LTCOS Data Management: CHPE and PDC.

The purpose of this short essay is to describe the data management processes utilized in the Long Term Career Outcome Study at the Center for Health Professions Education and the Postgraduate Dental College of the Uniformed Services University. It includes descriptions of our workflow, how we obtain the data, challenges, and recommendations based on our experience for data managers and institutions to follow. This descriptive writing may help guide practice for other institutions looking to streamline their data management plan.

Frameworks to Guide Faculty Development for Health Professions Education: A Scoping Review.

INTRODUCTION: The authors explored the existence of explicit definitions, guiding competency frameworks, and learning theory to inform health professions education faculty development (FD) programs. The authors analyzed identified frameworks based on thematic focus, scope of targeted faculty, and design structure. METHODS: A scoping review was used to identify health professions education literature between 2005 and 2020. Frameworks were characterized according to the scope of the faculty targeted and design structure, and then, domains were grouped into topical categories for analysis. RESULTS: Twenty-three articles met the criteria for data extraction, of which only one (4.3%) described the explicit use of a learning theory and three (13%) included an explicit definition of FD. One (4.3%) used a recognized framework, whereas 12 (52.2%) developed a novel framework based on an existing outline. Ten (43.5%) described de novo framework development. Only three (13.0%) used entrustable professional activities or similar constructs. Five (21.7%) programs targeted multiple health professions, 11 (47.8%) targeted a single health profession, and seven (30.5%) targeted a specific specialty within a health profession. Only two frameworks included a developmental component. DISCUSSION: Few authors describe an explicit definition, learning theory, or use a pre-established framework when framing their FD programs. The use of entrustable professional activities to structurally link competencies to work practices is also uncommon, as well as the use of developmental structures designed to support progressive FD over time.

Assessing the accuracy of two posterior tooth-size discrepancy prediction methods based on virtual occlusal setups.

OBJECTIVE: To assess accuracy of the Bolton and Johnson/Bailey (JB) analyses in identifying clinically significant posterior tooth-size discrepancies using virtually constructed occlusal setups. MATERIALS AND METHODS: Virtual models and cone-beam computed tomography data sets from 30 patients were utilized to construct 60 (two per patient) virtual posterior occlusal setups. Observed discrepancies in cusp-embrasure relationships were compared to estimated posterior interarch tooth-size discrepancies (ITSDs) calculated via Bolton and JB posterior analyses. Clinical significance for discrepancies was established at >1 mm from ideal cusp-embrasure relationships in accordance with current American Board of Orthodontics methodology. Data within groups were normally distributed, thus comparisons were completed via paired t-tests. Paired nominal data were analyzed utilizing McNemar's test, and simple linear regression was used to model the relationship of predicted to observed discrepancies. RESULTS: McNemar's test revealed significant differences (P ≤ .05) between the Bolton and JB groups' frequencies in matching the virtual setups correctly. JB predictions matched 100% (right) and 97% (left) setups; whereas, Bolton predictions matched only 23% (right and left) setups. A positive correlation was observed between JB predictions and cusp-embrasure discrepancies, demonstrating that average posterior discrepancy values increased 0.28 mm for every 1 mm predicted via the JB analysis. CONCLUSIONS: The JB analysis correctly characterized, but overestimated, the degree of posterior ITSDs corresponding to a clinically significant discrepancy in the virtual setups. Algebraically calculated posterior ITSDs based on the Overall and Anterior Bolton ratios were not accurate predictors of discrepancies observed in the virtual setups. Both Bolton and JB demonstrated weaknesses that limit precise identification of clinically significant ITSDs.

Analysis of Class II patients, successfully treated with the straight-wire and Forsus appliances, based on cervical vertebral maturation status.

