Treatment acceptance in adult patients with anterior open bite: A National Dental Practice-Based Research Network study.

INTRODUCTION: Orthodontists have many techniques to treat anterior open bites and must involve patients in making treatment decisions. This study aimed to investigate orthodontic treatment plan acceptance by United States adults with anterior open bites and to identify associations between treatment acceptance and patient demographics and dentofacial characteristics. METHODS: A prospective, observational cohort study enrolled the patients of 91 orthodontic providers. A total of 345 adults were included in the sample. Provider personal and practice demographics were captured. Patient demographics, treatment goals, dentofacial characteristics, and reasons for not accepting the recommended plans were recorded. Adjusted regression models were used to identify associations between patient characteristics and the likelihood of accepting the most highly recommended plan. RESULTS: Approximately 78% of patients accepted the most highly recommended treatment plan. 60% of the patients who were recommended surgical plans accepted them. Patients with a history of orthodontics and a concave profile were more likely to accept the most highly recommended plan. Insurance coverage for orthognathic surgery was associated with a higher acceptance rate for surgery. Severe crowding was associated with a lower acceptance of surgery. The most common reasons for declining the recommended plan were not wanting jaw surgery and considering the treatment to be too invasive, risky, and/or costly. CONCLUSIONS: Patient acceptance is less common at higher levels of invasiveness of treatment. Prior orthodontic treatment, concave profile, and insurance coverage for surgery were associated with accepting treatment. Most patients accepted a surgical plan when it was the most recommended option.

External apical root resorption in African American orthodontic patients.

OBJECTIVE: External apical root resorption (EARR) is a side effect of orthodontic treatment that results in root shortening. However, this condition has yet to be evaluated in African Americans. The aim of this study was to determine the EARR prevalence within this ethnicity and investigate how patient and treatment-related factors contribute to root resorption. METHODS: The records of 336 African Americans treated at the University of Alabama at Birmingham School of Dentistry Department of Orthodontics were retrospectively analyzed with Dolphin Imaging software. Pre-treatment and post-treatment panoramic radiographs were used to measure EARR. Resorption was recorded when final roots were at least 2 mm shorter after orthodontic treatment. Additionally, moderate and severe EARR was reported when 20% and 50% or more of the root structure was lost for any of the four maxillary incisors, respectively. The Pearson chi-square test was used to evaluate the associations of individual patient and treatment-related factors with EARR. RESULTS: The prevalence of root resorption with 2 mm or greater of root structure loss was 51.8%. The prevalence of ≥ 20% EARR was 29.8%. Only one patient displayed severe resorption (0.3%). The associations between the patient-specific and treatment-specific variables and EARR were not statistically significant (P > .05). CONCLUSIONS: More than half of the African American patients exhibit at least 2 mm of root resorption with orthodontic treatment. However, in this ethnicity, patient-related factors such as age, gender, dental malocclusion, and skeletal classifications, as well as treatment-related factors do not indicate a significant correlation with the risk of developing EARR.

Orthodontic Aligners: Current Perspectives for the Modern Orthodontic Office.

Orthodontic aligners are changing the practice of orthodontics. This system of orthodontic appliances is becoming the mainstay appliance of choice for orthodontic offices in many countries. Patient preferences and lifestyle needs have made this appliance the primary choice when seeking care. In the early days, appliances lacked the efficiency and effectiveness of traditional bracket-wire systems, but modern systems are now able to handle a more comprehensive orthodontic caseload. Current systems provide newer biomechanical strategies and artificial intelligence-driven tooth movements for better outcomes. These improvements now mean that an orthodontist can be better prepared to manage a larger number of orthodontic malocclusions. This paper aims to discuss some of the evolution of orthodontic aligners and to describe to orthodontists the fundamentals of aligner therapy. In addition, it will provide an evidence-based outcome to the existing treatment outcomes in the current literature.

Pro-Inflammatory Oral Microbiota in Juvenile Spondyloarthritis: A Pilot Study.

