Does teaching method affect students' perceptions regarding communication patterns in pediatric dentistry? A comparison of lecture and video methods.

The purpose of this study was to determine whether dental students' perceptions regarding six communication patterns for use in pediatric dentistry differed depending on whether they were taught by lecturing or by video-based teaching. Prior to the introduction of interpersonal skills in a clinical course in pediatric dentistry, four consecutive cohorts of students (n=107) in a German dental school were divided equally into two groups. Group one (n=57) was taught by video sequences and group two (n=50) by conventional lecture. Six communication patterns were presented: involvement of the child's toy(s), speaking in positive phrases, mentioning a personal aspect, recalling positive behavior of the patient, addressing fear verbally, and complimenting the patient. Immediately after the presentation, students were asked by means of a questionnaire about their assessment of and intentions regarding the clinical application of the communication patterns presented. After completion of the course, they were asked about the communication patterns that had been used. There were significant differences for three communication patterns in favor of video-based teaching (p<0.05); there were no significant differences regarding the intention for clinical application and the actual clinical application. In this study, students perceived differences between video-based teaching and lecturing regarding ease of use, but they did not seem to benefit from one method over the other regarding clinical application.

Effects of extraction treatment on maxillary and mandibular sagittal development in growing patients.

This retrospective investigation was designed to assess the effects of extraction treatment on the sagittal dimensions of the maxillary and mandibular skeletal structures of growing patients. The records of 40 patients (17 girls, 23 boys; median age 10 years 11 months) whose orthodontic treatment involved extraction of four premolars were evaluated and compared with a control group of 100 patients (54 girls, 46 boys; median age 10 years 7 months) treated non-extraction. Two lateral cephalograms were obtained of each patient, the first before the extractions, T1, and the second at a later point, T2 (mean difference 59 months). Linear parameters, including S-N, the maxillary/mandibular alveolar process, and maxillary/mandibular base, were measured. The same parameters were determined in the control group at corresponding time points (mean difference 63 months). For analysis, the sagittal dimensions of the alveolar processes and jaw bases were compared with each other. The relationships were also established to a reference line known to be unaffected by extraction treatment (S-N). This procedure was performed for the whole sample and for three subgroups formed according to the Wits appraisal. Statistical analysis was carried out using a Student's t-test. Comparisons of the total sample showed differences between the groups, which were statistically significant for the maxillary alveolar process, the mandibular alveolar process, and the mandibular base. They varied however in the different subgroups. Whenever extraction treatment is considered, it should be borne in mind that the effects on the sagittal dimension of different bony structures may vary.

Cephalometric analysis of molar and anterior tooth movement during cervical headgear treatment in relation to growth patterns.

OBJECTIVE: In this study we aimed to identify the reasons why cervical headgear treatment fails to induce bite opening or clockwise rotation of the mandible in the presence of a vertical growth pattern. In so doing, we investigated the dental effects of headgear treatment relative to growth patterns. MATERIALS AND METHODS: Records of 119 patients were analyzed, including casts and lateral cephalograms that had been obtained immediately before and after isolated cervical headgear treatment. Dental changes were determined relative to the SN line and a perpendicular line through point S. Inclusion criteria were: improvements in occlusal relationship of at least 4 mm in molar segments and treatment lasting at least 6 months. An orthodontic force of 3.5-4 N was applied in all cases through headgear featuring non-angulated outer arms. The headgear was worn for 14 hours a day during the active treatment phase. At the beginning of headgear treatment, patients were allocated into six groups according to y-axis values to quantify growth-related differences. RESULTS: The upper first molar was moved an average of 1.3 mm distally, while the lower first molar was moved an average of 2 mm mesially. These movements revealed no differences in terms of growth patterns. We were not able to make representative findings pertaining to upper molar extrusion due to distal tilting and the measuring point's position. We used the lower molars' movements for analysis instead, which demonstrated mean downward changes of 5.1 mm in all groups. The vertical growth pattern groups presented smaller caudal movements in the upper and lower anterior segments than did those groups with horizontal growth pattern. The occlusal plane's inclination decreased more extensively in the vertical growth pattern groups than in those with a horizontal pattern (e.g. H2: -0.1 degrees ; V3: -2.3 degrees ). CONCLUSION: Our results suggest that while the upper molars extrude, the mandible rotates around the molars in a hypomochlion fashion in the presence of a vertical growth pattern, thus leading to bite deepening.

Dislocation of an upper third molar by an ossifying fibroma--case report.

