The effect of digital diagnostic setups on orthodontic treatment planning.

INTRODUCTION: This study aimed to evaluate whether viewing digital treatment simulations influenced orthodontic treatment planning decisions or practitioners' confidence in their selected plans. METHODS: Records of 6 patients representing different case types (eg, missing teeth, crowding, sagittal discrepancies) were collected. A total of 22 orthodontists and 7 orthodontic residents viewed these records and formulated treatment plans for each case, indicating their most recommended plan and up to 2 alternative plans. After treatment planning each case, digital setups of each treatment plan indicated by the practitioner were shown. The practitioners were then asked if they still recommended their original plan, or if they would now recommend a different plan. Their confidence levels in the success of their plans were recorded before and after viewing the setups. RESULTS: After viewing the digital setups, there was a significant change in the treatment plan for 9.2% of the cases. These included modifications like changing the extraction pattern or proposing space closure rather than opening space for an implant. In an additional 14.4% of the cases, treatment plans underwent partial changes, like adding interproximal reduction or temporary anchorage devices. Practitioner confidence levels increased after viewing the setups. In cases where the treatment plan changed, the practitioner's confidence level in the plan increased the most, and the final confidence level was uniformly high among all practitioners. Practitioners reported the most helpful features of digital setups were the ability to superimpose the setup with the original model, determine the amount of tooth movement needed, check the final incisal relationship (overjet and overbite), and establish the amount of interproximal reduction required. CONCLUSIONS: Viewing digital setups resulted in changes to the treatment plans in about 24% of the cases. The use of digital setups was associated with higher levels of confidence in the selected plans.

Agreement of treatment recommendations based on digital vs plaster dental models.

INTRODUCTION: The purpose of this study was to investigate differences in orthodontists' treatment plans based on digital models compared with plaster models. Additionally, we assessed whether digital or plaster models influence the reliability of orthodontists' treatment plans, as well as the amount of time required to arrive at the plan. METHODS: Sixteen orthodontists planned treatment for 20 patients at 2 time points using either the same or different model formats (digital or plaster). The treatment plan decisions and time spent making the plans were recorded. The permutation test and a random effects model were used to analyze the data. RESULTS: The treatment plans arrived at with digital and plaster models were similar. With respect to extractions, the mean difference between digital and plaster formats was 11.9% (95% CI, 7.5%-16.3%). For surgery, the mean difference was 9.4% (95% CI, 5.0%-13.8%). There was no significant difference in the agreement rate between those who viewed models in different formats compared with those who viewed models twice in the same format (P >0.05). The time spent to plan treatment with plaster models was not significantly different from the time spent with digital models (P = 0.87). CONCLUSIONS: Based on this study, digital models can be substituted for plaster models with no significant differences in the final plans, the reliability of the plans, and the time required to create the plan.

Recommendations for clear aligner therapy using digital or plaster study casts.

BACKGROUND: Clear aligner therapy has evolved considerably since its introduction 20 years ago. Clinicians have become more experienced with aligner therapy, but little is known about the types of malocclusions that clinicians currently treat with aligners. Similarly, it is not known if viewing digital vs plaster models has any impact on the treatment planning process for aligners. The aim of this study was to assess which types of malocclusions are recommended for treatment with clear aligners, and also to determine if recommendations for aligner treatment differed when using digital versus plaster models. METHODS: Sixteen orthodontists treatment planned 20 cases at two time points with either the same or different model formats (digital versus plaster). As part of the treatment planning process, they were asked whether each patient was a good candidate for Invisalign® treatment, and if not, why. Generalized estimating equations regression (GEE), the permutation test, and a logistic regression model with GEE were used to analyze the data. RESULTS: No significant difference was found between the Invisalign® choices in the digital model group and those in the plaster model group at T1 (p = 0.59). There was no significant difference between the agreement rate of the different formats group and that of the same format group (p = 0.97). Cases with extractions had less Invisalign® recommendations (15%) compared to cases with no extractions (55%) (p = 0.0015). Cases with surgery had less Invisalign® recommendations (29%) compared to cases with no surgery (57%) (p = 0.035). CONCLUSIONS: In this study, viewing orthodontic records with digital versus plaster models did not influence decisions about Invisalign® recommendations. Additionally, the orthodontists in this study tended to not recommend Invisalign® for extraction cases, surgical cases, or difficult cases.

Considering theory-based reflection in the service-learning training of Advanced Education in General Dentistry (AEGD) residents.

Columbia University College of Dental Medicine, in partnership with the Harlem United Community AIDS Center, has developed a service-learning (SL) program for use in the training of Advanced Education in General Dentistry (AEGD) residents. This article presents basic tenets of SL, their applicability for dentistry, and our experience implementing SL in care of people living with HIV/AIDS. It proposes that social-behavioral theory, when incorporated into the basic components of SL, can play a useful role in resolving a number of challenges inherent in competency-based training programs. Although the article provides examples of how a particular theory, the Theory of Planned Behavior, might be applied in the SL context, opportunities for the application of other social-behavioral theories potentially exist.