The role of the microbiota in the pathogenesis of arthritis is gaining increasing attention. While multiple studies have queried the intestinal microbiota, very few have analyzed the contents of the oral microbiota. In this pilot study, we obtained salivary and sub-gingival specimens from a cohort of six healthy controls and five children with well-controlled spondyloarthritis (SpA) and performed 16S sequencing on bacteria obtained from both habitats. The Quantitative Insight into Microbial Ecology tool suite was used to generate operational taxonomic units, Phyloseq was used for diversity analyses, and DeSeq2 was used to compare abundances while adjusting for multiple comparisons. A repeat specimen was obtained from one subject during a flare. Clustering based upon diagnosis was observed from both habitats, with decreased alpha diversity seen within the plaque obtained from the patients vs. controls. Among the differentially abundant taxa were statistically significantly increased plaque Fusobacterium and salivary Rothia mucilaginosa among the patients compared to the controls. Additionally, the abundance of plaque Fusobacterium increased in one patient at the time of a flare. Our data suggest that the oral cavity may harbor bacteria involved in the pathogenesis of spondyloarthritis; additional studies are warranted.

Contemporary Smile Design: An Orthodontic Perspective.

Orthodontists play a vital role in the smile design of individuals. There are a variety of orthodontic goals and tooth movements that can be achieved to obtain the ideal smile that ultimately leads to the optimum esthetic outcomes. In this article, some methods and appliance systems to control and achieve the desired tooth movements are described and illustrated.

An Evaluation of Jaw Tracking Movements in Patients with Total Joint Replacements versus a Control Group.

Background and Objectives: One form of treatment for degenerative temporomandibular joint diseases such as osteoarthritis, rheumatic arthritis, TMJ ankylosis, and condylar resorption is total joint replacement. The aim of this study was to examine the function of the temporomandibular joint after prosthetic joint replacement. Materials and methods: Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via a SICAT JMT+ device. This non-invasive system measures 3D position and linear movements in all degrees of freedom and allows undisturbed functional mandibular movements to provide a quantitative evaluation. In addition, a TMJ questionnaire consisting of the subjective symptoms was also obtained. To date, no similar studies have been cited in the literature. Results: Mandibular movements after prosthetic joint replacement were recorded during opening, closing, protrusion, and lateral excursive movements and were all significantly decreased compared to those of controls. In the treatment group, the maximum incisal opening was 33.46 ± 5.47 mm, left lateral movement was 1.91 ± 2.7 mm, right lateral movement was 1.74 ± 1.74 mm, and protrusive movement was 2.83 ± 2.05 mm. The p-value comparison study and control group indicated significant difference (p < 0.0001) between the two groups. The study group stated a high level of satisfaction with the total joint replacement. Conclusion: Within the limitations of the study, the following conclusions can be drawn: (1) TMJ replacement patients showed significantly limited jaw movements compared to the control group; (2) a small percentage of TMJ replacement patients still present low levels of pain but improved chewing ability and quality of life.

Esthetic considerations in an orthodontic-orthognathic patient with Class III skeletal malocclusion.

Esthetics is one of the most important considerations in developing an orthodontic-orthognathic treatment plan. For patients with a Class III skeletal pattern, this multidisciplinary treatment option is designed to achieve adequate skeletal and functional enhancements and a harmonious esthetic outcome. This case report describes the orthodontic-orthognathic treatment of a 25-year-old female with skeletal Class III malocclusion, maxillary retrognathism, and anterior crossbite. The surgical plan included a maxillary LeFort I osteotomy and a mandibular bilateral sagittal split osteotomy. The double-jaw surgery combined with the orthodontic treatment improved her skeletal jaw relationship and occlusal function and resulted in excellent proportional facial esthetics.

Anterior openbite malocclusion in adults.