BACKGROUND: The occurrence of ossifying fibromas (OFs) in childhood and adolescence has been described in the literature, along with different courses of the disease due to different growth rates. CASE REPORT: In the case of the 15-year-old female patient presented here, an OF resulted in displacement of a maxillary third molar far into the maxillary sinus. It is assumed that the tumour originated coronal to the affected tooth 18. Radiographs document an initial rapid growth of this tumour over a period of 2 years, while its growth almost completely ceased in the next 2 years immediately prior to diagnosis and surgical treatment. The operation was complicated by unexpected profuse bleeding from the tumour tissue. CONCLUSION: The peculiarity of the OF in the case presented here is its similarity, in terms of clinical and radiological appearances, with a follicular cyst, its unusual place of origin that resulted in the migration of the tooth 18 into the maxillary sinus, its different growth dynamics, and the pronounced haemorrhage encountered as the tumour was surgically removed.

Angles of facial convexity in different skeletal Classes.

The objective of this study was to investigate whether it is possible to use a lateral (profile) photograph to determine the underlying skeletal Class and which reference points of the angle of convexity are most suitable for this purpose. Profile photographs and lateral cephalographs included in the baseline data for 180 orthodontic patients were retrospectively evaluated. The subjects were assigned to skeletal Classes based on Wits values obtained by radiolographic analysis. The Class I subjects were 58 patients (22 males, 36 females) with an average age of 13.63 +/- 2.1 years, the Class II subjects 60 patients (37 males, 23 females) with an average age of 13.60 +/- 2.6 years, and the Class III subjects 62 patients (28 males, 34 females) with an average age of 11.65 +/- 3.3 years. The angles measured were A'OrB' (=POrA'-POrA'), A'N'B', and the angle of convexity with its variants (N'SnPog', N'A'Pog', TrSnPog', TrA'Pog', Gl'SnPog', and Gl'A'Pog'). These angles were statistically evaluated using a two-sided t-test and linear discriminant analysis. Class II and Class III subjects exhibited highly significant differences (P < 0.001) for all angles. Class I and Class III exhibited highly significant differences (P < 0.001) for almost all angles, and significant differences for A'N'B' (P < 0.05). Class I and Class II differed significantly (P < 0.05) only for some angles (N'SnPog', TrA'Pog', Gl'SnPog', and Gl'A'Pog'). The error within the linear discriminant analysis was smallest for N'SnPog', GlA'Pog', and TrA'Pog' angles. However, the method error according to Dahlberg yielded rather high values for all angles (1.07-1.17 degrees). Discrimination between skeletal Class I and Class III was easier than that between Class I and Class II. One of the reasons may be that the subclasses division I and division II were not distinguished within the Class II subjects.

A minimally invasive approach in the interdisciplinary treatment of four fused maxillary incisors: a case report.

Tooth anomalies such as fusions and geminations present a considerable challenge for the practitioner. Functional, esthetic, periodontal, orthodontic, and psychological problems have been described. Quite often, the surgical measures taken lead to a considerable burden for the patient and to subsequent treatment. This report presents the treatment of a 15-year-old male bearing 2 x 2 fused incisors with different tissue structures in the maxilla. No surgical measures were performed; instead, restorative and orthodontic departments cooperated to achieve an adequate treatment result with a minimally invasive approach.

[Cervical headgear treatment and growth patterns: analysis by lateral cephalometry].

OBJECTIVE: Retrospective cephalometric study of changes in vertical and sagittal relations after headgear treatment depending on preexisting growth patterns. MATERIALS AND METHODS: Lateral cephalograms obtained from 119 patients before and after headgear treatment were analyzed. All patients were treated with headgears exclusively. Only cases were included that showed bilateral improvement of least 4 mm in Class II occlusion after headgear treatment lasting at least 6 months. Patients were assigned to six groups based on y-axis values obtained at baseline. RESULTS: Almost all groups revealed substantial improvements in skeletal Class II relations, including 1.38 degrees-1.72 degrees reductions in ANB angles and 0.62-0.81 mm reductions in Wits values. SNA values fell by 0.51-1.25 degrees. SNB angle values increased by 0.21 degrees-0.95 degrees. SN-MeGo angles and mandibular angles were reduced, while y-axis values remained essentially unchanged during headgear treatment. Different results were only obtained in the group with the most pronounced horizontal growth pattern. Those patients revealed lower SNB angle values (-0.93 degrees ) and increased vertical relations (y-axis: +1.39 degrees ; SN-MeGo angle: +1.22 degrees; mandibular angle: +0.01 degrees) after headgear treatment. All groups showed a reduction in basal plane angles and maxillary retroinclination after treatment. CONCLUSION: Our results do not support the conventional recommendation that cervical headgears should not be used in the presence of vertical growth patterns.

Effects of cervical headgear on overbite against the background of existing growth patterns. A retrospective analysis of study casts.

