OBJECTIVE: To explore the relationship between malocclusion, orthodontic treatment and peer relationships in adolescents. DESIGN: A cross-sectional qualitative study. SETTING: Three secondary schools in the South-East of...OBJECTIVE: To explore the relationship between malocclusion, orthodontic treatment and peer relationships in adolescents. DESIGN: A cross-sectional qualitative study. SETTING: Three secondary schools in the South-East of the U.K. PARTICIPANTS: A total of 14 schoolchildren aged 14-16 years (mean age = 15.7 years; age range = 14.4-16.5 years). METHODS: In-depth one-to-one semi-structured interviews carried out online. All interviews were transcribed verbatim and analysed thematically according to Braun and Clarke's model of thematic analysis. RESULTS: The central finding of this research was that adolescents are self-conscious of their dental appearance, it impacts on social interactions, and peers and friends are both a source of pressure and support regarding dental appearance and treatment. Two main themes were identified: (1) malocclusion and peer relationships; and (2) social expectations and experience of orthodontic treatment. Participants reported being self-consciousness of their teeth before treatment, and this increased with age. They feared being judged based on their dental appearance, undertaking behaviour to hide their teeth in social situations, in photographs or online. All participants reported either being teased personally about their teeth or witnessing this happening to someone else although they mostly did not see this as bullying. This had a negative impact on self-confidence. No one reported being teased after starting orthodontic treatment. Orthodontic treatment was seen as desirable and normal within this age group, with an expectation it would improve self-confidence, particularly in social settings. Friends and peers were a source of support during treatment. CONCLUSION: Young people are self-conscious of their dental appearance, which impacts their peer relationships and can make them a target for teasing and bullying. Orthodontic treatment is considered normal, with peers and friends providing support.
OBJECTIVES: To assess the prevalence of e-cigarette use among orthodontic patients in a UK hospital setting, while investigating patterns of use and evaluating patients' knowledge of the oral health effects of e-cigarett...OBJECTIVES: To assess the prevalence of e-cigarette use among orthodontic patients in a UK hospital setting, while investigating patterns of use and evaluating patients' knowledge of the oral health effects of e-cigarettes, along with how it may impact orthodontic treatment outcomes. METHODS: A cross-sectional survey was administered to patients aged 11 years and above attending routine appointments at the Orthodontic Department of St George's University Hospitals NHS Foundation Trust over 3 months. The 34-item survey captured demographics, e-cigarette use and device type, initiation age, cessation attempts, knowledge of oral health effects, perceived treatment impact and patient-clinician communication. Descriptive statistics were used for data analysis. RESULTS: A total of 140 participants completed the survey. A high prevalence of e-cigarette use was observed, with 25% of participants having tried them and 14.3% of all participants being regular users. The average age of initiation was 16 years, and 68% of users had no history of tobacco smoking. Reasons for use were primarily 'curiosity' (38%) and 'social reasons' (32%). A significant knowledge gap regarding oral health risks was identified, with only 11% of participants rating themselves as 'very' or 'extremely' knowledgeable. Despite this, 82% of participants believed e-cigarette use could affect their braces and 59% expressed some concern. A notable communication gap was found, as 92% of all participants had never spoken to their orthodontist about e-cigarette use. However, when advice was given, three out of four users reported a reduction or cessation of their habit. CONCLUSION: The prevalence of e-cigarette use in this cohort of orthodontic patients exceeds national averages and is largely driven by social factors. These patients have limited knowledge of the oral health risks and report a lack of clinical discussion, highlighting the need for routine screening, targeted education and cessation support from orthodontists.
OBJECTIVE: To explore experiences affecting patients' compliance with removable retention appliances, and to investigate strategies for improving adherence to wear recommendations from the profession. DESIGN: A qualitati...OBJECTIVE: To explore experiences affecting patients' compliance with removable retention appliances, and to investigate strategies for improving adherence to wear recommendations from the profession. DESIGN: A qualitative study designed alongside a randomised controlled trial regarding post-treatment stability and patients' perceptions. SETTING: Orthodontic Clinic, Public Dental Health Service, Region Gävleborg, Gävle, Sweden. PARTICIPANTS: A total of 15 purposively selected participants (age range = 25-32 years) with a recommendation of long-term retainer wear. METHODS: In-depth interviews were performed, using a pre-tested topic guide, and analysed according to the qualitative method of Grounded Theory. RESULTS: Compliance failures were preceded by one or more triggers that emerged after a couple of weeks or after several years of retention. A core category was identified and labelled 'Pragmatic actions for improved adherence', which summarises the decisions to either discontinue or continue to follow current retention protocol as being based on pragmatic patient-centred considerations. Data analysis revealed three interacting categories for improving compliance from both the patient and the clinician perspectives: Individual factors, Support, Self-motivation and Routines. CONCLUSIONS: To be successful, strategies to enhance compliance with removable retainers must originate from the individual patient and their life situation. Long-term support from both family and professionals as well as good routines are considered crucial for this process.