OBJECTIVES: To investigate stability and satisfaction in adult anterior open bite (AOB) patients at least 9 months post-treatment, as well as patient and practitioner factors that may be associated with stability and satisfaction. MATERIALS AND METHODS: Practitioners and their adult AOB patients were recruited through the National Dental Practice-Based Research Network. Data on patient and practitioner characteristics, treatment recommendations and factors were previously collected. Treatment stability was determined by assessing post-treatment intraoral photographs. Patient satisfaction was determined from post-treatment questionnaires. Treatment was categorized into aligners, fixed appliances, temporary anchorage devices, and orthognathic surgery. Extractions were also investigated. Retention type was categorized into vacuum-formed, Hawley-style, or bonded retainers, and regimens were classified as full-time or part-time wear. RESULTS: Retention data collected from 112 patients had a mean post-treatment time of 1.21 years. There were no statistically significant differences in stability between treatment groups. Depending on whether a qualitative index or a millimetric measure was employed, stability ranged from 65% to 89%. Extractions and less initial lower incisor proclination were associated with higher stability in patients treated with fixed appliances only. High satisfaction was reported by patients at retention. There were no clear differences in stability or satisfaction among retention types or regimens. CONCLUSIONS: The stability of adult AOB orthodontic treatment was high, regardless of treatment or retainer modality. Satisfaction in adult AOB patients was high, regardless of retention type or regimen.

Comparison of the condyle-fossa relationship and resorption between patients with and without Juvenile Idiopathic Arthritis (JIA).

PURPOSE: The purpose of this study was 1) to compare condyle - fossa relationships in the temporomandibular joint (TMJ), and 2) to score condylar resorption by using a TMJ indexing system in patients with JIA and without JIA. METHODS: The present retrospective cross-sectional study included cone-beam computed tomography (CBCT) images obtained from the sagittal, coronal, and axial slices. In the multidisciplinary Pediatric Rheumatology Outpatient Clinic at The University of Alabama at Birmingham (UAB) children with JIA are also examined by a group of orthodontists working in the same institute from October 2018 to July 2019. The predictor variable consists of patients with JIA and without JIA. The primary outcome variables are the depth of the mandibular fossa, joint spaces, axial angles, medio-lateral width, and condyle resorption. Other study variables were age and sex. In this study, the measurements obtained from 2 different groups (with JIA and without JIA) are compared using a t-test, where Tukey is utilized to adjust for multiple comparisons. The left and right joints are analyzed separately as the paired t test conducted showed a significant difference between the 2 joints (P < .05). RESULTS: The study was comprised of 34 patients diagnosed with JIA and 34 healthy subjects. The depth of the mandibular fossa, the anterior joint spaces, the axial angles, and the resorption index showed statistically significant differences between the JIA and healthy groups in both left and right sides (P < .05). However, there was no statistically significant difference in the posterior joint spaces and mediolateral width between JIA and healthy groups in both sides (P > .05). CONCLUSIONS: The results of our study presented the destructive potential of juvenile idiopathic arthritis by using CBCT. CBCT scanning is a helpful tool in the evaluation of the radiographic result of TMJ.

Smile Attractiveness Evaluation of Patients Selected for a U.S.-Based Board Certification Examination.

OBJECTIVES: The aims of this study were to assess smile attractiveness of a collection of 68 smiling photographs of successfully treated cases submitted to the American Board of Orthodontics (ABO) clinical examination and identify variables that influence the assessment. MATERIALS AND METHODS: A panel of 81 non-Caucasian assessors from various clinical disciplines were instructed to score the smile attractiveness on a visual analog scale from 1 (least attractive) to 10 (most attractive) and to select which components contributed to a lesser attractive smile. The mean, standard deviations (SDs), and quartiles of the smile attractiveness were obtained with descriptive statistics. Multilinear regression analysis was performed to investigate the scores of the perceived quality of smile attractiveness when the clinical disciplines and gender of the assessors were the factors taken into consideration. Receiver operating characteristic (ROC) curve was generated to establish the relationship between smile attractiveness and the achievement of a perfect smile. RESULTS: The mean (SD) rating of each clinical photograph of the anterior occlusion on smiling ranged from 3.11 (1.47) as the least attractive smile to 7.59 (1.45) as the most attractive smile. The overall mean (SD) score for smile attractiveness was 5.30 (1.10). Problems associated with teeth, gingiva, and lips corresponded with a reduction of the smile attractiveness score by 1.56, 1.82, and 1.47, respectively. Gender was not associated with smile attractiveness ratings. Orthodontists, periodontists, and prosthodontists demonstrated no difference in the ratings, while plastic surgeons were more critical than orthodontists regarding smile attractiveness. CONCLUSIONS: This study suggested that only 2 out of 68 AOB validated treatment finishes had a perfect and attractive smile.

