Comparison between Classic Twin-block and a Modified Clear Twin-block in Class II, Division 1 Malocclusions: A Randomized Clinical Trial.

AIM: The aim of this study was to compare dentoskeletal effects and patient's satisfaction with a modified twin-block (clear twin-block) and classic twin-block. MATERIALS AND METHODS: A total of 62 patients with skeletal class II malocclusion contributing to mandibular retrognathism with a minimum of 4 mm overjet, the FMA angle between 20 to 25 degree and being in stage 2 to 3 of cervical vertebral maturation participated in this study. Subjects were randomized in 1:1 ratio to classic and clear twin-block. Lateral cephalograms were taken at two stages-Pre- and post-treatment (when the overjet reduced to 1 to 0 mm). All the measurements were done with Dolphin software version 10.5. Four months after the start of the treatment the patients were asked to fill the questioners regarding their compliance from the appliances. RESULTS: Both classic and clear twin-block groups showed mandibular advancement without statistically significant difference between them. However, SNB angle increased slightly more in clear group than the classic one. "Headgear effect" is not statistically noticeable in both groups. However, SNA angle decreased slightly more in classic group. Increased in lower incisors proclination was happening in both groups, but in a clear group, this increase was significantly less. Overbite reduction could be seen in both groups with significantly more reduction in the classic group. CONCLUSION: Increase in lower incisors proclination was less in clear group than the classic one. Overbite reduction was more in the classic group than the classic one. CLINICAL SIGNIFICANCE: Clear twin-block is more beneficial in skeletal class II patients with proclined lower incisors and vertical growth pattern.

Braces versus Invisalign®: gingival parameters and patients' satisfaction during treatment: a cross-sectional study.

BACKGROUND: Fixed orthodontic appliances (FOA) temporarily interfere with periodontal health of patients, as the appliance complicates oral hygiene. The use of aligners in orthodontic therapy increased strongly during the last decade. In the literature, the reports about effects of aligner treatment on oral hygiene and gingival conditions are scarce. This cross-sectional study evaluated oral hygiene and patient's satisfaction during orthodontic treatment of patients with FOA or Invisalign®. METHODS: 100 patients (FOA = 50, Invisalign® = 50) were included who underwent orthodontic treatment for more than 6 months. Clinical examinations were performed to evaluate patients' periodontal condition and were compared with clinical data at the beginning of the orthodontic treatment. Oral hygiene, patients' satisfaction and dietary habits were documented by a detailed questionnaire. For statistical analysis, the Mann-Whitney U-Test and Fisher's Exact Test were used; as multiple testing was applied, a Bonferroni correction was performed. RESULTS: At the time of clinical examinations, patients with FOA were in orthodontic therapy for 12.9 ± 7.2 months, whereas patients with Invisalign® were in orthodontic therapy for 12.6 ± 7.4 months. Significantly better gingival health conditions were recorded in Invisalign® patients (GI: 0.54 ± 0.50 for FOA versus 0.35 ± 0.34 for Invisalign®; SBI: 15.2 ± 7.6 for FOA versus 7.6 ± 4.1 for Invisalign®), whereas the amount of dental plaque was also less but not significantly different (API: 37.7 % ± 21.9 for FOA versus 27.8 % ± 24.6 for Invisalign®). The evaluation of the questionnaire showed greater patients' satisfaction in patients treated with Invisalign® than with FOA. CONCLUSION: Patients treated with Invisalign® have a better periodontal health and greater satisfaction during orthodontic treatment than patients treated with FOA.

Differences in psychological traits between lingual and labial orthodontic patients: perfectionism, body image, and the impact of dental esthetics.

OBJECTIVE: To examine some of the patients' psychological traits in relation to their levels of perfectionism and their body image, and to discover whether these differ between lingual and labial orthodontic patients. MATERIALS AND METHODS: A cross-sectional study was designed with a consecutive sample of 80 patients attending a private orthodontic office. Three questionnaires were used to assess the patients' body image and level of perfectionism. The mean age was 33 years. The men numbered 32 and the women 48. The validated Spanish version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) was used to assess the psychosocial impact of their dental esthetics. The Multidimensional Perfectionism Scale (MPS) was used to assess how perfectionist the patients were. A version of the Multidimensional Body-Self Relations Questionnaire (MBSRQ) was used for assessment of their body image. Student's t-test was used to compare the means and 95% confidence intervals (P < .05), and a logistic regression model was used for multivariate analysis. RESULTS: The PIDAQ (55.4 vs 60, P  =  .218) and MBSRQ (128.7 vs 125.9, P  =  .523) results of the patients who chose lingual orthodontics did not differ significantly from those who opted for labial orthodontics. However, the MPS scores of the lingual orthodontic patients were significantly higher (95.9 vs 86.3, P  =  .044), and high social class, over 30 years of age, and perfectionist traits were significant independent variables in this group. CONCLUSIONS: This pilot study may indicate that lingual orthodontic patients are more perfectionists than labial orthodontic patients.