OBJECTIVE: To test the questions "Does cervical headgear treatment necessarily lead to a reduction of overbite?" and "Are there differences in treatment results due to different growth patterns or the initial overbite?" MATERIALS AND METHODS: Initial and intermediary casts of 247 patients who had been treated exclusively with headgear were analyzed for changes in the occlusal relationship of the first molars and overbite. Orthodontic treatment consisted of the application of cervical headgear with nonangulated external arms applied at a force of 3.5-4.0 N. Only patients showing dental changes of occlusal relationship > or = 4 mm during at least a 6-month treatment duration were selected. Growth patterns were identified by the y-axis values measured on lateral cephalograms obtained at study entry. Six groups were formed on the basis of these growth patterns. RESULTS: Headgear treatment induced bite deepening in patients with vertical growth patterns and bite opening in patients with horizontal growth patterns. Further subdivision based on initial overbite revealed bite deepening in patients with small initial overbite and bite opening in patients with large initial overbite. These differences were statistically significant (P < .05). Only minor changes were observed in patients with an initial overbite of 3-4 mm. CONCLUSIONS: Overbite reductions were not dependent on the growth pattern. Orthodontists should expect bite opening in deep-bite situations and bite deepening in open-bite situations. However, initial overbite situations of 3-4 mm should not be expected to change in a significant way.

The hierarchical cluster analysis of oral health attitudes and behaviour using the Hiroshima University--Dental Behavioural Inventory (HU-DBI) among final year dental students in 17 countries.

OBJECTIVE: To explore and describe international oral health attitudes/ behaviours among final year dental students. METHODS: Validated translated versions of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) questionnaire were administered to 1,096 final-year dental students in 17 countries. Hierarchical cluster analysis was conducted within the data to detect patterns and groupings. RESULTS: The overall response rate was 72%. The cluster analysis identified two main groups among the countries. Group 1 consisted of twelve countries: one Oceanic (Australia), one Middle-Eastern (Israel), seven European (Northern Ireland, England, Finland, Greece, Germany, Italy, and France) and three Asian (Korea, Thailand and Malaysia) countries. Group 2 consisted of five countries: one South American (Brazil), one European (Belgium) and three Asian (China, Indonesia and Japan) countries. The percentages of 'agree' responses in three HU-DBI questionnaire items were significantly higher in Group 2 than in Group 1. They include: "I worry about the colour of my teeth."; "I have noticed some white sticky deposits on my teeth."; and "I am bothered by the colour of my gums." CONCLUSION: Grouping the countries into international clusters yielded useful information for dentistry and dental education.

A clinical method to determine the optimal apical preparation size. Part I.

OBJECTIVE: To establish a new approach for determination of the optimal apical preparation size (APS). STUDY DESIGN: After preflaring 212 root canals from 80 extracted molars, electronic working length (WL) was measured to establish where the apical preparation size (APS) should be determined. Subsequently, nontapered, noncutting special instruments were used to reach WL. The diameter of the largest special instrument (SI) width that had to overcome some resistance to advance to WL was defined as d(SI). After sectioning the roots apically, the diameter of a potential rotary instrument was determined for each section, allowing a complete cutting of the root canal wall. The estimation of APS was related to d(SI). RESULTS: Theoretically, individual APS of d(SI) + 0.60 mm yielded circumferential apical preparations in 98% of the cases. When shaping palatal/distal root canals of molars to d(SI) + 0.40 mm, and mesiobuccal/mesiolingual/distobuccal root canals of molars to d(SI) + 0.30 mm, complete preparations of root canal walls resulted in 78% (95% CI, 69%-87%) and 72% (95% CI, 65%-80%) of canals, respectively. CONCLUSION: The described approach allowed evaluation of the APS for most root canals. Root canals should be shaped to larger sizes than normally recommended.

Extended apical enlargement with hand files versus rotary NiTi files. Part II.

OBJECTIVE: The objective of this study was to compare 2 preparation techniques performed under simulated clinical conditions with extended apical enlargement following determination of the optimal apical preparation size (APS). STUDY DESIGN: After preflaring 240 root canals, APS was evaluated as outlined in Part I. The apical portion was shaped to APS either with rotary NiTi Lightspeed instruments (LS) or NiTi hand instruments (HA) using the balanced force technique in a phantom head. After sectioning the apical area at 3 levels, every cross section was analyzed microscopically for circumferential removal of canal wall dentine. Loss of working length, instrument separation, and perforation were additionally recorded. RESULTS: In 70% (LS) and 69% (HA) of the root canals, 2 of 3 levels demonstrated that the root canal dentin was cut circumferentially. Neither loss of working length nor perforation occurred in both groups. Four LS instruments separated. CONCLUSIONS: APS frequently results in a nearly complete apical preparation regardless of the preparation techniques. In a few cases apical enlargement to APS does not achieve complete cutting of the canal walls. There was a rather slight risk of serious procedural errors.

Molar and canine occlusal changes in study casts before and after treatment with cervical headgears.