Management of juvenile idiopathic arthritis: Preliminary qualitative findings from the National Dental Practice-Based Research Network.

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is the most common chronic arthritis in childhood and represents a series of chronic inflammatory arthritides that develop before 16 years of age. METHODS: In 2020, investigators with an interest in the management of JIA engaged the National Dental Practice-Based Research Network by conducting a preliminary qualitative questionnaire ("Quick Poll") that comprised 6 questions about JIA management. RESULTS: A total of 604 persons responded. Results suggested that there was an interest in the management of JIA, but many clinicians did not feel that they had the necessary knowledge or experience to treat these patients. CONCLUSIONS: The study clearly highlights a distinct gap in awareness and understanding of JIA among clinicians polled. Future work in this area should focus on education and awareness across multiple specialties, clinical guidelines for the management of JIA, and a data repository of long-term outcomes.

Orthodontic Management of a Palatal Fistula in a Patient With Pierre Robin Sequence Using 3D Intraoral Scanning and Computer-Aided Design.

Pierre Robin sequence (PRS) is a rare congenital abnormality that may be classified as a first branchial arch syndrome. Patients with PRS who present with cleft palate have a deformity to the soft or hard palate of the maxilla that is repaired within the first year of birth. Despite the repair, patients may experience oronasal complications. Surgical repair is usually necessary if palatal fistula presents, and prosthetic obturators are used to provide temporary relief prior to surgery. This case report outlines the steps in the successful fabrication of a custom-fitted temporary vacuum-formed prosthetic obturator using computer-aided design technology to provide a more comfortable and effective treatment option for the patient.

The National Dental Practice-Based Research Network Adult Anterior Open Bite Study: Treatment success.

INTRODUCTION: Anterior open bite (AOB) continues to be a challenging malocclusion for orthodontists to treat and retain long-term. There is no consensus on which treatment modality is most successful. This study reports on the overall success rate of AOB orthodontic treatment in the adult population across the United States, as well as 4 major treatment modalities and other factors that may influence treatment success. METHODS: Practitioners and their adult patients with AOB were recruited through the National Dental Practice-Based Research Network. Patient dentofacial and demographic characteristics, practitioner demographic and practice characteristics, and factors relating to orthodontic treatment were reported. Treatment success was determined from posttreatment (T2) lateral cephalometric films and intraoral frontal photographs. Treatment was categorized into 4 main groups: aligners, fixed appliances, temporary anchorage devices (TADs), and orthognathic surgery. Extractions were also evaluated. Bivariate and multivariable models were used to investigate the association between treatment success and treatment modality, pretreatment (T1) dentofacial characteristics, patient and practitioner demographics, and practice characteristics, adjusting for clustering of patients within practice. RESULTS: A total of 254 patients, enrolled by 84 practitioners, contributed to T2 data for this study. There were 29 patients in the aligner group, 152 in fixed appliances, 20 in TADs, and 53 in surgery. A total of 49 patients underwent extractions of teeth other than third molars. Ninety-three percent finished treatment with a positive overbite on the T2 lateral cephalogram, and 84% finished with a positive vertical overlap of all incisors. The small number of aligners and TAD patients limited the ability to compare success rates in these groups. Patients treated with orthognathic surgery had a higher rate of success compared with those treated with fixed appliances only. Treatment success was also associated with academic practice setting, T1 mandibular plane angle ≤30°, no to mild T1 crowding, and treatment duration <30 months. CONCLUSIONS: The overall success of orthodontic treatment in adult patients with AOB who participated in this study was very high. Orthognathic surgery was the only treatment modality that exhibited a statistically higher odds of successful outcomes. Some T1 dentofacial characteristics and treatment factors were associated with the successful closure of AOB.

3D Analysis of Tooth Movement Using 3D Technology.

