Relationship between occlusion and satisfaction with dental appearance in orthodontically treated and untreated groups. A longitudinal study.

The aims of this study were to assess the relationship between occlusion, satisfaction with dental appearance, and self-esteem at the ages of 11 (T1) and 15 years (T2), and to study perceived treatment effects. Separate questionnaires were completed by children and their parents to determine their attitude. The dental casts of 224 children were collected at T1 and T2, and assessed by the Aesthetic Component (AC) and Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN), and Peer Assessment Rating (PAR) Index. At T2, 16 children had been treated with removable and 51 with fixed appliances, while 157 were untreated. The children in the fixed appliance group had better dental aesthetics (AC) and occlusion (DHC) than those in the two other groups. Average PAR score reduction was 71.6 per cent (T1-T2) and satisfaction with own or child's dental appearance increased significantly. The untreated group showed increased malocclusions. In spite of that, the children expressed higher satisfaction with their own dental appearance at T2 than at T1, while the parents' satisfaction level was unchanged. For the total group, orthodontic concern at T1, AC at T2, and gender accounted for 18.0 per cent of the variation in the children's satisfaction with their own dental appearance. Parents' concern at T1 and AC at T2 accounted for 32.2 per cent of the variation in parents' satisfaction. Improvement in self-esteem from 11 to 15 years was not correlated with treatment changes. A gender difference was found. The answers to the questionnaire indicated that both children and parents rate pleasant aesthetics as an important factor for psychosocial well being.

A radiographic comparison of apical root resorption after orthodontic treatment with a standard edgewise and a straight-wire edgewise technique.

The purpose of this study was to compare the severity of apical root resorption occurring in patients treated with a standard edgewise and a straight-wire edgewise technique, and to assess the influence of known risk factors on root resorption incident to orthodontic treatment. The sample consisted of 80 patients with Angle Class II division 1 malocclusions, treated with extraction of at least two maxillary first premolars. Variables recorded for each patient included gender, age, ANB angle, overjet, overbite, trauma, habits, invagination, agenesis, tooth shedding, treatment duration, use of Class II elastics, body-build, general factors, impacted canines, and root form deviation. Forty patients were treated with a standard edgewise and 40 with a straight-wire edgewise technique, both with 0.018-inch slot brackets. Crown and root lengths of the maxillary incisors were measured on pre- and post-treatment periapical radiographs corrected for image distortion. Percentage of root shortening and root length loss in millimetres were then calculated. There was significantly more apical root resorption (P < 0.05) of both central incisors in the standard than in the straight-wire edgewise group. No significant difference was found for the lateral incisors. Root shortening of the lateral incisors was significantly associated with age, agenesis, duration of contraction period (distalization of incisors), and invagination, while root shortening of the central incisors was related to treatment group and trauma.

Factors influencing the decision about orthodontic treatment. A longitudinal study among 11- and 15-year-olds and their parents.

The aims of the study were to evaluate the attitude towards orthodontic treatment among 11-(T1) and 15-year-old children (T2) and their parents, to present the distribution of referral rate and treatment uptake by a treatment need index assessed at T1 and to elucidate factors influencing the decision about orthodontic treatment in the period from T1 to T2. A group of 359 children and their parents answered separate questionnaires at T1, and 293 families responded to a follow-up study 4 years later. For the clinical examination, 224 children participated after exclusion of children in active treatment. The dental study casts were assessed by the Index of Orthodontic Treatment Need (IOTN). The mean referral rate was 56%, with a variation from 40% to 71% among different dental clinics. About 44% of the children had completed or were undergoing orthodontic treatment at T2. No significant sex differences among referred and treated children were discovered. Aesthetic motives were the most frequently reported subjective reason for orthodontic care. The untreated group expressed diminishing treatment desire in the follow-up period. The logistic regression analysis selected Dental Health Component (DHC) grades as a strong predictor for treatment uptake, followed by parents' concern and attitude to braces, while the 11-year-olds' own orthodontic concern was less significant. Children in the untreated group with late treatment decisions (T2) were best predicted by Aesthetic Component (AC) changes from T1 to T2. The results indicate that dentists play a key role in determining orthodontic treatment levels. High referral rates secured low risk of denying care to some patients. Treatment decision may be guided by the orthodontist. However, individual variation in attitude and desire influence treatment uptake even among children with great need.

Effects of topical metronidazole and tetracycline in treatment of adult periodontitis.

