Effect of personality traits on the association between clinically assessed malocclusion and the psychosocial impact of dental aesthetics.

OBJECTIVE: We aimed to assess whether personality traits affect the relationship between malocclusion and the psychosocial impact of dental aesthetics and whether they act as its mediators or moderators. SETTINGS AND SAMPLE POPULATION: The cross-sectional study included 252 participants with permanent dentition (62% female) aged 12-39 years. MATERIALS AND METHODS: The Big Five Inventory, the Psychosocial Impact of Dental Aesthetics Questionnaire and the Index of Complexity, Outcome and Need were used. Moderation and mediation were tested by hierarchical stepwise multiple linear regression. RESULTS: Malocclusion was the most significant predictor of dental self-confidence (DSC), aesthetic concern (AC), social impact (SI) and psychological impact (PI), accounting for 12%-28% of respective variability (P < .05). Adult age, male sex and higher neuroticism and agreeableness were additional predictors of higher DSC (P < .05). Adolescent age was a predictor of higher AC, SI and PI, and female sex of higher AC and PI (P < .05). Mediation by personality traits was not proven, however, openness, agreeableness and neuroticism were moderators. A tendency of decrease in AC was associated with an increase in malocclusion complexity in adolescents lower in openness and decrease in SI in adolescents with lower agreeableness. There was also a tendency of higher increase of AC associated with an increase of malocclusion degree in adults higher in neuroticism. CONCLUSION: In adolescents, openness and agreeableness moderate the relationship between malocclusion and AC and SI, respectively. Neuroticism is a moderator of the association between malocclusion and AC in adults.

Satisfaction with smile appearance mediates oral health-related quality of life in adolescents regardless of orthodontic treatment need - a cross-sectional study.

OBJECTIVES: To explore the relationship between adolescents' oral health-related quality of life (OHRQoL), satisfaction with smile appearance, treatment need and treatment demand through direct and serial mediation models. MATERIALS AND METHODS: This cross-sectional study included 215 11-14-year-olds and their parents. The instruments included the Child Perceptions Questionnaire and the Index of Orthodontic Treatment Need. Satisfaction with smile appearance, orthodontic treatment demand and parental perception of their child's orthodontic treatment need was recorded on a Likert scale (0 = not at all to 4 = very much). Serial mediation models were used to assess the effects of malocclusion on the OHRQoL. RESULTS: Objective treatment need explained less than 5% of the adolescents' OHRQoL. Serial mediation models through satisfaction with smile appearance, parental perception of their child's orthodontic treatment need, and patients' orthodontic treatment demand explained 23-25% of the variance. CONCLUSIONS: Satisfaction with smile appearance mediates the OHRQoL in adolescents. Parents have no direct influence, but their perception of the need to correct their child's teeth might amplify adolescents' orthodontic treatment demand, leading to lower OHRQoL.

Facial aesthetic concern is a powerful predictor of patients' decision to accept orthognathic surgery.

OBJECTIVE: To investigate differences in quality of life in subjects with and without skeletal malocclusions and factors influencing patients' decision to accept orthognathic surgery. MATERIALS AND METHODS: DESIGN: Cross-sectional with stratified sampling. SETTINGS AND SAMPLE POPULATION: 190 Caucasian subjects (65% females), aged 17-46 years. 95 subjects were consecutive patients referred to University Dental Clinic for skeletal malocclusion treatment of which 58 subjects accepted suggested surgery, 37 refused. The other 95 were age-and sex-matched controls, without malocclusions, recruited from the pool of students and employees of local high schools and university. MAIN OUTCOME MEASURES: Psychosocial and functional issues were evaluated by Orthognathic Quality of Life Questionnaire. Complexity of malocclusion and treatment need was assessed by the Index of Orthognathic Functional Treatment Need. RESULTS: Discriminant analysis demonstrated that in quality of life, three groups differed mostly in facial aesthetic concern, followed by altered oral function, then by social interactions which were the highest in the group that accepted surgery. When controlling for age, sex, oral function impairment, awareness of facial deformity and inhibitions in social contacts in a multiple logistic regression analysis, only IOFTN and facial aesthetic concern were significant predictors of orthognathic surgery acceptance, increasing the odds for acceptance by 2.9x and 4.7x, respectively (P ≤ .045). CONCLUSION: Facial aesthetic concern is very important factor in patients' decision-making process for accepting orthognathic treatment for skeletal malocclusions, with greater importance than high normative need for functional orthognathic treatment.

