Future trials evaluating the effectiveness of approaches for retainer prescription based on the presenting malocclusion would be timely.

How to appraise the literature: basic principles for the busy clinician - part 2: systematic reviews and meta-analyses.

With the increasing numbers of primary research papers being published in dentistry and healthcare in general, it is almost impossible for busy clinicians to keep up with the literature. Reviews summarising the outcomes of trials can therefore be a considerably efficient tool for obtaining the relevant information about what works and what does not. To this end, systematic reviews are critical in summarising the best available evidence and providing an indication of its strength. However, as with clinical trials, they can be difficult to interpret, of varying quality and dependent on the studies they include. This is the second part of a two-part series and will discuss the principles of critically appraising systematic reviews and meta-analyses. It follows on from part one, which focused on appraising randomised controlled trials.

How to appraise the literature: basic principles for the busy clinician - part 1: randomised controlled trials.

Critical appraisal is the process of carefully, judiciously and systematically examining research to adjudicate its trustworthiness and its value and relevance in clinical practice. The first part of this two-part series will discuss the principles of critically appraising randomised controlled trials. The second part will discuss the principles of critically appraising systematic reviews and meta-analyses.Evidence-based dentistry (EBD) is the integration of the dentist's clinical expertise, the patient's needs and preferences and the most current, clinically relevant evidence. Critical appraisal of the literature is an invaluable and indispensable skill that dentists should possess to help them deliver EBD.This article seeks to act as a refresher and guide for generalists, specialists and the wider readership, so that they can efficiently and confidently appraise research - specifically, randomised controlled trials - that may be pertinent to their daily clinical practice.

The reach, influence and tenor of professional orthodontic societies on social media: A cross-sectional content analysis.

BACKGROUND AND OBJECTIVES: Orthodontic societies should support the profession and improve patient awareness. We aimed to investigate the scope and influence of orthodontic societies on social media. METHOD: A total of 120 orthodontic societies were identified on the World Federation of Orthodontists (WFO) affiliates list. Presence of orthodontic societies on Instagram, Facebook and Twitter was ascertained. All societies with Instagram accounts were included for further analysis of the nature and content of posts as well as user engagement. Pilot coding and thematic analysis were undertaken (n=200 posts). The most recent 20% of the total number of posts for each account were then analysed for content. RESULTS: Only 10 (8.3%), 34 (28.3%) and 52 (43.3%) orthodontic societies had accounts on Twitter, Instagram and Facebook, respectively. A total of 2124 Instagram posts were analysed. On average, 318 posts were identified per account (range=1 to 1901). The average number of followers was 2337 (range=85 to 11,400) with average user engagement of 1.25% (range=0.0%-7.17%). A total of 6 themes (subthemes; n=28) were identified including "announcements on professional events" (51.6%), "patient education, enlightenment and commendation" (26%), "running and operation of the society" (9.1%), "highlighting research and evidence" (3.1%), "COVID-related advice and updates" (4%) and "observance and commemoration" (10.4%). The posts targeting patients were limited (18.7%). CONCLUSIONS: The limited reach of the accounts of international orthodontic societies highlights the need to develop a more effective and influential social media presence. Orthodontic societies should involve members, providers and patients in developing more effective social media resources.

Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 1: assessment and management.

There remains debate as to whether, when there is a missing maxillary lateral incisor, space should be orthodontically opened to allow for prosthetic replacement or closed to camouflage the canines to substitute the absent lateral incisor by recontouring and simple restorative procedures. Each case presents its own features which will help decision making. Treatment planning these cases is multifactorial in nature and the decision ultimately depends on factors such as the malocclusion; inter-arch and intra-arch relationship; and canine properties (size, colour and shape). The ideal treatment is the most conservative one that satisfies the individual's aesthetic and functional requirements. Often, but not always, it is therefore space closure with camouflaging of the canines as lateral incisors. Multidisciplinary planning and delivery of care is essential and 'mandatory' in the delivery of optimal outcomes. The first part of this two-part series will discuss the principles of assessment, diagnosis and management. The second part will discuss the challenges encountered and possible solutions.

Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 2: challenges and solutions.

The developmental absence of permanent maxillary lateral incisors is a common developmental anomaly and presents clinical challenges. The maxillary lateral incisor is the second most common developmentally absent tooth after the mandibular second premolar, therefore can present frequently in practice. Patients with hypodontia of the maxillary lateral incisor present clinical challenges in relation to function and aesthetics. In part one of this two-part series, we focused on the assessment, diagnosis and management. In this part, we will discuss some of the frequently encountered challenges in canine camouflage cases and possible solutions.

Decision making regarding management of compromised first permanent molars in patients with molar incisor hypomineralisation: A comparison of orthodontists and paediatric dentists.

