Outcome differences after orthodontic camouflage treatment in hypo- and hyperdivergent patients - A retrospective cephalometric investigation.

OBJECTIVES: To compare differences in outcome in skeletal and dental parameters in hypo- and hyperdivergent Class II patients after extraction of upper first premolars and comprehensive orthodontic treatment. MATERIALS AND METHODS: 37 Class-II-patients with dental camouflage treatment were divided into a hypo- (n = 18) or a hyperdivergent (n = 19) group depending on the mandibular plane angle (hypo: < 34° or hyper: ≥ 34°). Lateral cephalograms were available before (T1) and after (T2) treatment and were analyzed with customized measurements. Data from a growth survey served as a control and were used to calculate the actual treatment effect. Data were analyzed by one-sample Student's t-tests and independent Student's t-tests. Statistical significance was set at p < 0.05. RESULTS: The measurements showed similar changes in both groups. The effects were mainly dentoalveolar. Hypodivergent patients showed an almost equal increase in anterior and posterior facial height, while hyperdivergent patients only showed an increase in anterior facial height. CONCLUSIONS: In hyperdivergent patients, the anterior facial height increases despite camouflage treatment. This indicates a tendency towards bite opening and backward rotation of the mandible. Hypodivergent patients do not experience deepening of the bite. CLINICAL RELEVANCE: In hyperdivergent patients with upper first premolars extraction the anterior facial height increased differently than in hypodivergent patients. This should be considered if a bite opening is a possible contraindication to treatment.

Effects of fixed functional orthodontic treatment in hypodivergent and hyperdivergent class II patients-a retrospective cephalometric investigation.

OBJECTIVE: To compare skeletal and dentoalveolar changes after orthodontic treatment of class II malocclusion in patients with hypodivergent and hyperdivergent growth patterns through cast splint fixed functional appliances (FFA). MATERIALS AND METHODS: N = 42 out of n = 47 patients with mandibular plane angles < 34° or ≥ 34° were divided into a hypodivergent (n = 24) and a hyperdivergent (n = 18) group. All patients received a single-step mandibular advancement protocol through an FFA. Lateral cephalograms were analyzed after initial leveling and alignment (T1) and immediately after FFA removal (T2). The therapeutic effect was calculated through comparison with age-matched controls from a growth survey. Statistical significance was set at p < 0.05. RESULTS: Hypodivergent and hyperdivergent patients showed different treatment outcomes, but significant differences existed only for overbite and interincisal angle. Nearly all measurements suggested similar treatment-related changes for both groups with exception for dentoalveolar parameters. CONCLUSION: Treatment with FFA causes similar skeletal and dentoalveolar effects in hypodivergent and in hyperdivergent patients. The correction of overjet and molar relationship is mainly caused by dentoalveolar changes. CLINICAL RELEVANCE: Hyperdivergent patients do not respond unfavorably to FFA treatment compared to hypodivergent patients. Lower incisor protrusion occurs more pronounced in hypodivergent patients. The growth pattern ought to be considered when choosing FFA for class II treatment.

A retrospective cephalometric investigation of two fixed functional orthodontic appliances in class II treatment: Functional Mandibular Advancer vs. Herbst appliance.

OBJECTIVE: The objective of the study is to compare skeletal and dental changes in class II patients treated with fixed functional appliances (FFA) that pursue different biomechanical concepts: (1) FMA (Functional Mandibular Advancer) from first maxillary molar to first mandibular molar through inclined planes and (2) Herbst appliance from first maxillary molar to lower first bicuspid through a rod-and-tube mechanism. MATERIALS AND METHODS: Forty-two equally distributed patients were treated with FMA (21) and Herbst appliance (21), following a single-step advancement protocol. Lateral cephalograms were available before treatment and immediately after removal of the FFA. The lateral cephalograms were analyzed with customized linear measurements. The actual therapeutic effect was then calculated through comparison with data from a growth survey. Additionally, the ratio of skeletal and dental contributions to molar and overjet correction for both FFA was calculated. Data was analyzed by means of one-sample Student's t tests and independent Student's t tests. Statistical significance was set at p < 0.05. RESULTS: Although differences between FMA and Herbst appliance were found, intergroup comparisons showed no statistically significant differences. Almost all measurements resulted in comparable changes for both appliances. Statistically significant dental changes occurred with both appliances. Dentoalveolar contribution to the treatment effect was ≥70%, thus always resulting in ≤30% for skeletal alterations. CONCLUSION: FMA and Herbst appliance usage results in comparable skeletal and dental treatment effects despite different biomechanical approaches. CLINICAL RELEVANCE: Treatment leads to overjet and molar relationship correction that is mainly caused by significant dentoalveolar changes.