Sudden, Severe, Idiopathic Occlusal Relationship Change Coexisting with Pain-Related Temporomandibular Disorders: A Case Report.

The article presents a case of a young female patient who sought help due to myofascial pain followed by a sudden occlusal change (anterior open bite (AOB)) that occurred shortly after the administration of a soft night guard that had been previously provided by a general dentist. Palpation of the masseter and temporal muscles elicited the presence of familiar pain. After magnetic resonance imaging of temporomandibular joints, which ruled out disc displacement, the final diagnosis was myalgia. Since the patient had myalgia and malocclusion, the therapy included treatment of both conditions. Temporomandibular disorders (TMDs) management included a combination of kinesiotherapy, pharmacotherapy, and a stabilization splint. After TMD symptoms had resolved, the patient underwent an orthodontic evaluation. Cephalometric analysis revealed skeletal class II, retrognathic face, convex profile, and normal vertical growth pattern. Orthodontic treatment included a fixed appliance with vertical intermaxillary elastics. After 19 months of treatment, both sides achieved acceptable occlusion with Class I. Since the patient had myalgia and severe malocclusion, it was important to follow a systematic diagnostic and therapeutic workflow. Although it is impossible to establish a relationship between TMD symptoms and orthodontic therapy, patients who have TMD symptoms should have their pain resolved through a conservative treatment protocol before commencement of orthodontic treatment. The beginning of orthodontic therapy comes into consideration only when the TMD pain resolves.

ORTHODONTIST CLINICAL EXPERIENCE AND CLINICAL SITUATION SIGNIFICANTLY INFLUENCE THE RETENTION PROTOCOL - A SURVEY FROM CROATIA.

The aim was to assess the views and practice of Croatian orthodontists concerning retention protocols. A total of 150 questionnaire copies were distributed, of which 92 were validly completed. The survey included sociodemographic characteristics, practices of informing patients about retention options, commonly used appliances, and reasons for choosing a particular type of retention and treatment duration. Orthodontists informed patients about retention mostly verbally, the retention period was 3-5 years, the choice of method depended on the malocclusion (76%), and the protocol was influenced by clinical experience of the orthodontist (39%). The most commonly used appliance in the maxilla was the vacuum-formed retainer (52%), whereas a combination of fixed and removable retainers was most common in the mandible (34%). Modus of acquiring knowledge, biological reasons (malocclusion type, oral health, treatment outcome, and growth) and the patient's wishes were not a predictor of retention duration or recall frequency. With an increase in orthodontic experience, the duration of retention decreased and orthodontists were more likely to change the duration of retention (p=0.001), as well as the type of retention appliance (p<0.001). In conclusion, retention protocols among Croatian orthodontists were influenced mostly by their clinical experience and clinical situation.

Symptoms of titanium and nickel allergic sensitization in orthodontic treatment.