AIM: We carried out a retrospective study on 246 pairs of casts to compare the extent of changes in occlusal relationship and overjet reduction induced by cervical headgears. MATERIAL AMD METHODS: Molar-canine occlusal relationships and overjet were determined from study casts made immediately before headgear treatment. Those findings were then compared to another cast made immediately after headgear monotherapy and before multiband-appliance administration. Headgear treatment lasted at least 6 months. Only patients whose upper first molars were distalized by at least 4 mm were included. RESULTS: Strikingly, the distalization and overjet reduction induced by headgear treatment were most pronounced in posterior positions and decreased progressively toward more anterior positions along the arch. The mean amount of distalization was 6.87 mm at molar, and 1.87 mm at canine positions. The mean reduction of initial overjet was 0.78 mm. No significant differences resulted by grouping the data based on upper anterior tooth inclinations before treatment. Significant differences, however, were obtained by grouping the data based on initial overjet. Significantly greater changes in molar-canine occlusal relationships and overjet reductions were observed in patients with a major initial overjet of > 6 mm than in those with a relatively minor overjet of < 4 mm.

Retrospective analysis of casts to assess cervical headgear treatment in the presence of vertical growth pattern.

OBJECTIVE: Does molar distalization as effected by cervical headgear increase the vertical dimension of occlusion in patients with vertical growth pattern? MATERIALS AND METHODS: A sample of 86 patients with neutral and vertical growth pattern in the late mixed dentition stage underwent headgear treatment. Their initial and intermediary casts were retrospectively analyzed for occlusal relationships at the maxillary first molars and degrees of overjet and overbite. The only cases included were those in which headgear treatment was carried on for at least 6 months, achieving a minimum distalization of 4 mm. The intermediary casts were fabricated after headgear treatment had been completed and prior to the initiation of multiband treatment. Patients were divided into three groups (N, V1 and V2) according to the degrees of vertical growth pattern, which were determined based on y-axis angle values. RESULTS: Grouped by degrees of vertical growth, the data revealed occlusal relationship changes of 6-8 mm and overjet reductions of 0.6-1.2 mm. The overbite changes were unexpectedly small (0-0.04 mm). Grouped by degrees of overbite, the data revealed that headgear treatment increased the vertical dimension of occlusion in deep-bite patients (>4 mm), while giving rise to decreases in patients with overbites of <3 mm.

An intrusion injury as an example of interdisciplinary aspects in dental traumatology: a case report.

Traumatic injury to teeth presents a considerable challenge for the practitioner. Very often a variety of oral tissues are involved, such as enamel, dentin, periodontal ligament, alveolar bone, and mucosa. Extraoral lesions are often another focus of attention for the patient and the practitioner. To cover all these various demands and necessities in a proper and adequate manner, a sound knowledge and experience of many different dental fields is needed. This case report presents the treatment of an 8-year-old girl during which surgical, restorative, endodontic, and orthodontic practices cooperated to achieve an adequate rehabilitation of the patient.

Acceptance of video-based teaching in paediatric dentistry by undergraduate dental students.

Five cohorts of undergraduate students (n = 160) were filmed on video tape while performing paediatric treatments. Sequences of these recordings were shown 1 day later and discussed. Thus, within one term each student was able to view himself as well as fellow students on video. After the completion of the clinical course in paediatric dentistry, students were asked by means of a questionnaire about the acceptance and benefits of video-based teaching in paediatric dentistry. 95.5% welcomed the use of video in paediatric dentistry. Concerning the benefits gained from the video showing the treatment that had been performed by the student himself, 83.4% said they had gained new insights in their own behaviour and 80.3% thought these insights to be useful for their clinical work. For the video showing treatments by fellow students, numbers were higher: 84.7 and 89.8%, respectively. Gender-specific differences revealed that women feel more disturbed by the fact that they are being filmed (7.8% vs. 14.9%), some even think that they would have performed a better treatment without the video. Out of four didactical means, video gained the highest vote, followed by seminars, lectures and slides. It is concluded that the use of video is a valuable didactical means that should be considered in teaching undergraduate students.

Transplantation of a lower bicuspid after traumatic loss of three upper incisors.

BACKGROUND: Prosthodontic and orthodontic procedures have been described for the treatment of patients with traumatic loss of teeth. PATIENT AND METHODS: Both upper central incisors and the upper right lateral incisor had to be extracted in an 8-year-old patient after failure of conservative procedures following a sports accident. The patient was treated on a temporary basis with a space retainer as a substitute for the teeth. Definitive therapy was carried out by transplanting a lower bicuspid germ into the upper arch with subsequent orthodontic gap closure. RESULTS: 8 years after the intervention, the transplanted tooth is still in place. The patient is fully rehabilitated both functionally and esthetically with no discomfort. CONCLUSIONS: The transplantation of bicuspid germs in conjunction with orthodontic gap closure is a valuable alternative to prosthodontic treatment, particularly in the case of loss or aplasia of several teeth.