Quality of orthodontic care-A multicenter cohort study in Germany : Part 1: Evaluation of effectiveness of orthodontic treatments and predictive factors.

AIMS: Orthodontic care and its effectiveness have increasingly become the focus of political and public attention in the recent past. Therefore, this multicenter cohort study aimed to report about the effectiveness of orthodontic treatments in Germany and to identify potential influencing factors. METHODS: A total of 586 patients from seven German study centers were screened for this cohort study, of which 361 patients were recruited at the end of their orthodontic treatment. Of these, 26 patients had missing study models and/or missing treatment information. Thus, 335 participants were included. The severity of malocclusion was rated using the Peer Assessment Rating (PAR) Index at baseline (T0) retrospectively and-prospectively-after the retention period (T1). Practitioner-, treatment- and patient-related information were analyzed in order to detect potential predictive factors for treatment effectiveness. RESULTS: Study participants (202 female and 133 male) were on average 14.8 (standard deviation [SD] ± 6.1) years old at start of active treatment. Average PAR score at T0 was 25.96 (SD ± 10.75) and mean posttreatment PAR score was 3.67 (SD ± 2.98) at T1. An average decrease of total PAR score by 22.30 points (SD ± 10.73) or 83.54% (SD ± 14.58; p < 0.001) was detected. Furthermore, 164 treatments (49.1%) were categorized as 'greatly improved' but only 3 treatments (0.9%) as 'worse or no different'; 81.5% of all cases finished with a high-quality treatment outcome (≤5 PAR points at T1). Logistic regression analyses detected staff experience as a significant predictive factor for high-quality results (odds ratio 1.27, p = 0.001, 95% confidence interval 1.11-1.46). CONCLUSION: The improvement rate among this selected German cohort indicated an overall very good standard of orthodontic treatment. Staff experience proved to be a predictive factor for high-quality results.

Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference?

Orthodontic treatment with fixed appliances is considered a risk factor for the development of white spot caries lesions (WSL). Traditionally, brackets are bonded to the buccal surfaces. Lingual brackets are developing rapidly and have become more readily available. Buccal surfaces are considered to be more caries prone than lingual surfaces. Furthermore, lingual brackets are shaped to fit the morphology of the teeth and seal almost the entire surface. In the present study we tested the hypothesis that lingual brackets result in a lower caries incidence than buccal brackets. We tested this hypothesis using a split-mouth design where subjects were allocated randomly to a group receiving either buccal or lingual brackets on the maxillary teeth and the alternative bracket type in the mandible. The results indicate that buccal surfaces are more prone to WSL development, especially when WSL existed before treatment. The number of WSL that developed or progressed on buccal surfaces was 4.8 times higher than the number of WSL that developed or progressed on lingual surfaces. When measured using quantitative light-induced fluorescence (QLF), the increase in integrated fluorescence loss was 10.6 times higher buccally than lingually. We conclude that lingual brackets make a difference when caries lesion incidence is concerned.

A comparison of pain experienced by patients treated with labial and lingual orthodontic appliances.

SUMMARY: The aim of this prospective longitudinal study was to compare pain experiences among Chinese adult patients treated with labial and lingual orthodontic appliances. Sixty patients, 30 with labial appliances (18 females and 12 males, mean age 20.33 years, SD +/- 4.205) and 30 with lingual appliances (22 females and 8 males, mean age 21.63 years, SD +/- 2.236), rated their overall pain experience on a 100 mm visual analogue scale (VAS) at three time points: 1 week (T(1)), 1 month (T(2)), and 3 months (T(3)) after bracket placement. In addition, on a separate 100 mm VAS, they rated their pain experience at the locations of the tongue, lips, cheeks, gums, face, and jaw at T(1), T(2), and T(3). Changes in pain VAS were conducted using Friedman analysis of variance, area under the curve (AUC) analysis and the data were compared using a t-test. There was no significant difference in global ratings of pain among those treated with labial or lingual appliances (P > 0.05). Among both groups, global ratings of pain decreased over the study period (P < 0.001). Patients treated with lingual appliances reported higher ratings of tongue pain (P < 0.001), while those treated with labial appliances reported higher ratings of lip (P < 0.001) and cheek (P < 0.001) pain. The findings indicate that patients treated with labial and lingual appliances rate similarly the level of overall pain they experience during treatment. Ratings of overall pain experienced decreased for both treatment groups with time. However, ratings of pain differed at various sites with respect to the type of orthodontic appliance. These findings have implications in informing patients' treatment decision-making processes regarding labial and lingual appliances and in the management of discomfort associated with different treatment modalities.