OBJECTIVES: To obtain the views and opinions of specialist members of the British Orthodontic Society (BOS) and British Society of Paediatric Dentistry (BSPD) in relation to (1) the multidisciplinary management of patients affected by molar incisor hypomineralisation (MIH) and (2) the diagnosis and management of MIH-affected first permanent molars (FPMs) in four clinical scenarios, and compare the responses to those of an expert panel consensus. DESIGN: A prospective cross-sectional study. SETTING: Part 1: Eastman Dental Institute and part 2: online questionnaire. METHODS: Four clinical scenarios showing patients with differing severities of MIH affected FPMs were considered by a panel of orthodontists and paediatric dentists to agree on the severity of MIH and management. A 21-item online questionnaire sent to both specialist groups, after pilot study. The questionnaire covered demographics, access to multidisciplinary clinics, clinicians' opinions on various management aspects, and questions relating to the management of the same 4 clinical scenarios. RESULTS: The overall response was 21.9% (20% of the orthodontists and 45% of the paediatric dentists). Approximately half of the respondents from both groups felt that these patients should be managed through a multidisciplinary treatment type clinic (49.0% of the orthodontists and 47.2% of the paediatric dentists). Only 40.3% of the orthodontists and 35.0% of the paediatric dentists agreed completely with the panel consensus on all management options. When assessing overall agreement on all four FPMs for all scenarios, agreement was predicted by severity of MIH (P<0.001) and complexity of malocclusion (P<0.001) where more complex malocclusions and more severe MIH resulted in poorer agreement, but specialty was not a significant predictor (P=0.21). CONCLUSION: The majority of the respondents from both groups, felt that managing patients with MIH affected FPMs is challenging. Approximately half of the orthodontists and the paediatric dentists, felt that MIH affected patients should be managed through a multidisciplinary type clinic. Managing more severe cases on multidisciplinary clinics is indicated, to incorporate specialist input into decision making.

The influence of mobile applications and social media-based interventions in producing behavior change among orthodontic patients: A systematic review and meta-analysis.

INTRODUCTION: The objective of this project was to systematically review the effectiveness of mobile applications and social media-based interventions in producing a behavioral change in orthodontic patients. METHODS: Electronic databases and reference lists of relevant studies were searched on March 1, 2021, with no language restrictions (PROSPERO: CRD42019157298). Randomized and nonrandomized controlled trials assessing the impact of mobile applications and social media-based interventions on orthodontic patients were identified. Primary outcomes included adherence to wear, appointment attendance, knowledge, oral health-related behaviors, oral hygiene levels, periodontal outcomes, and related iatrogenic effects. The quality of the included trials was assessed using the Cochrane risk of bias tools. A weighted treatment effect of interventions on periodontal outcomes was calculated. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: A total of 3617 articles were identified. Of these, 16 studies (14 randomized controlled trials and 2 nonrandomized controlled trials) were deemed eligible. Nine randomized controlled trials were judged to be of either low or unclear risk of bias. The intervention was favored in relation to gingival and plaque indexes, standardized mean difference: -0.81 (95% confidence intervals [CI], -1.35 to -0.28) and -0.91 (95% CI, -1.64 to -0.19), respectively. However, no significant effect was observed in bleeding on probing (standardized mean difference: -0.22; 95% CI, -0.5 to 0.05). The level of evidence was high in probing depth and bleeding on probing outcomes. CONCLUSIONS: A very low to moderate level of evidence supports the effects of mobile applications and social media-based interventions in producing positive behavioral changes in orthodontic patients. Further high-quality trials would assist in further elucidating the potential of these approaches to influence orthodontic treatment outcomes and experiences.

The nature and accuracy of Instagram posts concerning marketed orthodontic products.

OBJECTIVES: To scrutinize claims contained within Instagram posts related to six popular marketed orthodontic products. MATERIALS AND METHODS: Three hundred publicly available Instagram posts were identified using the following Instagram hashtags: #carrieremotion, #damonbraces, #invisalign, #acceledent, #propelorthodontics, and #myobrace. Pilot coding was undertaken on a subset of claims (n = 50) and a coding guide was developed. The associated claims were categorized under 24 recognized themes and their accuracy assessed on a five-point scale. RESULTS: Of 1730 posts screened, 300 were included for analysis. The majority of posts were based on photographs (n = 244, 81.3%) with the remainder (n = 56, 18.7%) including videos. Half of the posts involved a picture of the product in isolation (n = 150, 50%), with clinical cases presented in a minority (n = 99, 33%). Overall, 472 claims were included with treatment duration being the most frequent theme (n = 125, 26.5%). In terms of accuracy, most of the claims were judged to be "false" (n = 283, 60%) with less than 2% considered "objectively true." CONCLUSIONS: Most of the claims relating to six popular marketed orthodontic products concerned treatment duration. The vast majority of these claims were not supported by evidence and were judged to be false. Efforts should be made to promote the provision of accurate orthodontic information and to verify marketing claims on social media platforms.

Does the exposure to 'ideal' facial images on Instagram influence facial and bodily satisfaction?