Impact of metal and ceramic fixed orthodontic appliances on judgments of beauty and other face-related attributes.

INTRODUCTION: Physical attributes, behavior, and personal ornaments exert a direct influence on how a person's beauty and personality are judged. The aim of this study was to investigate how people who wear a fixed orthodontic appliance see themselves and are seen by others in social settings. METHODS: A total of 60 adults evaluated their own smiling faces in 3 different scenarios: without a fixed orthodontic appliance, wearing a metal fixed orthodontic appliance, and wearing an esthetic fixed orthodontic appliance. Furthermore, 15 adult raters randomly assessed the same faces in standardized front-view facial photographs. Both the subjects and the raters answered a questionnaire in which they evaluated criteria on a numbered scale ranging from 0 to 10. The models judged their own beauty, and the raters assigned scores to beauty, age, intelligence, ridiculousness, extroversion, and success. RESULTS: The self-evaluations showed decreased beauty scores (P <0.0001) when a fixed orthodontic appliance, especially a metal one, was being worn. There was no statistically significant difference between the 3 situations in the 6 criteria analyzed. CONCLUSIONS: A fixed orthodontic appliance did not affect how personal attributes are assessed. However, fixed orthodontic appliances apparently changed the subjects' self-perceptions when they looked in the mirror.

A randomized crossover study comparing two mandibular repositioning appliances for treatment of obstructive sleep apnea.

PURPOSE: The purpose of this study was to determine whether treatment outcomes vary according to the design of the mandibular repositioning appliance (MRA). Two titratable MRA's were compared. The designs differ in advancement hardware and configuration of acrylic both in bulk and interocclusal contact. MATERIALS AND METHODS: The primary treatment outcome was the Respiratory Disturbance Index (RDI). Other outcomes that were compared included Sleep Apnea Quality of Life Index (SAQLI), Epworth Sleepiness Scale, oxygen saturation, and subjective feedback regarding experiences with the appliances. Twenty-four subjects were recruited from consecutive referrals for MRA therapy following diagnosis of obstructive sleep apnea (OSA) by polysomnography. Subjects were randomly assigned to a treatment arm of the crossover study. Each subject underwent an initial sleep study with a type III home monitor to establish a baseline RDI. Subjects were then treated with one of the two MRAs determined by random assignment. The MRA self-titration phase was monitored until a treatment position was determined, and the home sleep study was repeated. After a 2-week period without any OSA treatment, subjects received the second MRA and the self-titration treatment protocol was repeated. At completion of treatment with each appliance, subjects answered questionnaires and underwent a sleep study with the type III monitor. The outcome data for each appliance were compared using analysis of variance. RESULTS: Eighteen subjects completed the treatment protocol. There were no significant statistical differences in treatment outcomes between the two appliances. There was a statistically significant (p ≤ 0.05) preference for a MRA design with minimal coverage of teeth and palate. The subjects' appliance selection was consistent with a corresponding reduction in SAQLI score for the selected appliance. CONCLUSION: Although no statistically significant difference was observed between the two appliances in the outcomes measured, there was a trend toward greater improvement with the appliance with less acrylic resin bulk and less interocclusal contact. MRA selection should favor titratable, unobtrusive designs with appropriate construction to promote acceptance and adherence to MRA therapy.

Cross sectional: perception of children from public and private schools regarding the esthetic impact of different types of face masks.

PURPOSE: The purpose was to evaluate the esthetic perception among children from public and private schools regarding the use of different types of face masks. METHODS: Six different types of orthopedic face masks made from images of the same patient were evaluated. Initially, the images were standardized with the help of Adobe Photoshop software. The variable considered was type of mask: (A) Delaire with facebow; (B) Petit; (C) Delaire; (D)Turley; (E) Hickham; and (F) Sky Hook. The images were printed on photographic paper and incorporated into a specific personalized questionnaire that was distributed to 7- to 10-year-olds attending public and private schools (n=120). The data obtained were compared via chi-square, Fisher's exact tests, Mann-Whitney and Spearman's tests. RESULTS: The proportion of participants who chose image A as the best was significantly higher (P<.05) compared to the other masks. Images B and F were chosen as the worst, without a significant difference between them (P>.05). The mean scores between groups were not significantly correlated between private vs public schoolchildren (r=0.32) and between boys and girls (r=0.41). CONCLUSIONS: Delaire face mask with facebow was chosen as the most attractive, and the Petit and Sky Hook face masks were voted the least attractive.