AIM: The study aimed to evaluate to which extent self-reported symptomatology, age, and sex are predictors of titanium and nickel allergic sensitization in patients in treatment with fixed orthodontic appliances. METHODS: The study analyzed 228 subjects aged 11-45 years (median 18, interquartile range 16-22); 68% of them were females, and 52% were adolescents. The allergic sensitization testing included epicutaneous patch test to titanium, titanium dioxide, titanium oxalate, titanium nitride, and nickel sulfate. The questionnaire on symptoms potentially linked to titanium and nickel sensitization was used. RESULTS: Prevalence of the allergic sensitization to titanium in patients undergoing orthodontic treatment was 4% (2% only to titanium without nickel) while to nickel 14% (12% nickel without titanium). Hypersensitivity to both metals at the same time was present in 2% of subjects. Sensitization to nickel was more common in females than in males (17 vs. 8%) and much more common in adults than in adolescents with small effect size (20 vs. 8%; p = 0.013). Sensitization to titanium was more common in females than in males (6 vs. 1%) with no difference in age. Multiple logistic regression analysis revealed that adult age increases the odds for being sensitized to nickel for 2.4 × (95% CI 1.1-5.6; p = 0.044) while watery eyes for 3.7 × (95% CI 1.2-11.1; p = 0.022). None of the symptoms were significant predictors of titanium sensitization. CONCLUSION: Allergic sensitization to titanium and nickel are not very frequent in orthodontic patients, and self-reported symptomatology is a weak predictor of those sensitizations.

Parental influence is the most important predictor of child's orthodontic treatment demand in a preadolescent age.

The aim was to explore the predictive value of objective treatment need, impaired quality of life, and parental influence on orthodontic treatment demand in preadolescents and adolescents. A secondary goal was to validate 16-item Child Perceptions Questionnaire for the 11-14 year age group (CPQ11-14): item-impact and stepwise-regression short-forms. A convenience sample of 287 participants (55% female) was used for validation. Internal consistency, test-retest reliability, and convergent validity were evaluated. Predictors of treatment demand were explored in 197 orthodontic patients: 93 preadolescents (51% females), 104 adolescents (55% females). Hierarchical linear regression and multilevel logistic regression models were used to explore the predictive power of age, gender, objective treatment need, impaired quality of life and parental influence on treatment demand. CPQ11-14 regression short-form had acceptable psychometric properties. Significant linear predictors of treatment demand were impaired emotional well-being (EW) (ß = 0.335, p = 0.002), parental influence (ß = 0.221, p = 0.002), and malocclusion severity (ß = 0.152, p = 0.025). In logistic regression, parental influence was revealed as the most important predictor of treatment demand in preadolescents, OR = 7.7 (95% confidence interval CI 2.4-25.1; p = 0.001); objective treatment need in adolescents, OR = 4.5 (95% CI 1.5-12.9; p = 0.006). The increase of impairment in EW by one scalar point increased treatment demand by 1.4 (95% CI 1.1-1.9; p = 0.017) in preadolescents; 1.3 (95% CI 1.0-1.7; p = 0.021) in adolescents. Greater parental agreement and motivation for treatment could result in higher preadolescents' cooperation. Orthodontic treatment in adolescents might be more effective with the patient-oriented approach.

Changes of bite force and occlusal contacts in the retention phase of orthodontic treatment: A controlled clinical trial.

INTRODUCTION: We aimed to determine whether appliance type affects changes in maximum voluntary bite force (MVBF) and the number of occlusal contacts (NOC) during retention, controlling for sex, age, and body mass index. METHODS: The sample comprised 176 examinees (70 male, 106 female) aged 14 to 20 years: 30 had maxillary and mandibular Essix retainers, 30 had wrap-around retainers, and 30 had a combination of fixed mandibular canine-to-canine retainers bonded on each tooth separately (double twisted, 0.254 mm in diameter, stainless steel ligature wire) and Essix retainer in the maxillary arch; 86 with normal occlusion were not treated. MVBF and the NOC were measured immediately after removal of preadjusted edgewise appliances (Roth prescription), 6 weeks after that, and after the next 4 weeks. RESULTS: Increases in MVBF and the NOC were demonstrated, but subjects with 2 Essix retainers showed lower values than did the others. Changes were related to type of appliance, sex, and age (P <0.05) but not to body mass index. The increase in NOC occurred faster than the increase of MVBF, more and sooner with the wrap-around retainer and in male subjects than with the Essix and in female subjects. MVBF and NOC nearly reached the values of the control subjects. CONCLUSIONS: Settling of the occlusion depends on appliance type: it takes longer in female patients and with Essix in both dental arches than with the other tested appliances.