PURPOSE OF REVIEW: 3D cone beam imaging (CBCT) has allowed clinicians to better understand the anatomical variations of cranial anatomy. One crucial aspect of this technology plays is the understanding of alveolar bone morphology and remodeling. Variations in cortical bone thickness between individuals have been reported. No published study has analyzed the relationship between cortical bone thickness and rate of tooth movement. The aim of this study is to begin answering the question: is there an association between rate of tooth movement and cortical bone thickness? RECENT FINDINGS: Twenty-three patients underwent extraction of a single premolar in each of the four quadrants prior to orthodontic therapy. Routine clinical records including 3D CBCT images were acquired of all patients prior to first premolar extractions. Rate of tooth movement in each quadrant for each patient was determined via mesiodistal millimetric measurements obtained by a single calibrated operator. With CBCT images, cortical bone thickness was measured at various levels from the alveolar crest along the long axis of the to-be-extracted first premolars. The association between cortical bone thickness and rate of tooth movement was analyzed. Statistically significant associations were found between rate of tooth movement and cortical bone thickness at levels 2 mm, 5 mm, and 8 mm, apical to the alveolar crest in both the right and left maxillary quadrants (p < 0.05). Statistically significant associations were found between rate of tooth movement and cortical bone thickness at levels 5 mm and 8 mm apical to the alveolar crest in both mandibular quadrants (p < 0.05). Increased cortical bone thickness was associated with decreased rate of tooth movement. There was no statistically significant association between rate of tooth movement and cortical bone thickness 2 mm apical to the alveolar crest of the to-be-extracted first premolars in the mandibular left nor right quadrants (p > 0.05). Results suggest an inverse relationship may exist between cortical bone thickness and rate of tooth movement in both the maxilla and mandible. Cortical bone thickness may have the potential to serve as a predictive tool for rate of orthodontic tooth movement.

Enhancing the Orthognathic Surgery Experience: Treatment in 10 Weeks "Surgery First" Approach.

This case report describes the successful treatment of a 25-year-old male with maxillary retrognathism, skeletal and dental Class III malocclusion, anterior and posterior crossbite, negative overjet and overbite, mild mandibular crowding, and lower midline deviation. The nonextraction treatment plan included: (1) maxillary and mandibular arch fixed appliance and (2) Le Fort 1 maxillary osteotomy and postsurgical orthodontic treatment. The orthodontic treatment was initiated with 0.022" preadjusted brackets bonded to all the teeth except the maxillary second molars, 2 days before the surgery without any archwires. Two weeks after the surgery, maxillary and mandibular arch alignment along with the occlusal adjustments was started with the use of 0.018" NiTi wires, in both arches. Optimum esthetic and functional results were achieved in 10 weeks after the surgery, with the cooperation of two specialties and the use of surgery first approach.

A randomized trial on the effects of root resorption after orthodontic treatment using pulsating force.

BACKGROUND: An orthodontic device that moves teeth with pulsating force was invented and underwent a single center, controlled, clinical trial to test its safety and efficacy for treatment. The device has a custom-made thermo-plastic mouthpiece which fits over the teeth with an inflatable silicone element. A console that measures and controls the pulsating force level in real-time controls the air pressure that delivers a pulsating force. In this study, the effect of the device on root resorption during orthodontic treatment was evaluated using 3D cone beam computed tomography and compared with a control group of patients who received Invisalign treatment. METHODS: Twenty-eight subjects were enrolled in the investigational arm and 15 in the control group. Subjects were followed until the average score of the mandibular and maxillary teeth achieved a Little's Irregularity Index of 1.5 mm or less. RESULTS: There were no adverse events reported throughout the study for either treatment arm. No clinically significant root resorption was observed for either group. The investigational device did not cause root resorption greater than the control group. Both devices produced a safety profile compared to current orthodontic techniques. CONCLUSION: The investigational device did not produce more root resorption than similar conventional orthodontic appliances. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03421886 . Registered 12 January 2018 - Retrospectively registered.

Contemporary management of an orthodontic-orthognathic patient with limited time availability in an orthodontic office setting: Case report.