Comparison of oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances.

INTRODUCTION: Our objective was to compare the oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances. METHODS: This was an age- and sex-matched prospective longitudinal study of 60 adult patients treated with either labial or customized lingual fixed orthodontic appliances over a 3-month period. Ratings of oral impacts experienced and satisfaction were made on visual analog scales at 3 time points after appliance fixation. Variations in oral impacts and satisfaction over the trajectory of treatment were assessed. Area-under-the-curve analyses were conducted to assess variations in oral impacts and satisfaction between the groups. RESULTS: All patients experienced oral impact disturbances, although these disturbances decreased over time (P < 0.001). Patients treated with customized lingual appliances reported more oral discomfort (P < 0.001), dietary changes (P < 0.001), swallowing difficulty (P < 0.001), speech disturbances (P < 0.001), and social problems (P < 0.001) than did those in the other group. There was no significant difference between the groups regarding ratings of oral self-care, mastication, and satisfaction level of treatment (P > 0.05). CONCLUSIONS: The findings indicate that oral impacts are commonly experienced during both labial and customized lingual fixed orthodontic therapies. However, the oral impacts decreased over the observational period. Patients treated with customized lingual appliances experienced more oral impacts. Both groups had similar levels of treatment satisfaction.

Assessment of perceived orthodontic appliance attractiveness.

INTRODUCTION: To date, no studies have been published in the literature evaluating the esthetics of orthodontic appliances. The purpose of this study was to assess appliance variables, including appliance type, brand, wire, and ligature tie, for their relative attractiveness. Demographic factors were also evaluated. METHODS: Appliances were placed in an adult, and digital images were captured, standardized, and incorporated into a computer-based survey. Subjects (n = 200) rated each image for attractiveness on a visual analog scale. The attractiveness ratings were analyzed by using factorial analysis of variance with repeated measures. Post-hoc testing was done with the Tukey-Kramer test (overall a <.05). RESULTS: For all demographic factors, attractiveness ratings were significantly different between alternative (clear trays and simulated lingual appliances), ceramic, and all self-ligating/stainless steel appliances. No differences between brands in each appliance type were found. Ratings of some ceramic appliances were significantly affected by archwire and ligature tie, depending on several demographic interactions. CONCLUSIONS: Orthodontic appliance attractiveness varies by the following hierarchy of appliance types: alternative > ceramic > all stainless steel/self-ligating. Wire and tie selection can affect the appearance of ceramic appliances but have no impact on stainless steel or self-ligating appliances. Certain demographic factors have variable effects on attractiveness ratings.

Lingual technique--patients' characteristics, motivation and acceptance. Interpretation of a retrospective survey.

AIM: The aim of the present study was to collect personal data of patients treated solely with fixed lingual appliances. In addition, motivation and appliance acceptance were to be assessed. PATIENTS AND METHODS: The collective comprised 98 patients from our orthodontic clinic (C) and from an orthodontic practice (P). In addition to personal data such as gender, age, profession and marital status, the questionnaire covered the following parameters: initial source of information, motivation, phonetic-functional impairment, and subjective assessment of the treatment outcome. RESULTS: Statistical analysis of the personal data revealed a characteristic type of patient with a preference for lingual treatment: females below 40 years of age, whose preference for the lingual technique was based primarily on esthetic considerations. The main impairment (65%) due to the lingual appliance was reported to be injury to or irritation of the tongue and the restricted functional space for the tongue. The phonetic-functional adaptation period was 1-3 weeks. 99% of the patients were content or very content with the treatment outcome. 87% would recommend the lingual technique without reserve to relatives and friends. The majority of the patients would have refused orthodontic treatment with the labial technique. CONCLUSION: The results indicate that treatment with a fixed lingual appliance appeals to a characteristic patient group. In general, the level of acceptance among patients was positive and impairments during the adaptation period were tolerated after 1-3 weeks. The lingual technique should be integrated into routine orthodontic practice.