A comparison of pain experienced by patients treated with labial and lingual orthodontic appliances.

UNLABELLED: There has been a paradigm shift within orthodontics in the use of lingual fixed appliances compared with the use of labial fixed appliances on the basis of perceived benefits and acceptance by patients. METHODS: A matched case-control prospective longitudinal study of adult patients treated in the Orthodontic Department, Prince Philip Dental Hospital, Hong Kong. Group A consisted of 30 patients treated with lingual orthodontic appliances. Group B consisted of 30 patients treated with labial orthodontic appliances. Data were collected at five different time points using questionnaire: pre-treatment; one week after the placement of the fixed appliance, and then at 1-month, 3-months, and 6-months thereafter. The questionnaire consisted of 15 items, in which 11 items were rated on a visual analogue scale. RESULTS: Patients' experience of pain decreased over the study period (p < 0.001); Those treated with lingual appliances reported significantly greater pain experience than those treated with labial appliances with respect to tongue pain (p < 0.001). However, those treated with labial appliances reported experiencing significantly more lip pain (p < 0.01), cheek pain (p < 0.001), and gum pain (p < 0.05). Patients treated with lingual appliances reported experiencing pain earlier on than those treated with labial appliances (p < 0.05). Both groups reported the pain level to be the same throughout the day (p > 0.05). There was no significant difference in reported disturbance of sleep or analgesic consumption between the two groups (p > 0.05). CONCLUSION: Patients treated with both labial and lingual orthodontic appliances experienced pain during treatment, but this decreased over the treatment period. Patients treated with lingual appliances experienced more tongue pain whereas those treated with labial appliances experienced more lip, cheek and gum pain. Patients treated with lingual appliance reported experiencing pain earlier on than those treated with labial appliances.

[Computer-assisted occlusal finishing]. / Les finitions occlusales assistées par ordinateur.

The finishing of a fixed appliance case is one of the greatest challenges in our specialty and is playing an ever-increasing role in treatment considerations as patients become more demanding. The quality of the finishing is, in fact, often seen as an indicator of the orthodontist's skills. The finishing of a lingual case is subject to exceptionally exacting requirements. This often leads not only to longer chair times towards the end of the treatment but to longer treatment times overall. The procedure described in this article permits high-quality finishing with no greater clinical resource input than with conventional labial appliances. Five essential factors are presented and discussed.

Incremental validation of situational judgment tests.

Using 3 different samples, the authors assessed the incremental validity of situational judgment inventories (SJIs), relative to job knowledge, cognitive ability, job experience, and conscientiousness, in the prediction of job performance. The SJI was a valid predictor in all 3 samples and incrementally so in 2 samples. Relative to the other predictors, SJI's partial correlation with performance, controlling for the other 4 predictors, was superior in most comparisons. Subgroup differences on the SJI also appear to be less than those for cognitive ability and job knowledge, but greater than differences in conscientiousness. The SJI should prove to be a valuable additional measure in the prediction of job performance, but several additional areas of research are suggested.

Lingual orthodontics (Part 4): Economic lingual treatment (ECO-lingual therapy).

One key factor in the economic lingual treatment concept presented in this series of articles is the use of prefabricated, customized nickel titanium arch wires with superelasticity and temperature-dependent spring-back qualities (memory effect). Using a modern, e-modulus driven archwire sequence, a non-extraction case can be treated with 1 or 2 wires per arch, and an extraction case with 2 or 3 wires per arch. This article, the last in the Lingual Orthodontics series, uses clinical examples to show the various clinical potentials of these wires with temperature-dependent superelasticity, as not only part of but occasionally all the treatment is done with these prefabricated, customized nickel titanium wires.