OBJECTIVE: To assess skeletal and dental changes in patients successfully treated with the Forsus appliance based on cervical vertebral maturation status. METHODS: Forty-seven Class II patients, successfully treated with the Forsus appliance, were divided into peak and postpeak growth groups determined immediately prior to Forsus placement. The mean (SD) ages of the peak and postpeak groups were 13.4 (1.0) and 14.1 (1.3) years, respectively. Superimpositions of initial, Forsus placement, Forsus removal, and final cephalometric radiographs were completed, allowing the measurement of changes during three treatment phases. RESULTS: There were no significant differences between groups during treatment phase 1 (alignment/leveling), with both groups demonstrating a worsening of the Class II molar relationship. However, during treatment phase 2 (Class II correction), patients within the peak group demonstrated significantly higher mean apical base, mandibular and molar changes, and an increased rate of change compared with those in the postpeak group. No significant differences were observed during treatment phase 3 (detail/finishing). CONCLUSIONS: Following an initial worsening of the Class II molar relationship as a result of straight-wire appliance effects, Forsus appliance treatment initiated during cervical vertebral maturation status (CS) 3-4 elicits more effective and efficient correction of Class II molar relationships than when initiated during CS 5-6. Data support that these effects are due mainly to maxillary skeletal and dentoalveolar restraint during a period of more rapid mandibular growth.

Three-dimensional reproducibility of natural head position.

INTRODUCTION: Although natural head position has proven to be reliable in the sagittal plane, with an increasing interest in 3-dimensional craniofacial analysis, a determination of its reproducibility in the coronal and axial planes is essential. This study was designed to evaluate the reproducibility of natural head position over time in the sagittal, coronal, and axial planes of space with 3-dimensional imaging. METHODS: Three-dimensional photographs were taken of 28 adult volunteers (ages, 18-40 years) in natural head position at 5 times: baseline, 4 hours, 8 hours, 24 hours, and 1 week. Using the true vertical and horizontal laser lines projected in an iCAT cone-beam computed tomography machine (Imaging Sciences International, Hatfield, Pa) for orientation, we recorded references for natural head position on the patient's face with semipermanent markers. By using a 3-dimensional camera system, photographs were taken at each time point to capture the orientation of the reference points. By superimposing each of the 5 photographs on stable anatomic surfaces, changes in the position of the markers were recorded and assessed for parallelism by using 3dMDvultus (3dMD, Atlanta, Ga) and software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). RESULTS: No statistically significant differences were observed between the 5 time points in any of the 3 planes of space. However, a statistically significant difference was observed between the mean angular deviations of 3 reference planes, with a hierarchy of natural head position reproducibility established as coronal > axial > sagittal. CONCLUSIONS: Within the parameters of this study, natural head position was found to be reproducible in the sagittal, coronal, and axial planes of space. The coronal plane had the least variation over time, followed by the axial and sagittal planes.

Shear bond strength of orthodontic brackets bonded to various esthetic pontic materials.

INTRODUCTION: In this in-vitro study, we compared the shear bond strengths of orthodontic brackets bonded to various commonly used esthetic pontic materials. METHODS: Prefabricated denture teeth (acrylic resin, Trubyte, Dentsply, York, Pa) and samples made from Integrity (bis-acryl composite resin, Dentsply Caulk, Milford, Del) and Alike (polymethylmethacrylate resin, GC America, Alsip, Ill) were used to represent the more common esthetic provisional materials. Each material group contained 30 samples; a total of 90 samples were bonded in the same fashion with APC PLUS maxillary lateral incisor brackets (3M Unitek, Monrovia, Calif). Each material group was then divided into 2 testing subgroups. One subgroup was tested for shear bond strength 24 hours after bonding, and the other subgroup was tested after bonding and storage in distilled water at 37 degrees C for a week. Each bracket was loaded perpendicularly in a universal testing machine at a crosshead speed of 1.0 mm per minute until bonding failure. The mean shear bond strength and standard deviation were determined for each group. Analysis of variance (ANOVA, 2-factor and 1-factor) with Tukey HSD post-hoc tests, Student t tests, and Mann-Whitney U tests were used to test the main effects of pontic materials and time of loading (alpha = 0.05). The data were stratified, and 1-way ANOVA tests were performed with the Bonferroni adjustment (alpha = 0.01) to examine the effect of the pontic material on shear bond strength after either 1 day or 7 days of storage. RESULTS: Significant differences were found based on pontic material and time (P <0.05), but there was a significant interaction (P = 0.044), making the results uninterpretable. At 1 day, the Integrity material had a significantly higher mean shear bond strength than both Alike and the denture tooth materials (P <0.001). However, at 7 days, both Integrity and Alike had significantly higher mean shear bond strengths compared with the prefabricated denture tooth (P <0.001). CONCLUSIONS: Although the use of Integrity or Alike requires an additional armamentarium, necessitating individual pontic fabrication by the dental practitioner, indications for clinical use are evident with direct applications to multi-disciplinary treatment modalities.