Soft tissue profile changes after Functional Mandibular Advancer or Herbst appliance treatment in class II patients.

OBJECTIVE: The objective of the present study is to compare the effects on soft tissue profile in class II patients after treatment with either "Functional Mandibular Advancer" (FMA) or Herbst appliance. MATERIALS AND METHODS: The study included n = 42 patients treated with either FMA (n = 21) or Herbst appliance (n = 21) by the same experienced orthodontist. The treatment followed a single-step advancement protocol. Lateral cephalograms were analyzed through a set of customized measurements. The actual therapeutic effect was calculated using data from a growth survey. After testing for normal distribution and homogeneity of variance, data were analyzed by one-sample Student's t tests and independent Student's t tests. Statistical significance was set at p < 0.05. RESULTS: For both FFAs, significant upper lip retrusion, increase in lower lip's thickness, and length of the lower face occurred. Additionally, significant lower lip retrusion and straightening of the profile were found in FMA and Herbst appliance patients. All remaining variables revealed no significant differences. CONCLUSIONS: Treatment-related changes on the facial soft tissue profile could be regarded similar in class II patients treated with FMA or Herbst appliance. No treatment-related changes that were specific for FMA or Herbst appliance could be identified. Only moderate changes were noted comparing pre- and posttreatment soft tissue profiles. CLINICAL RELEVANCE: Despite proven differences in skeletal and dental treatment effects, the facial profile has not to be taken into consideration when choosing between FMA and Herbst appliance for class II treatment.

Preconceptions about the infection process among prenursing students.

Two hundred seven prenursing students in a large university-based nursing college participated in a study about their preconceptions concerning the infection process. Most students had a poor understanding of the distinction between bacteria and viruses and had little knowledge about the immune system or the mechanism of action of antibiotics. Instructors can use knowledge of student preconceptions to create more relevant learning experiences.

Fathers' Experience With Autism Spectrum Disorder: Nursing Implications.

INTRODUCTION: Autism spectrum disorder (ASD) is a lifelong condition characterized by very mild symptoms to severe impairments in communication skills, social interactions, and unusual behaviors that interfere with independent functioning and interactions with others. ASD may cause financial, social, and emotional difficulties that negatively affect the entire family. The main focus of current research in caregivers of children with ASD focuses on the mothers rather than fathers or both parents, and no studies have used the fathers' words to describe their experience with ASD. Fathers have an important role to improve outcomes for their children receiving therapy. With more fathers taking on the primary caregiver role, it is important to understand their experience with ASD and their needs to help them actively engage in their role as fathers. The purpose of this study was to describe fathers' experience with ASD using their own words and identify any resources needed to help them actively engage in their role as a father of a child with ASD. METHODS: A single-case, multiple-participant, phenomenological approach case study was conducted to describe the experience of fathers of children with ASD. The case was defined as White non-Hispanic (the population identified as having the highest incidence of ASD) fathers who are living in the same home with their child(ren) who has/have a formal diagnosis of ASD. Fathers answered open-ended questions about their experience with ASD, including the challenges they face, their advice for other fathers of children with ASD, and what they need to overcome the challenges of ASD. The theoretical model for the study was the Resiliency Model of Family Stress, Adjustment, and Adaptation. The model was designed to help health care professionals identify a family's strengths and weaknesses as they face existing and new stressors related to a long-term medical condition and then provide interventions to help the family become resilient so they can meet the challenges. RESULTS: Fathers in this study had experiences similar to those described in previous studies with regard to mothers of children with ASD. The similarity of the findings in the small sample size of fathers and those in studies with larger sample sizes of mothers supports development of clinical interventions that will benefit both mothers and fathers of children with ASD. Fathers described the adjustments made by each member of the family to face the challenges of ASD. Fathers also explained their needs, including money, teamwork, honesty, information, and time. The fathers experienced stages of grief and loss that are similar to those that occur when experiencing a death. DISCUSSION: Nurses are the eyes and ears of the health care team and the voice for the parents, thus creating a critical connection between the parents and health care team. Fathers in the current study and mothers in previous studies described their need for someone to listen to them, educate them and others about ASD, acknowledge their experience and emotions, and direct them to appropriate resources. Nursing implications include taking action to lead the parents through the challenges and helping them develop resiliency and facilitating improved outcomes for the children and the entire family. A resource book or computer file including information about available resources and information about ASD and treatment can be a valuable tool to help overcome challenges related to ASD.

