Class II Skeletal Growth Modification Treatment: Has Hope Triumphed Over Evidence?

The hierarchy of evidence in the health sciences is primarily determined by study methodology and avoidance of systematic bias. As such, the systematic review and meta-analysis of randomized controlled trials sits at the top of the evidence pyramid while case studies, anecdotes, and personal opinions are located at its base. Ideally, clinical practice guidelines and reference manuals should be developed with this hierarchy in mind and clearly state what level of evidence supports any given clinical recommendation. When there is inadequate evidence to guide a clinical recommendation, we need to clearly state that. Unfortunately, many clinicians do not differentiate between the levels of evidence and consequently elevate highly biased studies to the level of the randomized controlled trial. Nowhere is this more evident than in the American Academy of Pediatric Dentistry Councils on Clinical Affairs' and Scientific Affairs' Reference Manual of Pediatric Dentistry best practice statement on the management of the Class II malocclusion.

The Degree of Overjet and Anterior Traumatic Dental Injury in the Mixed Dentition: A Single-Center Experience.

Objective. The objective of this retrospective chart review study was twofold. The first was to determine whether there is a correlation between the degree of overjet and the type of anterior traumatic dental injury (ATDI) in the mixed dentition. The second was to assess whether the decision to not treat young patients with prominent upper front teeth for trauma prevention resulted in a greater number of ATDI's in patients of record from a single-center. Study Design. The authors conducted a retrospective chart review of patients presenting to the Boston Children's Hospital (BCH) Emergency Department with an ATDI in the mixed dentition between October 2011 and March 2016. Results. Patients with an overjet less than or equal to 4 millimeters experienced all types of ATDI with greater frequency than those patients with an overjet greater than 4 mm. Conclusions. Our experience at BCH described in this study has led us to believe that a patient's risk of suffering an ATDI has more to do with the type of activities they participate in rather than the degree of their overjet.

Rapid Coating Process Generates Omniphobic Dentures in Minutes to Reduce C. albicans Biofouling.

Localized infections caused by biofilm formation on dentures pose a serious health risk for patients, especially the elderly, as they can lead to complications such as pneumonia. Daily enzymatic denture cleaners do not fully prevent biofilm formation on dentures. Here we developed a rapid coating process to apply a liquid repellent surface to dentures in ∼5 min and demonstrated a significant 225-fold reduction of Candida albicans adhesion over 6 days, compared to uncoated dentures. This rapid coating process could be applied to dentures and other dental devices chair-side and allow the research community to quickly and easily generate ominphobic surfaces.

Longitudinal trends in discharge patterns of orthognathic surgeries: is there a regionalization of procedures in teaching hospitals?

OBJECTIVE: The aim of this study was to determine if there is regionalization of orthognathic surgeries to teaching hospitals during the study period. STUDY DESIGN: The Nationwide Inpatient Sample for years 2000-2008 was used. Every hospitalization that had an orthognathic surgery was selected. Patient and hospital level variables were examined. The odds of an orthognathic surgery procedure being performed in a teaching hospital over the study period was computed with the use of a multivariable logistic regression model. RESULTS: During the study period, a total of 108,264 hospitalizations underwent orthognathic surgeries in the United States. The average age ranged from 27 years during the years 2006-2008 to 28.2 years during the years 2000-2002. After adjusting for multiple patient and hospital level factors, the year of procedure was not a significant predictor of increasing odds of an orthognathic surgery being performed in a teaching hospital. CONCLUSIONS: There is no evidence of concentration of orthognathic surgical procedures in teaching hospitals.

The human capital crisis in orthodontics.

The economics of dental practice are changing. The author reflects on the loss of a long-term, highly effective, and dedicated assistant in an orthodontic practice. Changes in technology, numbers of dentists, expected benefit levels, and a competitive workplace environment are combining to put pressures on the traditional model of oral health care. Whatever the solution turns out to be, the profession should take the lead in actively developing alternatives, and these will necessarily involve development of human capital in the dental practice.

Posttreatment compliance with removable maxillary retention in a teenage population: a short-term randomized clinical trial.

Removable retainer wear is most related to patient comfort and acceptance. Patient compliance is essential for retention and maintenance of the orthodontic treatment results. Even though patients are educated about the need for prolonged retention after active treatment and asked to sign informed consent regarding the risk of noncompliance (relapse) prior to treatment, most orthodontists would estimate that at least half of their teenage patients do not comply at optimal levels. The aim of the present study was to quantify teenage patient compliance with removable maxillary retention and compare actual usage vs prescribed usage between subjects who knew they were being monitored via an implanted microsensor in the retainer and those subjects who were unaware of any monitoring. The final sample consisted of 9 subjects in the test group (5 males and 4 females) and 10 subjects in the control group (4 males and 6 females). The evidence suggests that individuals who were made aware of the orthodontist's ability to monitor compliance wore the device for a significantly larger number of hours per day than those who were unaware of this fact. Patients reporting full usage of the retainer wore the appliance a mean of 4.3 hours more per day than those reporting less than full usage, holding all other variables constant. Patients who misrepresented their retainer use (reported full usage but wore the device less than 19 hours per day) wore the appliance a mean 12.4 hours less than the more honest patients who participated in the study.