Analysis of intra-arch and interarch measurements from digital models with 2 impression materials and a modeling process based on cone-beam computed tomography.

INTRODUCTION: Study models are an essential part of an orthodontic record. Digital models are now available. One option for generating a digital model is cone-beam computed tomography (CBCT) scanning of orthodontic impressions and bite registrations. However, the accuracy of digital measurements from models generated by this method has yet to be thoroughly evaluated. METHODS: A plastic typodont was modified with reference points for standardized intra-arch and interarch measurements, and 16 sets of maxillary and mandibular vinylpolysiloxane and alginate impressions were made. A copper wax-bite registration was made with the typodont in maximum intercuspal position to accompany each set of impressions. The impressions were shipped to OrthoProofUSA (Albuquerque, NM), where digital orthodontic models were generated via CBCT. Intra-arch and interarch measurements were made directly on the typodont with electronic digital calipers and on the digital models by using OrthoProofUSA's proprietary DigiModel software. RESULTS: Percentage differences from the typodont of all intra-arch measurements in the alginate and vinylpolysiloxane groups were low, from 0.1% to 0.7%. Statistical analysis of the intra-arch percentage differences from the typodont of the alginate and vinylpolysiloxane groups had a statistically significant difference between the groups only for maxillary intermolar width. However, because of the small percentage differences, this was not considered clinically significant for orthodontic measurements. Percentage differences from the typodont of all interarch measurements in the alginate and vinylpolysiloxane groups were much higher, from 3.3% to 10.7%. Statistical analysis of the interarch percentage differences from the typodont of the alginate and vinylpolysiloxane groups showed statistically significant differences between the groups in both the maxillary right canine to mandibular right canine (alginate with a lower percentage difference than vinylpolysiloxane) and the maxillary left second molar to mandibular left second molar (alginate with a greater percentage difference than vinylpolysiloxane) segments. This difference, ranging from 0.24 to 0.72 mm, is clinically significant. CONCLUSIONS: In this study, digital orthodontic models from CBCT scans of alginate and vinylpolysiloxane impressions provided a dimensionally accurate representation of intra-arch relationships for orthodontic evaluation. However, the use of copper wax-bite registrations in this CBCT-based process did not result in an accurate digital representation of interarch relationships.

Learning styles of orthodontic residents.

Significant challenges face many orthodontic residency programs, particularly a shortage of full-time experienced faculty members. Due to this shortage, it is critical that program directors design comprehensive curricula that incorporate the most effective and efficient teaching methods. It is theorized that teaching effectiveness and efficiency are optimized when the course design and content closely match students' learning preferences. This survey study was designed to distinguish the learning preferences of orthodontic residents utilizing Felder and Soloman's Index of Learning Styles, which assesses student learning preferences in four dimensions using dichotomous scales, thereby providing insight into how teaching strategies can best be structured. As a secondary focus, additional questions on the survey were asked to gain information about residents' access to the Internet and comfort level with online learning so as to address acceptance of web-based courses in response to the shortage of full-time faculty members. Orthodontic residents, contacted via email, were requested to complete an online survey; 261 responses were collected. The results indicate that orthodontic residents are highly visual learners and show a preference for sensing and sequential learning strategies. In terms of information technology, the residents are comfortable with and have adequate access to current technological assets; therefore, they may be well suited for inclusion of computer-based teaching modules and other multimedia devices in their residency curriculum.