Neoclassical canons of facial beauty: Do we see the deviations?

AIM: To explore the presence of neoclassical canons of facial beauty among young people in Croatia and to question possible psychosocial repercussions occurring in those who demonstrate deviations in relation to canons. SUBJECTS AND METHODS: The study was cross-sectional and the sample included 249 subjects (60% female) aged 12-39 (median 20). Their en face and profile photographs were taken in Natural Head Position. Photogrammetry included analysis of nine neoclassical canons of facial beauty originating from the Renaissance. Psychosocial issues were assessed using the Self-Esteem Scale, Big Five Inventory and three domains of Orthognathic Quality of Life Questionnaire. RESULTS: Significant deviations from neoclassical facial beauty canons were observed in 55-65% of adolescents and young adults. Gender and age showed no relation to deviations. The deviations from canons that influenced the quality of life were mainly those related to vertical facial proportions and demonstrated increased facial aesthetics concern and social impact, and higher self-reported treatment need (p < 0.05). Deviations from canons were not related to self-esteem but a decrease in openness, agreeableness and neuroticism was observed. CONCLUSION: Neoclassical canons were not valid for the majority of adolescents and young adults in Croatia. Only deviations from some canons appear to provoke mild psychosocial repercussions.

Influence of Manual Screwdriver Design in Combination With and Without Predrilling on Insertion Torque of Orthodontic Mini-Implants.

PURPOSE: The study focused on the influence of screwdriver design in combination with and without predrilling a pilot hole of inner implant diameter on insertion torque of orthodontic mini-implants, controlling for cortical thickness and vertical insertion force as cofactors. METHODS: One hundred twenty mini-implants (Forestadent) of 1.7 mm in diameter and 6 and 8 mm in length were manually inserted into 120 swine rib bone samples. Maximal insertion torque as a measure of primary stability and vertical force were measured. The study included procedures with and without pilot hole and different screwdriver handles and shaft length and 2 implant lengths. RESULTS: Design of manual screwdriver does not modify insertion torque to a significant extent. In multiple linear regression model, significant predictors of insertion torque are thicker cortical bone (explaining 16.6% of variability), higher vertical force at maximal torque (13.5%), 6-mm implant length (2.5%), and the presence of pilot hole (2.3%). CONCLUSIONS: Handle type and shaft length of manual screwdriver do not significantly influence insertion torque, whereas predrilling a pilot hole has low impact on torque values of manually inserted self-drilling orthodontic mini-implants.

Machine-driven versus manual insertion mode: influence on primary stability of orthodontic mini-implants.

PURPOSE: The study aimed to explore the effect of the insertion method on maximal insertion torque as a measure of primary stability while controlling for the effect of cortical bone thickness, mini-implant length and diameter, and vertical insertion force on insertion torque. METHODS: Six types of mini-implants (Dual Top; Jeil Medical, Corp.) with diameters of 1.4, 1.6, and 2.0 mm and lengths of 6 and 8 mm were inserted manually and in a machine-driven mode into pig rib bone samples, and experiments were repeated 10 times, which totaled 120 tested implants in 120 pig rib samples. Cortical bone thickness was measured with a sliding caliper, whereas insertion torque and vertical insertion forces were recorded with a specially designed device. RESULTS: Significant predictors of better primary stability are thicker cortical bone (explaining 24.2% of variability), wider diameter (20.6%), manual insertion (9.9%), greater length (3.7%), higher maximal vertical insertion force (2.2%), and lower vertical force at maximal insertion torque (1.4%). CONCLUSIONS: Manual insertion is associated with higher primary stability of orthodontic mini-implants than mechanical insertion, but thicker cortical bone and larger implant diameter seem to be stronger predictors of primary stability.