Lingual orthodontics (Part 3): Intraoral sandblasting and indirect bonding.

Bracket loss is a severe complication in the course of orthodontic treatment, especially when using lingual appliances. High adhesive strength between bracket and tooth is therefore an important requirement for the successful integration of lingual orthodontics into everyday practice. The present article examines the influence of intraoral sandblasting prior to etching on the adhesive strength of indirect bonding. The shear bond strength of 20 cylinders made of composite were measured 24 hours after these had been bonded onto the enamel of bovine teeth. The enamel was prepared by sandblasting (Microetcher, 50 microns Al2O3) for 3 seconds prior to bonding, followed by 30 seconds of enamel etching with 37% phosphoric acid. Twenty specimens were tested without sandblasting in the control group. The results show that intraoral sandblasting prior to etching can significantly (p < 0.001) increase the adhesive strength between enamel and bonding material. Thus intraoral sandblasting is an integral part of the indirect bonding record described in the second section of this article.

Lingual orthodontics (part 2): archwire fabrication.

One essential component of a successful lingual treatment concept is the precise calculation and manufacture of individual lingual arch wires. As in several parts of daily life, the use of modern CAD/CAM technology leads in lingual orthodontic treatment to a rationalisation of working processes with maximized precision. The lingual module developed by the author is a new scanner-independent procedure for calculation and manufacture of individual lingual arch wires with the Orthomate/Orthotherm system (OrthoTel, Berlin/Dallas, Tx). Especially the precise individualization of superelastic, shape-memory materials reduces the archwire sequence and simplifies lingual treatment considerably. Individual second and third order overcorrections (incisal torque, reverse curve of Spee) can be programmed into the first archwire, with further three-dimensional corrections being added for each single tooth during finishing. Embedded in a systematic treatment concept, the use of modern CAD/CAM technology for individual lingual archwire production with the Orthomate/Orthotherm system is an important aid to successful integration of lingual orthodontic treatment into routine practice.

Lingual orthodontics (part 1): laboratory procedure.

A key factor for successful correction of a malocclusion with lingual orthodontics is optimal bracket positioning. This presentation focuses on the development of an innovative laboratory procedure for indirect bracket positioning using a modified positioning device (TARG Professional) called Transfer Optimized Positioning System (TOP). In contrast to commonly used approaches to indirect bonding such as CLASS and BEST, the TOP System uses a target set-up technique in order to facilitate the 3-dimensional individualized positioning of brackets while allowing the brackets to be placed on the malocclusion model. The reliability and accuracy of this system in both the laboratory and the clinical environment are discussed. This discussion highlights the high precision of the TOP System and its significance in eliminating the usage of second and third order corrective archwire bends in the finishing stage of lingual orthodontic therapy. In other words the TOP System allows for the usage of almost flat orthodontic arch wires to successfully treat a malocclusion with lingual braces. This is the key factor in enhancing the cost effectiveness and success of a lingual treatment concept.

[A prefabricated, calibrated double-base procedure--KDMMS. For the simulation and 3-dimensional planning using an articulator in orthognathic surgery]. / Le procédé de double socle calibré préfabriqué--KDMMS. Pour simulation et planification tridimensionnelle dans l'articulateur en chirurgie orthognathique.

A tight cooperation between the orthodontist and oral surgeon is a key factor for success in orthognathic surgery. The quality of the final result is determined a great deal by the pre-operative model-surgery. The KDMMS is a planning tool which allows, even in the most complex cases, accurate and quick model-surgery. The two main components of the KDMMS are the double base plates and the model positioning system, which resemble a "fixation extérieure". The double base plates enable the operator to reproduce the original, pre-operative situation at all times. This allows multiple set-ups for one case, three dimensional measurement and positioning of models with occlusal control can be achieved by use of the positioning system. Especially, in complex surgery cases, the KDMMS is an effective aid in three dimensional planning of orthognathic surgery.