OBJECTIVE: To evaluate bovine enamel surfaces after removal of clear aligner composite attachments using different methods, considering temperature, noise and vibration generated by rotating instruments. The null hypothe...OBJECTIVE: To evaluate bovine enamel surfaces after removal of clear aligner composite attachments using different methods, considering temperature, noise and vibration generated by rotating instruments. The null hypothesis stated that there would be no differences among methods. MATERIAL AND METHODS: A total of 56 specimens were randomly assigned to seven groups according to the removal technique: pencil-tip diamond bur at high-speed (CG); latch-lock multiblade bur at low-speed (LG); friction-grip multiblade bur at high-speed without irrigation (HG); friction-grip multiblade bur at high-speed with irrigation (HIG); aluminium-oxide tips at low-speed (AOG); Sof-Lex™ Pop-On discs at low-speed (SLG), applied from coarse to fine; and Enhance silicone tips at low-speed (EG). Surface roughness was measured using a 3D optical profilometer (Nanovea PS50) and microhardness with a Knoop microhardness tester (Buehler MICROMET 5104). During composite removal, temperature was monitored with a digital infrared thermometer (Lasergrip GM 400), noise with a decibel metre (DL-1100), and vibration with a vibration metre (WT63A). RESULTS: AOG produced the highest mean vibration (2.6 ± 0.4 mm/s; < 0.001), LG generated the highest mean temperature (31 ± 1.2°C; < 0.001) and CG produced the highest mean noise levels (90.3 ± 2.1 dB; < 0.001). SLG showed the smallest mean change in roughness (ΔRa: 0.46 ± 0.57). CONCLUSION: All removal methods increased enamel roughness and reduced microhardness, with significant differences in temperature, noise and vibration. AOG and SLG caused less enamel damage and better surface preservation, indicating they may represent safer clinical options. The null hypothesis was therefore rejected.
OBJECTIVES: To explore the prevalence of discrepancies between estimated and actual orthodontic treatment duration and identify predictors of treatment delays. MATERIAL AND METHODS: A total of 96 patients (62.5% female;...OBJECTIVES: To explore the prevalence of discrepancies between estimated and actual orthodontic treatment duration and identify predictors of treatment delays. MATERIAL AND METHODS: A total of 96 patients (62.5% female; age = 15.6 ± 6.8 years) who completed an orthodontic treatment with pre-adjusted edgewise fixed appliances between 2015 and 2023 were retrospectively included. Differences between actual and estimated treatment duration >3 months were classified as discrepancies and categorized as "overestimation" or "underestimation." Such discrepancies were compared on demographics, COVID period, and orthodontic parameters using Student's -tests and chi-square tests, as appropriate. Predictors of underestimated treatment duration were assessed with logistic regression analysis. RESULTS: Actual treatment duration significantly differed from the estimated duration (26.5 ± 9.6 vs. 21.6 ± 3.6 months; <0.001), with 65.6% cases exhibiting treatment discrepancy ( = 0.003) and 61.5% of them being underestimated ( = 0.032). Cases with underestimated durations more commonly displayed posterior crossbite (30.9% vs. 5.4%; = 0.004), larger SNA angle (83.7 ± 3.7 vs. 78.8 ± 3.8; = 0.005), bracket debonding (53.4% vs. 31.4%; = 0.039; odds ratio [OR] = 2.51, 95% confidence interval [CI] = 1.04-6.04), and were most likely conducted during COVID period (33.9% vs. 10.8%; = 0.011; OR = 4.23, 95% CI = 1.31-13.62) compared to overestimated ones. Posterior crossbite ( = 0.006) and COVID period ( = 0.007) were significant predictors of treatment underestimation. CONCLUSIONS: Approximately two-thirds of orthodontic treatments showed discrepancies between estimated and actual duration, with 61.5% being underestimated especially in presence of posterior crossbite and during COVID period.