Design Randomised controlled trial.Intervention Undergraduate students aged 18 to 35 years were randomly allocated to either navigate a bespoke Instagram page featuring 'ideal' facial images as judged by five orthodontists (n = 71) or neutral images of nature (n = 61). Participants were allowed to view the Instagram page once and for a duration of five minutes.Outcome measures The primary outcome was facial dissatisfaction which was measured using the Facial Satisfaction Scale (FSS). Secondary outcomes included: body dissatisfaction, which was measured using the Body Satisfaction Scale (BSS), and overall body and facial dissatisfaction, measured as a sum of scores of BSS and FSS.Data analysis Data were analysed using repeated measures analysis of variance (ANOVA) and multivariate regression analyses.Results Exposure to 'ideal' facial images on Instagram resulted in significantly lower facial satisfaction scores (-2.39; 95% confidence interval [CI]: -4.32, -0.46 P <0.016), with no significant difference in BSS (-2.74; CI: -5.66, 0.19) and overall scores (-3.49; CI: -6.10, -0.87) when compared to the control group. Based on the multivariate regression analysis, high baseline self-discrepancy scores negatively affected both FSS and BSS.Conclusions Exposure to 'ideal' facial images on Instagram resulted in an immediate and negative impact on FSS when compared to neutral images of nature. While this study is interesting, further robust research to clarify the effect of various social networking sites on facial and bodily satisfaction remains necessary.

A novel and simple technique for correcting localised rotations in the early alignment stage.

Correcting severe tooth rotations can be challenging. There are many ways to de-rotate teeth with fixed or removable appliances. Mechanically, the best and most effective way is one that produces a two-force couple system to rotate a tooth around its centre of rotation (longitudinal axis). The aim of this article was to introduce a simple and efficient technique using a closed coil to correct localised tooth rotations in the early alignment stage, utilising a simple two-force couple system. Furthermore, some of the biomechanical principles concerning de-rotation will be revisited.

Patient focused oral hygiene apps: an assessment of quality (using MARS) and knowledge content.

Introduction Smartphone apps can be a valuable means for education and prevention to improve the health of children, adolescents and adults. A recent review of apps has revealed that there are over 1,000 patient-focused oral hygiene apps available on the Apple App Store and Google Play (Android) store.Objective The purpose of this research is to objectively assess the quality of 20 commercially available, patient-focused oral hygiene apps using the Mobile App Rating Scale (MARS). Furthermore, the accuracy of oral hygiene-related information contained within the apps will be assessed.Methods Apps meeting inclusion criteria were evaluated for: 1) quality using the MARS tool; and 2) information accuracy using an eight-item, evidence-based checklist relating to important aspects in the prevention of caries and periodontal disease.Results The mean app quality score was 3.4/5 (2.3-4.9). On average, of the four MARS subscales assessed, 'functionality' had the highest mean score (4) and 'information' had the lowest (2.9). With regard to the accuracy of information contained within these apps, only two were found to contain accurate information for all eight items of the checklist. The majority (60%) of the apps (n = 13) did not contain information relating to at least 50% or more of the items present.Conclusions Currently available apps appear to be functional, however, there is a need to improve engagement, aesthetics and most importantly information content of apps.

Miniscrews for orthodontic anchorage: a review of available systems.

INTRODUCTION: In recent years, extensive research has introduced novel ways of reinforcing orthodontic anchorage using a variety of devices temporarily anchored in bone (miniscrews). Currently, there are numerous manufacturers with different miniscrew designs on the market. AIMS: The aim of this paper is to discuss the key design features of different miniscrew systems on the market. Furthermore, to present clinical selection criteria of miniscrews in different settings taking into account the determinant factors. METHODS: Review of the literature was carried out using the following search methods: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The search was focused on studies published until January 2018. RESULTS: We studied each individual miniscrew from all the identified manufacturers in details. All the features were then summarised and presented as a clinical guideline for the selection of miniscrews. CONCLUSIONS: In this article, we reviewed the development of miniscrews and outlined the general design features of miniscrews as well as specific design features of the current miniscrews in the market. Extensive research of the current products was carried out to help clinicians better understand the difference between the various designs of miniscrews that can be used.

Mandibular implant-supported overdentures: attachment systems, and number and locations of implants--Part I.

The use of dental implants in replacing missing teeth is an integral part of restorative dental treatment. Use of conventional complete dentures is associated with several problems such as lack of denture stability, support and retention. However, when mandibular complete dentures were used with two or more implants, an improvement in the patients' psychological and social well-being could be seen. There is general consensus that removable implant-supported overdentures (RISOs) with two implants should be considered as the first-choice standard of care for an edentulous mandible. This treatment option necessitates the use of attachment systems that connect the complete denture to the implant. Nevertheless, each attachment system has its inherent advantages and disadvantages, which should be considered when choosing a system. The first part of this article provides an overview on options available to restore the mandibular edentulous arch with dental implants. Different types of attachment systems, their features and drawbacks are also reviewed.