The present study was performed to assess and compare the clinical healing and the microbiological findings following local application of metronidazole or tetracycline to augment subgingival scaling in previously untreated adult periodontitis sites. Eighteen patients with moderate to severe adult periodontitis at single-rooted teeth were selected. In each patient, 3 interproximal sites having comparable root anatomy, probing depth > or =5 mm and bleeding on probing were randomly assigned to 1 of 3 treatment groups: 1) two sessions of subgingival scaling and root planing; 2) similar to 1, with each treatment supplemented with a 25% metronidazole sustained release gel; 3) similar to 1 with each treatment supplemented with a 3% tetracycline ointment. The treatments were performed by 1 operator and the clinical variables probing depth, attachment level, and bleeding on probing were evaluated at baseline, 3 months and 6 months by a second blinded examiner. The microbiological findings were evaluated using a commercial test kit. The average probing depth reduction for the 3 groups at 6 months was 1.5 mm and the average gain of clinical attachment was 0.8 mm. There were no significant differences between the effects following topical application of the metronidazole gel or the tetracycline ointment. Scaling and root planing alone appeared as effective as the drug augmented regimens, although there was a weak but non-significant tendency for better results in sites treated with the antibiotic drugs. Actinobacillus actinomycetemcomitans was generally not detected; Prevotella intermedia was not significantly reduced, while Porphyromonas gingivalis was significantly reduced in all treatment groups. It was concluded that the augmentative effect of the metronidazole gel and the tetracycline ointment was comparable but small compared to scaling and root planing alone. The clinical importance of such small augmentation effects should be further evaluated.

Evaluation of treatment and post-treatment changes by the PAR Index.

To assess the outcome of orthodontic treatment, 224 cases treated in a postgraduate clinic were evaluated. Pre-treatment (T1), post-treatment (T2) and 5-year follow-up (T3) study casts were assessed by the Peer Assessment Rating (PAR) Index. The influence of various factors upon treatment and long-term outcome was analysed. According to the PAR Index, orthodontic treatment reduced the malocclusions on average by 76.7 per cent, and at follow-up the reduction was 63.8 per cent. Follow-up stability was good for 76.3 per cent of the cases. Some cases (4.0 per cent) even improved, while moderate to severe post-treatment relapse occurred in 19.7 per cent of the cases. Orthodontic treatment changed Angle Class I, II and III malocclusions to near ideal occlusion (PAR scores 4.4-6.8). No long-term interaction between the groups was discovered. Sex and extraction/non-extraction treatments did not significantly affect the results. The initial PAR score accounted for 77.8 per cent of the variation in treatment PAR score change (T1-T2), and for 61.8 per cent of the variation of long-term PAR score change (T1-T3). Age at treatment start accounted significantly for the variability of treatment changes (P < 0.001). The PAR score at the end of treatment had some explanatory importance (R2 = 0.099) for the long-term (T1-T3) result. However, PAR score changes in the follow-up period were difficult to predict.

Subjective assessment of dental and psychosocial effects of orthodontic treatment.

The aims of the study were to relate patient satisfaction and perceived psychosocial benefit to professional assessed treatment and long-term outcome. Questionnaires were mailed to 250 patients treated previously in a postgraduate clinic. The response rate was 79%, and the mean age was 28.3 years. Professionally defined outcome was assessed according to the Index of Orthodontic Treatment Need (IOTN) and the Peer Assessment Rating (PAR) index applied to dental casts at the start of treatment (T1), at the end of active treatment (T2) and 5 to 10 years out of retention (T3). Data from 177 cases were used in comparison analysis between patients' and orthodontists' assessments. There was high patient satisfaction with dental appearance (87.0%) and treatment results (77.4%). The aesthetic component of IOTN at T2, PAR score at T3, extraction/non-extraction, pre-treatment concern for dental appearance, sex and treatment time accounted for 33% (R2 = 0.33) of the variability of satisfaction with own dental appearance. Explanatories for self-perceived psychosocial benefit of treatment were pre-treatment concern for dental appearance, aesthetic component at T1 and T3 and PAR score at T3, (R2 = 0.22). Stepwise logistic regression analysis selected change in upper anterior segment (T3-T2) as the most important component of PAR index features for grouping satisfied and dissatisfied individuals (Odds ratio = 0.65) together with satisfaction with own dental appearance (Odds ratio = 7.28). The results indicate some discrepancies between professionally assessed outcome and patient satisfaction and perceived psychosocial benefit. The aesthetic component was a stronger indicator for patient satisfaction and perceived benefit than the PAR index.