OBJECTIVE: To investigate access to, frequency of use, justification, challenges and training regarding cone-beam computed tomography (CBCT) imaging in orthodontics in the UK. DESIGN: Cross-sectional questionnaire study....OBJECTIVE: To investigate access to, frequency of use, justification, challenges and training regarding cone-beam computed tomography (CBCT) imaging in orthodontics in the UK. DESIGN: Cross-sectional questionnaire study. SETTING: Web-based. METHODS: An online questionnaire was developed after a review of the literature and discussion with practising orthodontists to identify key themes of importance. It was piloted before use and then distributed via the British Orthodontic Society (BOS). All responses were anonymous. RESULTS: A total of 82 complete responses were received (~7% response rate). Access to CBCT facilities was primarily through NHS secondary care (68%). Usage was mainly for assessment of impacted teeth, and 80% of respondents who use CBCT reported increased CBCT imaging referrals over the past 5 years. Barriers included geographic distance and cost. Almost 60% of respondents had formal CBCT training, but over one-third lacked easy access to dental/maxillofacial radiology reporting. CONCLUSIONS: Access to CBCT for orthodontic patients in the UK was mainly through NHS secondary care. Most respondents reported using CBCT for fewer than 10% of patients, most commonly for assessment of unerupted or impacted teeth. The majority of those who used CBCT reported an increase in CBCT referrals over the past 5 years. Reported challenges included cost, travelling distance to CBCT facilities, and limited access to dental and maxillofacial radiology reporting. Although most respondents had undertaken formal CBCT training, over one-third reported difficulty accessing specialist radiology support.
OBJECTIVE: To determine the ideal site for mini-screw (MS) insertion in the mandibular symphysis by obtaining total, intraosseous and extraosseous height and depth measurements in this anatomical region in relation to th...OBJECTIVE: To determine the ideal site for mini-screw (MS) insertion in the mandibular symphysis by obtaining total, intraosseous and extraosseous height and depth measurements in this anatomical region in relation to the mandibular anterior teeth and further categorise the results by sex and age. DESIGN: Cross-sectional study. SETTINGS: Cone-beam computed tomography (CBCT) images were analysed from existing clinical records. METHODS: CBCT images of 90 patients were examined from a single centre at UniCIEO University. The sample was divided into three age groups: G1 = 30 patients aged 9-13 years; G2 = 30 patients aged 14-23 years; and G3: 30 patients aged 24-50 years. Total, intraosseous and extraosseous height and depth measurements of the mandibular symphysis were obtained at the lower central incisor (LCI), lower lateral incisor (LLI) and lower canine (LC), along the long axis of each respective tooth, by a calibrated operator. For statistical analyses, -tests and Mann-Whitney U-test, analysis of variance (ANOVA) and Kruskal-Wallis test were used. Two-way ANOVA was applied for variables with significant differences ( <0.05). RESULTS: Sex-related differences were observed, with male patients presenting greater measurements than female patients, including total height at LCI (mean difference = -2.54, 95% confidence interval [CI] = -3.93 to -1.17) and LC (mean difference = -3.12, 95% CI = -4.71 to -1.54), as well as intraosseous height at LCI (mean difference = -3.00, 95% CI = -4.32 to -1.68) and LLI (mean difference = -2.24, 95% CI = -3.39 to -1.08). CONCLUSIONS: An age-related increase in mandibular symphysis height and depth was observed. With respect to the ideal MS dimensions and the optimal site for orthodontic skeletal anchorage, MSs with a length of 20-28 mm may be placed vertically and deep in the lower vestibule of the mandibular symphysis, in the region of the lateral incisor and canine.