Class II treatment with fixed functional orthodontic appliances before and after the pubertal growth peak - a cephalometric study to evaluate differential therapeutic effects.

OBJECTIVE: The aim of this clinical trial was to investigate and compare outcomes after treating a skeletal Class II malocclusion with two fixed functional orthodontic appliances, the Herbst appliance and the Functional Mandibular Advancer, by evaluating their skeletal and dentoalveolar effects and the repercussion on the profile in relation to patient age. PATIENTS AND METHODS: The sample population comprised 42 subjects with skeletal Class II malocclusion. They were divided into two groups depending on age. Group A (n = 21) included nine female subjects aged up to 12 years and twelve male subjects aged up to 14 years. Group B (n = 21) comprised twelve females older than 12 years and nine males older than 14 years. Treatment course was documented cephalometricly. The net therapeutic effects were calculated with reference to the control group. RESULTS: A significant reduction of the overjet was achieved in both treatment groups. Within the two groups there were no significant sagittal effects in terms of mandibular advancement. However, there was an inhibiting effect on the maxilla, which counteracted the natural growth process. Significant changes in vertical direction were detected mainly in the younger patients in the sense of lengthening of the lower face. Significant dental changes were predominantly found in the group of older patients. For instance, treatment with fixed functional orthodontic appliances led to retrusion of the upper incisors by a mean of 2.21 mm +/- 2.66 mm (p = 0.0015), protrusion of the lower incisors by a mean of 2.28 mm +/- 2.39 mm (p =

Class II treatment in adults: comparing camouflage orthodontics, dentofacial orthopedics and orthognathic surgery--a cephalometric study to evaluate various therapeutic effects.

AIM: It was the aim of this clinical study to compare the skeletal and dentoalveolar effects as well as those on the profile of three different treatment approaches in Class II patients (camouflage orthodontics, dentofacial orthopedics, and combined orthodontic and surgical treatment). PATIENTS AND METHOD: Our study cohort consisted of 60 young adults presenting a skeletal Class II, Division 1 malocclusion: 20 patients whose overjet was reduced by camouflage following premolar extraction, 20 patients whose occlusions were corrected by placement of a fixed functional orthopedic appliance, and 20 who underwent orthognathic surgery (bilateral sagittal split osteotomy of the mandible without genioplasty). We documented the therapeutic progress using cephalometry. RESULTS: Each patient group achieved a reduction in overjet via their respective treatment. While no treatment-related changes in the maxillary area were assessable, the effects on the mandible differed. We observed advancement of the bony chin and an increase in mandibular length in the sagittal-diagonal dimension in the surgical and functional orthopedic groups. However, the extent of the treatment-related changes was significant only in the group of patients that had undergone orthognathic surgery. Only the surgical group presented changes in vertical relationships. Incisor repositioning as an outcome of the respective treatments differed fundamentally, with those in the surgical group revealing significant protrusion of the upper incisors. The maxillary incisors were retruded and mandibular incisors proclined in the functional orthopedic group, whereas the upper and lower incisors both retruded significantly in the extraction group. Soft-tissue remodeling bore no linear relationship to treatment-induced skeletal and dental effects. Still, orthognathic surgery led to the most marked profile changes. Treatment using fixed functional orthopedic appliances reduced the convexity of the soft-tissue profile at least moderately. Camouflage orthodontics, on the other hand, resulted in an increase in the nasolabial angle. CONCLUSIONS: In young adults fixed functional appliances are a treatment alternative to extraction therapy but to a lesser extent to orthognathic surgery. Because of their limited skeletal effects and minor changes in the profile they are indicated only in patients with a moderately severe Class II malocclusion. Pre-treatment proclined mandibular incisors limit the scope of indications for fixed functional appliances, as they can cause an increase in lower incisor proclination. Significant reductions in profile convexity are achievable only by combined orthodontic and surgical treatment of the malocclusion. When performing camouflage orthodontics in conjunction with maxillary premolar extractions in adults, an increase in the nasolabial angle, which is often esthetically undesirable, has to be discussed as a potential side effect and has to be taken into account when considering the different therapeutic approaches.

Integration of occupational health and safety: case study of a successful program.

1. Occupational health nurses are key players in formulating a diagnosis, designing a plan of care, and implementing any interventions needed to promote safety. 2. While adhering to accepted confidentiality parameters, occupational health nurses share findings with appropriate individuals and teams when they are relevant to the health and safety of others. 3. No individual or department works alone to effect successful safety outcomes. Members of Occupational Health Services, Human Resources and Personnel, and the Safety Team depend on each other to improve work processes and create a safer work environment.