A correlation study of inflammatory cell mobilization in response to subgingival microbial colonization.

This study evaluated site-by-site the relations between subgingival microbial colonization and gingival tissue reactions. Experimental, deep periodontal defects were established at buccal surfaces of mandibular and maxillary canine teeth in 5 beagle dogs. The root surfaces were instrumented by a flame-shaped, fine-grained, rotating diamond point, or by a sharp curet. Following a 10-day postsurgical healing period, the dogs were fed a plaque-inducing diet for 70 days. The animals were then sacrificed and tissue blocks of the experimental sites including teeth and periodontal tissues were secured. The buccal gingiva was removed and processed for histomorphometric analysis while the teeth were prepared for scanning electron microscopic evaluation of the extent of subgingival microbial colonization. The results revealed that inflammatory cell density in the junctional epithelium and in the connective tissue were positively correlated to subgingival microbial colonization (P < 0.01). Furthermore, the degree of significance decreased with increasing distance from the plaque. The present study demonstrates that a close relation may exist between the extent of subgingival microbial colonization and inflammatory gingival tissue reactions.

Orthodontic concern among 11-year-old children and their parents compared with orthodontic treatment need assessed by index of orthodontic treatment need.

The aims of the study were to compare the opinions of both the children and the parents with an orthodontist's assessment of treatment need, to investigate the children's self-esteem, and parents' opinion of treatment results. The study group of 359 children (51% girls, 49% boys, mean age 10.6 years) and their parents were asked about their opinions in separate questionnaires. The self-esteem of the children was measured by the global negative self-evaluation scale (GSE). An orthodontist assessed the children's dental casts with the index of Orthodontic Treatment Need (IOTN). Allocated to the dental health component (DHC) of IOTN, 53.2% children had very great to moderate need and 46.8% had little to no need. No sex difference was noted. The children's own assessments of the aesthetic component (AC) of IOTN were closer to the attractive end of the scale than the orthodontist's (p < 0.05). Desire for treatment was more frequent than dissatisfaction with children's occlusion (p < 0.001). The patients' orthodontic concern correlated significantly with both DHC and AC grades (p < 0.001). The children's GSE scores were not correlated to components of IOTN. For children with very great need, high self-esteem was related to orthodontic concern. The parents (90.8%) perceived dental esthetics to be equally important for girls and boys. Most parents (93.0%) thought the results of orthodontic treatment were good. The results indicate meaningful association between orthodontic concern and orthodontic treatment need assessed by IOTN. However, some patients with great need do not express orthodontic concern, whereas others with near ideal occlusion express concern.

Influence of tooth instrumentation roughness on gingival tissue reactions.

Histological studies have demonstrated a relationship between the amount of subgingival plaque and the magnitude and extension of gingival tissue reactions. The objective of the present study was to evaluate inflammatory reactions in the gingival tissues facing plaque accumulation at a diamond and curet-instrumented root surfaces. Experimental, deep periodontal defects were established at buccal surfaces of mandibular and maxillary canine teeth in 5 beagle dogs. The root surfaces were instrumented by a flame-shaped, fine-grained. rotating diamond point, or by a sharp curet. Next, the dogs were fed a plaque-inducing diet for 70 days. The animals were then sacrificed, and tissue blocks of the experimental sites including teeth, alveolar bone, and gingival tissues were secured. The gingival soft tissue was processed for histomorphometric analyses at 3 levels. Epithelium and connective tissue area measurements showed no differences between the two instrumentations. Junctional epithelium (JE) cell point counts exhibited a higher proportion of inflammatory cells (IC)in specimens facing diamond compared to curet-instrumented defects. A higher proportion of IC was present within the coronal compared to the apical aspect of the JE for both instrumentations (P < 0.05). A significant difference in IC density between instrumentations was detected for non-infiltrated (P < 0.05), as well as for infiltrated (P < 0.01) connective tissue. The infiltrated connective tissue (ICT) inflammatory cell density was significantly (P < 0.01) and positively correlated to the JE inflammatory cell density (r = 0.75), and to area measurements of ICT (r = 0.55). The overall results demonstrate that the character of subgingival root instrumentations significantly affects gingival inflammatory reactions, most likely by influencing subgingival plaque formation.

Effect of doxycycline on surgically induced osteoclast recruitment in the rat.