INTRODUCTION: Placing mini-screws between teeth can risk contacting or damaging dental roots and injuring adjacent nerves, blood vessels or maxillary sinus when local anatomy is not visualised precisely. The latest digit...INTRODUCTION: Placing mini-screws between teeth can risk contacting or damaging dental roots and injuring adjacent nerves, blood vessels or maxillary sinus when local anatomy is not visualised precisely. The latest digital advances in orthodontics have enabled three-dimensional (3D) virtual protocol designing, allowing orthodontists to simulate the orthodontic treatments and collaboratively map out the surgical intervention before procedures. Computed tomography (CT)-based surgical guides are strongly recommended for patients with delicate and complex anatomical conditions. CASE PRESENTATIONS: Three patients presented with concerns related to their occlusion and required precise orthodontic mini-screw insertion.Clinical findings and investigations:In all cases, augmented reality (AR)-guided systems were used to assist in the precise positioning of orthodontic mini-screws. INTERVENTIONS AND OUTCOMES: Successful placement of the mini-screw without damage to the tooth root, confirmed by postoperative radiographs.Relevance and impact:The non-invasive AR-guided system can efficiently highlight the precise position of the tooth root. Hence, AR-assisted mini-screw positioning might potentially aid in avoiding root damage and reducing mini-screw failure rates. This technology offers significant benefits over traditional methods, including adaptability, real-time adjustments and cost efficiency, making it a promising tool for clinicians who place mini-screws.
INTRODUCTION: Orthodontic traction of impacted maxillary canines remains a clinical challenge, particularly when the tooth is severely angulated. Conventional force application to the crown may increase the risk of damag...INTRODUCTION: Orthodontic traction of impacted maxillary canines remains a clinical challenge, particularly when the tooth is severely angulated. Conventional force application to the crown may increase the risk of damage to adjacent roots due to insufficient control of root positioning. This case demonstrates the use of a boot loop in combination with a micro-screw to upright the canine root within the alveolar bone before potential root contact. Treatment alternatives and biomechanics are discussed to illustrate the effectiveness of this approach.Diagnosis and treatment plan:A boy aged 14 years 1 month presented with a severely angulated impacted maxillary left canine, with the root apex located above the maxillary left second premolar. The primary treatment objective was to align the impacted canine while preventing injury to adjacent roots. The treatment plan involved uprighting the canine root using a boot loop and micro-screw designed to apply light, controlled forces through loop activation. RESULTS: During active treatment, the root angulation of the impacted canine was corrected from 60° distal to 13° mesial, achieving a maximum angular change of 73° through controlled uprighting. The canine was then successfully repositioned into its ideal position. No root resorption, gingival recession, or loss of supporting tissue was observed. CONCLUSION: The combination of a boot loop and micro-screw offers effective three-dimensional control of crown and root movement, providing a reliable and effective solution for managing severely angulated impacted canines.
OBJECTIVE: To explore the experience, knowledge and confidence of orthodontic practitioners in the United Kingdom in managing patients with learning disability or autism. DESIGN: National online survey. SETTING: British...OBJECTIVE: To explore the experience, knowledge and confidence of orthodontic practitioners in the United Kingdom in managing patients with learning disability or autism. DESIGN: National online survey. SETTING: British Orthodontic Society membership. METHODS: A novel questionnaire was developed and distributed online to orthodontic practitioners within the British Orthodontic Society. It included questions on the participants' prior training, experience in treating patients with learning disability or autism, knowledge levels using the Learning Disability Knowledge Questionnaire and Autism Knowledge Survey, and self-efficacy in managing these patients. RESULTS: A total of 171 responses were received with participation from various practitioner groups: orthodontic consultants, specialists, postgraduates, therapists and dentists with special interest. The median score for the Learning Disability Knowledge Questionnaire was 73% (interquartile range [IQR] = 20). The median score for the Autism Knowledge Survey was 93% (IQR = 6.7). The percentage of respondents who reported feeling confident in patient management varied across the self-efficacy domains: (1) treating patients with learning disability (51%) and autism (64%); (2) making reasonable adjustments for patients with learning disability (54%) and autism (61%); (3) recognising the signs of learning disability (38%) and autism (48%); and (4) signposting patients with learning disability (27%) and autism (30%) to the relevant local care pathways or services. The participants employed a range of techniques and resources when managing these patients. These included tailoring communication to individuals, adapting to sensory needs, involving parents/carers in treatment planning, adjusting the pace of care, and building trust through behavioural and acclimatisation strategies. CONCLUSION: Having a good knowledge of learning disability or autism does not always translate to greater confidence in patient management. Improving access to orthodontic-specific learning disability and autism training, national guidance and communication aids could enhance the confidence of orthodontic practitioners in managing these patient groups.
