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.

Deconstructing evidence in orthodontics: making sense of systematic reviews, randomized clinical trials, and meta-analyses.

Much has been written in support of systematic reviews and the randomized clinical trials and meta-analyses upon which they are based. Clearly, the medical profession (as opposed to the dental profession) has been the leader in publishing the benefits of systematic reviews over the traditional, qualitative narrative reviews. At the same time, the medical profession also appears to be ahead of the dental profession in recognizing the limitations of such reviews. That said, there are a number of inherent problems with systematic reviews, as well as the randomized clinical trials and meta-analyses that back them up. To better facilitate evidence-based decision making, this article discusses the shortcomings of systematic reviews so that practitioners are fully aware of their drawbacks, as well as their benefits.

Hard- and soft-tissue contributions to the esthetics of the posed smile in growing patients seeking orthodontic treatment.

INTRODUCTION: The purpose of this investigation was to broaden the understanding of how various skeletal, dental, and soft-tissue relationships are related to the esthetics of the smile in patients with malocclusions before orthodontic treatment. METHODS: Images of the posed smile were captured from digital video clips of 60 growing patients (33 girls, 27 boys) seeking orthodontic treatment; they were judged by panels of laypersons and orthodontists. Discriminant analysis identified determinants of the "pleasing smile" from the results of a visual analog scale. Quantitative measurements of the soft and hard tissues were made by using the smile images, cephalometric radiographs, and study models. The esthetics of the smile were correlated with specific skeletal, dental, and soft-tissue structures in the anteroposterior, vertical, and transverse dimensions (Pearson test on non-topographic correlations). RESULTS: The esthetic smile judgments of orthodontists agreed with those of laypersons (r >0.93). The vertical thicknesses of the lips were the most significant component of a pleasant smile, for both the orthodontists (upper lip) and laypersons (lower lip) (discriminant power: 75%). The vertical thickness of the upper lip had a significant positive correlation with the position of the maxillary incisor. CONCLUSIONS: Vertical lip thickness proved to be the most influential variable in smile esthetics. The significant relationship of incisor protrusion with the vertical thickness of the vermilion border of the upper lip must be considered when planning orthodontic treatment.

Pitch, roll, and yaw: describing the spatial orientation of dentofacial traits.

The value of systematically enhancing the Angle classification by including transverse and vertical characteristics in addition to anteroposterior relationships for the face and the dentition is universally accepted. Three aeronautical rotational descriptors (pitch, roll, and yaw) are used here to supplement the planar terms (anteroposterior, transverse, and vertical) in describing the orientation of the line of occlusion and the esthetic line of the dentition. Each of the latter traits affects the modern clinical practice of orthodontics because of its greater focus on dentofacial traits beyond the correction of malocclusion. Consistent with the principle that every orthodontic intervention should begin with a thorough consideration of variation in a patient's dentofacial traits, this article offers further refinement of diagnostic description and classification.

ABO certification in the age of evidence and enhancement.

The American Board of Orthodontics (ABO) phase III certification examination was originally constructed and recently modified to "help the Board determine the candidate's knowledge of clinical orthodontics and provide a basis to assess the quality of the candidate's clinical treatment results." For the most part, the ABO phase III examination measures the orthodontic treatment-induced changes in occlusion in a limited and biased patient sample. The process and outcome measures used in the current model-the discrepancy index and the objective grading system-are so narrowly focused that an orthodontist might lack up-to-date clinical knowledge, psychomotor and critical thinking skills, diagnostic acumen, patient management ability, and patient-centered ethics, and still pass the examination largely because of mechanically morphing the patient's teeth into the board's construct of ideal occlusion. The goal of this article is to provide provocative insight into the core concepts that drive the ABO phase III certification process and to recommend an alternative paradigm predicated on a patient-centered, evidence-based clinical practice model.

An evaluation of dynamic lip-tooth characteristics during speech and smile in adolescents.

This retrospective study was conducted to measure lip-tooth characteristics of adolescents. Pretreatment video clips of 1242 consecutive patients were screened for Class-I skeletal and dental patterns. After all inclusion criteria were applied, the final sample consisted of 50 patients (27 boys, 23 girls) with a mean age of 12.5 years. The raw digital video stream of each patient was edited to select a single image frame representing the patient saying the syllable "chee" and a second single image representing the patient's posed social smile and saved as part of a 12-frame image sequence. Each animation image was analyzed using a SmileMesh computer application to measure the smile index (the ratio of the intercommissure width divided by the interlabial gap), intercommissure width (mm), interlabial gap (mm), percent incisor below the intercommissure line, and maximum incisor exposure (mm). The data were analyzed using SAS (version 8.1). All recorded differences in linear measures had to be > or = 2 mm. The results suggest that anterior tooth display at speech and smile should be recorded independently but evaluated as part of a dynamic range. Asking patients to say "cheese" and then smile is no longer a valid method to elicit the parameters of anterior tooth display. When planning the vertical positions of incisors during orthodontic treatment, the orthodontist should view the dynamics of anterior tooth display as a continuum delineated by the time points of rest, speech, posed social smile, and a Duchenne smile.

Dynamic smile visualization and quantification: Part 2. Smile analysis and treatment strategies.

The "art of the smile" lies in the clinician's ability to recognize the positive elements of beauty in each patient and then create a strategy to enhance the attributes that fall outside the parameters of the prevailing esthetic concept. New technologies have enhanced our ability to see our patients more dynamically and facilitated the quantification and communication of newer concepts of function and appearance. In a 2-part article, we present a comprehensive methodology for recording, assessing, and planning treatment of the smile in 4 dimensions. In part 1, we discussed the evolution of smile analysis and reviewed the dynamic records needed. In part 2, we review smile analysis and treatment strategies and present a brief case report.

Dynamic smile visualization and quantification: part 1. Evolution of the concept and dynamic records for smile capture.

The "art of the smile" lies in the clinician's ability to recognize the positive elements of beauty in each patient and to create a strategy to enhance the attributes that fall outside the parameters of the prevailing esthetic concept. New technologies have enhanced our ability to see our patients more dynamically and facilitated the quantification and communication of newer concepts of function and appearance. In a 2-part article, we present a comprehensive methodology for recording, assessing, and planning treatment of the smile in 4 dimensions. In part 1, we discuss the evolution of smile analysis and review the dynamic records needed. In part 2, we will review smile analysis and treatment strategies and present a brief case report.