The influence of systemic doxycycline on the number of surgically induced osteoclasts was studied in young albino rats. Forty Wistar rats, aged 50 d at the start of the experiments, were randomly assigned to two groups. The experimental group (20 animals) received 0.5 mg/ml doxycycline added to the drinking water. Mucoperiosteal flaps were raised on the palatal aspect of left maxillary molars in all animals. Two rats from each group were killed daily during a post-operative period of 10 d, and specimens were prepared for light microscopy. Cellular counts in serial sections of crestal bone indicated a delay of initial surface colonization of 2 d. Statistical analysis revealed a smaller number of osteoclasts in doxycycline-treated animals as compared to control rats. In conclusion, systemic doxycycline suppresses recruitment of osteoclasts following surgery.

Severe overjet and overbite reduced alveolar bone height in 19-year-old men.

Few investigations have reported convincing evidence of an association between malocclusion and loss of periodontal tooth support. The contradictory findings may in part be explained by the selection of material and by method differences. In many studies not-very-severe malocclusion was compared with not-very-correct occlusion. Only recently have measuring methods been developed that calculate the distance between the cementoenamel junction (CEJ) and the interproximal alveolar bone crest (AC) to the nearest 0.01 mm with acceptable accuracy. The association between overjet > or = 8 mm and the reduction of the bone support as expressed by the distance between CEJ and AC in 21 military recruits was compared with a peer group of 50 recruits with nearly ideal occlusion. The results showed a significant reduction of bone height (mean = 0.96 mm) of the four upper front teeth and of the four lower incisors (mean = 0.35 mm) in the malocclusion group. Similarly, a group of 31 army recruits with overbite > or = 6 mm revealed a significant reduction of bone height of 0.71 mm of the upper front teeth and 0.49 mm of the lower front teeth. Overjet and overbite did not appear in combination in this material. In conclusion, alveolar bone height was reduced in regions with severe malocclusion when compared with corresponding regions in healthy men with near ideal occlusion. The material was military recruits (age 19 years).

Predictor evaluation of postoperative morbidity after surgical removal of mandibular third molars.

The effect of several pre- and per-operative variables on indicators of postoperative morbidity was assessed in 204 patients after unilateral mandibular third-molar surgery. The variables included gender, age, use of tobacco and alcohol, state of eruption, depth and angulation of the tooth, duration of the operation, pericoronitis, and time of day of surgery. Visual analogue scales were used for patient assessment of pain and swelling and for clinical assessment of swelling. Maximum pain was indicated 6 h postoperatively and maximum swelling the first postoperative evening. The results showed a mean reduction of mouth opening capacity (trismus) of 31% the 1st postoperative day. Mean analgesic consumption was 3.7 tablets, mean number of days of inability to work 1.1, and the rate of postoperative alveolitis 1.9%. The variation of the morbidity indicators was considerable. Multiple classification analyses showed that the predictors explained from 17% (clinically assessed swelling) to 8% (pain 6 h postoperatively) of the variance of these indicators. It is concluded that these commonly used predictors only to a minor extent can explain the wide variation in postoperative morbidity after mandibular third-molar surgery.

Duration of vecuronium-induced neuromuscular blockade predicted by dose and onset time.

We investigated the adequacy of using dose and onset time as variables to predict the duration of action of vecuronium in patients. The onset time until 95% twitch depression and the duration until 25% twitch recovery were measured for doses ranging from 0.1 to 0.3 mg kg-1. Statistical analyses were performed by simple and multiple regressions. The duration of action was better predicted by dose (r2 = 0.61) than by onset time (r2 = 0.51). However, the predictability was significantly improved by a multiple regression model of the variables, and the explanatory power was largest when using the square root of duration as the dependent variable (r2 = 0.69). We conclude that the duration of neuromuscular blockade after vecuronium can be predicted more accurately by the combined use of dose and onset time than by dose alone.

Symptoms and lesions associated with retained or partially erupted third molars. Some variables of third-molar surgery in Norwegian general practice.

A questionnaire on third-molar problems was mailed to a systematic random sample of 200 Norwegian general dental practitioners in November 1991. A 88% return rate was obtained. The following conclusions were drawn: on an average, 3.8 patients with lesions or complaints from retained or partially erupted third molars were seen in general practice in 1 month, and most of these consultations were associated with partially erupted third molars. A mean of 1.3 surgical removals of third molars was performed in general practice in 1 month. The mean one-way travel time for patients to specialists in oral surgery was 1.3 h, and variations were not related to surgical activity in practice. Fourteen per cent of the general practitioners refer surgical cases to non-specialists.

Orthopedic protraction of the upper jaw in cleft lip and palate patients during the deciduous and mixed dentition periods in comparison with normal growth and development.