INTRODUCTION: Impacted anterior teeth are common, with sequalae including root resorption of adjacent or nearby teeth. Management depends on patient- and tooth-specific factors; however, in cases of severe resorption, el...INTRODUCTION: Impacted anterior teeth are common, with sequalae including root resorption of adjacent or nearby teeth. Management depends on patient- and tooth-specific factors; however, in cases of severe resorption, elective tooth loss may be favoured. This case discusses an aesthetic solution to disimpaction of an anterior tooth, involving multidisciplinary input. PATIENT CONCERNS: A girl aged 13 years 10 months presented to an orthodontic department, complaining of missing teeth and poor dental aesthetics. CLINICAL FINDINGS: Class II division 1 incisor relationship on a Class I skeletal base, complicated by unerupted maxillary canines (UR3, UL3), retained URC and potential for severe crowding in the upper arch. Radiographic assessment confirmed impacted maxillary canines and an unerupted supernumerary tooth lying palatal to UR1. The impacted UR3 had caused significant root resorption to the UR1. INTERVENTIONS: After a multidisciplinary discussion, the impacted UR3 was exposed and aligned into the UR1 position, with elective loss of the resorbed UR1. A novel pontic design, incorporating a traction spring, was used, enabling maintenance of a pontic in-situ while simultaneously allowing for orthodontic traction of the UR3. Restorative input after debond disguised the UR3 as the UR1. OUTCOMES: UR3 was successfully disimpacted and aligned into the UR1 position with the use of a novel pontic design. CONCLUSION: This case delivers a novel solution to a complex aesthetic dilemma in the anterior dentition that can be modified, and adapted, to suit other anterior impactions.
OBJECTIVE: To assess salivary insulin-like growth factor-1 (IGF-1) and bone alkaline phosphatase (BALP) levels during mandibular advancement with Twin Block appliance. METHODS: The study enrolled 49 participants with ske...OBJECTIVE: To assess salivary insulin-like growth factor-1 (IGF-1) and bone alkaline phosphatase (BALP) levels during mandibular advancement with Twin Block appliance. METHODS: The study enrolled 49 participants with skeletal Class 2 malocclusion, a retrognathic mandible, positive visual treatment objective (VTO), horizontal to average growth pattern and cervical vertebrae maturation index stages 3-4 (CVMI). Participants were treated with Twin Block appliance (Twin Block group [TBG]; n = 39). Salivary samples were collected before treatment (T0), at 7-10 days (T1), 6-10 weeks (T2), 8-10 months (T3) and after treatment (T4). Non-compliant participants formed the non-compliant group (NCG; n = 10). Lateral cephalograms were obtained for cephalometric evaluation. Statistical analyses compared salivary IGF-1 and BALP levels and cephalometric parameters within and between groups. RESULTS: The final sample included 39 participants in the TBG (17 boys, 22 girls; mean age =12.56 ± 1.09 years) and 10 participants in the NCG (5 boys, 5 girls; mean age =12.7 ± 1.16 years). A significant difference was observed in the salivary IGF-1 and BALP levels within the TBG across different time intervals. In the TBG, IGF-1 increased significantly at T1, and BALP significantly increased at T2 and T3. The NCG showed no significant changes in levels of IGF and BALP. A significant positive correlation between IGF-1 and BALP was noted at T1 in the TBG ( <0.05), whereas a significant negative correlation was observed at T2 and T3 ( <0.05). Mann-Whitney test showed a significant increase in mandibular length in TBG compared to NCG. Cephalometric analysis revealed significant improvements in mandibular length in TBG compared to NCG between T0 and T4. CONCLUSIONS: The study demonstrated a significant increase in salivary IGF-1 levels within 7-10 days, with BALP levels peaking at 6-10 weeks. These findings suggest a potential role of IGF-1 and BALP in the biochemical response to Twin Block appliance therapy.
A frequent and well-documented issue that is seen with clear aligner treatment (CAT) is the development of posterior open bites. The theories of posterior open bite development are discussed, and the treatment and preven...A frequent and well-documented issue that is seen with clear aligner treatment (CAT) is the development of posterior open bites. The theories of posterior open bite development are discussed, and the treatment and prevention of each aetiological factor are outlined. Predictable prevention and management of posterior open bites during CAT would serve to improve treatment outcomes and patient satisfaction both aesthetically and functionally.