INTRODUCTION: This case report describes the treatment of a 21-year-old man who presented in an orthodontic office for treatment but lived in a city 100 miles away and wanted the orthognathic surgery in another state in America. The patient presented with an anterior open bite and skeletal Class III relationship. METHODS: The treatment plan included: (1) effective and careful communication of the treatment plan with the patient, orthodontist and oral and maxillofacial surgeon; (2) pre-surgical alignment and levelling of the teeth in both arches with Invisalign; (3) a long-distance communication between the orthodontist and the surgeon for surgical plan with virtual surgical planning (VSP Orthognathics; 3D Systems, www.3Dsystem.com) online; (4) maxillary advancement (LeFort I osteotomy) with mandibular set-back (bilateral sagittal split osteotomy); (5) postsurgical correction of the malocclusion with clear brackets and aligners; and (6) retention and final small tooth movement adjustments with aligners/clear retainers. RESULTS: The anterior open bite was treated, crowding was eliminated in the upper and lower anterior segment, correction of skeletal and dental Class III malocclusion was obtained, mandibular plane angle was reduced and facial profile improved. CONCLUSIONS: The results suggest that aesthetic and functional results can be achieved with long-distance communication of two specialties and with the combined use of clear aligners and clear fixed appliances.

Rating of smile attractiveness of patients finished to the American Board of Orthodontics standards.

BACKGROUND: This study collected 68 smiling photos of cases taken to American Board of Orthodontics clinical exam and were considered as successfully treated. MATERIALS AND METHODS: A panel of 52 raters from different specialties and laypeople were asked to rate the smile attractiveness on a scale from 1-10 and to also choose what components made the smile less attractive. Simple descriptive statistics were used to determine the mean, standard deviations, and quartiles of the smile attractiveness. Multilinear regression (MLR) analysis was used to examine the relationship of smile attractiveness when the variables of age, professional experience, and gender of the raters were considered. Receiver operating characteristic (ROC) was created to correlate the association between smile attractiveness and the perfect smile. RESULTS: The mean rating of each picture ranged from 3.42 ± 1.83 (least attractive smile) to 8.46 ± 1.59 (most attractive smile). The overall mean for smile attractiveness was 6.23 ± 1.09; additionally, it was found that problematic teeth, gum, and lips reduce the smile attractiveness score by 1.7, 1.7, and 1.2, respectively. CONCLUSION: The study showed that only 2 out of 68 American Board of Orthodontics treatment finishes had an attractive and perfect smile.

3D Analysis of Facial Morphology of a Colombian Population Compared to Adult Caucasians.

OBJECTIVE: The purpose of this study involves describing the facial morphology of a Colombian population with three-dimensional (3D) imaging, and comparing their facial morphology with the Caucasian to create a database for this ethnicity. MATERIALS AND METHODS: The study, which included 135 subjects selected from the Valle University in Cali, Colombia, and 535 Caucasian subjects selected from the FaceBase-Data (1U01DE024449-01), was funded by the National Institute of Dental and Craniofacial Research. All images were taken in the natural head position (NHP) and captured using a stereo-photogrammetric camera system (3dMDface) to obtain a 3D image of each patient. The subjects were between 19 to 31 years of age, with a normal body mass index (BMI), and no craniofacial deformities. All images were plotted and analyzed using the 3dMDVultus software to calculate linear and angular measurements. Standard deviation (SD) and means were calculated for each measurement and analyzed using t-test for different samples. RESULTS: The Hispanic population had wider eyes, more protruded upper and lower lips, wider face, and greater mandibular width. Caucasian females had a more acute full profile, larger middle third, and less protrusive lips. Understanding the facial morphology of different populations would help to establish a better diagnosis and treatment planning for each ethnicity. CONCLUSIONS: From this study, the following conclusions may be drawn:1. The mean values of Colombian males showed greater measurements than females in the majority of measurements.2. Caucasian females had a more acute full profile, larger middle and lower third, and less protrusive lips.3. This study showed significant ethnic differences in the linear and angular measurements, showing us the importance of considering these findings in the diagnosis and treatment planning when a Hispanic population is involved. Soft tissue values should reflect the norms according to each ethnic population in order to achieve treatment goals.