Cleft lip and palate (CLP) patients often develop maxillary retrusion after cleft repair. Since 1977, a group of 98 cases with negative overjet (anterior crossbite) during the period of deciduous dentition has been treated by the Bergen CLP team. The purpose of treatment has been to achieve favorable occlusion with positive overjet and overbite by means of anterior orthopedic traction (protraction). The average age at start of treatment was 6 years 11 months, and mean treatment duration was 13 months. The protraction force was 700 g. The serial lateral cephalograms of the treated CLP group were compared with those of a noncleft group with normal growth. Normalization of the sagittal maxillomandibular relationship (ANB angle) was achieved. Significant changes were a more anterior position of the upper jaw, and a more posterior position of the lower jaw, due to mandibular clockwise rotation. The variation was considerable. This paper reports the overall changes in the whole CLP group (ALL-C group).

Intercanine widening and sagittal effect of maxillary transverse expansion in patients with cleft lip and palate during the deciduous and mixed dentitions.

Since 1977 cleft lip and palate (CLP) patients with maxillary deficiency have received an interceptive orthopedic treatment consisting of (a) transverse expansion, (b) protraction, and (c) fixed retention. Ideally the treatment should be completed early enough to permit spontaneous eruption of the maxillary permanent incisors into normal occlusion without orthodontic intervention. The early transverse expansion considerably increases space so that unerupted malpositioned incisors spread out spontaneously, creating optimal conditions for eruption and root formation. Dental diagnosis in the cleft areas is made easier. Posterior crossbites in 112 CLP patients were expanded with a modified quad-helix appliance cemented with four bands in the deciduous or mixed dentition. Intercanine widening was about 3 mm per month regardless of cleft type. Several authors have claimed that transverse expansion of the upper jaw will increase sagittal overjet. Other authors have not found such an effect. The sagittal effect on the maxilla was studied in 68 CLP patients who had received transverse expansion. Analysis of the lateral cephalograms revealed no significant sagittal dentofacial maxillary treatment effects involving forward movement of maxilla, but a downward clockwise rotation of the mandible was found.

Skeletofacial changes by mandibular advancement using sagittal split osteotomies.

Forty-five patients with mandibular retrognathism treated by surgical mandibular advancement by sagittal split osteotomies were evaluated cephalometrically before treatment at the intermaxillary fixation release, and 6 months postoperatively. The treatment resulted in appreciable improvement of the mandibular retrognathism, and the facial morphology was changed positively toward normal values. The mandibular prognathism was accomplished by an anterior displacement of the mandibular corpus and by a slight increase of the mandibular corpus length. The anterior facial height and the mandibular plane angle were increased by a clockwise rotation of the anterior segment and a counterclockwise rotation of the posterior segment, which consequently increased the gonial angle. These changes partly reversed during the postfixation period. Dentoalveolar changes were found in the position of the maxillary and mandibular incisors; both were uprighted, the mandibular incisors more than the maxillary incisors. In general, the long-term positive effects of the surgical mandibular advancement revealed great stability.

Prevalence of malocclusion and need for orthodontic treatment in Saudi Arabia.

The prevalence of different malocclusion features was investigated in 500 14-yr-old male Saudi Arabian children, using a modification of the registration method described by Björk et al. (3). Most of the children were in dental stage DS4 (all permanent teeth anterior to the first molars erupted). Totally 62.4% of the children had one or more malocclusion features related to dentition, occlusion, or space. The treatment need was evaluated according to the guidelines used in the Norwegian Health Service. About 40% were found to need treatment with fixed appliances, and for 33% extraction of permanent teeth would be part of the treatment. Only about 2.5% would benefit from treatment with simple removable appliances.

Malocclusion in 12-year-old Sudanese children.

Malocclusions are generally less common among African and Arab children than Europeans. This difference may be due to racial as well as external and environmental factors. Angle CI. III malocclusion is, however, more common among African and Arab children than in Europeans, whereas the opposite is found for Angle CI. II malocclusions. Space conditions are better in African and Arab than in European populations. The aim of the study was to assess the prevalence of malocclusion in 12 year old Sudanese children using the method for epidemiological registration devised by Björk, Krebs and Solow. The majority of the children had Angle CI. I (normal and malocclusion), followed by CI. II and CI. III malocclusion. Sagittal, vertical and transversal occlusal anomalies were not common. The number of the abnormal conditions found in the survey suggests that public awareness and preventive orthodontics are important fields when the future orthodontic service in Sudan is organized.